Irritable Bowel Syndrome

Irritable Bowel Syndrome Overview

IBS affects between 25 and 45 million Americans. Most of them are women. People are most likely to get the condition in their late teens to early 40s.

IBS is a mix of belly discomfort or pain and trouble with bowel habits: either going more or less often than normal (diarrhea or constipation) or having a different kind of stool (thin, hard, or soft and liquid).

It’s not life-threatening, and it doesn’t make you more likely to get other colon conditions, such as ulcerative colitis, Crohn’s disease, or colon cancer. But IBS can be a long-lasting problem that changes how you live your life. People with IBS may miss work or school more often, and they may feel less able to take part in daily activities. Some people may need to change their work setting: shifting to working at home, changing hours, or even not working at all.

What Are the Symptoms of IBS?

People with IBS have symptoms that can include:

  • Diarrhea (often described as violent episodes of diarrhea)
  • Constipation
  • Constipation alternating with diarrhea
  • Belly pains or cramps, usually in the lower half of the belly, that get worse after meals and feel better after a bowel movement
  • A lot of gas or bloating
  • Harder or looser stools than normal (pellets or flat ribbon stools)
  • A belly that sticks out

Stress can make symptoms worse.

Some people also have urinary symptoms or sexual problems.

There are four types of the condition. There is IBS with constipation (IBS-C) and IBS with diarrhea (IBS-D). Some people have an alternating pattern of constipation and diarrhea. This is called mixed IBS (IBS-M). Other people don’t fit into these categories easily, called unsubtyped IBS, or IBS-U.

What Are the Causes?

While there are several things known to trigger IBS symptoms, experts don’t know what causes the condition.

Studies suggest that the colon gets hypersensitive, overreacting to mild stimulation. Instead of slow, rhythmic muscle movements, the bowel muscles spasm. That can cause diarrhea or constipation.

Some think that IBS happens when the muscles in the bowels don’t squeeze normally, which affects the movement of stool. But studies don’t seem to back this up.

Another theory suggests it may involve chemicals made by the body, such as serotonin and gastrin, that control nerve signals between the brain and digestive tract.

Other researchers are studying to see if certain bacteria in the bowels can lead to the condition

Because IBS happens in women much more often than in men, some believe hormones may play a role. So far, studies haven’t borne this out.

How Is It Diagnosed?

There are no specific lab tests that can diagnose IBS. Your doctor will see if your symptoms match with the definition of IBS, and he may run tests to rule out conditions such as:

  • Food allergies or intolerances, such as lactose intolerance and poor dietary habits
  • Medications such as high blood pressure drugs, iron, and certain antacids
  • Infection
  • Enzyme deficiencies where the pancreas isn’t releasing enough enzymes to properly digest or break down food
  • Inflammatory bowel diseases like ulcerative colitis or Crohn’s disease

Your doctor may do some of the following tests to decide if you have IBS:

  • Flexible sigmoidoscopy or colonoscopy to look for signs of blockage or inflammation in your intestines
  • Upper endoscopy if you have heartburn or indigestion
  • X-rays
  • Blood tests to look for anemia (too few red blood cells), thyroid problems, and signs of infection
  • Stool tests for blood or infections
  • Tests for lactose intolerance, gluten allergy, or celiac disease tests to look for problems with your bowel muscles

How Is IBS Treated?

Nearly all people with IBS can get help, but no single treatment works for everyone. You and your doctor will need to work together to find the right treatment plan to manage your symptoms.

Many things can trigger IBS symptoms, including certain foods, medicines, the presence of gas or stool, and emotional stress. You’ll need to learn what your triggers are. You may need to make some lifestyle changes and take medication.

Diet and Lifestyle Changes

Usually, with a few basic changes in diet and activities, IBS will improve over time. Here are some tips to help reduce symptoms:

  • Avoid caffeine (in coffee, teas, and sodas).
  • Add more fiber to your dietwith foods like fruits, vegetables, whole grains, and nuts.
  • Drink at least three to four glasses of water per day.
  • Don’t smoke.
  • Learn to relax, either by getting more exercise or by reducing stress in your life.
  • Limit how much milk or cheese you eat.
  • Eat smaller meals more often instead of big meals.
  • Keep a record of the foods you eat so you can figure out which foods bring on bouts of IBS.

Common food “triggers” are red peppers, green onions, red wine, wheat, and cow’s milk. If you’re concerned about getting enough calcium, you can try to get it from other foods, like broccoli, spinach, turnip greens, tofu, yogurt, sardines, salmon with bones, calcium-fortified orange juice and breads, or calcium supplements.

Medications

The following types of drugs are used to treat IBS:

  • Antispasmodics can control colon muscle spasms, but experts are unsure that these drugs help. They also have side effects, such as making you drowsy and constipated, that make them a bad choice for some people.
  • Antidiarrheal drugs, such as Imodium, may help with diarrhea.
  • Laxatives can give short-term relief from constipation.
  • Bulking agents, such as psyllium, wheat bran, and corn fiber, help slow the movement of food through the digestive system and may also help relieve symptoms.
  • Antidepressants may also help relieve symptoms in some people.
  • Linaclotide (Linzess) is a capsule you take once daily on an empty stomach, at least 30 minutes before your first meal of the day. It helps to relieve constipation by helping bowel movements happen more often. It’s not for anyone 17 years old or younger. The drug’s most common side effect is diarrhea.
  • Lubiprostone (Amitiza) can treat IBS with constipation in women when other treatments have not helped. Studies haven’t fully shown that it works well in men. Common side effects include nausea, diarrhea, and belly pain. More serious side effects may include, fainting, swelling of the arms and legs, breathing problems, and heart palpitations.

