Description

Irritable bowel syndrome (IBS) is a common condition that affects the stomach and intestines, also called the gastrointestinal tract. Symptoms include cramping, abdominal pain, bloating, gas, and diarrhea or constipation, or both. IBS is a disease that requires long-term treatment.

Only a small number of people with IBS have severe symptoms. Some people can control their symptoms by managing diet, lifestyle and stress. More severe symptoms can be treated with medication and therapy.

IBS does not cause changes in bowel tissue or increase the risk of colorectal cancer.

Symptoms

The symptoms of IBS can vary, but are usually present for a long time. The most common include:

  • Abdominal pain, cramping or bloating that is associated with the passage of stool.
  • The changes in the appearance of the stool.
  • The changes in the frequency of defecation.

Other symptoms that are often related, which include sensation of incomplete evacuation, and the increase of gas or mucus in the stool.

When to see a doctor

Consult a health care professional if you have a persistent change in bowel habits, or other symptoms of IBS . That may mean a more serious condition, such as cancer of colon. More-severe symptoms include:

  • The loss of weight.
  • Diarrhea at night.
  • Rectal Bleeding.
  • Iron-deficiency Anemia.
  • Unexplained vomiting.
  • Pain that is not relieved by the passage of gas or stool.

Causes

The exact cause of ibs is not known. The factors that seem to play a role include:

  • The contractions of the muscles in the intestine. The walls of the intestines are lined with layers of muscle that contracts to move food through the digestive tract. The contractions are stronger and last longer than usual may cause gas, bloating and diarrhea. Weak contractions can slow food step, and lead to the hard, dry stool.
  • Of the nervous system. Problems with the nerves in the digestive system can cause discomfort when the belly area, called the abdomen stretches from gas or stool. Poorly coordinated signals between the brain and the intestines can cause the body to react to the changes that occur normally in the digestive process. This can result in pain, diarrhea, or constipation.
  • The infection is severe. IBS can develop after a severe attack of diarrhea caused by a bacteria or a virus. This is called gastroenteritis. IBS may also be associated with an excess of bacteria in the intestines, known as bacterial overgrowth.
  • Early-life stress. People exposed to stressful situations, especially in childhood, are more likely to have symptoms of IBS .
  • The changes in the gut microbes. Examples include changes in the bacteria, fungi and viruses, which normally live in the gut and play a key role in health. The research indicates that the microbes in people with IBS may differ from those of the people who do not have IBS .

Triggers

The symptoms of IBS may be caused by:

  • Food. The role of allergy or food intolerance in IBS has not been well understood. A true food allergy is rarely the cause of IBS . But many people have worse symptoms of IBS by eating or drinking certain foods or beverages. These include wheat, dairy products, citrus fruits, beans, cabbage, milk and carbonated drinks.
  • Stress. Most people with IBS experience worse or more frequent symptoms during periods of increased stress. But while stress can worsen the symptoms, not the cause.

Risk factors

Many people have occasional symptoms of IBS . But you are more likely to have the syndrome if:

  • They are young. IBS occurs more frequently in people under the age of 50 years.
  • Are of the female sex. In the united States, IBS is more common among women. Estrogen therapy before or after menopause is also a risk factor for IBS .
  • Have a family history ofIBS. Genes may play a role, as can the common factors in a family environment or a combination of genes and the environment.
  • You have anxiety, depression or other mental health problems. A history of sexual, physical or emotional abuse, it can also be a risk factor.

Complications

Long-term constipation or diarrhea can cause hemorrhoids.

In addition, IBS is associated with:

  • Poor quality of life. Many people with moderate-to-severe IBS report of quality of life. The research indicates that people with IBS to lose three times the number of days of work as those without intestinal symptoms.
  • Mood disorders. Experience IBS symptoms can lead to depression or anxiety. Depression and anxiety also can make IBS worse.

Diagnosis

There is no test to definitively diagnose IBS . A health professional is likely to begin with a complete medical history, physical exam and tests to rule out other conditions, such as celiac disease and inflammatory bowel disease (IBD).

After other conditions have been ruled out, a care professional is likely to use one of these sets of criteria for the diagnosis of IBS :

  • Rome criteria. These criteria include abdominal pain and discomfort on average at least one day per week in the last three months. This also occurs usually with at least two of the following: pain and discomfort associated with defecation; a change in frequency of stool, or a change in the consistency of stools.
  • Type of ofIBS. For the purpose of treatment, IBS can be divided into four types, based on the symptoms: constipation-predominant, diarrhea-predominant, mixed or unclassified.

A health professional is also likely to explore if you have other symptoms that might suggest another, more serious. These include:

  • The onset of symptoms after the age of 50 years old.
  • The loss of weight.
  • Rectal Bleeding.
  • Fever.
  • Nausea or repeated vomiting.
  • Pain in the belly, especially if it is not to pass stools, or occurs at night.
  • Diarrhea that is in progress or wakes up from sleep.
  • The Anemia associated with a low level of iron.

If you have these symptoms, or if initial treatment for IBS does not work, it is likely that you will need more tests.

Additional tests

A health professional may recommend several tests to help with diagnosis.

