Encyclopedia | Women & Infants Providence, RI

Irritable Bowel Syndrome

(Functional Colitis; IBS; Intestinal Neurosis; Irritable Colon; Laxative Colitis; Mucous Colitis; Nervous Indigestion; Spastic Colon)

Definition

Irritable bowel syndrome (IBS) is a chronic disorder of the intestines. IBS does not cause inflammation and does not lead to a more serious condition.

Causes

The cause is unknown. With IBS, the muscles in the colon do not work normally and may spasm. If you have IBS, your colon may be more sensitive, reacting strongly to food and medication. Food allergies and certain bacteria may add to the symptoms. IBS may also occur after having the stomach flu (called gastroenteritis ).

Risk Factors

These factors increase your chance of developing IBS:

Sex: female
Family members with IBS
Age: typically begins in young adulthood
Stress
Abuse (may be associated with IBS)

Tell your doctor if you have any of these risk factors.

Symptoms

Symptoms usually come and go and range from mild to severe. They include:

Abdominal cramps
Gas and bloating
Pain that resolves with a bowel movement
Loose stools
Diarrhea
Constipation
Alternating diarrhea and constipation
Urge to move bowels again immediately following a bowel movement
Mucus in the stool

These factors may worsen your symptoms:

Stress
Menstrual periods
Large meals or fatty foods
Excess gas

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. In many cases, a diagnosis can be made based on this. Since there is no diagnostic test for IBS, doctors have created criteria for making a diagnosis.

Your doctor may order the following tests to rule out other conditions:

Analysis of a stool sample to check for blood or evidence of inflammation
Blood tests
Barium enema —injection of fluid into the rectum to make the colon show up on an an x-ray , allows the doctor to see abnormal spots in the colon
Flexible sigmoidoscopy —a thin, lighted tube inserted into the rectum to examine the rectum and the lower colon
Colonoscopy —a thin, lighted tube inserted through the rectum and into the colon to examine the lining of the entire colon

Your doctor may also screen you for celiac disease , which is more common in people with IBS.

Colonoscopy

2009 Nucleus Medical Art, Inc.

Treatment

There is no cure for IBS. Treatment focuses on controlling symptoms.

Diet

The following changes to your diet may help control symptoms:

Keep a food diary of what you eat and how your body responds. Share this with your doctor. You may have a food allergy.
Make gradual changes to your diet. Record the results.
Avoid foods that have caused problems in the past. A dietitian can help you substitute foods.
Avoid foods and drinks that may cause symptoms:
- High fat foods, spicy foods
- Dairy products
- Onions, cabbage, and other gas-producing food
- Large amounts of alcohol or caffeine
Eat foods that may reduce the chance of spasm, such as:
- Fruits and vegetables
- Whole grains and other high-fiber foods (More fiber may increase gas and bloating until your body adjusts.)
Eat smaller meals more often or smaller portions.
Eat slowly and try not to swallow air.
Drink plenty of water. This will help to reduce constipation.

Stress Management

Talk to your doctor about ways to reduce stress , such as:

Relaxation
Biofeedback
Counseling
Exercise (This also improves bowel function.)

Medication

Depending on your symptoms, your doctor may prescribe:

Antibiotic ( Rifaximin may help symptoms for several months.)
Antispasmodic agent (eg, dicyclomine )
High-fiber bulking agent (eg, psyllium )
Antidiarrheal agent (eg, loperamide )
Low-dose antidepressant
Peppermint oil
Pain reliever (eg, acetaminophen )—A study showed modest benefit of acetaminophen for treatment of crampy abdominal pain in patients with IBS. *¹
Serotonin receptor agonists and antagonists—may be helpful for women (eg, alosetron for diarrhea)
- Note: Tegaserod, a medicine used for constipation, was withdrawn from the market in March 2007. This was due to a slightly increased risk of heart attack , angina , and stroke . *²
Probiotics ("friendly" bacteria)—may be helpful, but talk to your doctor before taking
Peppermint oil * ³

Prevention

There are no guidelines for preventing IBS because the cause is unknown.

RESOURCES:

American College of Gastroenterology
http://www.acg.gi.org/

American Gastroenterological Association
http://www.gastro.org/

Irritable Bowel Syndrome Association
http://www.ibsassociation.org/

CANADIAN RESOURCES

Health Canada
http://www.hc-sc.gc.ca/index_e.html/

Irritable Bowel Syndrome Association
http://www.ibsassociation.ca/

References:

Acidophilus and other probiotics. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=114 . Updated June 2008. Accessed July 15, 2008.

Conn HF, Rakel RE. Conn's Current Therapy . Philadelphia, PA: WB Saunders Co; 2001.

Drossman DA. Treatment for bacterial overgrowth in the irritable bowel syndrome. Ann Intern Med . 2006;145:626-628.

Griffith HW. Griffith's 5-Minute Clinical Consult . Baltimore, MD: Lippincott Williams Wilkins; 1999.

Halvorson HA, Schlett CD, Riddle MS. Postinfectious irritable bowel syndrome—a meta-analysis. Am J Gastroenterol . 2006;101:1894-1899.

Irritable bowel syndrome. American Society of Colon and Rectal Surgeons website. Available at: http://www.fascrs.org/ Update October 2007. Accessed July 15, 2008.

Irritable bowel syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated December 2008. Accessed January 6, 2009.

Irritable bowel syndrome (IBS). EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81 . Updated July 2008. Accessed July 7, 2008.

Irritable bowel syndrome. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/ . Update September 2007. Accessed July 15, 2008.

Murch S. Allergy and intestinal dysmotility—evidence of genuine causal linkage? Curr Opin Gastroenterol . 2006;22:664-668.

Rubin G, De Wit N, Meineche-Schmidt V, Seifert B, Hall N, Hungin P. The diagnosis of IBS in primary care: consensus development using nominal group technique. Family Practitioner . 2006;23:687-692.

Sleisenger MH, Fordtran JS, Feldman M, Scharschmidt B. Sleisenger Fordtran's Gastrointestinal and Liver Disease . 6th ed. Philadelphia, PA: WB Saunders Co; 1998.

Talley NJ, Boyce PM, Jones M. Is the association between irritable bowel syndrome and abuse explained by neuroticism? A population based study. Gut. 1998;42: 47-53.

Yan F, Polk DB. Probiotics as functional food in the treatment of diarrhea. Current Opinion in Clinical Nutrition and Metabolic Care . 2006;9:717-721.

*¹9/26/2006 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mueller-Lissner S, Tytgat GN, Paulo LG, et al. Placebo-and paracetamol-controlled study on the efficacy and tolerability of hyoscine butylbromide in the treatment of patients with recurrent crampy abdominal pain. Alimentary Pharmacology and Therapeutics . 2006;23:1741-1748.

*²4/10/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : US Food and Drug Administration. FDA announces discontinued marketing of GI drug, Zelnorm, for safety reasons [press release]. March 30, 2007. US Food and Drug Administration website. Available at: http://www.fda.gov/bbs/topics/NEWS/2007/NEW01597.html.

*³1/6/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Ford AC, Talley NJ, Spiegel BM, et al. Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ. 2008;337:a2313.

Last reviewed February 2009 by Daus Mahnke, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.