Irritable bowel syndrome (patient information)
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Overview
Irritable bowel syndrome is a disorder characterized most commonly by cramping, abdominal pain, bloating, constipation, and diarrhea. IBS causes a great deal of discomfort and distress, but it does not permanently harm the intestines and does not lead to a serious disease, such as cancer. Most people can control their symptoms with diet, stress management, and prescribed medications. For some people, however, IBS can be disabling. They may be unable to work, attend social events, or even travel short distances.
As many as 20 percent of the adult population, or one in five Americans, have symptoms of IBS, making it one of the most common disorders diagnosed by doctors. It occurs more often in women than in men, and it begins before the age of 35 in about 50 percent of people.
What are the symptoms?
Symptoms range from mild to severe, however most people have mild symptoms. IBS symptoms may be worse in patients with underlying stress or mood disorders such as anxiety and depression, but it is important to understand that these conditions do not cause IBS. Symptoms may include:
- Abdominal distention
- Abdominal fullness, gas, bloating
- Abdominal pain or tenderness that:
- Comes and goes
- Goes away after a bowel movement
- Occurs after meals
- Chronic and frequent constipation, usually accompanied by pain
- Chronic and frequent diarrhea, usually accompanied by pain
- Emotional distress
- Depression
- Loss of appetite
- Nausea and vomiting
What are the causes?
Researchers have yet to discover any specific cause for IBS. One theory is that people who suffer from IBS have a colon, or large intestine, that is particularly sensitive and reactive to certain foods and stress. The immune system, which fights infection, may also be involved.
- Normal motility, or movement, may not be present in the colon of a person who has IBS. It can be spasmodic or can even stop working temporarily. Spasms are sudden strong muscle contractions that come and go.
- The lining of the colon called the epithelium, which is affected by the immune and nervous systems, regulates the flow of fluids in and out of the colon. In IBS, the epithelium appears to work properly. However, when the contents inside the colon move too quickly, the colon loses its ability to absorb fluids. The result is too much fluid in the stool. In other people, the movement inside the colon is too slow, which causes extra fluid to be absorbed. As a result, a person develops constipation.
- A person’s colon may respond strongly to stimuli such as certain foods or stress that would not bother most people.
- Recent research has reported that serotonin is linked with normal gastrointestinal (GI) functioning. Serotonin is a neurotransmitter, or chemical, that delivers messages from one part of your body to another. Ninety-five percent of the serotonin in your body is located in the GI tract, and the other 5 percent is found in the brain. Cells that line the inside of the bowel work as transporters and carry the serotonin out of the GI tract. People with IBS, however, have diminished receptor activity, causing abnormal levels of serotonin to exist in the GI tract. As a result, they experience problems with bowel movement, motility, and sensation—having more sensitive pain receptors in their GI tract.
- Researchers have reported that IBS may be caused by a bacterial infection in the gastrointestinal tract. Studies show that people who have had gastroenteritis sometimes develop IBS, otherwise called post-infectious IBS.
- Researchers have also found very mild celiac disease in some people with symptoms similar to IBS. People with celiac disease cannot digest gluten, a substance found in wheat, rye, and barley. People with celiac disease cannot eat these foods without becoming very sick because their immune system responds by damaging the small intestine. A blood test can determine whether celiac disease may be present.
Who is at highest risk?
Risk factors for IBS:
- gender: females are at higher risk than males
- age: people younger than 35 are at greater risk[1]
Diagnosis
Most of the time, your doctor can diagnose IBS without ordering many tests. Tests usually reveal no problems.
Some patient may need an endoscopy, especially if symptoms begin later in life. Younger patients with persistent diarrhea may need this test to look for inflammatory diseases that can cause similiar symptoms such as Crohn's disease or ulcerative colitis. You may need additional tests if you have blood in your stool, weight loss, or signs of anemia.
Patients over age 50 should be screened for colon cancer.
When to seek urgent medical care?
Call your health care provider if you have symptoms of irritable bowel syndrome or if you notice a persistent change in your bowel habits.
Treatment options
The goal of treatment is to relieve symptoms.
Lifestyle changes can be helpful in some cases of IBS. For example, regular exercise and improved sleep habits may reduce anxiety and help relieve bowel symptoms.
Dietary changes can be helpful, but no specific diet can be recommended for IBS in general because the condition differs from one person to another. Increasing dietary fiber and avoiding items that stimulate the intestines such as caffeine may help.
Foods and drinks that may cause or worsen symptoms include:
- fatty foods, like french fries
- milk products, like cheese or ice cream
- chocolate
- alcohol
- caffeinated drinks, like coffee and some sodas
- carbonated drinks, like soda
Other possible treatments may include:
- Counseling in cases of severe anxiety or depression
- Antidiarrheal medications for those whose main symptom is diarrhea
- Low-dose antidepressants to help relieve intestinal pain
- Medications to stimulate bowel movements for those with constipation
Medications
Medications used to help with symptoms of IBS include:
- Laxatives treat constipation. Many kinds of laxatives are available. Your doctor can help you find the laxative that is right for you.
- Antispasmodics control spasms in the colon and help ease abdominal pain.
- Antidepressants, even in lower doses than are used for treating depression, can help people with IBS. They can help reduce the abdominal discomfort or pain associated with IBS and, depending on the type chosen, may help the diarrhea or constipation.
Another drug is sometimes prescribed for the treatment of IBS. Alosetron hydrochloride (Lotronex) is for women with severe IBS whose main symptom is diarrhea. Because it can cause serious side effects, Lotronex is only used if other medicines do not work.
You need to follow your doctor’s instructions when you use the medicine. Otherwise, you may need to keep taking it in order to have a bowel movement. Talk with your doctor about potential side effects and what to do if you experience them.
Where to find medical care for Irritable bowel syndrome?
Directions to Hospitals Treating Irritable bowel syndrome
Prevention
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 (relaxation) training and relaxation therapies such as meditation
- counseling and support
- regular exercise such as walking or yoga
- changes to the stressful situations in your life
- adequate sleep
What to expect (Outlook/Prognosis)?
Irritable bowel syndrome may be a life-long condition, but symptoms can often be improved or relieved through treatment.
Possible Complications
- Dehydration
- Depression
- Discomfort
- Malnutrition resulting from avoiding food
Diseases with similar symptoms
- Lactose intolerance
- Inflammatory bowel disease
- Celiac disease
- Thyroid disease
- Diverticulitis
- Endometriosis
- Gallstones
- Gastroesophageal reflux disease (GERD)[2]
Sources
- http://digestive.niddk.nih.gov/ddiseases/pubs/ibs/
- http://www.nlm.nih.gov/medlineplus/irritablebowelsyndrome.html
- http://www.nlm.nih.gov/medlineplus/ency/article/000246.htm