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Irritable bowel syndrome

Also listed as: Spastic colon

• Signs and Symptoms
• What Causes It?
• What to Expect at Your Provider's Office
• Treatment Options
• Following Up
• Supporting Research

Irritable bowel syndrome (IBS) occurs when muscles in your intestines contract faster or slower than normal. This causes pain, cramping, gassiness, sudden bouts of diarrhea, and constipation.

There are two types of IBS. People who suffer from spastic colon IBS experience constipation, diarrhea, or both, and often have pain after eating. Painless diarrhea IBS involves the sudden onset of diarrhea during or after meals, or upon waking. Between 10 - 20% of the population has IBS at some time. The syndrome often starts in adolescents or young adults. It affects almost twice as many women as men, and is often associated with stress.

Signs and Symptoms

• Cramping pain in your lower abdomen
• Bloating and gas
• Changes in your bowel habits
• Diarrhea or constipation, or both alternately
• Immediate need to move your bowels when you wake up or during or after meals
• Relief of pain after bowel movements
• Feeling of incomplete emptying after bowel movements
• Mucus in your stool

What Causes It?

There are many possible causes. For instance, there may be a disturbance in the muscle movement of the intestine or a lower tolerance for stretching and movement of the intestine. There is no abnormality in the structure of the intestine.

Irritable bowel syndrome (IBS) can occur at any age, but often begins in adolescence or early adulthood. It is more common in women. Predisposing factors may include a low-fiber diet, emotional stress, use of laxatives, a bout of infectious diarrhea, or other temporary bowel inflammation.

What to Expect at Your Provider's Office

Your doctor will feel your abdomen to check for signs of pain. Other tests may include a rectal exam, pelvic exam (for women), sigmoidoscopy, stool sample testing, blood and urine tests, ultrasound, and x-rays.

Treatment Options

The objective of treatment is to relieve symptoms. Changes in diet may help alleviate symptoms in some patients. Increasing dietary fiber and eliminating gastrointestinal stimulants such as caffeine may help. Anxiety-reducing measures, such as regular exercise, and counseling in cases of severe anxiety or depression, may also be effective.

Drug Therapies

• Anticholinergic agents -- reduce the pain from bowel spasm
• Antiflatulents -- reduce gas
• Antidiarrheal medication — such as Loperamide (Imodium)
• Bulk-producing agents -- such as psyllium (Metamucil) and other fiber supplements can help with diarrhea or constipation
• Selective Serotonin medications Tegaserod is available for patients with constipation-predominant irritable bowel syndrome.

Complementary and Alternative Therapies

IBS has many underlying causes that can often be successfully treated with alternative therapies. Stress reduction techniques such as biofeedback, hypnosis, or counseling may help.

Nutrition

• Remove known food allergens or irritants. The most common food allergens are dairy products, wheat, corn, peanuts, citrus, soy, eggs, fish, and tomatoes. An elimination/challenge trial may help uncover sensitivities. Eliminate all suspected allergens from the diet for two weeks. Add back one food every three days and wait for a reaction.
• If you suffer from gas, eliminate beans, cabbages, and other "gassy" vegetables from your diet, as well as apple juice, grape juice, bananas, nuts, and raisins.
• Fiber supplementation can help reduce pain, cramping, and gas. Supplements include psyllium, flaxmeal, slippery elm (Ulmus fulva) powder, and marshmallow root (Althaea officinalis) powder.
• Digestive enzymes taken 20 minutes before meals can help enhance digestion and normalize bowel function.
• One teaspoon of raw bran with each meal, supplemented by extra fluids, provides fiber.
• Taking pro-flora supplements such as acidophilus and lactobacillus species two to three times per day can help rebalance normal bowel bacteria and reduce gas and bloating.
• Magnesium (200 mg two to three times per day) and B-complex (50 to 100 mg per day) with extra B5 (pantothenic acid; 100 mg per day) may help reduce the effects of stress.
• Low-fat diets may relieve abdominal pain following meals.

Herbs

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

• Enteric-coated peppermint oil: one to two capsules (0.2 ml peppermint oil per capsule) three times a day after meals
• Drinking a tea of fennel seed (Foeniculum vulgare) or ginger root (Zingiber officinale) after meals promotes good digestion
• A tincture of equal parts of the following before meals (30 drops three times per day): valerian (Valeriana officinalis), passionflower (Passiflora incarnata), anise seed (Pimpinella anisum) extract, meadowsweet (Filipendula ulmaria), wild yam (Dioscorea villosa), and milk thistle (Silybum marianum)

Homeopathy

Homeopathy may be useful as a supportive therapy.

