Irritable Bowel Syndrome (IBS)

What is Irritable Bowel Syndrome (IBS)?

Irritable Bowel Syndrome, IBS, is a chronic condition of the large intestine. It causes cramping, abdominal pain, diarrhea and constipation.

It is 2-6 times more likely to occur in women. It can cause severe symptoms in a small number of people.

Most people can manage their symptoms by modifying their diet and lifestyle, others may need medication or counseling.

IBS is not a form of inflammatory bowel disease, it does not increase your risk of colorectal cancer, or cause any changes in the bowel tissue.

The symptoms of IBS can vary from person to person, but the most common symptoms include:

  • Abdominal pain or cramping
  • A bloated feeling
  • Gas
  • Diarrhea or constipation — sometimes alternating bouts of constipation and diarrhea
  • Mucus in the stool

Severe symptoms may be a sign of a more serious disorder.

It’s important to see your doctor if you notice:

  • Rectal bleeding
  • Abdominal pain that progresses or occurs at night
  • Abnormal weight loss

The exact cause of IBS is unknown.

Some factors that may play a role are:

  • Abnormal contractions of muscles lining the gastrointestinal tract
  • Poor communication between the brain and nerves in the intestines
  • Other Abnormalities in the gastrointestinal tract

IBS can be triggered in some people, and the triggers can vary from person to person.

Common triggers include:

  • Certain foods, like;
    • Chocolate
    • Spices
    • Fats
    • Fruits
    • Beans
    • Cabbage
    • Cauliflower
    • Broccoli
    • Milk
    • Sodas
    • Alcohol
    • Stress
  • Hormones associated with menstruation
  • Other illnesses

Diagnosis for IBS is often a process of ruling out other conditions. There are two sets of diagnostic criteria that your doctor may use to diagnose IBS.

They include:

  • Rome criteria: This criteria consists of abdominal pain that lasts at least 3 days a month, and it must be associated with 2 or more of the following:
    • Improvement with defecation
    • Altered frequency of stool
    • Altered consistency of stool
  • Manning criteria: This focuses on pain relieved by defecation, incomplete bowel movements, mucus in the stool and changes in stool consistency

Treatment for IBS focuses on relieving symptoms. Most cases can be successfully controlled through changes in diet and lifestyle, and by managing stress.

Severe cases may require medications to manage symptoms.

Dietary changes include:

  • Eliminating high-gas foods, such as;
    • Carbonated beverages
    • Cabbage
    • Broccoli
    • Cauliflower
    • Raw Fruits
  • Eliminating gluten
  • Eliminating FODMAPS, which are specific types of carbohydrates.

FODMAPs are found in:

  • Certain grains
  • Vegetables
  • Fruits
  • Dairy products

Medications include:

  • Fiber supplements, such as;
    • Psyllium (Metamucil)
    • Methylcellulose (Citrucel)
  • Anti-diarrheal medications, such as;
    • Loperamide (Imodium)
  • Anticholinergic and antispasmodic medications, such as;
    • Hyoscyamine (Levsin)
    • Dicyclomine (Bentyl)
  • Antidepressants
  • Antibiotics

Medications specifically for severe cases of IBS include;

  • Alosetron (Lotronex), which relaxes the colon and slows the movement of waste through the bowel. Alosetron is currently only approved for patients enrolled in a study protocol with close supervision from the prescribing physician. It should be considered as a last resort.
  • Lubiprostone (Amitiza), which increases fluid secretion in the small intestine to help with the passage of stool. It is approved for women age 18 and older who have IBS with constipation. It has not been proven effective in men. Common side effects include nausea, diarrhea and abdominal pain.
  • Linaclotide (Linzess), which helps to increases intestinal contraction and reduces activation of colonic sensory nerves. It is used for the treatment of constipation and pain in IBS.
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