Irritable Bowel Syndrome

Source: Adapted from Know Your Options: The Definitive Guide to Choosing The Best Medical Treatments, Reader

What is irritable bowel syndrome (IBS)?

While no one is exactly sure what causes the mysterious, misery-making complaint of irritable bowel syndrome, doctors now admit that it is definitely not ‘all in your head.’ They will also tell you it’s not a life-threatening condition and confirm that it won’t develop into a more serious illness like inflammatory bowel disease or colon cancer.

To better comprehend IBS, it helps to understand how it compares with normal digestion. When partially digested food leaves your stomach, it is usually moved through your intestines by the gentle, wavelike contraction and relaxation of muscles of the intestinal wall’a process known as peristalsis. When you have IBS, the muscles in your colon (part of your large intestine) go into spasm, contracting too quickly and forcefully (causing diarrhea) or too slowly and weakly (resulting in constipation).

Who is at risk for irritable bowel syndrome?

The alternating bouts of diarrhea and constipation associated with irritable bowel syndrome typically develop in the late teens or early 20s, primarily in women. Many people who have it are never diagnosed, however, because medical tests routinely show nothing out of the ordinary.

There’s plenty of speculation about why the colon misfires. Some suggest that hormonal problems play a role (women with irritable bowel syndrome seem to have more symptoms on premenstrual days) or that a chemical imbalance in the brain may be present. Specific foods seem to trigger IBS flare-ups in some people, including the inability to digest lactose. Overuse of antibiotics could be another cause, as can a bacterial, viral, or parasitic infection.

Stress also appears to be another key factor of irritable bowel syndrome. Even a healthy person experiencing the natural ‘fight or flight’ response that occurs in a very stressful situation will have intestinal spasms and sometimes an involuntary emptying of the bowels. But, people susceptible to IBS experience this intestinal response to stress to an excessive degree.

Treatment for irritable bowel syndrome

To be safe, your doctor will probably begin with tests to rule out more serious intestinal ailments, such as Crohn’s disease, ulcerative colitis, diverticulitis, and colon cancer. Once these are out of the way, your IBS treatment plan will depend on your predominant symptoms’diarrhea, constipation, and/or abdominal pain and bloating. If you have a mild case of irritable bowel syndrome (as two-thirds of patients do), your doctor will likely recommend that you start with self-care measures’including diet changes, stress reduction, and exercise. Drug therapy is usually reserved for those whose severe symptoms do not respond to lifestyle measures.

Medications for irritable bowel syndrome

If your symptoms don’t respond to lifestyle changes, your doctor may suggest one or more of the following medicines (be sure to discuss side effects and use the drug only as directed):

Antidiarrheal agents, such as OTC loperamide (Imodium A-D) and prescription diphenoxylate hydrochloride/atropine sulfate (Lomotil), help stop contractions that lead to diarrhea. While not for daily use, these work particularly well in preventing diarrhea at inconvenient and predictable times.

Hyperosmotic laxatives, such as magnesium hydroxide (Phillips’ Milk of Magnesia) and lactulose (Chronulac, Duphalac), sold over- the-counter, may relieve constipation. As with antidiarrheal agents, don’t make them a habit: Long-term use can worsen constipation. You may want to try a psyllium product first.

Antispasmodics, such as dicyclomine (Bentyl), hyoscyamine (Levsin), or atropine sulfate (Donnatal), are available by prescription. They help relax the intestinal muscles and are useful if you suffer from acute abdominal pain. Take the medication 30 to 60 minutes before a meal.

Tricyclic antidepressants, such as imipramine (Tofranil, Norfranil) and amitriptyline (Elavil), counteract the brain neurons responsible for telling your intestines to spasm. Prescribed at much lower doses for IBD than for depression, these drugs also stop pain receptors in your gut from relaying their signals to your brain.

5-HT3 antagonists are being developed specifically for treating IBS symptoms.

Tegaserod maleate (Zelnorm) has recently been approved for treatment of women whose primary IBS symptom is constipation.

