Managing irritable bowel syndrome

These are all common complaints recently voiced by people dealing with irritable bowel syndrome (IBS), a chronic condition characterized by abdominal pain or cramping and changes in bowel function – including bloating, gas, diarrhea and constipation. Some people experience only mild symptoms of IBS. Others have intermittent episodes, where the symptoms come and go. Still others may have severe and debilitating forms of the condition.

“I’ve struggled with abdominal pain and constipation for over 15 years it seems like nothing really helps.”

“I’ve had bouts of cramping and diarrhea for nearly 6 months.”

“It’s hard to go to work – the bloating and diarrhea make it hard to sit at my desk all day.”

“She’s had the symptoms since kindergarten. Now she’s in 7th grade, and she’s still having the diarrhea, cramping and stomach pains. We just don’t know what to do anymore.”

These are all common complaints recently voiced by people dealing with irritable bowel syndrome (IBS), a chronic condition characterized by abdominal pain or cramping and changes in bowel function – including bloating, gas, diarrhea and constipation. Some people experience only mild symptoms of IBS. Others have intermittent episodes, where the symptoms come and go. Still others may have severe and debilitating forms of the condition.

For people with mild forms of IBS, the condition may be a minor inconvenience. For others, the pain and symptoms may seem unbearable. In general, the key to living with IBS is to first learn about your symptoms and then determine what you can do to manage and tolerate them.

“There’s no cure for IBS, so the key is learning about the condition and then adopting healthier lifestyles that will help you manage your symptoms,” says Brenda Luther, R.N., an IBS educator at Mayo Clinic, Rochester, Minn.

Telltale signs and symptoms

Most of the symptoms of IBS result from spasms in the intestines, increased sensitivity of the intestines and movement of materials through the intestines either too quickly or too slowly. Signs and symptoms may include:

• Diarrhea that may be urgent, explosive and worse after meals
• Constipation that may be uncomfortable, with straining and a feeling of incompleteness after bowel movements
• Diarrhea alternating with constipation
• Bloating, gas or abdominal swelling
• Mucus on stools
• Abdominal pain and cramping that may improve when you pass gas or have a bowel movement
• Nausea Indigestion

You may have one or more symptoms at any time. Any symptom may range from mild to severe, becoming worse with stresses such as travel, social events, changes in daily routines, poor nutrition, large meals and during parts of the menstrual cycle.

“The symptoms of IBS differ from person to person,” says Luther. “And, stressful events – both good and bad – may trigger new symptoms or worsen those that a person typically experiences.”

Breaking down the causes

It’s unclear exactly what causes IBS. Normally, the muscles in your intestine contract and relax in a coordinated rhythm as food is pushed from your intestinal track to your rectum. But if you have IBS, the contractions are stronger and last longer than normal. Food may be forced through your intestines more quickly, causing gas, bloating and diarrhea. In some cases the opposite may occur food passage slows and your stools become hard and dry. Why this happens is unclear. For this reason, IBS used to be considered a psychological problem rather than a physical one.

But IBS is a very real physical problem. An estimated 55 million Americans have the condition – that’s nearly 15 of every 100 adults. It ranks second only to the common cold as a cause of lost work time and accounts for about 3 million physician visits in the United States every year.

Unlike many chronic conditions, IBS isn’t a condition that will shorten your life. And it’s unrelated to several other disorders of the digestive system, including ulcerative colitis and Crohn’s disease. Additionally, IBS doesn’t cause cancer, and it doesn’t make a person more likely to develop cancer. Before diagnosing IBS your doctor will have considered and excluded other conditions, particularly those affecting the colon, which may cause similar symptoms.

Making matters worse

“While we don’t know what exactly causes IBS, we do know things that aggravate it,” says Luther. According to Luther, aggravators of IBS may include:

• Stressful situations, both positive and negative. Planning a wedding, traveling during the holidays and starting a new job can all provoke symptoms of IBS.
• Certain foods and beverages, including alcohol, carbonated beverages, high-fat and greasy foods.
• Specific ingredients – like fructose (the natural sugar found in fruit) and lactose (the natural sugar found in milk) – also may aggravate symptoms.
• Changes in your schedule – whether at work or at home.

