Irritable bowel syndrome (IBS) occurs when muscles in your intestines contract faster or slower than normal. This causes pain, cramping, gas, sudden bouts of diarrhea, and constipation.

Two types of Irritable Bowel Syndrome exist. In spastic colon Irritable Bowel Syndrome, you experience constipation, diarrhea, or both, and you often have pain after eating. Painless diarrhea Irritable Bowel Syndrome involves the sudden onset of diarrhea during or after meals, or upon waking. Between 10 and 20 percent of the population has Irritable Bowel Syndrome at some time. The syndrome often starts in adolescents or young adults. It affects three times as many women as men and is often associated with stress.

Signs and Symptoms of Irritable Bowel Syndrome (IBS)

- Cramping pain in your lower abdomen
- Bloating and gas
- Changes in your bowel habits
- Diarrhea or constipation, or both alternately
- Immediate need to move your bowels when you wake up or during or after meals
- Relief of pain after bowel movements
- Feeling of incomplete emptying after bowel movements
- Mucus in your stool

What Causes Irritable Bowel Syndrome?

The underlying cause remains unknown. But the syndrome has no relation to actual disease, and it does not lead to other diseases.

What to Expect at Your Health Care Provider’s Office

Your health care provider will feel your abdomen to check for signs of pain. He or she will place a gloved finger in your rectum to check its condition. If you’re female, you may have a pelvic examination. The provider may use a sigmoidoscope—a flexible instrument inserted into the rectum—to examine your lower colon. You may be asked to provide three days’ worth of stool samples. Your provider may also want samples of your blood and urine. The provider may also want an ultrasound or X-rays.

Treatment Options for Irritable Bowel Syndrome

Treatment Plan for Irritable Bowel Syndrome

Try to avoid stressful situations or foods that have triggered Irritable Bowel Syndrome in the past. Monthly hormonal changes and some drugs can affect your condition. Establishing regular bowel habits can be helpful. Your health care provider may prescribe medications to help you with the symptoms.

Drug Therapies for Irritable Bowel Syndrome

Prescription

- Antispasmodic agents—reduce the pain from bowel spasm, some also help with depression; take before meals; various side effects
- Antiflatulents—if symptoms indicate

Over the Counter Treatments for Irritable Bowel Syndrome

- Loperamide (Imodium)—for diarrhea
- Bulk-producing agents—such as psyllium (Metamucil) can help with diarrhea or constipation
- Lactase capsules—if lactose intolerant

Complementary and Alternative Therapies for Irritable Bowel Syndrome

Irritable Bowel Syndrome has many underlying causes that can often be successfully treated with alternative therapies. Stress reduction techniques through biofeedback, hypnosis, or counseling can help you deal with stress.

Nutrition for Irritable Bowel Syndrome

- Removal of known food allergens or irritants is important. The most common food allergens are dairy products, wheat, corn, peanuts, citrus, soy, eggs, fish, and tomatoes. An elimination/challenge trial may help uncover sensitivities. Eliminate all suspected allergens from the diet for two weeks. Add back one food every three days and wait for reaction to the challenge.
- If you suffer from gassiness, eliminate beans, cabbages, and other “gassy” vegetables from your diet, as well as apple juice, grape juice, bananas, nuts, and raisins.
- Fiber supplementation can help reduce pain, cramping, and gas. Supplements include psyllium, flax meal, slippery elm (Ulmus rubra) powder, and marshmallow root (Althea officinalis) powder.
- Digestive enzymes taken 20 minutes before meals can help enhance digestion and normalize bowel function.
- One teaspoon of raw bran with each meal, supplemented by extra fluids, provides fiber reliably.
- Pro-flora supplements such as acidophilus and lactobacillus species taken two to three times per day can help to rebalance normal bowel bacteria and reduce gas and bloating.
- Magnesium 200 mg two to three times per day and B-complex (50 to 100 mg per day) with extra B5 (pantothenic acid; 100 mg per day) may help reduce the effects of stress.
- Low-fat diets may relieve abdominal pain following meals.

Herbal Remedies for Irritable Bowel Syndrome

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

- Enteric-coated peppermint oil: one to two capsules (0.2 ml peppermint oil per capsule) three times a day after meals
- A tea of fennel seed (Foeniculum vulgare) or ginger root (Zingiber officinalis) taken after meals promotes good digestion.
- A tincture of equal parts of the following before meals (30 drops three times per day): valerian (Valeriana officinalis), passionflower (Passiflora incarnata), anise seed (Pimpinella anisum) extract, meadowsweet (Filependula ulmaria), wild yam (Dioscorea villosa), and milk thistle (Silybum marianum)

Homeopathy for Irritable Bowel Syndrome

Homeopathy may be useful as a supportive therapy.

Physical Medicine

- Electric heating pads, hot water bottles, and long hot baths can relieve painful spasms and cramping in the abdomen.
- Regular exercise, such as walking, can reduce stress and encourage bowel movements if you are constipated.
- Castor oil pack. Apply oil directly to skin, cover with a clean soft cloth and plastic wrap. Place a heat source over the pack and let sit for 30 to 60 minutes.
- Abdominal breathing helps to induce the relaxation response and may aid normal physiological functioning (such as digestion).

Acupuncture

Acupuncture can help relieve Irritable Bowel Syndrome episodes.

Massage

Therapeutic massage may help in reducing the effects of stress.

Following Up

Be aware that the syndrome itself may cause you stress.

Supporting Research on Irritable Bowel Syndrome (IBS)

Berkow R, ed. Merck Manual of Diagnosis and Therapy. 16th ed. Rahway, NJ: The Merck Publishing Group; 1992.

Dambro MR. Griffith’s Five-Minute Clinical Consult. New York, NY: Lippincott, Williams and Wilkins; 1998.

Koch TR. Peppermint oil and irritable bowel syndrome [In Process Citation]. Am J Gastroenterol. 1998;93:2304–2305.

Liu JH, Chen GH, Yeh HZ, Huang CK, Poon SK. Enteric-coated peppermint-oil capsules in the treatment of irritable bowel syndrome: a prospective, randomized trial. J Gastroenterol. 1997;32:765–768.

Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine. Rocklin, Calif: Prima Publishing; 1998:396–400.

Pittler MH, Ernst E. Peppermint oil for irritable bowel syndrome: a critical review and metaanalysis. Am J Gastroenterol. 1998;93:1131–1135.

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