Irritable bowel syndrome
Date Posted: January 1, 2008
Irritable bowel syndrome
Another common intestinal disorder with a myriad of unpleasant symptoms is irritable bowel syndrome (IBS). IBS affects millions of people, but has no known cause and no effective remedy. It is the most common diagnosis made by gastroenterologists and accounts for as many as 3.5 million physician visits and 2.2 million prescriptions per year. Today, IBS affects as many as 20% of adults in North America, with women being twice as likely as men to experience it.
Irritable bowel syndrome may well be the most challenging functional GI disorder for patients and doctors alike. Several studies have found that patients with IBS have a significantly lower quality of life than patients without the syndrome and that the illness is seriously underdiagnosed. Through the years, IBS has been called by many names — spastic colon, spastic bowel, colitis, mucous colitis, and functional bowel disease. None of these names is quite accurate.
A 2005 survey of 1,713 people who met the criteria for IBS found that 22% had IBS symptoms for more than 10 years, and another 41% had experienced symptoms for one to five years. Sixty-seven percent said their most recent episode occurred within the past three months. Ninety-one percent had used at least one over-the-counter medication for IBS during the past year, and 46% had used at least one prescription drug. Over all, they scored lower than the average for the U.S. population in all quality of life categories surveyed, including bodily pain, general health, vitality, social functioning, and mental health. All in all, too many people are suffering from this perplexing condition.
If you have some of the symptoms of IBS, you may need to seek medical attention if you are truly miserable or worried about the possibility of more serious illness. However, there may be good reason not to seek medical attention; the cost of such care can be high. In rare cases, IBS patients undergo unnecessary surgery. And the drugs used to treat IBS are costly, even though studies have not proved most of them to be more effective than placebos. On the other hand, studies have shown that any drug used to treat an IBS patient exhibits a strong placebo effect.
What is IBS?
IBS usually begins in your late teens, 20s, or 30s. You're a relatively healthy person; then one day you begin to suffer intermittent cramps in the lower abdomen. You have to move your bowels more often than usual, and when you have to go, you have to get to a toilet right away. Your stools are loose and watery, possibly containing mucus. Sometimes, you feel bloated and full of gas.
After a while, the cramps return, but this time when you try to go to the bathroom, nothing happens. You're constipated. And back and forth it goes — diarrhea, then constipation, and pain and bloating in between. Some people with IBS alternate between constipation and diarrhea, while others always have one without the other. Irritable bowel syndrome is the catchall term for this mixed bag of symptoms.
It's a common disorder, with no known cause. The most frequently reported symptom is pain or discomfort in the abdomen. People with IBS generally feel their pain subside after a bowel movement or passing gas. But they also may feel that they haven't fully emptied their rectum after a movement.
While some patients have daily episodes or continuous symptoms, others experience long symptom-free periods. These patterns make it hard to know whether someone has IBS or some occasional complaint that's part of the bowel's normal response to stress or diet. Whether it is IBS usually depends on its frequency. The formal criterion for diagnosis is that symptoms have occurred for at least three days per month during the preceding three months. If you have recurring abdominal pain without constipation or diarrhea, your symptoms suggest a different disorder known as functional abdominal pain syndrome. IBS, on the other hand, is accompanied by changes in bowel movement.
IBS has no organic basis — that is, there's no physical abnormality or disease at the root of the problem. And doctors don't regard IBS as a forerunner of more serious diseases, such as ulcerative colitis, Crohn's disease, colon cancer, or stomach cancer (see "Irritable bowel syndrome: What else could it be?").
