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Irritable Bowel Syndrome
What is an Irritable Bowel?
Medically, irritable bowel syndrome (IBS) is known by a variety of other terms:
spastic colon, spastic colitis, mucous colitis and nervous or functional bowel.
Usually, it is a disorder of the large intestine (colon), although other parts
of the intestinal tract -- even up to the stomach -- can be affected.
The colon, the last five feet of the intestine, serves two functions in the
body. First, it dehydrates and stores the stool so that, normally, a well-formed
soft stool occurs. Second, it quietly propels the stool from the right side over
to the rectum, storing it there until it can be evacuated. This movement occurs
by rhythmic contractions of the colon.
When IBS occurs, the colon does not contract normally. instead, it seems to
contract in a disorganized, at times violent, manner. The contractions may be
terribly exaggerated and sustained, lasting for prolonged periods of time. One
area of the colon may contract with no regard to another. At other times, there
may be little bowel activity at all. These abnormal contractions result in
changing bowel patterns with constipation being most common.
A second major feature of IBS is abdominal discomfort or pain. This may move
around the abdomen rather than remain localized in one area. These dis-organized,
exaggerated and painful contractions lead to certain problems. The pattern of
bowel movements is often altered. Diarrhea may occur, especially after meals, as
the entire colon contracts and moves liquid stool quickly into the rectum. Or,
localized areas of the colon may remain contracted for a prolonged time. When
this occurs, which often happens in the section of colon just above the rectum,
the stool may be retained for a prolonged period and be squeezed into small
pellets. Excessive water is removed from the stool and it becomes hard.
Also, air may accumulate behind these localized contractions, causing the bowel
to swell. So bloating and abdominal distress may occur. Some patients see gobs
of mucous in the stool and become concerned. Mucous is a normal secretion of the
bowel, although most of the time it cannot be seen. IBS patients sometimes
produce large amounts of mucous, but this is not a serious problem.
The cause of most IBS symptoms -- diarrhea, constipation, bloating, and
abdominal pain -- are due to this abnormal physiology.
IBS is not a disease. Although the symptoms of IBS may be severe, the disorder
itself is not a serious one. There is no actual disease present in the colon. In
fact, an operation performed on the abdomen would reveal a perfectly normal
appearing bowel.
Rather, it is a problem of abnormal function. The condition usually begins in
young people, usually below 40 and often in the teens. The symptoms may wax and
wane, being particularly severe at some times and absent at others. Over the
years, the symptoms tend to become less intense.
IBS is extremely common and is present in perhaps half the patients that see a
specialist in gastroenterology. It tends to run in families. The disorder does
not lead to cancer. Prolonged contractions of the colon, however, may lead to
Diverticulosis, a disorder in which balloon-like pockets push out from the bowel
wall because of excessive, prolonged contractions.
Causes
While our knowledge is still incomplete about the function and malfunction of
the large bowel, some facts are well-known. Certain foods, such as coffee,
alcohol, spices, raw fruits, vegetables, and even milk, can cause the colon to
malfunction. In these instances avoidance of these substances is the simplest
treatment.
Infections, illnesses and even changes in the weather somehow can be associated
with a flare-up in symptoms. So can the premenstrual cycle in the female.
By far, the most common factor associated with the symptoms of IBS are the
interactions between the brain and the gut. The bowel has a rich supply of
nerves that are in communication with the brain. Virtually everyone has had, at
one time or another, some alteration in bowel function when under intense
stress, such as before an important athletic event, school examination, or a
family conflict.
People with IBS seem to have an overly sensitive bowel, and perhaps a super
abundance of nerve impulses flowing to the gut, so that the ordinary stresses
and strains of living somehow result in colon malfunction.
These exaggerated contractions can be demonstrated experimentally by placing
pressure- sensing devices in the colon. Even at rest, with no obvious stress,
the pressures tend to be higher than normal. With the routine interactions of
daily living, these pressures tend to rise dramatically. When an emotionally
charged situation is discussed, they can reach extreme levels not attained in
people without IBS. These symptoms are due to real physiologic changes in the
gut -- a gut that tends to be inherently overly sensitive, and one that
overreacts to the stresses and strains of ordinary living.
Diagnosis
The diagnosis of IBS often can be suspected just by a review of the patient's
medical history. In the end it is a diagnosis of exclusion; that is, other
conditions of the bowel need to be ruled out before a firm diagnosis of IBS can
be made.
A number of diseases of the gut, such as inflammation, cancer, and infection,
can mimic some or all of the IBS symptoms. Certain medical tests are helpful in
making this diagnosis, including blood, urine and stool exams, x-rays of the
intestinal tract and a lighted tube exam of the lower intestine. This exam is
called endoscopy, sigmoidoscopy or colonoscopy.
Additional tests often are required depending on the specific circumstances in
each case. If the proper medical history is obtained and if other diseases are
ruled out, a firm diagnosis of IBS then can usually be made.
Treatment
The treatment of IBS is directed to both the gut and the psyche. The diet
requires review, with those foods that aggravate symptoms being avoided.
Current medical thinking about diet has changed a great deal in recent years.
There is good evidence to suggest that, where tolerated, a high roughage and
bran diet is helpful. This diet can result in larger, softer stools which seem
to reduce the pressures generated in the colon.
Large amounts of beneficial fiber can be obtained by taking over-the-counter
bulking agents such as psyllium mucilloid (Metamucil, Konsyl) or methylcellulose
(Citrucel).
As many people have already discovered, the simple act of eating may, at times,
activate the colon. This action is a normal reflex, although in IBS patients it
tends to be exaggerated. It is sometimes helpful to eat smaller, more frequent
meals to block this reflex.
There are certain medications that help the colon by relaxing the muscles in
the wall of the colon, thereby reducing the bowel pressure. These drugs are
called antispasmodics. Since stress and anxiety may play a role in these
symptoms, it can at times be helpful to use a mild sedative, often in
combination with an antispasmodic.
Physical exercise, too, is helpful. During exercise, the bowel typically quiets
down. If exercise is used regularly and if physical fitness or conditioning
develops, the bowel may tend to relax even during non-exercise periods. The
invigorating effects of conditioning, of course, extend far beyond the intestine
and can be recommended for general health maintenance.
As important as anything else in controlling IBS is learning stress reduction,
or at least how to control the body's response to stress. It certainly is
well-known that the brain can exert controlling effects over many organs in the
body, including the
intestine.
Summary
Patients with IBS can be assured that nothing serious is wrong with the bowel.
Prevention and treatment may involve a simple change in certain daily habits,
reduction of stressful situations, eating better and exercising regularly.
Perhaps the most important aspect of treatment is reassurance. For most
patients, just knowing that there is nothing seriously wrong is the best
treatment of all, especially if they can learn to deal with their symptoms on
their own.
reprinted with the kind permission of
Jackson Gastroenterology
Expert
resources on Irritable Bowel Syndrome below.
U.N.C Center for Functional GI and Motility Disorders
MayoClinic
What Is Irritable Bowel Syndrome?
IFFGD
International Foundation for Functional
Gastrointestinal Disorders
UCLA/CURE Neuroenteric Disease Program
IBS Health
The Mind-Body Digestive Center
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