Irritable Bowel Syndrome

Irritable Bowel Syndrome

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

Two types of IBS exist. In spastic colon IBS you experience constipation diarrhea or both and you often have pain after eating. Painless diarrhea IBS involves the sudden onset of diarrhea during or after meals or upon waking. Between 10 and 20 percent of the population has IBS 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

Cramping pain in your lower abdomen
Bloating and gassiness
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 It?

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 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

Treatment Plan

Try to avoid stressful situations or foods that have triggered IBS 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

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

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

IBS 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

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.

Herbs

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

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 IBS 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

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.

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.