Irritable bowel syndrome: What else could it be?A number of gastrointestinal diseases can cause nonspecific symptoms similar to those of IBS. Diverticular disease. Small, finger-like sacs or pouches — known as diverticula — may protrude off the colon's inner lining, where the blood vessels enter the colon, piercing its walls and causing areas of weakness. Although the condition is most common after age 50, younger people occasionally develop diverticula. When a diverticulum becomes inflamed or infected, the condition is called diverticulitis. The symptoms of diverticulitis are much more intense than those of IBS and include severe left lower abdominal pain, chills, fever, and an elevated white blood cell count. Treatment of diverticulitis involves a liquid diet to let the bowel rest and antibiotic therapy to clear the infection. After the immediate inflammation has stabilized, patients switch to a steady high-fiber diet to help prevent flare-ups. Although patients are often advised to avoid nuts and seeds, there is no scientific support for this recommendation. Surgery may be required for complicated or recurrent diverticulitis. Inflammatory bowel disease (IBD). Inflammatory bowel disease has a wide variety of symptoms, including persistent abdominal pain, diarrhea, rectal bleeding, fever, and weight loss. Crohn's disease and ulcerative colitis, two conditions that together are referred to as inflammatory bowel disease, often have similar symptoms and are treated in similar ways, yet physicians regard them as distinct. Crohn's disease can occur anywhere in the gastrointestinal tract, from the mouth to the anus, but it's usually found at the end of the small intestine (ileum), in the colon, or both. It involves the full thickness of the bowel wall and may burrow into nearby organs. The bowel wall becomes thickened as well as constantly inflamed, and leakage of intestinal contents from the bowel can cause internal abscesses. A leak (fistula) that allows intestinal material to pass into the abdomen may require surgery. Severe bleeding is not likely. Crohn's disease usually appears in young people, who develop pain in the right side of the abdomen, a low-grade fever, and perhaps changes in bowel movements. Some patients develop an abscess or fistula around the anus. In some cases, surgery is needed to treat a complication of the disease, such as bowel obstruction. About 40% to 60% of those with Crohn's eventually need surgery to remove damaged areas of their small intestine or colon. Ulcerative colitis is characterized by inflammation of the lining, or mucosa, of the colon. Like IBS, it can cause lower abdominal pain and diarrhea. Unlike IBS, the stool generally contains blood, and bowel symptoms may be accompanied by fever, weight loss, an elevated white blood cell count, and a variety of skin lesions and arthritis. Ulcerative colitis is easier to diagnose than Crohn's disease and is treated with many of the same medications. While drugs cannot cure IBD, they are effective in reducing inflammation. The drugs used most commonly are aminosalicylates (cousins of aspirin); steroids (potent anti-inflammatory agents) such as prednisone and budesonide (Entocort); immunosuppressants like azathioprine (Imuran) and 6-mercaptopurine (Purinethol); and antibiotics. Biologic agents, including infliximab (Remicade) and adalimumab (Humira), have also proved effective for selected patients with IBD. Natalizumab (Tysabri), an immunomodulator, was approved, with restrictions, to treat Crohn's disease. Colorectal cancer. Colorectal cancer is the third most common form of cancer in both men and women, with an estimated 154,000 new cases diagnosed in the United States each year. Early on, colon cancer causes no symptoms. Later, its symptoms can be similar to those of IBS — abdominal pain, cramping, bloating, gas pains, and a change in bowel patterns. In addition, blood in the stool or rectal bleeding is often present. Advanced cancer is likely to cause bloody bowel movements, severe constipation if the intestine is obstructed, and weight loss. Thus, it's vital to get checked without delay should these symptoms occur. The good news is that colon cancer can be prevented in most cases through screening. Almost all precancerous growths (polyps) can be spotted and removed during a colonoscopy. Early-stage, localized colon cancers are curable by surgery in 90% of cases. Celiac disease. Also known as celiac sprue, celiac disease is a genetically based disorder that damages the small intestine and may result in debilitating symptoms. As many as one million Americans may have the disease, which clusters in families, primarily occurring in whites of European ancestry. It often goes undiagnosed. When people with celiac disease eat foods containing gluten — a protein found in wheat, rye, and barley — their immune systems attack and destroy the tiny finger-like projections lining the small intestine. A simple blood test for higher-than-normal levels of antibodies is the first step in diagnosing the disease. If the test is positive, a biopsy of the small intestine, performed through a standard endoscope, can confirm the diagnosis. Treatment is straightforward: a gluten-free diet. Symptoms often improve within days, and the small intestine gradually returns to normal function. |
Causes of IBS
IBS is probably not a single disease, but rather a set of symptoms that stem from a variety of causes. It may be generally described as a disorder in the functioning of the gastrointestinal tract. Some experts suspect that IBS involves disturbances in the nerves or muscles in the gut. Others believe that abnormal processing of gut sensations in the brain may hold the key, at least in some cases.
