If your bowels have been growling, grumbling and causing you distress, there are many possible causes, such as ulcerative colitis or Crohn’s disease. The most common reason, though, is irritable bowel syndrome, much less serious than the others.
Irritable bowel syndrome (IBS) is what is known as a functional disorder. The symptoms are not caused by disease or inflammation but rather by changes in how the gastrointestinal system works. It’s important not to over-treat IBS, but patients also want and need relief from the troubling symptoms.
Patty is a sales representative for a pharmaceutical company, and a rush to the toilet is not always convenient or possible. Frank often has cramping and loose bowel movements right after meals–sometimes before the meal is finished.
The most troubling symptoms are abdominal pain, cramping or discomfort and a change of bowel movements that typically includes either diarrhea or constipation–sometimes both. Mucus in the stool is another sign.
If symptoms improve after a bowel movement or if there are changes in the frequency or appearance of stools, then the problem is likely irritable bowel syndrome. There are times when the symptoms are better or worse, but basically irritable bowel syndrome is a chronic condition. Many patients learn to suffer without seeing a doctor, but that is not always a good idea since changes in bowel habits can be a sign of serious diseases, including cancer.
Signs that could signal a more serious disorder include:
• weight loss,
• rectal bleeding
• fever,
• anemia and
• abdominal pain that gets worse or that occurs at night.
Who Is at Risk?
About 10 to 15 percent of Americans are believed to have irritable bowel syndrome, although only about half that many have a diagnosis. It usually affects people under 45 years of age, particularly those with a family history of bowel problems. And women are twice as likely as men to have symptoms.
The causes are not very well known, but most doctors believe it involves a combination of physical and mental issues.
The intestines work on signals between the brain and the nerves of the small and large intestines. Anything that changes those signals can bring on bowel symptoms.
Muscle contractions–abnormally fast or abnormally slow–can also cause diarrhea, constipation or spasms. Contractions may also change in response to stress or to eating. Some individuals are more sensitive than others to stretching of the bowels caused by gas or the presence of stool.
Finally, for whatever reason, IBS is common in persons with psychiatric problems such as panic disorder, anxiety, depression and post-traumatic stress disorder. Individuals who have been victims of past physical or sexual abuse often find their stress translated into physical symptoms, such as those of irritable bowel syndrome.
Most individuals with irritable bowel syndrome are reacting to a trigger. The problem is that triggers vary from person to person.
Foods that have been reported include chocolate, spices, fats, fruits, beans, cabbage, cauliflower, broccoli, milk, carbonated beverages, artificial sweeteners and alcohol.
Many women find that symptoms are worse around the time of their menstrual periods. That suggests that hormones are probably involved.
Other illnesses such as infectious diarrhea can also trigger IBS, perhaps because they cause an overgrowth of bacteria in the intestine.
Finally, stress is clearly a factor for many patients. But while it may make symptoms worse, stress doesn’t cause them.
Treatment usually focuses on managing or changing the triggers–once those are discovered. Keeping a food diary will help you identify foods that should be limited or avoided. For those bothered by constipation, foods high in fiber might help. In some persons, though, fiber causes gas and triggers symptoms.
If large meals tend to cause cramping and diarrhea, the solution is probably to eat smaller, more frequent meals throughout the day.
Some IBS patients seem to be sensitive to certain kinds of carbohydrates, such as fructose, fructans and lactose. These are called FODMAPS (fermentable oligo-, di-, and monosaccharides and polyols). For these patients, a low-FODMAPS diet may be recommended.
Others may need to eliminate gluten (wheat, barley, rye) and/or high-gas foods such as cabbage, broccoli, cauliflower, raw fruits and carbonated beverages.
Stress can be managed through regular exercise, good sleep and various forms of relaxation therapy, including yoga and meditation. When there are mental health issues, talk therapy, hypnotherapy and mindfulness training can help.
Medications, if needed, depend on the symptoms. They include:
• fiber supplements or laxatives, for those with constipation;
• anti-diarrheal medications such as loperamide for those with diarrhea;
• antispasmodics to help control muscle spasms in the colon;
• antibiotics for persons with an overgrowth of bacteria, particularly in the small intestine;
• probiotics to introduce “good” bacteria; and
• low doses of tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs).
One recent study from the Leeds Gastroenterology Institute in England concluded that antidepressants and psychological therapies are effective and should be considered core treatment approaches.
Three drugs are prescribed for their direct action on the gastrointestinal tract and are designed to treat specific types of irritable bowel syndrome.
Alosetron relaxes the colon and slows the movement of feces through the lower bowel. It has been linked to some rare but serious side effects and was once removed from the market. It is now approved only for women with severe diarrhea-dominant IBS that hasn’t responded to other treatments. It has not been approved for men.
Linaclotide is approved for the treatment of moderate to severe IBS with constipation. It works by increasing fluid secretion in the bowels, thus speeding the movement of stool. It also relieves abdominal fullness, bloating and pain.
Lubiprostone, which is used to treat general constipation, is also prescribed for women with constipation-dominant irritable bowel syndrome. It too increases fluid secretion in the bowels.
It’s important to remember that irritable bowel syndrome is not a disease; nor does it cause bowel damage or lead to cancer. There is no need to get carried away with treatment unless the symptoms interfere with work, social activities or travel.
REFERENCES:
American Gastroenterological Association, “IBS: A patient’s guide to living with irritable bowel syndrome,” 2014.
Tracey J. Cannova, et al, “Irritable bowel syndrome treatment options,” U.S. Pharmacist, 2012;37(12):45-48.
“Irritable bowel syndrome,” MedicineNet.com, medically reviewed by a doctor on February 28, 2014.
“Irritable bowel syndrome (IBS) fact sheet,” WomensHealth.gov, last updated July 16, 2012.
Mayo Clinic Staff, “Irritable bowel syndrome,” MayoClinic.com, May 6, 2014.
National Digestive Diseases Clearinghouse, “Irritable bowel syndrome,” NIH Publication No. 13-693, September, 2013.
W.B. Yu Siegfried, M.D., et al, “Advances in the management of constipation-predominant irritable bowel syndrome,” Therapeutic Advances in Gastroenterology, 2014;7(5):193-205.
Michael W. Smith, Ph.D., “IBS, chronic constipation: new guidelines issued,” WebMD HealthNews, August 7, 2014.
Peter M. Yellowlees, MNBBS, M.D., “Antidepressants and psychological therapies in irritable bowel syndrome,” Medscape Psychiatry, August 26, 2014.
11/19/2014
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