What is Irritable Bowel Syndrome?
Irritable bowel syndrome (IBS) is a common disorder that
may affect up to 30 percent of all Americans at some time
during their lives. The disorder has many names, including
nervous colon, spastic colon, spastic bowel, mucous colitis
and spastic colitis. However, it should not be confused
with diseases like ulcerative or Crohn's colitis.
IBS is a syndrome, a pattern of symptoms such as pain and
bloating that tend to occur together. It is not a "disease"
in the normal sense of the word (i.e., it cannot be caught
or transmitted from person to person as a cold can nor can
it be cured by an operation or medication). It is not life-threatening.
What are the symptoms of IBS?
People with IBS may experience constipation, diarrhea, or
a combination - constipation at some times and diarrhea
at other times. In addition, IBS may produce cramps, urgency,
or a gassy, bloated feeling in the abdomen. Mucus, sometimes
seen in bowel movements, is also a symptom of IBS. Rectal
bleeding is never caused by IBS, and any rectal bleeding
must be properly and thoroughly evaluated.
What causes IBS?
The
underlying cause of this disorder is an abnormality in the
way the intestinal muscles contract. These muscles, which
form the outer layer of the intestine, work automatically
to move food products along the intestine to the rectum
and out the anus. IBS is a disorder of the function of the
intestinal muscles. Even when the muscles appear normal
under a microscope, they may not function normally, contracting
too forcefully or weakly, too slowly or rapidly, at certain
times.
Although there is no physical obstruction, a patient may
perceive cramps or functional blockage.
What role does stress play in IBS?
Emotional stress may contribute to IBS. The brain and the
intestine are closely connected by nerve fibers that control
the automatic functioning of the intestinal muscles, and
many people may experience nausea or diarrhea when nervous
or anxious. While we may not be able to control the effect
stress has on our intestines, reducing the sources of stress
in our lives - high pressure jobs, family tensions, etc.
- may alleviate the symptoms of IBS.
How can I tell if the problem is IBS or something
else?
A careful medical history and physical examination by a
colon and rectal surgeon or other physician are essential
to proper diagnosis. Tests performed to ensure that your
symptoms are not caused by other problems may include a
flexible sigmoidoscopic examination, colonoscopy, a hemmocult
test to detect hidden blood in the stool, an x-ray examination
of the lower intestines and psychological evaluation. These
tests may rule out other diseases or conditions - cancer,
diverticulitis, inflammation of the intestines or depression,
for example.
How is IBS treated?
Simply understanding that IBS is not a serious or life-threatening
condition may relieve anxiety and stress, which often contribute
to the problem. Mental health counseling and stress reduction
(relaxation training) can help relieve the symptoms of IBS
in some individuals.
In others, increasing the amount of non-digestible, bulk-forming
foods ("roughage") in the diet may be all that
is needed to relieve symptoms. Adding roughage, such as
psyllium seed, to your diet may eliminate or lessen the
severity of cramps, result in softer stools that pass along
the intestine more easily, and absorb excess water in the
intestine to prevent diarrhea. When the major complaint
is constipation, additional water should be provided in
the diet along with bulk agents to soften the stool.
In some cases, dietary roughage alone may not provide adequate
relief from cramping and bloating. Your physician may prescribe
medications that act directly on the intestinal muscles
to help the contractions return to normal. Some people obtain
greater relief from one medication than another. Therefore,
your physician may recommend changing medications to improve
symptomatic relief.
Are there any foods to be avoided?
Sometimes, caffeine, milk products or alcohol can make symptoms
of IBS worse. Your physician may recommend avoiding foods
that contain significant amounts of caffeine - coffee, tea,
chocolate and cola drinks, for example - and alcoholic beverages,
including beer, wine and "mixed" drinks.
Your physician may also recommend that you avoid dairy
products, such as cheese and milk, which may cause diarrhea
in some people and constipation in others. Because dairy
products are an important source of calcium and other nutrients
that your body needs, be sure to get adequate nutrients
in the foods that you substitute.
In addition, smokers should beware: IBS symptoms may be
aggravated by nicotine.
How long does the treatment take to relieve symptoms?
Relief of IBS Symptoms is often a slow process. It may take
six months or more for definite improvement to be appreciated.
Patience is extremely important in dealing with this problem.
The tendency for the intestine to respond to stress will
always be present. With attention to proper diet, an increase
in dietary roughage, and in some cases, use of appropriate
medications, the symptoms of IBS can be greatly improved
or eliminated. Mild symptoms may recur from time to time,
but rarely will become more than a minor nuisance.
Can IBS lead to more serious problems?
IBS does not cause cancer, bleeding or inflammatory bowel
diseases, such as ulcerative colitis. Over the long term,
IBS can be associated with but does not cause diverticulosis,
"pockets" in the intestinal wall, which is a benign
condition. This can occasionally result in diverticulitis,
an inflammatory condition of one or more of the diverticula
or "pockets" in the intestine that sometimes requires
surgery. Treatment of IBS with bulk agents helps to prevent
diverticulosis and other colon problems.
