What is irritable bowel syndrome?

Irritable bowel syndrome (IBS), also called spastic colon, is a chronic (long-lasting) disorder of the colon, or large intestine. It is the most common gastrointestinal disorder. It affects women twice as often as men and usually begins in early adult life. Although the disorder can cause much distress, it is not serious and does not lead to serious disease.

How does it occur?

Irritable bowel syndrome is not a disease but a functional disorder, which means there is no sign of disease when the colon is examined by x-ray or other tests.

The cause of IBS is not fully understood. Most symptoms of IBS are probably related to abnormal muscle movement or spasm of the lower part of the colon. Sometimes the spasm delays the bowel movement. At other times it may lead to more rapid passage of the bowel movement, resulting in diarrhea.

Attacks may be triggered by a specific food or by stress or depression because muscle movement in the colon is partly controlled by the nervous system.

What are the symptoms?

The most common symptoms include:

• cramping and pain in the lower stomach (may be severe)

• constipation, with bowel movement in small balls or ribbons

• daytime diarrhea (less frequent symptom)

• constipation alternating with diarrhea

• a lot of gas.

Other symptoms include:

• bloating

• a feeling of fullness in the rectum.

Symptoms commonly occur after you've eaten a big meal or when you are under stress. Your symptoms may be temporarily relieved by having a bowel movement.

How is it diagnosed?

The symptoms of IBS are similar to the symptoms of serious disorders such as Crohn's disease, colon cancer, ulcerative colitis, and lactose intolerance. Therefore, the doctor will want to be sure your problem is not being caused by something serious.

After getting your complete medical history, your doctor may want to give you a physical exam including an exam of the rectum.

Your doctor may want you to have the following:

• exam of samples of bowel movement for traces of blood or infectious agents

• x-rays

• endoscopy or sigmoidoscopy

• barium enema

• blood tests

• trial of a milk-free diet.

If the doctor can rule out serious disease and if there is no positive finding after appropriate tests, then IBS is the reasonable diagnosis.

How is it treated?

Although there is no known cure, your doctor will help you control your diet and emotional stress, which usually relieves the symptoms of IBS. Your doctor may also give you some medicines.

• Diet

  Your doctor will tailor your diet to meet your specific needs. Your doctor may or may not recommend that you follow a high-fiber diet, which may help keep the colon from going into spasm. He or she may also suggest that you eat smaller meals more often, or eat smaller portions of foods at a meal. Your doctor may also suggest that you eat less fat, which is hard to digest. In addition, you should avoid any foods that cause you distress. Common foods that may cause trouble include fatty foods, such as bacon and cheese, and gas-producing foods, such as onions and cabbage.

• Diet diary

  Your doctor may ask you to keep a food diary to determine if a particular food, for example, milk or sausage, worsens your symptoms.

• Stress

  Your doctor will help you identify stress-producing factors in your life and suggest ways to help you control them. Relaxation or biofeedback techniques may help you manage stress. Mental health counseling is sometimes helpful.

• Medicines

  Your doctor may prescribe a combination of bulk-forming agents (such as bran or methylcellulose), antispasmodic drugs, and tranquilizers or antidepressants.

How can I take care of myself?

Follow these guidelines to relieve the symptoms of IBS:

• Learn stress-management techniques to lessen stress and anxiety in your life. Seek professional mental health counseling if necessary.

• Drink eight 8-ounce glasses of water a day.

• Do not drink alcohol, which can make symptoms of IBS worse.

• Select your foods carefully. If a food appears to bring on your symptoms, avoid it. However, don't eliminate a food because it appears to cause symptoms only on one occasion. Be sure that a food produces symptoms on several occasions before giving it up. A varied diet provides better nutrition.

• Ask your doctor if you should follow a high-fiber diet, especially if you tend to be constipated. High-fiber foods may cause gas and bloating, but usually these symptoms lessen as the digestive tract gets used to the increased fiber intake. High-fiber foods include:
  • whole grain breads and cereals

  • fruits, especially apricots, blackberries, coconut, dates, figs, kiwi, peaches, pears, pineapple, prunes, raspberries, and strawberries

  • nuts, especially almonds, pistachios, and walnuts

  • vegetables, particularly Brussels sprouts, corn (and popcorn), broccoli, and parsley

  • beans and lentils.
• Eat less fat. Fat is found mainly in the following foods:
  • meat, especially bacon, sausage, beef hotdog, bologna

  • poultry skin

  • dairy products including milk, cream, cheddar cheese, butter, cream cheese

  • vegetable oils, margarines, and shortenings

  • pecans and black walnuts

  • avocados

  • peanut butter.
• Ask your doctor about using an over-the-counter fiber supplement.

• Eat smaller meals more frequently. Eat smaller portions of foods at a meal.

Because IBS is a chronic disorder, the effects from a flare- up may occur throughout your life. Although there is no known cure, the disorder can usually be controlled and symptoms relieved. The disorder will not turn into something worse.