Southwest Internal Medicine - Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS)
By M. J. Galceran, M. D., Southwest Internal Medicine Specialists

Irritable bowel syndrome is a disorder of the bowel, in particular, the large intestine or colon. It is not a disease but a group of symptoms including abdominal cramping, bloating, and frequently, alternating bouts of diarrhea and constipation. There is no obvious cause; patients with IBS have perfectly healthy digestive systems. Many times the symptoms come and go for no apparent reason, and can occur in any combination. About 20% of Americans have IBS, with women being affected about twice as often as men.

There is no known cause of IBS. There is no predisposition to cancer with IBS. There is no convincing evidence that infection or an altered immune system is the culprit in IBS. There is some research though - suggesting that people with IBS seem to have an intestinal system that is more sensitive and reactive than usual to a variety of things, including certain foods and stress. Stress and emotions can strongly affect the colon, just as it can affect the heart and respiration.

It is thought that the colon¹s motility accounts for how efficiently nutrients and water are absorbed from the intestine and colon. This motility is altered in patients with IBS. It can be spasmodic, speed up or slow down. The spasms can be sudden and strong, causing the cramping. In cases where there is an increase in motility, the patient experiences diarrhea. With decreased motility, constipation is seen.

Seeing your doctor for a thorough physical examination is the first step in diagnosing and treating IBS. Diagnosis begins by exclusion of other illnesses that can mimic IBS. These include intestinal tumors, inflammatory bowel disease such as Crohn¹s colitis and ulcerative colitis, diverticulitis, lactose intolerance, and Celiac disease or gluten sensitivity. Although there is no known cure for IBS, there are many things that can be done to lessen the symptoms and reduce the number of flare-ups. Your doctor can best recommend these, depending on the individual symptoms and history.

There are several dietary changes that can reduce the discomfort from IBS:

Avoid any foods that aggravate symptoms Avoid large meals Reduce caffeine consumption Increase the fiber in your diet
Increase your intake of water

In many cases, increased dietary fiber and fiber supplements is the mainstay of treatment. Your doctor or a registered dietitian can assist you in making these changes. Reducing stress and stress management are also very important in controlling IBS. These include adequate sleep, relaxation techniques, and a regular exercise program.

There are many medications that can help in controlling the symptoms when non-pharmacological means are not sufficient. These include stool softeners, anti-diarrheals, and medications that can alter or affect the bowel¹s motility (bentyl, librax, levsyn, lotronex, and xelnorm). If you think you may have IBS, see your doctor first to get on the right track to feeling better.