Lifestyle changes

Many people feel much better simply by changing what they eat. Basically, you need to avoid foods that make your symptoms worse and stick with those that agree with you. Keeping a food diary will help you track the relationship between symptoms and diet. Write down what you eat and note which foods bring on what symptoms, so you’ll be better able to pinpoint offenders. You may, for instance, have trouble with dairy, wheat, or corn products, or you might find acidic or spicy foods to be the problem. Artificial sweeteners, such as sorbitol and mannitol, as well as caffeine, alcohol, and even chocolate, can also cause spasms.

Eating too much at one time may trigger intestinal contractions, so you’ll be advised to eat smaller, more frequent meals. You may also want to experiment with getting more fibre. Try gradually increasing the amount of soluble fibre in your diet over a period of weeks. This can be a big help if your primary IBS symptom is constipation or abdominal cramping. By absorbing water from the intestines, soluble fibre helps prevent the stool from becoming hard and painful to expel. Fibre also bulks up the stool, which in turn fills out the colon and reduces the chances of spasms. Foods high in soluble fibre include oatmeal, soy foods, barley, oat bran, and beans. You can try a bulking agent, such as psyllium seed (Metamucil, Citrucel), but be sure to take it with plenty of water and drink other fluids throughout the day to keep things moving.

When your main symptom is gas, try to eliminate gas-forming foods such as beans, peas, lentils, broccoli, cauliflower, onions, cucumbers, and leafy vegetables. As your symptoms improve, gradually start eating these foods again and see what happens.

Get more exercise, too. In studies of women with irritable bowel syndrome, those who exercised reported fewer symptoms. Not only does exercise help stimulate digestion, it firms abdominal muscles, helping keep those out-of-control intestines in their place. Working out is also a great way to beat stress. Do some other form of aerobic exercise for at least 30 minutes, three times a week.

Related procedures for irritable bowel syndrome

If stress clearly aggravates your irritable bowel syndrome, relaxation techniques such as biofeedback and hypnosis may help. You can learn them from a trained professional, then do them at home. In a typical biofeedback session, you’re hooked up to a machine that reads bodily functions such as heart rate, blood pressure, and muscle tension. As you try to relax, the machine provides constant feedback, letting you know exactly how relaxed you’ve become.

Eventually you’ll be able to generate the same results without the machine. During hypnosis for IBS, you enter a deeply relaxed state as the hypnotherapist talks you through a visualization that involves relaxing your intestinal muscles. After a few training sessions, you’ll learn to place yourself in the hypnotic state, implant the positive suggestions you’ve been taught, and leave the hypnotic state at will.

Alternative therapies for irritable bowel syndrome

Many people with IBS find relief by taking peppermint oil supplements, which can act as a natural muscle relaxant. In one recent study of 110 people with irritable bowel syndrome, those who took one capsule 15 to 20 minutes before meals had less bloating, diarrhea, and pain within a month. Look for an ‘enteric-coated’ supplement, which ensures that the peppermint oil is released in your intestine, where it’s needed. Take one or two capsules (containing 0.2 ml of oil each) two or three times a day before eating. Don’t take peppermint oil if you’re pregnant (it relaxes the uterus) or if you have a hiatal hernia. Avoid peppermint tea, which may aggravate IBS symptoms.

Questions for your doctor

‘ Why aren’t you testing me for colon cancer and other bowel diseases?
‘ Would I be a good candidate for a clinical trial? If so, what risks would I face?
‘ Do you think I’m anxious because of IBS or vice versa?
‘ Because there’s no cure, will I feel this uncomfortable forever? What else can I do?

Living with irritable bowel syndrome

If you’re living with irritable bowel syndrome, here are a few quick tips to help you take control:

‘ Seek counselling. If you’re feeling down because IBS has taken such a toll on your life, you may want to consider professional advice from a psychotherapist or behavioral counselor.

‘ Find out whether you’re lactose intolerant. For many people, symptoms of IBS can be hard to distinguish from those of lactose intolerance. But don’t simply stop eating dairy. Try this quick test instead: Drink two glasses of nonfat milk on an empty stomach. If you experience symptoms (gas, bloating, diarrhea) within four hours, repeat the test with lactase-treated milk, such as Lactaid. If, after four hours, you are symptom-free, you may very well be lactose intolerant. Or ask your doctor about a reliable test to diagnose lactose intolerance.