About IBS
On this page you'll find links to help explain and
understand Irritable Bowel Syndrome and the symptoms associated with this
chronic condition, by some of the most respected doctors in the field. You
will also find information on digestion and the digestive process.
There is also printable information to take to
the doctor with you. I have found that this helps considerably, if I am
armed with specific questions to take with me. This saves valuable time
for both you and your doctor. It also helps in getting your specific
questions answered. With IBS it pays to do your homework.
Glossary click here
The Rome Criteria Process: Diagnosis and
Legitimization
of Irritable Bowel Syndrome
Irritable Bowel Syndrome: How far do you go
in the Workup?
Printable information:
Ten questions to ask your doctor.
Molly's Brochure
IBS Information:
U.N.C Center for Functional GI and Motility
Disorders
MayoClinic
What Is Irritable Bowel Syndrome?
IFFGD
International Foundation for Functional
Gastrointestinal Disorders
The Mind-Body Digestive Center
80 Central Park West New York, N.Y. 10023
UCLA/CURE Neuroenteric Disease Program
IBS Clinical Issues *
Adapted from a radio interview conducted by Bob Enteen, host of
Living Without Limits, with Douglas Drossman, MD, UNC Center for
Functional GI and Motility Disorders at Chapel Hill North Carolina
UNC
Center for Functional GI & Motility Disorders "Digest"
Irritable Bowel Syndrome: with Permission from
Jackson Gastroenterology.
Irritable Bowel Syndrome
What is an Irritable Bowel?
Medically, irritable bowel syndrome (IBS) is known by a variety of other
terms: spastic colon, spastic colitis, mucous colitis and nervous or
functional bowel. Usually, it is a disorder of the large intestine
(colon), although other parts of the intestinal tract -- even up to the
stomach -- can be affected.
The colon, the last five feet of the intestine, serves two functions in
the body. First, it dehydrates and stores the stool so that, normally, a
well-formed soft stool occurs. Second, it quietly propels the stool from
the right side over to the rectum, storing it there until it can be
evacuated. This movement occurs by rhythmic contractions of the colon.
When IBS occurs, the colon does not contract normally. instead, it seems
to contract in a disorganized, at times violent, manner. The contractions
may be terribly exaggerated and sustained, lasting for prolonged periods
of time. One area of the colon may contract with no regard to another. At
other times, there may be little bowel activity at all. These abnormal
contractions result in changing bowel patterns with constipation being
most common.
A second major feature of IBS is abdominal discomfort or pain. This may
move around the abdomen rather than remain localized in one area.
These disorganized, exaggerated and painful contractions lead to certain
problems. The pattern of bowel movements is often altered. Diarrhea may
occur, especially after meals, as the entire colon contracts and moves
liquid stool quickly into the rectum. Or, localized areas of the colon may
remain contracted for a prolonged time. When this occurs, which often
happens in the section of colon just above the rectum, the stool may be
retained for a prolonged period and be squeezed into small pellets.
Excessive water is removed from the stool and it becomes hard.
Also, air may accumulate behind these localized contractions, causing the
bowel to swell. So bloating and abdominal distress may occur.
Some patients see gobs of mucous in the stool and become concerned. Mucous
is a normal secretion of the bowel, although most of the time it cannot be
seen. IBS patients sometimes produce large amounts of mucous, but this is
not a serious problem.
The cause of most IBS symptoms -- diarrhea, constipation, bloating, and
abdominal pain -- are due to this abnormal physiology.
IBS is not a disease
Although the symptoms of IBS may be severe, the disorder itself is not a
serious one. There is no actual disease present in the colon. In fact, an
operation performed on the abdomen would reveal a perfectly normal
appearing bowel.
Rather, it is a problem of abnormal function. The condition usually begins
in young people, usually below 40 and often in the teens. The symptoms may
wax and wane, being particularly severe at some times and absent at
others. Over the years, the symptoms tend to become less intense.
IBS is extremely common and is present in perhaps half the patients that
see a specialist in gastroenterology. It tends to run in families. The
disorder does not lead to cancer. Prolonged contractions of the colon,
however, may lead to diverticulosis, a disorder in which balloon-like
pockets push out from the bowel wall because of excessive, prolonged
contractions.
