The most common gastrointestinal complaint in the United States, irritable bowel syndrome (IBS)--also known as spastic colon, mucous colitis, and nervous bowel--affects 15% to 20%(1) of the adult population. It afflicts twice as many women as men, usually developing in late adolescence or early adulthood. The condition is characterized by intermittent periods of constipation or diarrhea, often accompanied by bloating or abdominal pain. Once partly digested food has left the stomach, it's moved through the digestive tract by rhythmic contractions of the muscles in the intestinal walls, a process called peristalsis. In irritable bowel syndrome, these muscles go into spasm for unknown reasons, becoming so uncoordinated that they move residues either too quickly (causing diarrhea) or too slowly (causing constipation). Although IBS is uncomfortable, inconvenient and sometimes quite painful, luckily this digestive disorder is not at all dangerous or life threatening. Nor does it ever lead to anything more "serious," like colon cancer or ulcerative colitis. For doctors, IBS can be challenging to diagnose, because tests often show no abnormalities even though symptoms are often all too real. As a result, a diagnosis of irritable bowel syndrome is usually arrived at by process of elimination, after other disorders with similar but more serious symptoms--such as diverticulitis, ulcerative colitis, Crohn's disease, or intestinal parasites--have been ruled out. Just as there's no cure for a tension headache (which also has "normal" test results), there's no cure for IBS. And, just as you can take specific steps to avoid a headache and treat it when it occurs. so it is with IBS. This condition is both avoidable and treatable through a combination of a sensible diet, stress management, and a program of therapeutic supplements and/or prescription drugs.
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Diarrhea, constipation, or alternating bouts of both for several months
Abdominal discomfort, pain, or cramps (often relieved by a bowel movement)
Bloating and excess gas
Nausea
White mucus in the stool
A feeling that the bowels have not emptied fully
A worsening of symptoms after eating a large meal, during or just before menstrual periods, or while under stress
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While experts have suggested many potential possibilities for irritable bowel syndrome, no single cause has been established beyond a reasonable doubt. The list of possible culprits has ranged from parasitic infections and lactose (dairy) intolerance to food allergies and overuse of antibiotics. Whatever the source, researchers do agree on one thing: Stress seems to aggravate the condition.
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Due to the fact that it is still not clear what causes IBS, treatment focuses on the relief of symptoms so that you can live your life as fully and normally as possible. In most cases, mild symptoms of IBS can be successfully controlled by learning to manage stress and making changes in your diet and lifestyle. But if your problems are moderate or severe, you may need more help than lifestyle changes alone can offer. For moderate IBS, your doctor may suggest taking fiber supplements such as psyllium (Metamucil) or methylcellulose (Citrucel) with fluids, to help control constipation and over-the-counter medications such as loperamide (Imodium) to help control diarrhea. In some cases, you may need drugs that affect certain activities of the nervous system (anticholinergics) to relieve painful bowel spasms. If so, follow-up with your doctor is very important.
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If your symptoms include pain and depression, your doctor may recommend a tricyclic antidepressant or a selective serotonin reuptake inhibitor (SSRI). These medications help relieve depression as well as inhibit the activity of neurons that control the intestines. For diarrhea and abdominal pain, your doctor may suggest tricyclic antidepressants such as imipramine (Tofranil) and amitriptyline (Elavil). Side effects of these drugs include drowsiness and constipation. Selective serotonin reuptake inhibitors such as fluoxetine (Prozac, Sarafem) or paroxetine (Paxil) may be helpful if you're depressed and have pain and constipation. If these medications don't work, you may have better results from counseling. If you have severe IBS, it's important to receive ongoing treatment and support from your physician. In November 2000, the Food and Drug Administration (FDA) approved the first medication specifically for the treatment of moderate to severe symptoms of IBS in women. Alosetron (Lotronex) is a nerve receptor antagonist that's supposed to relax the colon and slow the movement of waste through the lower bowel. However, the drug was pulled from the market just nine months after its approval when it was linked to at least four deaths and severe side effects in 197 people(2). In June 2002, the FDA took the unprecedented step of allowing Lotronex to be sold again — with a number of restrictions. The drug can be prescribed only by doctors enrolled in a special program and is intended for severe cases that haven't responded to other treatments. Lotronex is not approved for use by men or for women who don't have the diarrhea-predominant form of IBS (3;4). For women who have IBS with constipation, the FDA approved the medication tegaserod (Zelnorm) in July 2002. It's approved only for short-term use in women, and has not been approved for use in men. Tegaserod imitates the action of the neurotransmitter serotonin and helps to coordinate the nerves and muscles in the intestine.
