Irritable Bowel Syndrome
Dr. Joanmarie Pellegrini
Tuesday, April 6, 2010
Irritable bowel syndrome, commonly referred to as IBS, is a condition of the colon. We do not know what causes it and therefore it is very difficult to know how to cure it. The current most common medical theory is that IBS is a disorder of the nerves that control the function of the colon. IBS causes abdominal pain, bloating, gassiness, diarrhea, and/or constipation. The symptoms can be so severe that it limits one's activity and ability to work.
A doctor may diagnose IBS by the classic set of symptoms and by ruling out other common disorders. The doctor may order tests to rule out a malabsorption disorder such as lactose intolerance or celiac disease. Sometimes a colonoscopy is indicated in order to evaluate for inflammatory bowel disease.
Once a patient is given a diagnosis of IBS, there is a four-pronged approach to treatment. The four prongs are: dietary modification, stress reduction, exercise, and medications.
Dietary modification: A person with IBS should keep a food journal in order to determine which foods cause the most symptoms. Common foods to avoid are milk products and foods high in fat. Also, it is important to add fiber. There are many types of fiber on the market and most of them will cause less gas and bloating than the fiber found in foods. Many people find that the soluble fibers cause the least amount of symptoms. I usually recommend to my patients that they use a combination of soluble (inulin) and insoluble (psyllium) fibers along with increasing the fiber-rich foods in their diet. If someone has diarrhea, then it is usually recommended to avoid or limit caffeine intake. On the other hand, caffeine can benefit the person with constipation.
Stress reduction: Just about everyone with IBS notices that their symptoms are worse with stress. In fact just about every disease is worse with stress. There are many components to stress reduction with include psychological evaluation, counseling, breathing exercises, biofeedback, acupuncture, yoga, prayer, etc.
Exercise: The colon is fairly responsive to exercise. Many people notice that their constipation is much improved with aerobic exercise. It is not quite understood how exercise benefits the bowel but it is a well known fact that it does. Exercise can also be a source of stress reduction.
Medications: This is generally considered the last resort. There are medications that treat the symptoms such as laxatives for constipation, anti-diarrheals or anti-spasmodics for diarrhea, simethicone for the gas, and pain medication for the pain. In general, narcotics are least effective for bowel-related pain. Anti-depressants also may be effective. Finally, there are two drugs on the market for IBS (Lotrenex and Amitiza). These drugs have fairly serious side-effect profiles.
If you or a loved one have been given a diagnosis of IBS, the goal is to manage the symptoms and not allow the disease to control your life. There is no cure but there is promise in the future as more reseach is done on bowel motility disorders. Just about every patient who embarks on a well-rounded treatment program will experience significant relief. However, most of the options listed above will need to become part of a person's lifestyle in the long run.
The following is one of my favorite sites for information on IBS: