Irritable Bowel Syndrome

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What Is Irritable Bowel Syndrome?

Irritable bowel syndrome is a disorder characterized most commonly by cramping, abdominal pain, bloating, constipation, and diarrhea. However, symptoms can vary from person to person.

IBS causes a great deal of discomfort and distress, but it does not permanently harm the intestines and does not lead to a serious disease, such as cancer. Although IBS has been called by many names, including "colitis" and "spastic colon," there is no known link between IBS and inflammatory bowel diseases such as Crohn's disease or ulcerative colitis.

As many as one in five Americans has symptoms of IBS, making it one of the most common disorders diagnosed by doctors. It occurs more often in women than in men, and generally begins before the age of 35 in about 50 percent of people. 

There is no known cause for IBS. One theory is that people with IBS have a colon or large intestine that is particularly sensitive and reactive to certain foods and stress. The immune system may also be involved.  Most people can control their symptoms with diet, stress management, and prescribed medications. For some people, however, IBS can be disabling.

IBS is generally diagnosed on the basis of a complete history that includes a careful description of symptoms and a physical examination. There is no specific test for IBS, although stool sample testing, blood tests, x rays, and sigmoidoscopy or colonoscopy, and tissue biopsies may be performed to rule out other problems, such as inflammatory bowel diseases, which may share similar symptoms.

A diagnosis of IBS is based on negative test results plus a characteristic pattern of symptoms including how the frequency of abdominal pain or discomfort, when the pain starts and stops in relation to bowel function, and how bowel frequency and stool consistency have changed.

What Are the Conventional Treatments for Irritable Bowel Syndrome?

Because it's not clear what causes irritable bowel syndrome, treatment focuses on the relief of symptoms. In addition, since the triggers for IBS as well as the specific symptoms vary from person to person, the treatment plan must be tailored to each individual.

In most cases, people can cope with mild signs and symptoms of irritable bowel syndrome by learning to manage stress and making changes in diet and lifestyle. These are discussed in the following section. For individuals with moderate or severe IBS symptoms, the following treatments are commonly used:

• Fiber supplements. Taking fiber supplements such as psyllium (Metamucil) or methylcellulose (Citrucel) with fluids may help control constipation.
• Anti-diarrheal medications. Over-the-counter medications such as loperamide (Imodium) can help control diarrhea.
• Anticholinergic medications. Some people need medications that affect certain activities of the nervous system (anticholinergics) to relieve painful bowel spasms.
• Antidepressant medications. If your symptoms include pain or depression, your doctor may recommend a tricyclic antidepressant or a selective serotonin reuptake inhibitor (SSRI). These medications help relieve depression as well as inhibit the activity of neurons that control the intestines.
• Counseling. If antidepressant medications don't work, you may have better results from counseling if stress tends to worsen your symptoms.

Two medications for IBS exist.

• Alosetron (Lotronex) is a medication with significant side effects and is intended for severe cases of diarrhea-predominant IBS in women who haven't responded to other treatments. Alosetron is not approved for use by men.  The drug can be prescribed only by gastroenterologists with expertise in IBS because of the potential side effects.
• Lubiprostone (Amitiza) is a new drug for IBS that is only approved for use in women. Its long-term effectiveness has not been well established.

What Are Recommended Lifestyle Changes for IBS?

Diet and Nutrition [2]

Diet is critical to the healthy function of the GI tract and to the reduction of problematic symptoms   An important first step is to identify foods that seem to trigger symptoms.   Keeping a food journal can be an effective way to do this.

Dietary habits [3] that may decrease IBS symptoms include:

• Eating at regular times. Don't skip meals, and try to eat about the same time each day to help regulate bowel function.
• Adding dietary fiber [4]. High-fiber diets keep the colon mildly distended, which may help prevent spasms. Whole grain breads and cereals, fruits, and vegetables are good sources of fiber. The addition of soluble fiber (1 tbsp psyllium seed with 8 oz water) can be helpful if the individual is troubled by constipation, but may not help relieve other IBS symptoms.
• Drinking adequate amount of liquids. Water [5]is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse. Carbonated drinks can produce gas.
• Avoiding problem foods. Common culprits include alcohol, chocolate, caffeinated beverages such as coffee and sodas, dairy products, and sugar-free sweeteners such as sorbitol or mannitol. High gas foods such as beans, cabbage, cauliflower and broccoli might make some individuals' symptoms worse. Fatty foods may also be a problem for some people. Chewing gum or drinking through a straw can lead to air swallowing, causing more gas.
• Avoiding large meals. Large meals can cause cramping and diarrhea. Eating smaller meals more often, or eating smaller portions, may help IBS symptoms.

Exercise

Exercise regularly. Exercise helps relieve depression and stress, stimulates normal contractions of your intestines and can help you feel better about yourself. If you've been inactive, start slowly and gradually increase the amount of time you exercise. If you have other medical problems, check with your doctor before starting an exercise program. But generally, light to moderate exercise [6]is recommended for everyone with IBS. 

Mind-Body Practices and Stress Reduction

Stress--feeling mentally or emotionally tense, troubled, angry, or overwhelmed--can stimulate colon spasms in people with IBS since the colon has many nerves that connect it to the brain.

Stress management [7] is an important part of treatment for IBS. Approaches that can be beneficial are:

• Stress reduction (relaxation) training and relaxation therapies such as meditation [8]
• Yoga [9]
• Biofeedback [10].
• Hypnosis [11]. Hypnosis may reduce abdominal pain and bloating. A trained professional teaches you how to enter a relaxed state and then guides you in relaxing your abdominal muscles.

What Are Some Integrative Therapies and Healing Practices to Consider for IBS?

Functional Medicine

This is a system of medicine that brings an integrative perspective to a scientific understanding of the body and the disease process.  It focuses on common ways in which illness develops and healing happens.  Functional medicine [12] offers a personalized approach that works on primary prevention and underlying causes for serious chronic disease instead of mere symptom management. 

If you see a Functional Medicine practitioner for GI dysfunction, he or she will likely evaluate the balance of bacteria in your gastrointestinal system, the permeability of the gut, the levels of inflammation (in the whole body), your immune function, and stress level. 

Treatments would vary, depending on what was found, but could include: rebalancing the gut bacteria, quieting inflammation by changing diet, eliminating problematic foods, adding adequate fiber and water, supplementing appropriate nutrients, addressing psychosocial issues, and encouraging stress reduction practices. 

Botanicals and Supplements

Typical doses for each botanical are indicated below. However, you should talk with your healthcare provider before adding botanicals to your health regimen and ask about the right dosage for you.

• Probiotics  repopulate the gut with a normal mix of healthy bacteria, including lactobacillus, bifidobacterium and streptococcus faecium.  Taking a 50/50 mix of lactobacillus plantarum and lactobacillus breve of 25 billion colony-forming-units (cfu) twice a day for 6-8 weeks can be helpful.  Other combinations that include bifidobacterium may also be helpful.  If you have an active infection and require antibiotic treatment first, the probiotic dose needs to be higher and more frequent.
• Prebiotics are simple sugar molecules that feed healthy bacteria, once they are in place, and have been shown to be helpful with IBS.  The usual dose is 4g a day of fructooligosaccharides (FOSs) after completing 6 weeks of probiotic treatment.
• Peppermint oil in enteric-coated capsules, 1-2 pills, 3 times a day between meals, has been shown to reduce GI complaints, although this may cause reflux in some individuals.
• Combination herbals are commonly used in Traditional Chinese Medicine [13], in Ayurvedic Medicine [14], and in Tibetan Medicine. Research studies have shown efficacy for some of these preparations, which are ideally prescribed individually by professional providers. Several proprietary mixes, such as Padma Lax, and Iberogast have demonstrated effectiveness.

How to Use Integrative Therapies and Healing Practices in IBS

It is especially important to see a conventional medical provider about any change in bowel habits, unexplained weight loss, blood in the stools, increasing pain, or any limitation of your daily activities. The first step in an evaluation is to determine if you have a more serious disorder, such as cancer or inflammatory bowel disease.

As always, it is critical to let ALL your health care providers know what supplements and medications you are taking. 

It is also critical to identify and monitor your symptoms to determine what treatments and practices actually improve your comfort and daily wellbeing.  A common tool is a diet and symptom diary, which can be indispensible for optimizing your care, whether your treatment is conventional care, lifestyle changes, functional medicine, acupuncture [15], or botanicals [16] and supplements.

References and Resources

Books

Irritable Bowel Syndrome & the MindBodySpirit Connection: 7 Steps for Living a Healthy Life with a Functional Bowel Disorder, Crohn's Disease, or Colitis  by William B. Salt and Neil F. Neimark

Your Gut Feelings: A Complete Guide to Living Better with Intestinal Problems, by Henry D. Janowitz, MD

The New Eating Right for a Bad Gut : The Complete Nutritional Guide to Ileitis, Colitis, Crohn's Disease, and Inflammatory Bowel Disease by James Scala

Websites

Institute for Functional Medicine:  www.functionalmedicine.org [17]

Mayo Clinic on IBS:  http://www.mayoclinic.com/health/irritable-bowel-syndrome/DS00106 [18]

National Center for Complementary and Alternative Medicine: Introduction to probiotics:  http://nccam.nih.gov/health/probiotics/index.htm [19]

Medline Plus: Irritable Bowel http://www.nlm.nih.gov/medlineplus/irritablebowelsyndrome.html#cat4 [20]