What is Irritable bowel Syndrome?
Tens of millions of people suffer from irritable bowel syndrome (IBS), an enigmatic problem with no known cause and no effective remedy. Sometimes referred to as spastic colon, it affects 10% to 20% of otherwise healthy adults, most of them women. In the United States it accounts for as many as 3.5 million visits to physicians and 2.2 million prescriptions each year.
The symptoms include intermittent lower abdominal cramps and bloating accompanied by spells of diarrhea, sometimes alternating with constipation. The abdominal pain generally subsides after a bowel movement or after passing gas, but there is excessive mucus in the stool, and patients often feel that the rectum is not fully emptied.
Since IBS is easily confused with other diseases, including Crohn’s disease, ulcerative colitis, diverticula disease, and colorectal cancer, it is important for a person with these symptoms to consult a physician. The most common dietary recommendation is fiber to increase the stool’s bulk and speed it through the gastrointestinal tract. Drug therapy is often not very useful; the drugs most commonly used are anticholinergics and antispasmodics such as Bentyl (dicyclomine) and Imodium (loperamide).
What does the colon do?
The colon, which is about five feet long, connects the small intestine to the rectum and anus. The major function of the colon is to absorb water, nutrients, and salts from the partially digested food that enters from the small intestine. Two pints of liquid matter enter the colon from the small intestine each day. Stool volume is a third of a pint. The difference between the amount of fluid entering the colon from the small intestine and the amount of stool in the colon is what the colon absorbs each day.
Colon motility—the contraction of the colon muscles and the movement of its contents—is controlled by nerves, hormones, and impulses in the colon muscles. These contractions move the contents inside the colon toward the rectum. During this passage, water and nutrients are absorbed into the body, and what is left over is stool. A few times each day contractions push the stool down the colon, resulting in a bowel movement. However, if the muscles of the colon, sphincters, and pelvis do not contract in the right way, the contents inside the colon do not move correctly, resulting in abdominal pain, cramps, constipation, a sense of incomplete stool movement, or diarrhea.
As its name indicates, IBS is a syndrome—a combination of signs and symptoms. IBS has not been shown to lead to a serious disease, including cancer. Through the years, IBS has been called by many names, among them colitis, mucous colitis, spastic colon, or spastic bowel. However, no link has been established between IBS and inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis.
The Causes of Irritable Bowel Syndrome:
There are many possible causes of IBS. For example, there may be a problem with muscles in the intestine, or the intestine may be more sensitive to stretching or movement. There is no problem with the structure of the intestine.
It is not clear why patients develop IBS, but in some instances, it occurs after an intestinal infection. It is called post-infectious IBS. There may also be other triggers.
Stress can worsen IBS. The colon is connected to the brain through nerves of the autonomic nervous system. These nerves become more active during times of stress, and can cause the intestines to squeeze or contract more. People with IBS may have a colon that is over-responsive to these nerves.
IBS can occur at any age, but it often begins in adolescence or early adulthood. It is more common in women. About one in six people in the U.S. have symptoms of IBS. It is the most common intestinal complaint for which patients are referred to a gastroenterologist.
Symptoms of Irritable Bowel Syndrome:
Symptoms range from mild to severe. Most people have mild symptoms. Symptoms vary from person to person. Abdominal pain, fullness, gas, and bloating that have been present for at least six months are the main symptoms of IBS. The pain and other symptoms will often:
• Occur after meals
• Come and go
• Be reduced or go away after a bowel movement
People with IBS may switch between constipation and diarrhea, or mostly have one or the other.
• People with diarrhea will have frequent, loose, watery stools. They will often have an urgent need to have a bowel movement, which is difficult to control.
• Those with constipation will have difficulty passing stool, as well as less frequent bowel movements. They will often need to strain and will feel cramping with a bowel movement. Often, they do not eliminate any stool, or only a small amount.
For some people, the symptoms may get worse for a few weeks or a month, and then decrease for a while. For other people, symptoms are present most of the time and may even slowly increase.
Irritable bowel syndrome is most likely a lifelong condition. For some people, symptoms are disabling and reduce the ability to work, travel, and attend social events. Symptoms can often be improved or relieved through treatment.
Bleeding, fever, weight loss, and persistent severe pain are not symptoms of IBS and may indicate other problems such as inflammation or, rarely, cancer.
What can Aggravate Irritable Bowel Syndrome?
The following have been associated with a worsening of IBS symptoms:
• large meals
• bloating from gas in the colon
• wheat, rye, barley, chocolate, milk products, or alcohol
• drinks with caffeine, such as coffee, tea, or colas
• stress, conflict, or emotional upsets
Researchers have found that women with IBS may have more symptoms during their menstrual periods, suggesting that reproductive hormones can worsen IBS problems. In addition, people with IBS frequently suffer from depression and anxiety, which can worsen symptoms. Similarly, the symptoms associated with IBS can cause a person to feel depressed and anxious. Symtoms range from mild to severe. Most people have mild symptoms. Symptoms vary from person to person. People with IBS may also lose their appetite.
Irritable bowel syndrome (IBS, or spastic colon) is a diagnosis of exclusion. It is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any detectable organic cause. In some cases, the symptoms are relieved by bowel movements. Diarrhea or constipation may predominate, or they may alternate (classified as IBS-D, IBS-C or IBS-A, respectively). IBS may begin after an infection (post-infectious, IBS-PI), a stressful life event, or onset of maturity without any other medical indicators.