Diagnostic procedures may include:

  • Colonoscopy. In colonoscopy, a camera connected to a small, flexible tube that is used to examine the entire length of the colon.
  • CTscan. This test produces images of the abdomen and pelvis, which could rule out other causes of the symptoms, especially if the abdominal pain is present.
  • The upper gastrointestinal endoscopy. A long, flexible tube is inserted through the throat and the esophagus, which is the tube that connects the mouth and stomach. A camera on the end of the tube which provides a view of the upper part of the digestive tract. During an endoscopy, a tissue sample called a biopsy can be collected. A fluid sample can be collected to look for the excessive growth of bacteria. This test may be recommended if there is suspicion of celiac disease.

Laboratory tests may include:

  • Lactose intolerance tests. Lactase is the enzyme needed to digest the sugar found in dairy products. If a person does not produce lactase, can have problems such as those caused by IBS , including abdominal pain, gas, and diarrhea. A healthcare provider may order a breath test or to ask you to remove the milk and dairy products from your diet for several weeks.
  • Breath test for bacterial overgrowth. A breath test can also determine if there is bacterial overgrowth in the small intestine. The bacterial overgrowth is more common among people who have had intestinal surgery or you have diabetes or any other disease that slows down the digestion.
  • The analysis of feces. The stool may be tested for bacteria, parasites, or to the presence of bile acids. Bile acid is a digestive fluid produced in the liver. Stool can also check to see if the intestine has trouble taking in nutrients. This is a condition that is known as malabsorption.

Treatment

The IBS treatment focuses on relieving the symptoms, so that you can live as symptom-free as possible.

Mild symptoms can often be controlled by the management of the stress and making changes in diet and lifestyle. Try:

  • Stay away from foods that trigger symptoms.
  • Eating high-fiber foods.
  • Drink plenty of fluids.
  • Exercise regularly.
  • Get enough sleep.

A health professional may suggest the removal of these foods:

  • High-gas foods. If the swelling or the gas is a problem, do not consume soft drinks and alcoholic beverages, or certain foods that can lead to increased gas.
  • The Gluten. The research shows that some people with IBS report improvement in diarrhea symptoms if you stop eating gluten, even if they do not have celiac disease. Gluten is located in foods that contain wheat, barley and rye.
  • FODMAPs. Some people are sensitive to certain carbohydrates, such as fructose, fructans, lactose, and other, known as FODMAPs-fermentable oligosaccharides, disaccharides, monosaccharides and polyols. FODMAPs are found in certain grains, vegetables, fruits, and dairy products.

A dietitian can help you with these changes in the diet.

If the problems are moderate or severe, a health professional could suggest advice — especially if the depression or the stress tends to worsen the symptoms.

It is based on the symptoms, the medications may be recommended, including:

  • Fiber supplements. Taking a supplement such as psyllium husk (Metamucil) with fluids can help control constipation.
  • Laxatives. If the fiber does not help with the constipation, laxatives without a prescription, such as magnesium hydroxide oral (Milk of Magnesia) or polyethylene glycol (Miralax), may be recommended.
  • The anti-diarrheal medications. - The-counter medications, such as loperamide (Imodium a-D), can help control the diarrhea. A care professional may also prescribe a bile acid binder, such as cholestyramine (Prevalite), colestipol (Colestid), or colesevelam (Welchol). Bile acid binders can cause swelling.
  • Anticholinergic medications. Medications such as dicyclomine (Bentyl) can help relieve the painful intestinal spasms. They are sometimes prescribed to people who have episodes of diarrhea. These drugs are generally safe, but may cause constipation, dry mouth, and blurred vision.
  • The tricyclic antidepressants. This type of medication can help to alleviate depression, but also blocks the activity of neurons that control the intestines. This can help reduce the pain. If you have diarrhea and abdominal pain without depression, a health professional may suggest a less typical dose of imipramine (Tofranil), desipramine (Norpramin), or nortriptyline (Pamelor). The side effects, which could be reduced if you take the medicine at bedtime — may include drowsiness, blurred vision, dizziness, and dry mouth.
  • SSRIantidepressants. Selective inhibitors of serotonin reuptake inhibitors (SSRIS), antidepressants, such as fluoxetine (Prozac) or paroxetine (Paxil), it might help if you are depressed and you have pain and constipation.
  • Medications for pain. Pregabalin (Lyrica) or gabapentin (Neurontin) could alleviate the severe pain or swelling.

Medications specifically for IBS

The drugs approved for certain people with IBS include:

  • Alosetron (Lotronex). The drug is designed to relax the colon and slow the movement of waste through the lower part of the bowel. It can be prescribed only by providers enrolled in a special program. This medicine is only for severe cases of diarrhea-predominant IBS in women who have not responded to other treatments. It is not approved for use by men. Alosetron has been linked to rare but important side effects, so it should only be considered when other treatments are not successful.
  • Eluxadoline (Viberzi). Eluxadoline can relieve diarrhea by reducing muscle contractions and fluid secretion in the intestine. It also helps to improve the muscle tone in the rectum. Side effects may include nausea, abdominal pain, and mild constipation. Eluxadoline has also been associated with pancreatitis, which may be severe and more common in certain people.
  • Rifaximin (Xifaxan). This antibiotic can reduce bacterial overgrowth, and diarrhea.
  • Lubiprostone (Amitiza). Lubiprostone may increase the secretion of fluids in the small intestine to help with the passage of stool. It is approved for women who have irritable bowel syndrome with constipation, and is usually prescribed for women with severe symptoms that have not responded to other treatments.
  • Linaclotide (Linzess). Linaclotide may also increase the secretion of fluids in the small intestine to help pass the stool. Linaclotide may cause diarrhea, but taking the medication 30 to 60 minutes before eating can help.

