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Irritable Bowel Syndrome: Strategies for Managing a Complex Condition

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A Common Diagnosis | Lifestyle Changes | Medications

HCA imageIrritable bowel syndrome (IBS) does not easily fit into the traditional medical model. Researchers have not yet come up with a coherent scientific explanation, let alone a cause, for its debilitating symptoms. This means that there is no cure or even a comprehensive treatment. Doctors can offer a way to manage symptoms, though.

A Common Diagnosis

Doctors diagnose IBS in women more often than in men. The main symptoms are abdominal pain, usually associated with bloating and gas, and a change in bowel movements (diarrhea, constipation, or alternating bouts of each). Mucus may be present with diarrhea, but there is no blood or pus.

Because tests show no abnormalities, doctors usually diagnose IBS only after ruling out other diseases.

Doctors may suspect IBS when a person experiences recurrent abdominal pain with at least two of the following features:

  • Pain is relieved after a bowel movement
  • The onset of pain is associated with diarrhea or constipation
  • The onset of pain is associated with a change in the form of the stool (loose, watery, or pellet-like)

Lifestyle Changes

Since IBS primarily affects the GI tract, diet is a good place to start. Many people benefit from avoiding certain foods and ingredients, such as:

  • Caffeine
  • Alcohol
  • Fatty foods
  • Gas-producing vegetables and legumes

For those who find a connection between their symptoms and what they eat, avoiding those foods can be helpful.

Depending on your age and gender, general guidelines recommend aiming for 25-38 grams of fiber in your daily diet. Fiber may improve the colon's function and reduce symptoms, especially in people who tend to be constipated. However, if your IBS symptoms are mainly gas and bloating, fiber may cause you to have more abdominal discomfort. Your doctor can help you select good sources of fiber based on your symptoms. Examples include:

  • Whole grains, fruits, vegetables, and legumes
  • Raw bran
  • Psyllium seeds
  • Flaxseeds

If you want to increase the amount of fiber in your diet, add small amounts at a time. Adding too much fiber too quickly can lead to a flare-up of IBS symptoms.

Of the many herbs and supplements that have been recommended for IBS, peppermint oil is one of the few backed by some scientific evidence. The recommended dose is 0.2 milliliter (ml) capsules three times daily after meals. Be sure to take the enteric-coated form, so that the capsule will not be broken down in the stomach before it reaches the intestines. Talk to your doctor before taking any herbs and supplements. They could affect medicines that you are taking or conditions that you have.

Stress management may be able to ease IBS symptoms. Some treatments that may be used to decrease stress include:

  • Relaxation response—This may include techniques like meditation, guided-imagery, and progressive relaxation.
  • Biofeedback —Biofeedback involves being hooked up to a machine that provides information about the body, like how tense the muscles are. The person can then use this information to take steps to reduce stress.
  • Cognitive-behavioral therapy (CBT) —CBT can help people to address their thought patterns and behaviors and manage how they react to their condition and symptoms.

Participating in a regular exercise program can help improve bowel function and other IBS symptoms. If you would like to start exercising, check with your doctor to make sure you are healthy enough.

Anther important part of treatment is becoming educated about IBS and ways to reduce the symptoms. Joining a support group may also be a good way to learn about the condition and to share your experiences with others.

Medications

In addition to lifestyle changes, there are a number of medicines that may be helpful in treating the individual symptoms of IBS. In some cases, these medicines may be used in combination. Examples include:

  • Antispasmodic agent (eg, dicyclomine)
  • Antiflatulant (eg, simethicone)
  • Antibiotics (eg, rifaximin)
  • Antidiarrheal agent (eg, loperamide )
  • Low-dose antidepressant
  • Probiotics (eg, acidophilus)
  • Pain reliever (eg, acetaminophen )
  • Serotonin receptor agonists and antagonists (also called 5-HT3 antagonists)

These medicines, while often helpful, are no substitute for a comprehensive lifestyle approach. By modifying your diet, managing stress, and making other healthy changes, you can work to address your IBS symptoms.

RESOURCES:

Irritable Bowel Syndrome Self Help and Support Group

http://www.ibsgroup.org/

National Center for Complementary and Alternative Medicine

http://www.nccam.nih.gov/

CANADIAN RESOURCES:

The Canadian Association of Gastroenterology

http://www.cag-acg.org/

References:

Biofeedback. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthLibrary/. Updated August 1, 2011. Accessed May 18, 2012.

Fiber: how to increase the amount in your diet. Family Doctor.org website. Available at: http://familydoctor.org/familydoctor/en/prevention-wellness/food-nutrition/nutrients/fiber-how-to-increase-the-amount-in-your-diet.html. Updated December 2010. Accessed May 18, 2012.

Fibre. IBS Research Update.org website. Available at: http://www.ibsresearchupdate.org/ibs/fibre1ie4.html. Accessed May 18, 2012.

Irritable bowel syndrome. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/ibs/#diagnostic. Updated April 23, 2012. Accessed May 18, 2012.

Irritable bowel syndrome (IBS). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated May 18, 2012. Accessed May 18, 2012.

Peppermint. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthLibrary/. Updated August 1, 2011. Accessed May 18, 2012.

Relaxation therapy. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthLibrary/. Updated April 30, 2012. Accessed May 18, 2012.

4/30/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Moayyedi P, Ford AC, Talley NJ, Cremonini F, Foxx-Orenstein AE, Brandt LJ, Quigley EM. The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut. 2010;59(3):325-32.

7/16/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Dorn SD. Systematic review: self-management support interventions for irritable bowel syndrome. Aliment Pharmacol Ther. 2010 May 22. [Epub ahead of print]

2/25/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Pimentel M, Lembo A, Chey WD, et al. Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med. 2011;364(1):22-32.

4/22/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/: Johannesson E, Simrén M, Strid H, Bajor A, Sadik R. Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol. 2011 Jan 4. [Epub ahead of print]

Last reviewed May 2012 by Brian Randall, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


 
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