What can be confused with Irritable Bowel Syndrome?
Several conditions may present as IBS including celiac disease, fructose malabsorption, mild infections, parasitic infections (like giardiasis), several inflammatory bowel diseases, bile acid malabsorption, functional chronic constipation, and chronic functional abdominal pain. In IBS, routine clinical tests yield no abnormalities, although the bowels may be more sensitive to certain stimuli, such as balloon insufflating testing. The exact cause of IBS is unknown. The most common theory is that IBS is a disorder of the interaction between the brain and the gastrointestinal tract (brain-gut), although there may also be abnormalities in the gut flora or the immune system.
IBS does not lead to more serious conditions in most patients. However, it is a source of chronic pain, fatigue, and other symptoms and contributes to work absenteeism. Researchers have reported that the high prevalence of IBS, in conjunction with increased costs, produces a disease with a high social cost. It is also regarded as a chronic illness and can dramatically affect the quality of a sufferer’s life.
Can changes in diet help IBS?
For many people, careful eating reduces IBS symptoms. Before changing the diet, keep a journal noting the foods that seem to cause distress. Then discuss these findings with the doctor. A registered dietitian can help a person make changes to the diet. For instance, if dairy products cause symptoms to flare up, try eating less of those foods. A person might be able to tolerate yogurt better than other dairy products because it contains bacteria that supply the enzyme needed to digest lactose, the sugar found in milk products. Dairy products are an important source of calcium and other nutrients. If a person needs to avoid dairy products, adequate nutrients should be added in foods or supplements should be taken.
In many cases, dietary fiber may lessen IBS symptoms, particularly constipation. However, it may not help with lowering pain or decreasing diarrhea. Whole grain breads and cereals, fruits, and vegetables are good sources of fiber. High–fiber diets keep the colon mildly distended, which may help prevent spasms. Some forms of fiber keep water in the stool, thereby preventing hard stools that are difficult to pass. Doctors usually recommend a diet with enough fiber to produce soft, painless bowel movements. High–fiber diets may cause gas and bloating, although some people report that these symptoms go away within a few weeks. Increasing fiber intake by two to three grams per day will help reduce the risk of increased gas and bloating.
Drinking six to eight glasses of plain water a day is important, especially if a person has diarrhea. Drinking carbonated beverages, such as sodas, may result in gas and cause discomfort. Chewing gum and eating too quickly can lead to swallowing air, which also leads to gas.
Large meals can cause cramping and diarrhea, so eating smaller meals more often, or eating smaller portions, may help IBS symptoms. Eating meals that are low in fat and high in carbohydrates such as pasta; rice; whole–grain breads and cereals, unless a person has celiac disease; fruits; and vegetables may help.
How does stress affect IBS?
Stress—feeling mentally or emotionally tense, troubled, angry, or overwhelmed—can stimulate colon spasms in people with IBS. The colon has many nerves that connect it to the brain. Like the heart and the lungs, the colon is partly controlled by the autonomic nervous system, which responds to stress. These nerves control the normal contractions of the colon and cause abdominal discomfort at stressful times. People often experience cramps or “butterflies” when they are nervous or upset. In people with IBS, the colon can be overly responsive to even slight conflict or stress. Stress makes the mind more aware of the sensations that arise in the colon, making the person perceive these sensations as unpleasant.
Some evidence suggests that IBS is affected by the immune system, which fights infection in the body. The immune system is affected by stress. For all these reasons, stress management is an important part of treatment for IBS. Stress management options include:
• stress reduction training and relaxation therapies such as meditation
• counseling and support
• regular exercise such as walking or yoga
• changes to the stressful situations in a person’s life
• adequate sleep
What is the treatment for IBS?
Unfortunately, many people suffer from IBS for a long time before seeking medical treatment. Up to seventy percent of people suffering from IBS are not receiving medical care for their symptoms. No cure has been found for IBS, but many options are available to treat the symptoms. The doctor will prescribe the best treatments for a person’s particular symptoms and encourage the person to manage stress and make dietary changes.
Medications are an important part of relieving symptoms. The doctor may suggest fiber supplements or laxatives for constipation or medicines to decrease diarrhea, such as diphenoxylate and atropine (Lomotil) or loperamide (Imodium). An antispasmodic is commonly prescribed, which helps control colon muscle spasms and reduce abdominal pain. Antidepressants may relieve some symptoms. However, both antispasmodics and antidepressants can worsen constipation, so some doctors will also prescribe medications that relax muscles in the bladder and intestines, such as belladonna alkaloid combinations and phenobarbital (Donnatal) and chlordiazepoxide and clidinium bromide (Librax). These medications contain a mild sedative, which can be habit forming, so they need to be used under the guidance of a physician.
With any medication, even over–the–counter medications such as laxatives and fiber supplements, it is important to follow the doctor’s instructions. Some people report a worsening in abdominal bloating and gas from increased fiber intake, and laxatives can be habit forming if they are used too frequently.
Medications affect people differently, and no one medication or combination of medications will work for everyone with IBS. Working with the doctor to find the best combination of medicine, diet, counseling, and support to control symptoms may be helpful.
Medical Marijuana has significant anti-spasmodic and pain relieving qualities and may be of help with the symptoms of irritable bowel.