Infection
Several studies have demonstrated that a bout of infectious gastroenteritis (stomach or bowel inflammation) may increase the risk of developing IBS by as much as seven to 14 times. Low-grade bowel inflammation may persist in these patients indefinitely, thereby leading to IBS. What's more, emotional upset or stress may heighten this risk even further. One study reported that among people hospitalized with gastroenteritis, those who had experienced a distressing life event (such as divorce or the death of a family member) during the previous year were significantly more likely to develop IBS than those who'd had an uneventful year.
Overgrowth of intestinal bacteria
Another explanation for IBS that has gained ground is the overgrowth of bacteria in the small intestine. One study found that 84% of IBS patients had an abnormal lactulose breath test (an indication of bacterial overgrowth), compared with only 20% of people who did not have IBS. Other research groups report lower, although still notable, prevalence of small intestinal bacterial overgrowth in IBS patients.
It appears that bacterial overgrowth may contribute to many common symptoms of IBS, including bloating and distension, diarrhea, constipation, and heightened sensitivity to pain. Treatment with antibiotics may improve some of these symptoms (see "Medications for IBS").
Colon activity
Because the spasmodic pain associated with IBS seems to emanate from the colon, researchers have concentrated on this part of the GI tract, searching for any irregularities. The findings, thus far, have been inconsistent.
Some researchers have found that the colon muscle of a person with IBS begins to spasm after only mild stimulation. The colon seems to be more sensitive than usual, so it responds strongly to stimuli that wouldn't affect other people. Sometimes, the spasms lead to diarrhea; other times, to constipation. But some studies show that most of the time, colonic motor activity is no different for IBS patients than for anyone else.
Heightened sensitivity
Another possible explanation for these bothersome symptoms is that people with IBS have a heightened awareness of the inner workings of their gut. In several well-known experiments, balloons were inflated in the sigmoid colon, rectum, and small intestine of subjects. Those with IBS generally had a much lower threshold for experiencing pain than the healthy volunteers. Scientists believe that this lower pain threshold may be related to the dispatch of nerve signals from gut to brain.
Hormonal and dietary factors
Hormones produced in the GI tract, such as cholecystokinin and motilin, have also been suspected of triggering IBS symptoms through their effects on bowel motility, but studies have not been definitive. Women with IBS often have more symptoms during their menstrual periods, suggesting that changes in the levels of reproductive hormones can increase IBS symptoms.
Certain medicines and foods trigger spasms in some people. Sometimes the spasm delays the passage of stool, leading to constipation. Chocolate, dairy products, or large amounts of alcohol are frequent offenders. Some people simply can't tolerate certain dietary substances — for example, lactose (a sugar found in milk), fructose (a sugar found in fruit and used as a sweetener), or sorbitol (an artificial sweetener) — and develop bloating and diarrhea as a result. Lactose intolerance is distinct from IBS, but the symptoms can overlap. Caffeine causes loose stools in many people, but is more likely to affect those with IBS. Bran and wheat flour may increase IBS symptoms. On the other hand, some believe that a lack of dietary fiber may contribute to IBS. Fat in any form (animal or vegetable) is a strong stimulus of colon contractions after a meal and can also contribute to IBS symptoms.
It's often a matter of trial and error to determine which foods trigger your symptoms. Try eliminating one food at a time to see which ones give you trouble. Keeping a food diary in which you record the foods that you eat as well as any IBS symptoms can also help.
Foods that may trigger IBS symptomsApples and other raw fruits Beans Broccoli Cabbage Caffeine Cauliflower Chewing gum, beverages, or foods sweetened with fructose or sorbitol Chocolate Dairy products Fatty foods Margarine Nuts Orange and grapefruit juices Wheat products |
Stress and emotion
Stress is known to stimulate colon spasms in people with IBS. The process is not completely understood, but scientists point out that the intestines are controlled partly by the nervous system (see "The Stress Connection"). Some studies have shown significantly higher stress levels among people with IBS compared with healthy individuals. And stress reduction or relaxation training or counseling has helped relieve IBS symptoms in some people.
Despite the influence of emotions, IBS is not an "imaginary complaint"; the symptoms are real and troublesome enough in many cases to warrant attention. But it does appear to have a psychological component. One theory related to this connection focuses on the neurotransmitter serotonin. Neurotransmitters are chemicals that convey messages between nerve cells. Like the brain, the gut produces serotonin, which in turn acts on nerves in the digestive tract. Some research suggests that IBS patients who suffer mainly from diarrhea may have higher levels of serotonin in the gut, while those with constipation-predominant IBS have lower levels.
