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Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a common disorder caused by changes in how the intestinal tract functions. It is a disorder with varied symptoms ranging from abdominal pain, cramping, diarrhea, constipation or alternating diarrhea and constipation. It has often been referred to as spastic colon, colitis, nervous colon or spastic bowel syndrome. In spite of the chronic uncomfortable symptoms, it does not cause permanent damage to the colon and has not been associated with any increase risk of colon cancer. IBS is diagnosed when a person has abdominal pain or other symptoms at least three times per month, over a period of three months in the absence of another disease that would produce the pain. IBS has been subdivided into four subtypes based on symptoms:

  • IBS with constipation (IBS-C) – pain associated with hard stools at least 25% of the time.
  • IBS with diarrhea (IBS-D) – pain associated with loose stools at least 25% of the time.
  • Mixed IBS (IBS-M) – associated with alternating diarrhea and constipation at least 25% of the time.
  • Unsubtyped IBS (IBS-U) – associated with hard or loose stools less than 25% of the time. IBS has been shown to occur in anywhere from 3-20% of the population according many studies. It more commonly affects women than men and usually has its earliest signs and symptoms occurring prior to age 35. A recent study reported that one in six-seven people in the U.S. has IBS and it is the most common problem referred to gastroenterologists for evaluation.

What are the symptoms and causes of IBS?

The signs and symptoms of IBS can vary and may resemble other conditions or diseases. The most common symptoms are:

  • Abdominal or pelvic pain or cramping
  • Diarrhea or constipation – either singularly or alternating
  • Bloating
  • Increased gas formation or gas passage
  • Mucous in the stool – a clear liquid that is made by the intestinal tract as a lubricant and protective substance for the lining of the intestines
  • Sensation that the bowel movement is incomplete

The diagnosis is made if the symptoms occur at least three days per month over a period of three months. The cause of IBS is unknown but is felt to be related to several physical and mental factors:

  • Brain-gut signal problems – there are signals between the intestinal tract and the brain that control the function of the intestines. If changes occur with the signals, then IBS may be stimulated to occur. Abnormal levels of serotonin may be a contributing factor.
  • Mechanical problems with the intestines – normal motility of the intestines may not be happening leading to constipation or diarrhea. Spasms or sudden strong muscle contractions may occur which leads to pain.
  • Stress – signs and symptoms usually worsen under times of stress or any change in daily routines.
  • Hormonal changes – signs and symptoms may be brought on near the menstrual period or near the time of menopause.
  • Foods – the intestinal tract may respond to certain food such as chocolate, milk products, certain vegetables or fruits, alcohol, caffeine or sugar free products and may stimulate symptoms to occur.
  • Mental health disorders – panic patterns, anxiety and depression may stimulate symptoms.

People with IBS often have other conditions which can be associated with IBS including chronic fatigue, chronic pain with no physical cause identified, chronic pelvic pain and depression.

How is IBS treated?

  • Diet – small meals four to six times per day may be helpful, and using meals low in fat and high in carbohydrates such as rice, pasta and cereals. Avoid any foods that seem to act as a trigger to increase symptoms. An increase in fiber may decrease constipation and allow the stool to pass easier. Be sure to drink plenty of liquids.
  • Laxatives – may be helpful if constipation is a major symptom.
  • Anti-diarrheals – medications such as Imodium can help if diarrhea is the major symptom.
  • Eliminate high-gas foods – carbonated beverages, salads, raw vegetables such as broccoli, cauliflower and cabbage.
  • Antispasmodic medications – these medications help control the muscle spasms and reduce pain – hyoscine, cimetropium and pinaverium.
  • Lubiprostone (Amitiza) – prescribed for individuals with IBS-C and works to improve symptoms of pain, stool consistency and constipation.
  • Antidepressants – reduce depression and control the nerve cells that control the intestinal tract.
  • Exercise – studies have shown that exercise can relieve depression and stress and stimulate normal contractions of the intestinal tract. Yoga has been shown to be helpful in several recent studies.
  • Massage and/or meditation – relieves stress which may improve symptoms.
  • Acupuncture – may reduce muscle spasms and improve bowel function.
  • Herbs – Peppermint has been used for IBS as it is a natural antispasmodic but it can increase heartburn if the tablet is not enteric coated.
  • Probiotics – the administration of “good” bacteria to help improve bowel function and may help reduce pain and bloating.

If you have concerns that you may have IBS, discuss your concerns with your physician.

More about Dr. Aulds

Donald G. Aulds, MD is an Obstetrician and Gynecologist and currently serves as the Medical Director for both the Women's Center and the Best Start Program of North Alabama. He is a Diplomat of the American Board of Obstetrics and Gynecology and Fellow of the American College of Obstetricians and Gynecologists.

Dr. Aulds completed his medical education at Louisiana State University School of Medicine, New Orleans, LA and his Internship and Residency in Obstetrics and Gynecology at Ochsner Medical Foundation, New Orleans, LA.

Dr. Aulds has been an active member of the Huntsville Hospital Medical Staff since 1980.