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Irritable
Bowel Syndrome (IBS) Life-Changing & Life-Challenging
By: Dr.
Stefanie Kelley
If you look out of
your office, cubicle, front door or look at the people commuting to and
from work, 1 in 10 of those people are likely to have irritable bowel syndrome
(IBS). IBS accounts for one of the most common disorders seen by health
care providers and is one of the most common diagnoses of gastroenterologists.
IBS is a disorder that affects people of all ages. It is frequently diagnosed
in the late teens or early twenties and affects 10-20% of adults. In the
United States, women are more affected than men are by IBS. IBS is a functional
disorder of the gastrointestinal tract. IBS is a term used for other functional
disorders of the intestines, such as, spastic colon, mucous colitis, spastic
colitis, nervous stomach, irritable colon, globus, or proctalgia fugax.
IBS is a multi-faceted
syndrome that has a group of three predominant symptoms: abdominal pain,
constipation or diarrhea. A list of IBS symptoms include:
 |
Abdominal bloating,
gas, pain |
|
Constipation |
|
Diarrhea |
|
Alternating bouts
of diarrhea and constipation |
|
Strong urge to have
a bowel movement |
|
Feeling of incomplete
evacuation of bowel |
|
Relief of abdominal
pain and cramping after bowel movement |
|
Mucous in the stool |
Patients
often present with one predominant symptom of IBS - pain, constipation
or diarrhea. However, there is often a history of all three predominant
symptoms.
There are several gastrointestinal symptoms that are not typical of IBS
that require further medical evaluation: pain or diarrhea that awakens
or interferes with sleep, blood in the stool (visible or occult), weight
loss, or fever.
The cause of IBS is unknown
and the pathology is uncertain. There are no structural, biochemical,
infectious or inflammatory abnormalities of the intestine. Healthy intestinal
walls are lined with muscles that contract and relax in coordinated patterns
and are controlled by the autonomic nervous system. In IBS, the nerves
cause the intestinal muscles to move food either too quickly or too slowly.
Food does not cause IBS. But some foods, like fatty food and caffeine,
may affect the IBS gastrointestinal tract. IBS may worsen during stressful
times, after gastrointestinal infections, antibiotic use, or overuse of
antidiarrheals or laxatives. IBS does not cause cancer or inflammatory
bowel diseases. During periods of low stress and healthy eating, IBS can
be minimized.
Diagnosing IBS requires
a through medical history and examination. The Rome criteria (http://www.romecriteria.org/diagnostic.html)
were developed to assist health care providers in diagnosing IBS.
Rome Diagnostic criteria includes:
| 1 |
The
patient experiences continuous or recurrent abdominal pain for at
least 12 weeks during the last 12 months that is: |
|
a |
relieved with defecation |
|
b |
associated with
a change in frequency of stool |
|
c |
associated with
a change in form of stool. |
| 2 |
ALSO,
two or more of the following that occur during the same period |
|
a |
Altered stool frequency
(fewer than 3 bowel movements a week or more than 3 bowel movements
a day |
|
b |
Altered stool passage
(straining, urgency, feeling of incomplete bowel movement, loose,
watery stools, hard or pellet-like stools) |
|
c |
Mucous in stools |
|
d |
Abdominal fullness,
bloating |
Additional
medical testing may be necessary to rule out structural and biochemical
conditions.
Receiving a diagnosis
of IBS can be a shock. IBS is a condition that is not cured. It is a condition
that is controlled. After making a diagnosis, encouraging a patient to
keep a journal of the specific triggers (stress and/or food) and accompanying
feelings associated with the triggers is important before developing a
plan of care. Data from a journal can offer greater understanding of IBS
specific to the patient. Generally, there are three main aspects of IBS
treatment: eating a healthy diet, avoiding food that affects IBS and decreasing
stress. Personalizing a plan of care based on the patient's IBS triggers,
setting realistic goals, and putting the patient in control of IBS is
the key to successful management of IBS.
Eating a healthy diet
and reducing stress seem to be the cure for most conditions. Here are
some helpful tips for people with IBS.
|
A great website
for eating a healthy diet is http://www.nal.usda.gov/fnic/.
Also, a website for healthy eating for kids is http://www.nal.usda.gov/childcare/. |
|
Fiber is an important
treatment component of constipation and diarrhea predominant IBS.
There are two types of fiber. Soluble fiber can be dissolved in water
and can help patients with diarrhea and/or constipation.
Insoluble fiber is found in fruits, vegetables, and whole grain foods.
But insoluble fiber may make diarrhea worse. High fiber foods provide
bulk and vitamins to your diet and are low in calories, fat and salt.
A high fiber diet provides 25-35 grams of fiber each day. The key
to adding fiber to your diet is to add it slowly. Start by adding
a source of fiber to one meal, gradually adding a fiber serving at
each meal.
A helpful fiber website: http://www.wehealny.org/healthinfo/dietaryfiber/fibercontentchart.html#fiber
|
|
If fiber is going
to be increased in a diet - fluids must be added as well. Eight glasses
of liquids each day is recommended. This is a total of 64 ounces of
fluid - alcohol and caffeine drinks are not included. One way to ensure
the total fluid intake is to drink an 8-ounce glass of water before
and after each meal, with 2 additional 8 ounces of fluid throughout
the day. With the advent of bottled water, keeping track of fluid
intake is getting easier. The most frequent complaint of adding fluid
to the diet is the frequent bathroom breaks. Over time, the body adapts
and the frequency can lessen. If you are taking prescription medications,
ask your health care provider if increasing fluid intake will adversely
affect your medication absorption. |
|
If dairy products
are identified as a trigger of IBS, you may be lactose intolerant.
Limiting dairy products to your diet may be necessary. Adding calcium
supplements may be necessary. Speak to your health care provider. |
|
Stress reduction
is key to managing IBS. Identifying life stressors are important;
however avoiding those stressors may not be possible. Finding a way
to better manage the symptoms of stress is important. Exercise is
a way to promote health and decrease stress. Exercise can be as simple
as walking around your office space or neighborhood or a commitment
to an exercise plan. Making exercise as integral to your life as eating
and sleeping is a goal to aspire to. Meditation, prayer, support groups,
and stress management classes are also affective ways to manage stress. |
|
There are now medications
to help manage the symptoms of IBS. These medications do not cure
IBS and there are side effects associated with the use of these medications
for IBS. Your health care provider can determine if medications are
appropriate for your IBS. |
IBS is a life-changing
and life-challenging condition. With proper medical care and personal
commitment, IBS can be managed and healthy lives are possible. For more
information on IBS check out these web sites:
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