Studies have found considerably higher rates of psychiatric problems among IBS patients who see a specialist than among healthy people or those with structural bowel diseases. Some 42% to 61% of patients with functional bowel disorders who are seen in gastrointestinal clinics also have a current psychiatric diagnosis — usually anxiety or depression, according to one report.
Fast factWhen introducing fiber to your diet, do so gradually. Too much, too fast can cause excessive gas, cramping, and bloating. Drink lots of water or other liquids to avoid constipation. |
Diagnosing IBS
Because there are no specific tests for IBS, the illness must be diagnosed based on symptoms and by the process of elimination, often with the use of tests for other conditions. Fortunately, a diagnosis usually can be made with a single visit to a doctor.
The doctor takes a complete medical history, including a careful description of your symptoms. A physical exam and some routine laboratory tests are likely to be part of the exam, and a stool sample is useful for evidence of bleeding. In some cases, the doctor may also recommend diagnostic procedures that involve viewing the inside of the colon with a scope inserted through the anus, such as sigmoidoscopy or colonoscopy. The doctor may also order an x-ray. But the goal is to use as few costly, invasive tests as possible. To accomplish this, experts in the treatment of gastrointestinal illnesses have developed a set of criteria to help identify people with IBS (see "Do you have IBS?").
The doctor will also ask whether your symptoms started after an episode of gastroenteritis, or if they seem to be triggered by specific foods or medications, particularly milk products (to rule out lactose intolerance) and foods and beverages that contain fructose or sorbitol. You may need to keep a food diary for a few weeks to help identify foods that provoke symptoms.
It's especially important to consider emotional and psychological triggers. The doctor will want to know what prompted the visit and will ask about your lifestyle and stress level. It's not unusual for a traumatic life event such as divorce or the loss of a job to wreak havoc on the bowels and the psyche.
Other symptoms that accompany the pain may offer clues. If there is pain in the lower abdomen and a change in bowel movements, an abnormality in the large intestine may be present. A combination of abdominal pain and fever can signal inflammation (for example, diverticulitis), which requires immediate medical attention.
Another major diagnostic clue is bleeding from the digestive tract. People with IBS can have rectal bleeding, but IBS does not cause bleeding. Instead, bleeding reflects another cause, such as hemorrhoids. Bright red blood comes from the lower digestive tract, while black, tarry blood comes from the upper GI tract. If there is bleeding, more tests must be performed to determine the cause.
During the physical exam, the physician will look for tenderness in the abdomen. If the tenderness is located in the lower right part, it may signal ileitis or appendicitis, and in the upper right part, gallstones and inflammation of the gallbladder. The doctor will also check for a mass, which might be a tumor, a large cyst, or impacted stool. If the patient has IBS, the physical exam will usually not reveal anything other than perhaps a mildly tender abdomen. And lab tests are generally normal in IBS patients. A digital rectal exam is also usually part of the evaluation to check for masses in the rectum and, in men, the prostate. If a serious disorder is suspected, more tests will be ordered immediately.
Do you have IBS?According to the Rome III criteria, you have IBS if you have had recurrent abdominal pain or discomfort at least three days a month in the past three months, beginning at least six months ago, and two or more of the following: improvement in symptoms after a bowel movement a change in the frequency of stool accompanying the onset of pain or discomfort a change in the form (appearance) of stool accompanying the onset of pain or discomfort. The following additional symptoms are not essential for diagnosis, but they support the diagnosis and may also be used to identify certain types of IBS: abnormal stool frequency (more than three bowel movements per day or less than three per week) abnormal stool form (hard or loose stool) more than one in every four times abnormal stool passage (straining, urgency, or the feeling of incomplete evacuation) more than one in four times passage of mucus in more than one in every four bowel movements bloating or the sensation of having a distended abdomen on more than one out of every four days. |
Diagnostic tests
Tests may include a complete blood count, thyroid tests, and erythrocyte sedimentation rate (ESR). The ESR, which measures the speed at which mature red blood cells settle, can be used to screen for inflammatory disease. If your blood tests and your temperature are normal, you're under age 40, and your symptoms are typical of IBS, no further tests may be needed.
