Irritable Bowel Syndrome
Irritable bowel syndrome, or IBS, is a problem that affects mainly the bowel
which is also called the large intestine. The bowel is
part of the digestive system that makes and stores stool. The word syndrome
means a group of symptoms. IBS is a syndrome because it can cause several
symptoms. For example, IBS causes cramping, bloating, gas, diarrhea, and
IBS is not a disease. It's a functional disorder, which means that the bowel
doesn't work as it should.
The condition most often develops in people between the ages of 20 and 30 and is
twice as common in women as in men. The
symptoms, which include abdominal pain, constipation, and/or diarrhoea, tend
to be intermittent but typically persist for many years. Although
irritable bowel syndrome can be distressing, it does not lead to serious
The precise cause of irritable bowel syndrome is unknown. It may result
of the muscles in the intestinal walls-
The colon, which is about 6 feet long, connects the small intestine with the
rectum and anus. The major function of the colon is to absorb water and salts
from digestive products that enter from the small intestine. Two quarts of
liquid matter enter the colon from the small intestine each day. This material
may remain there for several days until most of the fluid and salts are
absorbed into the body. The stool then passes through the colon by a pattern
of movements to the left side of the colon, where it is stored until a bowel
movement occurs. Colon motility is controlled by nerves and
hormones and by
electrical activity in the colon muscle. Movements of the colon propel the
contents slowly back and forth but mainly toward the rectum. A few times each
day strong muscle contractions move down the colon pushing fecal material
ahead of them. Some of these strong contractions result in a bowel movement.
increased sensitivity to certain foods, such as fruit, sorbitol (an
artificial sweetener), and fat, may also contribute. Chocolate, milk
products, or large amounts of alcohol are frequent offenders. Caffeine causes
loose stools in many people, but it is more likely to affect those with IBS.
In some cases, simply eating a large meal will trigger symptoms.
The disorder sometimes develops
after a gastrointestinal infection.
Heredity: The problem can run in families, which suggests that
genetic factors are involved. There are certain ethnic groups, such as
Ashkenazi Jews, who are more likely to have the condition than others. And
finally, there's been a recent discovery of a gene called the nod-2 gene,
which is twice as likely to occur in Crohn's patients than in patients who do
not have the disease.
depression are associated with the
syndrome and can make symptoms worse.
Researchers also have found that women with IBS may have more symptoms
during their menstrual periods, suggesting that
can increase IBS symptoms.
In fact, the bowel can overreact to all sorts of things, including food,
exercise, and hormones.
The symptoms are typically intermittent but usually recur for many years and
often persist into old age. They vary widely among people and with each
episode. The main symptoms include :
Abdominal bloating combined with excessive quantities of wind.
Abdominal pain, often on the lower left side, that may be relieved by
defaecation or passing wind.
Diarrhoea, which may be most severe on waking and sometimes alternates
with bouts of constipation that may produce "rabbit pellet" stools.
Feeling that the bowel has not been emptied completely.
Passage of mucus during defaecation.
Nausea and vomiting.
Feeling of fullness and difficulty in finishing meals.
Many people have symptoms unrelated to the digestive tract, such as
tiredness, headache, back pain, and an increased urge to pass urine. In
women, sexual intercourse may be painful, and symptoms may be worse before
You should consult your doctor if the symptoms are severe, persistent, or
recurrent of if you have unexpectedly lost weight. If you are over 40 when
the symptoms develop, you should seek medical advice so that serious disorders
with similar symptoms, such as colorectal cancer , can be ruled out.
There is no single test to diagnose irritable bowel syndrome. Instead,
your doctor will want to make sure that you have no other serious condition.
The type and number of tests used to investigate the disorder depend on your
If your symptoms suggest that you may have an inflammatory bowel disorder
such as Crohn's disease or if you are over the age of 40, your doctor
will probably want to investigate your symptoms further.
You may have a
blood test to check
for inflammation, which can indicate the presence of Crohn's
X ray of the bowel: This x-ray test is called a barium enema
or lower GI (gastrointestinal) series. Barium is a thick liquid that makes the
bowel show up better on the x ray. Before taking the x ray, the doctor will
put barium into your bowel through the anus.