Potential future treatments

Researchers are investigating new treatments for irritable bowel syndrome , such as the transplantation of fecal microbiota (FMT). Considered investigational at this time, FMT restores healthy intestinal bacteria by the placement of another person processed the stool in the colon of a person affected by IBS . Clinical trials for the study of the fecal matter transplants are currently in progress.

Lifestyle and home remedies

Simple changes in your diet and lifestyle often provide relief from IBS . Your body normally needs time to respond to these changes. Try:

  • Experiment with fiber. The fiber helps reduce constipation, but it can also cause gas and colic. Try to gradually increase the amount of fiber in your diet over a period of weeks with foods such as whole grains, fruits, vegetables, and beans. A fiber supplement can cause less gas and bloating foods rich in fiber.
  • Stay away from problem foods. Get rid of the foods that trigger symptoms.
  • Eat at regular hours. Do not skip meals, and try to eat at the same time each day to help regulate bowel function. If you have diarrhea, you may find that eating small, frequent meals that makes you feel better. But if you are constipated, eating large amounts of foods rich in fiber can help to move food through your intestines.
  • Exercise regularly. Exercise helps relieve depression and stress, stimulates contractions of the gut, and can help you feel better about himself. Ask a healthcare provider about an exercise program.

Alternative medicine

The role of alternative therapies in relieving the symptoms of IBS is unclear. Ask a health professional before starting any of these treatments. Alternative therapies include:

  • Hypnosis. A trained professional will teach you how to enter a relaxed state, and then we will help to relax the abdominal muscles. Hypnosis can reduce the pain and abdominal swelling. Several studies support the long-term effectiveness of hypnosis for IBS .
  • Mint. Studies show that, in people who have irritable bowel syndrome with diarrhea, especially coated pill that slowly releases the peppermint oil in the small intestine (enteric-coated peppermint oil) makes it easy to abdominal distension, urinary urgency, abdominal pain and painful bowel movements.
  • Probiotics. Probiotics are "good" bacteria that normally lives in the intestine and is found in certain foods, like yogurt and in dietary supplements. Recent studies suggest that certain probiotics can alleviate the symptoms of IBS, such as abdominal pain, abdominal distension, and diarrhea.
  • The reduction of stress. Yoga or meditation can help to relieve stress. You can take classes or practice at home with books, videos, or apps that you can download to a smartphone.

Preparing for your appointment

You may be referred to a provider who specializes in the digestive system, called a gastroenterologist.

What you can do

  • Be aware of any pre-appointment restrictions, such as restricting your diet before your appointment.
  • Write down your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down any triggers of the symptoms, such as specific foods.
  • Make a list of all your medications, vitamins and supplements.
  • Write down your key medical information, including other conditions.
  • Write down key personal information, including any recent changes or stressors in your life.
  • Write questions to ask their provider.
  • Ask a relative or friend to go with you, to help you remember what the health care professional says.

Questions to ask your doctor

  • What is the most likely cause of my symptoms?
  • What tests do I need? Is there any special preparation for them?
  • What treatment approach do you recommend? Are there side effects associated with these treatments?
  • Should I change my diet?
  • There are other lifestyle changes that you recommend?
  • Do you recommend that I talk with a counselor?
  • I have other health problems. How can I best manage these conditions?
  • If I have IBS, how long will it take for me to see to the improvement of therapy is you have been prescribed?

In addition to the questions you have prepared, do not hesitate to ask questions during your appointment anytime you don't understand something.

What to expect from your doctor

You'll likely be asked a couple of questions. Be prepared to answer them you can let go the more points you want to spend more time. You may ask:

  • What are your symptoms, and when they began?
  • How severe are the symptoms? Are continuous or occasional?
  • Is there something that seem to trigger your symptoms, such as food, stress or — women — your menstrual period?
  • You have lost weight without trying?
  • Have you had a fever, vomiting or blood in the stool?
  • Have you recently experienced a major emotional stress, difficulty, or loss?
  • What is the typical daily diet?
  • Have you ever been diagnosed with a food allergy or lactose intolerance?
  • Do you have any family history of diseases of the intestine or colon cancer?
  • How much would you say that your symptoms are affecting your quality of life, including personal relationships, and your ability to function in school or at work?

What you can do in the meantime

While you wait for your appointment:

  • Ask family members if any of your relatives have been diagnosed with the inflammatory bowel disease or colon cancer.
  • Begin to point out how often they occur, the symptoms and the factors that seem to trigger them.
Symptoms and treatment of Irritable bowel syndrome