For patients with persistent diarrhea, stool samples will be examined for infectious agents, including intestinal parasites. Occasionally, the doctor may arrange for a stool collection to check for excess fecal fat content or weight, which would suggest that IBS is not the diagnosis.
A patient's age or atypical symptoms may persuade the doctor to conduct additional — and sometimes more expensive — diagnostic procedures. A colonoscopy or flexible sigmoidoscopy can screen for tumors, particularly in people over age 40, or inflammatory bowel disease (see "Irritable bowel syndrome: What else could it be?"). Sigmoidoscopy can be performed in the doctor's office with no sedation. The doctor views the rectum and sigmoid colon through a viewing tube and may also take a tissue sample. To rule out colon cancer, the doctor may order a colonoscopy, in which the doctor uses a lighted tube to view the full length of the colon, or a form of x-ray called a barium enema. Not every patient with a gut problem will need every test. On the other hand, everyone age 50 and over should be screened for colon cancer.
If blood has been found in the stool and both colonoscopy and an upper endoscopy fail to detect the source, the doctor now has the option of using an M2A camera, also known as a "pill-camera." In this increasingly common procedure, electrodes are taped to the patient's abdomen and connected by wires to a small, portable recording instrument. The patient swallows the pill-camera, which is the size of a large capsule. During the eight hours that follow, the tiny camera within the capsule takes pictures at a rate of two per second as it traverses the coils of intestine. The patient is totally unaware of the progression of the capsule, experiences no discomfort, and is free to go about his or her business.
When the time is up, the patient is unhooked from the electrodes. There is no need to retrieve the capsule, which will be passed out of the body with the stool. The doctor then downloads the images onto a screen and views them as one would a movie in fast motion, but rolling back to study individual frames if anything suspicious is encountered. Often, but not always, a source of bleeding will be identified. The main use of the pill-camera is to evaluate bleeding when endoscopy and colonoscopy fail to reveal a source; the pill-camera is not used to diagnose IBS (or any functional GI disease).
Despite the long list of possible tests, an experienced gastroenterologist will probably be able to make a preliminary determination as to whether IBS is the problem after hearing the patient's initial story, even before ordering any tests.
Managing IBS
Because there is no cure for IBS, treatment aims to control individual symptoms. As a result, the management of IBS requires a great amount of understanding between doctor and patient. Patients need to educate themselves about IBS and receive adequate information from their physicians so they can learn to manage the syndrome and regain control over their lives.
Self-help
You can play an active role in managing your own condition. Begin with these measures.
Eliminate triggers. What we know is that something has disrupted the automatic functioning of the bowel in IBS patients. The trigger could be emotional stress, for example, or it could be a dietary irritant. One place to start the search is with something consumed — foods, beverages, or drugs, for example.
Eat fiber. The most common dietary recommendation for IBS is to add fiber to increase the stool's bulk and speed its movement through the GI tract. A high-fiber diet doesn't always improve bowel symptoms, but many clinical trials have shown that it does seem to relieve constipation and may ease abdominal pain. And sometimes it can even improve diarrhea. Doctors usually recommend bran or another fiber supplement, such as psyllium or methylcellulose, which are available in many products found in supermarkets or drugstores, such as Metamucil, Reguloid, and Citrucel. For some people, these measures may be all that are needed to reduce symptoms and calm the belly.
Try heat. For people who experience IBS intermittently, a home heating pad can be a simple and inexpensive way of soothing abdominal pain. Heat can help relax cramping muscles. Similarly, drinking a warm, noncaffeinated tea such as chamomile may help reduce discomfort.
Psychotherapy
Cognitive behavioral therapy is a type of therapy centered on the idea that people's thoughts and behaviors can affect their symptoms and quality of life. Changing the way they think and act, therefore, may help IBS patients better manage their symptoms and cope with their condition. One study found that patients with moderate to severe IBS who participated in cognitive behavioral therapy enjoyed considerable improvements in symptom severity after six months, compared with patients who did not have therapy.
Medications for IBS
If you have symptoms that are troublesome enough to stop you from participating in normal activities, talk with your doctor about drug therapy. While medications can't cure IBS, they may ease the symptoms.
Antispasmodics. These medications, including atropine and related agents, dicyclomine (Bentyl), or hyoscyamine (Levsin), may relieve mild abdominal pain by reducing bowel spasms. People who often experience cramps after eating may obtain some relief if they take one of these medications before meals.
