Answer: Irritable Bowel Syndrome is common, affecting at least 15% of the adult
population. IBS is a chronic disorder manifested by changes in bowel habits and recurrent
abdominal pain. Some affected by IBS have loose stool, some have constipation, and some
have both at different times. Other symptoms include bloating, passage of mucus during
bowel movements, and a feeling of incomplete emptying or cramping following a bowel
movement. The diagnosis requires a good history and physical from your doctor and possibly
further labs or diagnostic tests. If you are diagnosed with IBS, you can be reassured that
this condition does not lead to cancer.
Why do I have IBS?
Although theories as to the cause of IBS abound, we still
do not know its cause. There are associations with altered motility of the colon (the
usual muscle contractions of the intestines are either too fast or too slow) and altered
visceral sensation (your body’s sense of how full your intestines are), which certain
dietary irritants may worsen. IBS may be associated with psychosocial dysfunction such as
childhood or domestic abuse, or a psychological disorder such as anxiety or depression.
Stress can affect anyone’s intestines, and although it may play a major role in how
IBS is experienced, it is not the cause.
What is the treatment?
As with many other disorders, prevention is the key. By effectively managing stress
levels, exercising, drinking plenty of water, eating a high-fiber diet, and avoiding foods
that seem to aggravate symptoms (e.g. beans, cabbage, and caffeine), often the need for
daily medications is avoided.
For all with IBS, and especially those with a strong constipation component, a
high-fiber diet that includes ½ to 1 cup of bran daily is important. Fiber
supplementation with psyllium (e.g. Metamucil) ½ to 1 tablespoon one to three times daily
in a large glass of water or juice, or calcium polycarbophil (e.g. FiberCon) 2 tablets one
to four times daily followed by at least 8 ounces of water may be necessary and, if
effective, should be used on a regular basis. Some people may experience temporary
bloating after starting on fiber supplementation. This usually passes within two to three
weeks.
Scheduling toilet visits at the same time everyday can be helpful. Certain
prescription-only osmotic laxatives (e.g. Duphalac or Sorbitol) help the constipation but
may also increase bloating. Stool softeners (e.g. Colace) 50-200 mg daily can maintain a
good stool consistency. Medicines that calm the bowels or speed the propulsion of foods
are helpful for some with severe symptoms.
Antidiarrheal agents (e.g. Imodium A-D) one or two 2mg caplets three to four times a
day are used in those who have a strong diarrhea component.
Antidepressants, which have multiple uses including effective headache and back pain
treatment, can be used when pain is a predominant complaint. Even with no treatment,
symptoms disappear in over 30% of those affected as they get older.
The most important component of treatment in IBS is establishing a therapeutic,
communicative and trusting physician-patient relationship. Periodically completing a
symptom diary to review with your doctor may help identify factors that can aid your
treatment.
Psychological treatments, which have studies to support their use, include relaxation
training, cognitive behavioral therapy, hypnosis, and individual psychotherapy.
IBS is a chronic condition that has no cure. However, there is hope that IBS patients
may be symptom-free for long periods of time.
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