Make sure to follow your doctor’s instructions when taking IBS medications, including laxatives, which can be habit forming if you don’t use them carefully.

Alternative treatments such as acupuncture, dietary supplements, and herbs don’t always get the official scientific nod, but some patients turn to them for help with irritable bowel syndrome (IBS).

Acupuncture for IBS

Acupuncture is a popular alternative therapy for IBS and other conditions. It’s proven effective for treating chronic pain, according to researchers at the National Institutes of Health (NIH). However, the studies are mixed on whether this treatment really works for IBS.

Some small studies show that acupuncture may help with abdominal bloating and other IBS symptoms. Larger studies are still needed.

Philip Schoenfeld, MD, MSEd, MSc, investigated various IBS treatments when he co-authored the treatment guidelines published by the American College of Gastroenterology. He says the hard data showing acupuncture’s effectiveness isn’t very good. Yet “that does not mean that acupuncture might not be helpful,” he says. Many individuals say they feel better after acupuncture. Out of all alternative options, he suspects that acupuncture may help some people with IBS.

It is not entirely clear how this traditional Chinese treatment works. Some researchers believe the acupuncture needles stimulate electromagnetic signals in the body. They feel these signals either encourage the release of pain-killing chemicals, or nudge the body’s natural healing systems into action.

Acupuncture is ideally used with other treatments, says Jeanine Blackman, MD, PhD, medical director of the University of Maryland Center for Integrative Medicine. She says even in China, the therapy is never used on its own. Talk with your doctor if you are considering acupuncture.

Oils and Supplements for IBS

To help her IBS patients, Blackman recommends a combination of treatments, including changes in diet, stress reduction, and supplementssuch as evening primrose oil, borage oil, fish oil, or probiotics. She says the oil supplements help calm down the gut, and probiotics restore the good balance of bacteria in the digestive system.

Evening primrose oil comes from the seed of a small yellow wildflower and borage oil comes from the seed of a common weed. Both supplements are similar in nature. Some proponents say evening primrose oil can help improve IBS symptoms, especially in women who experience a worsening of pain, discomfort, and bloating during their menstrual period. But claims about evening primrose oil are largely unproven, reports the University of California at Berkeley Wellness Guide to Dietary Supplements. Plus, side effects reportedly include stomach upset, headaches, and rashes.

Fish oil supplements have been examined along with fish for a number of benefits, including preventing heart disease and easing autoimmune disorders. There doesn’t appear to be any scientific proof, however, that they work for IBS.

Herbs for IBS

Herbs are also popular options for people with IBS. Peppermint is used to calm muscles in the colon, which may cause some of the diarrhea and abdominal discomfort suffered by people with IBS. Studies have been mixed with this herb. The Mayo Clinic advises anyone who’d like to try it to get the enteric-coated capsules, and to be aware that it may make heartburn worse.

Registered herbalists never use peppermint on its own, nor do they recommend it for an extended period of time, says Jonathan Gilbert, who has a diploma in herbology and acupuncture from the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). He is a senior consultant for traditional oriental medicine at the Center for Integrative Medicine at the University of Maryland.

For people who are interested in true herbal therapy, Gilbert recommends a visit to an herbalist who has comprehensive training and is certified by the NCCAOM.

“In order to get a solution to a complex disorder, you need a complex formula, and in order to get that, you need to see someone who can actually prepare it,” says Gilbert, noting he could combine up to 30 to 40 herbs for one formula. He says classic Chinese medicine has thousands of preset formulas for different ailments.

A lot of these formulas can’t be bought on store shelves, adds Gilbert.

If you are interested in herbal therapy, dietary supplements, acupuncture, or any other treatment for your IBS, make sure you talk with your doctor. Herbs may interact with other medications you may be taking. Dietary supplements may become toxic if not used properly. Your doctor can also advise you on medicines for IBS with constipation and IBS with diarrhea.

Probiotics for IBS

On the other hand, there’s some evidence that taking probioticshelp IBS sufferers. Probiotics are bacteria that naturally live in the gut. Some people believe that several intestinal disorders may arise when there isn’t enough good bacteria in the gut.

One study found that probiotic treatment significantly improved IBS symptoms and quality of life. In the study, researchers primarily used the bacteria Lactobacillus acidophilusand Bifidobacteria infantis. People with IBS reported fewer symptoms and, in general, a higher quality of life after taking the probiotics for four weeks.

Just as significant, the probiotic therapy did not appear to cause side effects, according to the study’s author, Stephen M. Faber, MD, from Albemarle Gastroenterology Associates, PC, in Elizabeth City, North Carolina.

Therapy and Hypnosis for IBS

Researchers have found that focusing the mind with hypnotherapy can improve the emotional and physical symptoms in some who have IBS.

In one study, 20 men and 55 women received between five and seven half-hour hypnotherapy sessions over a three-month period. Afterwards, patients reported a 30% improvement in emotional quality of life and a 16% increase in overall physical health.

Two other studies conducted by one researcher included 135 people with IBS. The study participants who received 12 weekly one-hour hypnotherapy sessions focusing on their troubles with IBS showed a 52% improvement in their physical symptoms. Improvements were also maintained when researchers checked in with participants six months after the end of the study.

Cognitive behavior therapy (CBT) trains people to identify and change inaccurate perceptions they may have of themselves and the world around them. It’s also been used to help IBS patients ease symptoms and improve quality of life.

Researchers gave a group of IBS patients up to 10 weekly sessions of CBT in one study. The sessions covered information on IBS, muscle relaxation training, development of a flexible set of problem-solving skills related to IBS, and ways to curb worries about the illness. Results showed that 60% to 75% of participants had improvement in their symptoms.​

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