Antibiotics. A substantial percentage of IBS patients have an overgrowth of bacteria in their small intestines. Research shows treatment with antibiotics to eliminate this overgrowth may help improve symptoms. One small study compared the gut-specific, broad-spectrum antibiotic rifaximin against placebo. Eighty-seven study participants took either rifaximin or placebo for 10 days. Over the 10 weeks of follow-up, people who had taken the antibiotic enjoyed significant improvement in overall symptoms and in bloating in particular, compared with those taking placebo, with no notable side effects.
Antidepressants. Antidepressants are sometimes prescribed to treat IBS pain. It's not entirely clear whether the ability of antidepressants to relieve pain works independently of their ability to treat depression, or if the mechanism of action in IBS is related to the drugs' antidepressant effects. Medications such as amitriptyline (Elavil, Endep) and desipramine (Norpramin) may be prescribed at low doses for patients who have pain-predominant IBS. Because these tricyclic antidepressants can cause constipation, they should be used only by patients who have diarrhea- or pain-related IBS symptoms.
Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), do not control pain as effectively as the tricyclics, but they have become more popular for treatment of IBS because they tend to cause fewer side effects.
SSRIs help to relieve the anxiety and depression that is sometimes associated with moderate or severe IBS, so they may be a good treatment option for IBS patients who also have those psychological diagnoses.
Antidiarrheals. Loperamide (Imodium) and diphenoxylate with atropine (Lomotil) are generally recommended for patients whose main complaint is diarrhea. Loperamide, available over the counter, reduces the secretion of fluid by the intestine. Diphenoxylate, which is related to codeine and available by prescription only, helps to slow down intestinal contractions. It is combined with atropine in the prescription formulation.
Laxatives. Many clinicians think that some laxatives, including polyethylene glycol preparations (Miralax), which are also used for colon cleansing prior to colonoscopy, are safe and effective for IBS when used judiciously. However, laxatives with stimulant properties like bisacodyl (Dulcolax, Correctol) or senna (Ex-Lax) may cause some cramping.
Other medications. Amitiza (lubiprostone) is a prescription medication first approved to treat adults with persistent severe constipation without an identifiable cause and who have not responded to traditional therapies. More recently the FDA has extended approval of this drug for the treatment of women age 18 and older who have constipation-predominant irritable bowel syndrome (IBS). It is known as a chloride channel activator because it enhances production of chloride-rich fluid in the gut. The most common side effects of Amitiza are nausea, diarrhea, abdominal pain and headache.
Research is also focusing on the gut-brain connection, which appears to play a role in IBS, with serotonin-like medications among those being investigated. The first of these to be approved for diarrhea-predominant IBS was alosetron (Lotronex), which works on the serotonin type III receptor. However, Lotronex was temporarily taken off the market in 2000 because of colitis and severe constipation that resulted in 44 hospitalizations and five deaths. Lotronex is now available for women by prescription but only under a tightly controlled prescribing program.
Another related drug, tegaserod (Zelnorm), prescribed for constipation-predominant IBS, was voluntarily removed from the market in March 2007, when clinical trials showed a small but significant increase in risk of heart attack, stroke, and severe chest pain among people taking Zelnorm compared with those taking a placebo. But in July 2007, Zelnorm was reintroduced to the market on a severely restricted basis for patients in whom the benefits of the drug outweigh the risks. Zelnorm may now be prescribed to women with constipation-predominant IBS who are in critical need of the drug, are younger than age 55, and have no known heart problems. The drug remains off the market for general use.
Alternative and complementary treatments for IBS
IBS patients frequently turn to alternative or complementary therapies ranging from herbal remedies to meditation. Research shows that some patients experience improvement through any of several stress-reduction techniques taught by psychologists or other medical professionals. However, evidence of beneficial effects is lacking for most of the herbal therapies or other supplements.
Relaxation response training and meditation. Simple and easy to learn, these techniques help reduce nervous system activity and relax muscles. Therapies that induce a similar response include progressive muscle relaxation, guided imagery, hypnosis, and even biofeedback (see below).
Yoga. Some forms of yoga, the ancient Indian discipline that seeks to bring body and mind into balance, have proved valuable to some IBS sufferers. Yoga, like meditation, can provide a form of self-relaxation.
Hypnosis. Increasing evidence suggests that this mind-relaxation technique calms the autonomic nervous system and might contribute to improvement in symptoms.