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A diagnosis of IBS based largely on a complete medical history and physical exam. Your doctor may also recommend conducting several tests, including stool studies to check for infection or malabsorption problems. He or she may perform a flexible sigmoidoscopy, a test that examines the lower part of the colon (sigmoid) with a flexible, lighted tube (sigmoidoscope). In some cases, your doctor may perform a colonoscopy, a diagnostic test in which a small, flexible tube is used to examine the entire length of the colon. These tests help rule out more serious conditions such as ulcerative colitis, Crohn's disease and colorectal cancer.
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Anyone can experience digestive upset from worry or anxiety. But if you have IBS, stress-related problems such as abdominal pain and diarrhea tend to occur with greater frequency and intensity. Finding ways to deal with stress can be extremely helpful in preventing or alleviating symptoms. The following mind-body therapies are complementary to medical care for IBS and can be effective ways to manage stress:
Counseling. In some cases, a Behavioral Health care professional such as a psychologist or psychiatrist can help you learn to reduce stress by looking at how you respond to events in your life and then working with you to modify or change that response.
Biofeedback. This stress-reduction technique helps you reduce muscle tension and slow your heart rate with the feedback help of a machine. You're then taught how to produce these changes yourself. The goal is to help you enter a relaxed state so that you can cope more easily with stress. Biofeedback practitioners work in private practice or in hospitals and medical centers.
Hypnosis. Hypnotherapy or Guided Imagery may reduce abdominal pain and bloating. A trained professional teaches you how to enter a relaxed state and then guides you as you imagine your intestinal muscles becoming smooth and calm(5).
Regular exercise, yoga, massage or meditation. These can all be effective ways to relieve stress. You can work in a health club with a personal trainer or wellness coach, take classes in yoga or tai chi , seek out meditation or
mind-body skills instructors, or practice at home using books or tapes.
Progressive relaxation exercises. These help you relax muscles in your body, one by one. Start by tightening the muscles in your feet, then concentrate on slowly letting all of the tension go. Next, tighten and relax your calves. Continue until the muscles in your body, including those in your eyes and scalp, are completely relaxed.
Deep breathing. Most adults breathe from their chests. But you become calmer when you breathe from your diaphragm, the muscle that separates your chestfrom your abdomen. When you inhale, allow your belly to expand with air; when you exhale, your belly naturally contracts. Deep breathing can also help relax your abdominal muscles, which may lead to more-normal bowel activity.
Other techniques. Set aside at least 20 minutes a day for any activity you find relaxing — listening to music, reading, playing computer games or just soaking in a warm bath.
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To calm intestinal spasms and other IBS symptoms, try peppermint oil capsules that are enteric-coated; this ensures that the oil is released in the intestines rather than the stomach. One caution: Peppermint oil is not recommended for anyone with a hiatal hernia, as it may aggravate your condition. Psyllium, an herbal product derived from seeds of the plantago plant, is a source of dietary fiber that may aid constipation and diarrhea by absorbing water and adding bulk to the stool. (Be sure to drink one to two glasses of water when you take psyllium, and plenty of extra water throughout the day.) If psyllium aggravates symptoms instead of relieving them, discontinue using it (6). Acidophilus, a form of "beneficial" bacteria or probiotic, that normally inhabit the digestive tract, helps digest food and also fortifies the body against digestive disorders by stopping the harmful bacteria and yeasts that can cause disease from growing uncurbed. It's especially important to take after a round of antibiotics. (Get pills containing 1 to 2 billion (Get pills containing 1 to 2 billion "live" organisms per pill.) You can enhance the effect of the acidophilus by taking it in combination with FOS (fructo-oligosaccharides), a supplement containing indigestible carbohydrates that feed the friendly bacteria. Persons who have a lot of gas and bloating symptoms or feel overfull after eating often benefit from supplemental digestive enzymes to support the natural work of the pancreas secretions in processing food. Just a reminder: If you have a serious medical condition, always talk to your doctor before beginning a supplement program. Get supplement dosages and tips in our WholeHealthMD Supplement Recommendations for Irritable Bowel Syndrome.
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Experiment with fiber. Some people find that a high-fiber diet relieves their symptoms, while others discover that it only makes things worse. For instance some people do not tolerate the natural chemicals in high fiber beans or react to the natural chemicals in wheat bran. If you do add high-fiber foods to your diet, do it slowly to minimize bloating and gas. High-fiber foods include fruits, vegetables, grains, and beans.
Avoid high-fat foods, such as bacon and vegetable oils, and gas-producing foods, such as beans and broccoli.
Be on the lookout for sorbitol, an artificial sweetener found in candy, gum, and other sugarless products, that may trigger diarrhea.
Eat smaller, more frequent meals--they're easier to digest.
To pinpoint any food sensitivities in your diet, start keeping a food diary. You may also want to try a food elimination diet, which will help you figure out exactly which foods are the culprits.
Here's how to find out whether you're lactose intolerant, which may be triggering your IBS symptoms. Drink two glasses of nonfat milk on an empty stomach. If you experience gas, diarrhea, pain, or bloating within four hours, redo the test with lactase-treated milk. If no symptoms occur, stay away from dairy products.
Exercise for at least 20 minutes a day to keep the bowels moving normally. Walking is especially good for this.
Meditation, biofeedback, and other relaxation techniques may help reduce stress.
Quit smoking and limit your intake of caffeine, artificially sweetened beverages, and alcohol, which all may irritate the digestive tract. Acupressure This ancient and often very effective form of massage can stimulate the digestive system and ease your discomfort. Acupressure is also particularly effective in releasing the muscular tension frequently associated with IBS. I find that applying pressure to specific points on the feet, legs, and abdomen can provide significant relief from IBS symptoms. Acupressure for IBS can help ward off flare-ups by encouraging the smooth functioning of the digestive system. It can also relieve abdominal discomfort and muscular tension during flare-ups. Read a description of the General Acupressure Technique.
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An Australian systematic review of has found study has found that a Chinese herbal medicine formula was effective in relieving symptoms (7). But that study raises questions about which people with IBS would most likely benefit from Chinese herbal medicine, or why it appears to work. The reviewers looked at evidence for multiple complementary and alternative (CAM) therapies including, acupuncture, aloe, biofeedback, hypnotherapy, Chinese herbal medicine, colonic irrigation, therapeutic diets, acidophilus,lactobacillus and other probiotics, and peppermint oil. They expressed 'guarded optimism' for the efficacy of the psychological or mind-body therapies and Chinese herbal medicine, but added that there are few good studies in the medical literature and that it is therefore difficult to draw definitive conclusions on alternative therapies for IBS. Elimination diets were a reasonable thing to try when a clear dietary or food trigger was seen, but some patients find them difficult and could develop nutritional problems, the reviewers said. A modest benefit was seen when people used peppermint oil for IBS symptoms, but all studies involving peppermint oil were quite short, so they should be interpreted with caution. While ginger has been used to control nausea and vomiting, it has not been studied for its efficacy in IBS. The use of lactase to help digest milk sugar in dairy foods had not been shown to be effective in IBS, and although altering intestinal flora with acidophilus and lactobacillus products was appealing, studies did not support the routine use of probiotics in people with IBS. The effects of aromatherapy, Candida treatment , colonic enemas, Western herbs such as aloe, massage, meditation, reflexology, and other nutritional supplements and vitamins could not be evaluated based on published scientific studies. Researchers at the National Institutes of Health (NIH) have found that acupuncture can provide relief from chronic pain, and acupuncturists typically see improvement in muscle spasms and bowel functions when patients are treated for IBS. The research study results on the effects of acupuncture on symptoms of IBS have been mixed, however.
References
1. Saito YA, Schoenfeld P, Locke GR, III. The epidemiology of irritable bowel syndrome in North America: a systematic review. Am J Gastroenterol 2002; 97(8):1910-1915.
2. Horton R. Lotronex and the FDA: a fatal erosion of integrity. Lancet 2001; 357(9268):1544-1545.
3. FDA approves restricted marketing of Lotronex. FDA Consum 2002; 36(4):4.
4. Charatan F. FDA advisory panels recommend Lotronex be put back on market. BMJ 2002; 324(7345):1053.
5. Hypnosis helps irritable bowel syndrome. For IBS, beneficial effects of hypnotherapy may last for up to five years. Health News 2004; 10(1):9.
6. Bijkerk CJ, Muris JW, Knottnerus JA, Hoes AW, de Wit NJ. Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther 2004; 19(3):245-51.
7. Spanier JA, Howden CW, Jones MP. A systematic review of alternative therapies in the irritable bowel syndrome. Arch Intern Med 2003; 163(3):265-74.
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If symptoms are so frequent and/or severe that they interfere with normal activities.
If you have abdominal pain along with changes in bowel patterns or in stool size or consistency.
If blood shows up in your stool.
If you experience unexplained weight loss.
If you are taking drugs for treatment of other medical or emotional problems, discuss the IBS symptoms with your physician.
If abdominal pain is constant, severe, and if it is accompanied by fever.
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The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies with what our clinical advisors have found to be efficacious in their personal practice. This tool is meant to simplify which supplements and therapies demonstrate promise in the treatment of certain conditions. This scale does not take into account any possible interactions with any medication/ condition/ or therapy which you may be currently undertaking. It is therefore advisable to ask your doctor before starting any new treatment regimen.
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Limited utility found in research studies.
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