Causes
While our knowledge is still incomplete about the function and malfunction
of the large bowel, some facts are well-known. Certain foods, such as
coffee, alcohol, spices, raw fruits, vegetables, and even milk, can cause
the colon to malfunction. In these instances avoidance of these substances
is the simplest treatment.
Infections, illnesses and even changes in the weather somehow can be
associated with a flare-up in symptoms. So can the premenstrual cycle in
the female.
By far, the most common factor associated with the symptoms of IBS are the
interactions between the brain and the gut. The bowel has a rich supply of
nerves that are in communication with the brain. Virtually everyone has
had, at one time or another, some alteration in bowel function when under
intense stress, such as before an important athletic event, school
examination, or a family conflict.
People with IBS seem to have an overly sensitive bowel, and perhaps a
super abundance of nerve impulses flowing to the gut, so that the ordinary
stresses and strains of living somehow result in colon malfunction.
These exaggerated contractions can be demonstrated experimentally by
placing pressure- sensing devices in the colon. Even at rest, with no
obvious stress, the pressures tend to be higher than normal. With the
routine interactions of daily living, these pressures tend to rise
dramatically. When an emotionally charged situation is discussed, they can
reach extreme levels not attained in people without IBS. These symptoms
are due to real physiologic changes in the gut -- a gut that tends to be
inherently overly sensitive, and one that overreacts to the stresses and
strains of ordinary living.
Diagnosis
The diagnosis of IBS often can be suspected just by a review of the
patient's medical history. In the end it is a diagnosis of exclusion; that
is, other conditions of the bowel need to be ruled out before a firm
diagnosis of IBS can be made.
A number of diseases of the gut, such as inflammation, cancer, and
infection, can mimic some or all of the IBS symptoms. Certain medical
tests are helpful in making this diagnosis, including blood, urine and
stool exams, x-rays of the intestinal tract and a lighted tube exam of the
lower intestine. This exam is called endoscopy, sigmoidoscopy or
colonoscopy.
Additional tests often are required depending on the specific
circumstances in each case. If the proper medical history is obtained and
if other diseases are ruled out, a firm diagnosis of IBS then can usually
be made.
Treatment
The treatment of IBS is directed to both the gut and the psyche. The diet
requires review, with those foods that aggravate symptoms being avoided.
Current medical thinking about diet has changed a great deal in recent
years. There is good evidence to suggest that, where tolerated, a high
roughage and bran diet is helpful. This diet can result in larger, softer
stools which seem to reduce the pressures generated in the colon.
Large amounts of beneficial fiber can be obtained by taking
over-the-counter bulking agents such as psyllium mucilloid (Metamucil,
Konsyl) or methylcellulose (Citrucel).
As many people have already discovered, the simple act of eating may, at
times, activate the colon. This action is a normal reflex, although in IBS
patients it tends to be exaggerated. It is sometimes helpful to eat
smaller, more frequent meals to block this reflex.
There are certain medications that help the colon by relaxing the muscles
in the wall of the colon, thereby reducing the bowel pressure. These drugs
are called antispasmodics. Since stress and anxiety may play a role in
these symptoms, it can at times be helpful to use a mild sedative, often
in combination with an antispasmodic.
Physical exercise, too, is helpful. During exercise, the bowel typically
quiets down. If exercise is used regularly and if physical fitness or
conditioning develops, the bowel may tend to relax even during
non-exercise periods. The invigorating effects of conditioning, of course,
extend far beyond the intestine and can be recommended for general health
maintenance.
As important as anything else in controlling IBS is learning stress
reduction, or at least how to control the body's response to stress. It
certainly is well-known that the brain can exert controlling effects over
many organs in the body, including the intestine.
Summary
Patients with IBS can be assured that nothing serious is wrong with the
bowel. Prevention and treatment may involve a simple change in certain
daily habits, reduction of stressful situations, eating better and
exercising regularly.
Perhaps the most important aspect of treatment is reassurance. For most
patients, just knowing that there is nothing seriously wrong is the best
treatment of all, especially if they can learn to deal with their symptoms
on their own.