Acupuncture. This system of applying small needles to prescribed points on the body was found to improve symptoms in one study of 27 patients who received acupuncture treatments three times per week for two weeks.
Biofeedback. Biofeedback is a mind-body technique in which participants use a biofeedback machine to see and learn to control their body's response to stimuli such as pain. Some patients who periodically lose control of their bowels, for example, have been able to improve their control using biofeedback techniques.
Probiotics. Probiotics are live bacteria taken in capsule or powder form (or in yogurt). Many strains of bacteria are used as probiotics, but so far, none has proved effective against the entire spectrum of IBS symptoms. However, L. plantarum and B. infantis have shown promise in alleviating specific symptoms, such as gas, bloating, pain, or diarrhea. You can find probiotic supplements for sale online or in grocery stores, health food stores, and pharmacies.
Herbal remedies. A growing number of people are turning to herbal remedies for the relief of IBS symptoms, including St. John's wort, fish oils, flaxseed oil, aloe vera juice, chamomile tea, and a variety of Chinese herbs. However, there are few studies to support the safety and effectiveness of such remedies. One possible exception is peppermint oil. In 2007, investigators reported that 75% of the patients in their study who took peppermint oil capsules for four weeks had a major reduction in their IBS symptoms, compared with just 38% of those who took a placebo pill. Peppermint oil may work by blocking calcium channels, thereby relaxing smooth muscles in the walls of the intestine. Because most herbal preparations do not undergo rigorous scientific study, be alert to the possibility of unexpected side effects when you start taking an over-the-counter remedy.
Understanding food intoleranceFood intolerance and allergies often produce similar symptoms, but they're not the same. A food allergy is an immune system reaction to a substance that is not normally dangerous to the body. Food intolerance, on the other hand, is not an allergic response and doesn't involve the immune system, but rather some other issue, such as inadequate amounts of an enzyme to digest a particular type of food. For some people, heartburn, gas, nausea, upper abdominal stomach upset, diarrhea, cramps, and flatulence — all common symptoms of functional disorders — may be caused by a food that simply doesn't agree with them. The problem isn't that the food is spoiled, unripe, or contaminated by bacteria, but that the body is unable to digest a particular substance. The best-known example is lactose intolerance, a difficulty in digesting lactose, the primary sugar found in milk. It's been estimated that up to 70% of the world's people are unable to digest lactose, although the problem is minor for most. The difficulty occurs when a person's body does not produce enough of the enzyme lactase, which breaks down milk sugar into simpler forms that can be absorbed into the bloodstream. Lactose intolerance is more prevalent in certain ethnic groups, including Jews, African Americans, Native Americans, and Asians; it is less common in Scandinavians. Typically, early symptoms may appear as early as 30 minutes after you consume milk products. You may develop gas, diarrhea, bloating, cramps, or nausea. The symptoms represent a direct chemical toxic effect (unlike a food allergy, which involves the immune system and can have more serious consequences, including allergic shock). The best way to avoid the symptoms of lactose intolerance is to avoid milk products. But if you don't wish to make that concession, you can take a special enzyme preparation, such as Lactaid, when eating foods containing lactose. There are also now milks, yogurts, and ice creams that already contain the enzyme. Others who don't have as severe a problem may find that they can eat some milk products as long as they consume them with other foods. Yogurt (with live cultures) and aged cheeses may not cause as many problems as other milk products, probably because some of the lactose breaks down during fermentation. Alternatives to milk products include soy- or rice-based products, which are available in health food stores and many supermarkets. On the other hand, many foods contain hidden lactose. Be sure to read the labels on breads, processed breakfast cereals, instant potatoes, soups, margarine, lunch meats, salad dressings, pancake mixes, and similar products; check the ingredients list not only for milk, but also for whey. Nondairy kosher foods are a safe bet, however, since kosher laws mandate that these foods cannot contain any milk products. Another food intolerance centers on difficulties in digesting wheat or substances that contain the wheat protein called gluten. This protein is found in foods containing wheat, rye, and barley. In sensitive people, ingesting gluten can cause bloating, gas, abdominal distension, and diarrhea. Avoiding gluten-containing products will eliminate the problem. Gluten intolerance is distinct from celiac disease, which is an immunological reaction to gluten. |
Review Date: 2008-01-01
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