Irritable Bowel Syndrome / IBS
This section contains information about Irritable Bowel Syndrome/IBS. It is not intended to help you to diagnose or treat this or any other condition as that is the job of your doctor. Rather, this information is strictly provided for informational and educational purposes. If you are suffering from any type of abdominal pain or distress you should contact your doctor. In some cases, your doctor will need to refer you a Board Certified Gastroenterologist. If the pain is severe and your doctor is not available you should go to the emergency room since abdominal pain in some cases can be caused by serious life threatening conditions. If you are alone and are in severe pain do not attempt to drive to the hospital. It is better to call an ambulance. Do not attempt to wait out serious abdominal pain as it is better to be “safe than sorry”. If your doctor has already diagnosed you with IBS, you may also benefit by consulting a Naturopathic Physician or Clinical Nutritionist.
Irritable bowel syndrome is a common condition of the GI tract that may at one time or another affect as much as 20% of the population. Symptoms can include bloating, gas, cramping relieved by defecation, diarrhea and constipation (sometimes alternating but often either diarrhea predominant or constipation predominant), feeling of being unable to fully empty the bowel and in some cases, mucus in the stool. IBS patients also frequently experience urgency or the sudden need to defecate.
About half of all patients with fibromyalgia and chronic fatigue syndrome suffer from IBS. Headaches and altered sleep patterns are commonly seen in patients with IBS. People suffering from depression have a higher incidence of IBS perhaps because the neurotransmitter serotonin is involved with both gut motility and mood disorders. It is therefore no surprise that drugs known as selective serotonin re-uptake inhibitors (SSRI’s) have been used to treat both depression and IBS. Additional drugs such as Zelnorm (tegaserod maleate) are often used in patients with constipation predominant IBS for the purpose of improving gut motility.
Normal contraction of the smooth muscle of the GI tract is rhythmic. In the case of IBS, the contractions may become more intense and last for longer periods of time thus effecting normal gut motility and bowel frequency.
There are several causes of irritable bowel syndrome including stress, food allergies and sensitivities, hormonal influences and underlying illness. Because IBS is about twice more common with women than men, hormones are considered a cause or at least a contributing factor in women who are predisposed to IBS. If your condition appears suddenly or worsens over a short period of time, scheduling an appointment with your doctor is a must. In most cases, it is likely to be a flare up of your condition but because more serious conditions such as thyroid dysfunction, adrenal dysfunction, diabetes, helicobacter pylori or other infection, diverticlosis, appendicitis, Celiac disease, ulcerative colitis, Crohn’s Disease and colon cancer can all have similar presentations, it is best to consult with your doctor. Diagnosis of IBS involves the ruling out of other causes of gastrointestinal dysfunction such as those mentioned. If no underlying causes are found clinical diagnosis of IBS is made with the use of the Rome III Criteria for IBS which includes: At least 3 months, with onset at least 6 months previously of recurrent abdominal pain or discomfort** associated with 2 or more of the following:
* Improvement with defecation; and/or
* Onset associated with a change in frequency of stool; and/or
* Onset associated with a change in form (appearance) of stool
**Discomfort means an uncomfortable sensation not described as pain.
Signs and symptoms such as weight loss, blood in the stool, recurrent vomiting and prolonged loss of appetite are characteristic of more serious conditions than IBS itself. Less serious conditions such as lactose intolerance can also present in similar fashion to IBS. Because patients with IBS often strain during defecation, hemorrhoids can be common complication.
Recommendations for IBS
Eat Regular Meals - While it is important to eat the right types of food, it is also important to eat regularly and not skip meals. Gaps in meals can result in altered GI rhythm. Breakfast is a particularly important meal since the GI tract has not worked all night. Eating facilitates what is known as the gastrocolic reflex which in simple terms means that muscular activity in the large intestine increases when the stomach is stretched as would be the case with eating a good breakfast or drinking a couple glasses of water. Doing this in the morning is the best time as the function of defecation is best accomplished when the body is relaxed.
Increase Dietary Fiber - Dietary fiber tends to hold more water and increase stool weight. Patients with frequent diarrhea may find that increased dietary fiber can decrease transit time to a more reasonable and tolerable level while patients with constipation may experience increased transit time. In some cases however, increased dietary fiber can worsen diarrhea symptoms associated with IBS.
Reduce Fat Intake - While individuals without GI complaints may experience little to no GI distress after consuming a high fat meal, individuals with IBS may notice that high fat or greasy foods may trigger their condition.
Reduce Sugar Intake A diet high in sugar can exacerbate IBS symptoms. When sugar is absorbed too rapidly into the blood stream due to excessive sugar intake, frequency of rhythmic contractions in the intestines can be decreased.
Rule Out Food Allergies/Food Sensitivities - While in may be easy to implicate foods such as whole milk with diarrhea from to lactose intolerance it’s not always that easy. Some foods can act as culprits for years without the individual’s knowledge. Gluten (wheat, barley and rye) sensitivity can serve as a good example and should be ruled out in patients with IBS. Blood testing for food allergies or doing an elimination diet can uncover the hidden triggers in your diet. Dairy and grains are common allergens. Foods and beverages such as coffee, alcoholic beverages, chocolate, caffeinated sodas and even artificial sweeteners all too often result in negative effects on the GI tract. A daily food diary may also help to localize trigger foods
Manage Stress - Stress is a cause and contributor of countless illnesses both mental and physical. Stress can alter neurotransmitters within the brain and can also alter hormone levels such as cortisol. There are several ways to deal with stress such as biofeedback, physical exercise, deep breathing exercises, and of course working with a qualified counselor.
Enzymes - Digestive enzymes aid in the digestive process and are helpful with transit time through the GI tract. Digestive enzymes are taken before meals.
Glutamine - Glutamine is an amino acid with powerful healing properties and can help to restore damage to the gut lining of the large intestine. Common doses are 500 mg tid. Check with your doctor to determine if this supplement is right for you and in what amount.
Common Herbs Used for IBS - Chamomile, Ginger, Lemon Balm Rosemary and Valerian are often used in natural preparations to aid in the treatment of IBS because of their calming, antispasmotic and anti-inflammatory effects.
Peppermint Oil - Peppermint oil has been shown to reduce colon spasm. Enteric coated pills are recommended since direct consumption of peppermint oil can relax the sphincter muscle between the esophagus and the stomach resulting in esophageal reflux. Peppermint oil can also be effective to some degree against yeast overgrowth. Enteric coated capsules of peppermint and caraway oils can also help with IBS symptoms. One research study used the peppermint/caraway combination 3 times per day for 4 weeks. After two weeks 42% of the IBS patients using the oils were pain free while only 5% of the patients in the control group were pain free.
Probiotics - While normal bacteria are essential to health and immunity, many of us due to poor diet or recent antibiotic or steroid use, can have inadequate amounts of good bacteria such as acidophilus in our GI tracts. This can result in altered GI function and yeast overgrowth which in and of itself can cause bloating and abdominal discomfort.