Moving forward

Since IBS isn’t a life-threatening condition, the most important goal of treatment is to manage your symptoms and minimize them so that you can participate in regular, day-to-day activities.

“The best way to manage IBS is to develop new, healthier lifestyle behaviors that can help alleviate symptoms,” says Luther. “It’s important to focus on behaviors that we can change, like exercise, diet and stress management.”

Focusing on these three key areas – physical activity, nutrition and stress – may help you adopt long-term habits to help you manage the symptoms of IBS. Improve your nutrition. Healthy bowel function may be promoted by improving your dietary habits. Consider doing the following:

Eat regularly scheduled meals.

Eating meals at about the same time each day can help regulate bowel function.

Try not to skip meals or overeat. You may find that eating small, frequent meals agrees with you better than eating three larger meals.

Increase your intake of fiber-rich foods. Fiber may help improve the symptoms of IBS, whether you have diarrhea or constipation. The best sources of fiber are whole-grain products, raw or cooked fruits and vegetables, and dried beans and peas.

Eat 20 to 30 grams of fiber each day. Increase your amount of fiber gradually. If you increase it suddenly, it may cause more gas and bloating.

Drink adequate fluids. Fiber absorbs liquid in your intestine, so drink enough fluid to form a soft, bulky stool. Otherwise, you may become constipated.

Drink at least eight glasses of fluid each day, not counting beverages containing caffeine or alcohol.

Eat a balanced diet. Eat a diet rich in fruits and vegetables. Remember, every food doesn’t agree with every person. As you work toward eating a balanced diet, try different foods to find those that agree with you.

Avoid foods that seem to increase your symptoms. Caffeine, alcohol and tobacco. Decrease or eliminate your use of caffeine, alcohol and tobacco because they may irritate your digestive organs.

Manage your stress. Worry, anxiety and other mental stress can cause digestive problems, such as an upset stomach or diarrhea, in anyone. These types of symptoms occur more frequently and more severely in people with IBS. Symptoms of pain and irregular bowels may increase stress and make your symptoms worse. If possible, identify and avoid stressors that make your IBS symptoms worse.

Make time to relax spending quiet time alone can be therapeutic and rejuvenating. Prioritize your daily tasks. Know when enough is enough and say no to tasks that may overload your schedule.Some people may benefit from behavior therapy. A therapist may assist you in identifying the lifestyle changes that may be of benefit to you. He or she may address time management, problem solving and relaxation issues in an effort to help you cope with your condition.

Increase your physical activity. Besides improving your overall health, exercise can provide benefits that are especially valuable to people with IBS. It can help decrease feelings of stress and may help simulate rhythmic contractions of your intestines. Before you begin an exercise program, discuss it with your doctor. The best program for you will depend on individual factors such as your age and overall health.

Medications may be used to make you feel more comfortable as you develop your new, healthy habits. Your physician may recommend one or more of the following:Antispasmodic medications, such as dicyclomine (Bentyl), may relax intestinal muscles and relieve spasms. Antidepressants, like imipramine (Tofranil, others) and amitriptyline (Elavil), may decrease nerve sensitivity. Antidiarrheal medications, like loperamide (Imodium, Kaopectate, Pepto-Bismol), slow the speed that food moves through the intestines. Pain relieving medications may help reduce IBS-related pain.

Over-the-counter medications, such as simethicone (Gas-X, Mylicon) or antacids (Maalox, Mylanta, Tums) may relieve gas, bloating, nausea, heartburn and indigestion. Fiber supplements, like Metamucil, Citrucel and Konsyl, may help manage constipation and some diarrheal conditions. Improvement may be gradual – your body likely won’t respond immediately to changes that you make.

Because the goal is to find long-term solutions, don’t be discouraged if progress seems slow.”Lifestyle changes take time,” says Luther. “You cannot change overnight. Be patient and work on changing one behavior at a time.”(Source: Mayo Clinic, 23 June 2003)