Endoscopy: The doctor inserts a thin tube into your bowel. The tube
has a camera in it, so the doctor can look at the inside of the bowel to check
You may also have tests to exclude food
intolerance and lactose intolerance , which cause
symptoms similar to those of irritable bowel syndrome.
Although the symptoms can be distressing, irritable bowel syndrome is not a
serious condition. You should usually be able to control your symptoms
with a combination of a change in
However, if symptoms are troublesome enough to interfere with daily routines,
you should consult your doctor for advice on treatment.
In terms of the
medical treatments, the first group of drugs is called
the aminosalicylates, or 5-ASA agents. These include drugs such as sulfasalazine,
mesalamine, balsalazide and olsalazine, and they're good for treating mild to
moderate disease. When the disease becomes more severe, often steroids are used.
Steroids can be given intravenously or orally. The traditional oral drug had
been prednisone, but more recently a new medication called budesonide was
released which had similar efficacy but fewer side effects than prednisone.
You may be given
relax the contractions of the digestive tract and help to relieve abdominal pain . Your doctor may
also prescribe antidiarrhoeal drugs to help to alleviate diarrhoea,
especially if you have diarrhoea on waking. If you regularly have problems
with constipation, bulk-forming agents may help.
Alosetron hydrochloride (Lotronex) has been
re-approved by the U.S. Food and Drug Administration (FDA) for women with
severe IBS who have not responded to conventional therapy and whose primary
symptom is diarrhea.
If you have psychological symptoms such as anxiety in addition to irritable
bowel syndrome, you should ask your doctor to refer you to a therapist for
advice on how to control anxiety.
Irritable bowel syndrome tends to be a long-term disorder, often lasting into
old age. However, attacks usually become less frequent and severe with
LIVING WITH IRRITABLE BOWEL SYNDROME
Some people learn to control the symptoms of irritable bowel syndrome by
making dietary and lifestyle changes. The symptoms may improve if you
follow a diet that is high in fibre and low in fat .
You may need to try several different approaches before finding one that helps
you. Try the following:
Keep a food diary.
Try to eliminate any food or drink that seems to bring on an attack of
irritable bowel syndrome.
Avoid large meals;
spicy, fried, fatty foods; and milk products.
If constipation is a problem, try gradually increasing your
If bloating and diarrhoea are particular problems, reduce your fibre intake.
Cut out or reduce your intake of tea, coffee, milk, cola, and beer.
Eat regular times.
Try relaxation exercises
to alleviate stress, which is often a
contributing factor. Meditation, exercise, and counseling are some things that
TAKE PLENTY OF:
Fresh fruit and vegetables, which provide soluble fibre
Water - at least 1.7 litres (3 pints) a day
Live natural yoghurt, which contains beneficial
CUT DOWN ON
Until very recently, bran was recommended as part of the treatment for
irritable bowel syndrome (IBS). Some authorities now believe that, far
from being a cure for the complaint, bran is in fact an irritant that can make
the condition worse. Avoid bran and cut down on high-fibre breakfast
cereals which may contain it. Gas-producing foods, such as pulses (peas,
beans and lentils) can also exacerbate IBS and are best avoided. The daily diet should include 18g of fibre obtained from
ordinary foods - not concentrated bran or bran tablets. Most of this fibre
should be in soluble form, found in apples, pears, dates and most other fruits
and vegetables, as well as in oats, barley and rye.
High intakes of the sugar substitute sorbitol, and an intolerance to lactose
(a sugar found only in milk) may also sometimes cause the illness. In
cases where a food intolerance is suspected, an exclusion diet may be a useful
Eat regular, moderate-sized meals and drink at least 1.7 litres (3 pints) of
water daily. Include plenty of live natural yoghurt which will maintain a
healthy balance of bacteria in the gut. When antibiotics are prescribed
for other illnesses they have the side effect of destroying beneficial bacteria
in the gut, which can cause symptoms similar to IBS. Eating live YOGHURT
should help to counteract this problem.
For More Information:
International Foundation for Functional Gastrointestinal Disorders
P.O. Box 170864
Milwaukee, WI 53217
Phone: 1-888-964-2001 or (414) 964-1799
Fax: (414) 964-7176
Dated 01 March 2006