Physical Medicine

• Electric heating pads, hot water bottles, and long hot baths can relieve painful spasms and cramping in the abdomen.
• Regular exercise, such as walking, can reduce stress and encourage bowel movements if you are constipated.
• Castor oil pack. Apply oil directly to skin, cover with a clean soft cloth and plastic wrap. Place a heat source over the pack and let sit for 30 to 60 minutes.
• Abdominal breathing helps to induce the relaxation response and may aid normal physiological functioning (such as digestion).

Acupuncture

Several small studies suggest that acupuncture may be helpful for people who have IBS. Research shows that acupuncture may improve general well-being and reduce bloating. Large-scale trials are still needed.

Acupuncturists treat people with IBS based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of IBS, an acupuncturist usually detects a qi deficiency in the spleen and lung meridians. Acupuncturists frequently use moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) for treatment of IBS because they believe its effects  reach deeper into the body. Because acupuncture is considered safe, and IBS is not easily treated by currently available conventional methods, people with IBS may wish to try acupuncture therapy to improve symptoms.

Chiropractic

There have been no well-designed studies on the effects of chiropractic on individuals with IBS. However, chiropractors report that spinal manipulation may improve symptoms of the condition in some individuals. In these cases, spinal manipulation may have a balancing effect on the nerves that supply impulses to the intestinal tract.

Massage

Therapeutic massage may help reduce the effects of stress.

Following Up

Be aware that IBS itself may cause stress.

Supporting Research

Berardi PR. Safety and tolerability of tegaserod in irritable bowel syndrome management. J Am Pharm Assoc 2004 Jan-Feb;44(1):41-51.

Berkow R, ed. Merck Manual of Diagnosis and Therapy . 16th ed. Rahway, NJ: The Merck Publishing Group; 1992.

Chan J, Carr I, Mayberry JF. The role of acupuncture in the treatment of irritable bowel syndrome: a pilot study. Hepatogastroenterol . 1997;44:1328-1330.

Dambro MR, ed. Griffith's 5 Minute Clinical Consult . New York, NY: Lippincott, Williams and Wilkins; 1998.

Diehl DL. Acupuncture for gastrointestinal and hepatobiliary disorders. J Altern Complement Med. 1999;5(1):27-45.

Koch TR. Peppermint oil and irritable bowel syndrome [In Process Citation]. Am J Gastroenterol . 1998;93:2304-2305.

Li Y, Tougas G, Chiverton SG, Hunt RH. The effect of acpuncture on gastrointestinal function and disorders. Am J Gastroenterol. 1992;87:1372-1381.

Liu JH, Chen GH, Yeh HZ, Huang CK, Poon SK. Enteric-coated peppermint-oil capsules in the treatment of irritable bowel syndrome: a prospective, randomized trial. J Gastroenterol. 1997;32:765-768.

Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine . 2nd ed. Rocklin, Calif: Prima Publishing; 1998:396-400.

Locke GR, Yawn BP, Wollan PC, Melton LJ, Lydick E, Talley NJ. Incidence of a clinical diagnosis of the irritable bowel syndrome in a United States population. Aliment Pharmacol Ther 2004 May 1;19(9):1025-1031.

Pittler MH, Ernst E. Peppermint oil for irritable bowel syndrome: a critical review and metaanalysis. Am J Gastroenterol. 1998;93:1131-1135.

• Review Date: 10/5/2005
• Reviewed By: A.D.A.M. editorial, previously reviewed by: Lawrence J. Cheskin, MD, FACP, Director, The Johns Hopkins Weight Management Center, Lutherville, MD; Gary Guebert, DC, DACBR, (Chiropractic section October 2001) Login Chiropractic College, Maryland Heights, MO; Lonnie Lee, MD, Internal Medicine, Silver Springs, MD; Richard A. Lippin, MD, President, The Lippin Group, Southampton, PA; Joseph Trainor, DC, (Chiropractic section October 2001) Integrative Therapeutics, Inc., Natick, MA; Marcellus Walker, MD, LAc, (Acupuncture section October 2001) St. Vincent's Catholic Medical Center, New York, NY; Ira Zunin, MD, MPH, MBA, (Acupuncture section October 2001) President and Chairman, Hawaii State Consortium for Integrative Medicine, Honolulu, HI.

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