Focus on: IBS
by Amy Anderson, 27 March 2002, Daily Mail

This week, we investigate irritable bowel syndrome. It hits one in five people yet most would never talk about it. So what can you do if you have IBS?

What is it?

IBS is a functional disorder of the gastrointestinal tract, characterised by recurrent abdominal pain and discomfort, accompanied by alterations in bowel function.

It is hard to diagnose, as symptoms can vary widely, and needs to be monitored over a period of approximately 12 weeks for a proper diagnosis.

Fortunately, unlike more serious intestinal diseases such as ulcerative colitis and Crohn's disease, IBS doesn't cause inflammation or changes in bowel tissue, or increase the risk of colorectal cancer.

Symptoms of IBS can include: frequent bowel movements (more than three a day) or infrequent bowel movements (less than three a week), abnormal stool form (lumpy/hard or loose/watery), abnormal stool passage (straining, urgency or feeling of incomplete evacuation), extreme bloating, lethargy, nausea, abdominal pain or cramping, flatulence and mucus in the stool.

Symptoms may be intermittent and can range from severe to mild.

Who gets it?

Between 10 and 20 per cent of adults in the UK suffer from IBS and it is one of the most common bowel disorders in the Western world. It is twice as common in women as men and can last over a period of months or even years, often resurfacing during periods of high stress or lowered immunity.

IBS typically begins in adolescence or young adulthood. Although many older adults have it, about 30 per cent of people notice a reduction in symptoms as they get older.

It is important to see your doctor if a change in your bowel habits lasts longer than a week to ten days.

What causes it?

The causes of IBS are unknown, but are linked to the malfunction of the walls of the intestine, which are lined with layers of muscle that contract and relax as they move food from the stomach through the intestinal tract to the rectum.

Normally, these muscles contract and relax in a coordinated rhythm, but for IBS sufferers the contractions are stronger and last longer than normal.

Food is forced through the intestines more quickly, causing gas, bloating and diarrhoea. In some cases, however, the opposite occurs, food passage slows and stools become hard and dry.

Some researchers think IBS is caused by changes in the nerves that control sensation or muscle contractions in the bowel. Others believe the central nervous system may affect the colon.

And because women suffer more than men, researchers believe that hormonal changes also play a role.

For reasons that are still unknown, IBS suffers tend to react strongly to stimuli that don't bother other people.

Triggers for IBS can include gas or pressure on the intestines caused by certain foods, medications or even emotions. Chocolate, milk and alcohol might cause constipation or diarrhoea, for instance. Stress also appears to be a significant trigger. Sometimes another illness, such as an acute episode of infectious diarrhoea, can trigger IBS. Using antibiotics may also be a factor because they disrupt the normal bacterial flora living in the bowel.

If you are experiencing cramping and bloating mainly after eating dairy products or sugar-free products or sweets, the problem may not be irritable bowel syndrome.

Instead, your body may not be able to tolerate the sugar (lactose) in dairy products or the artificial sweeteners in many sugar-free products.

What happens if the Doctor thinks I have it?

Your doctor may recommend conducting several tests, including stool studies, to check infection, or may perform a flexible sigmoidoscopy - a test that examines the lower part of the colon with a flexible, lighted tube.

In some cases, your doctor may perform a colonoscopy, a diagnostic test in which a small, flexible tube is used to examine the entire length of the colon. These tests help rule out more serious conditions.

You may also have tests to determine whether you are lactose-intolerant.

Lactase is an enzyme needed to digest the sugar found in dairy products. If you lack this enzyme, you may have symptoms similar to those caused by IBS, including abdominal pain, gas and diarrhoea.

How is it treated?

In most cases, people can successfully control mild symptoms of IBS by learning to manage stress and making changes in their diet and lifestyle.

But if symptoms are either moderate or severe, you may need more help than lifestyle changes alone can offer.

For moderate symptoms of IBS, the doctor may suggest fibre supplements such as psyllium or methylcellulose or overthecounter medications such as loperamide (Imodium) to help control diarrhoea or constipation.

In some cases, you may be given drugs that affect certain activities of the nervous system (anticholinergics) to relieve painful bowel spasms.

If your symptoms include pain and depression, your doctor may recommend an antidepressant or a selective serotonin re-uptake inhibitor (SSRI).

These medications help relieve depression as well as inhibit the activity of neurons that control the intestines.

Finding ways to deal with stress can be extremely helpful in preventing or alleviating symptoms of IBS.

Regular exercise, yoga, massage or meditation can all be effective ways to relieve stress.

Deep breathing can also help, as you become calmer when you breathe from your diaphragm, the muscle that separates your chest from your abdomen.

It helps relax your abdominal muscles, which may lead to more normal bowel activity.

Studies show that hypnosis may reduce abdominal pain and bloating. In 1998, the National Institutes of Health (NIH) found that among other benefits, acupuncture could provide significant relief from chronic pain.

Although the NIH didn't study the effects of acupuncture on other symptoms of IBS, some people have found that acupuncture can relax muscle spasms and improve bowel function.

Changes in your diet and lifestyle can provide relief from symptoms of IBS. Although your body may not respond immediately to these changes, your goal is to find long-term, not temporary, solutions.

Should I change my diet?

Rich food high in saturated fat, such as butter and margarine, mayonnaise, nuts, cream, ice-cream and red meat, often aggravates symptoms and should be avoided.

So should caffeine and alcohol, which are diuretics and make fluid flow through the intestine the wrong way, which can alter bowel function.

And don't assume you should eat more fibre. It can have mixed results. Although it helps reduce constipation, it can also make diarrhoea, gas and cramping worse.

The best approach is to gradually increase the amount of fibre in your diet over a period of weeks. You may also want to talk to a dietician.

If you take a fibre supplement, be sure to introduce it gradually and drink at least eight to ten glasses of water every day to minimise gas, bloating and constipation.

If certain foods make your symptoms worse, don't eat them. Common culprits include alcohol, chocolate, caffeinated drinks, medications that contain caffeine, spicy foods, fruit juices, raw fruits and vegetables, dairy products, beans, broccoli, cabbage and other gassy foods and sugarfree sweeteners.

Don't skip meals, and try to eat about the same time each day to help regulate bowel function.

If you have diarrhoea, you may find that eating small, frequent meals makes you feel better. But if you're constipated, eating larger amounts of high-fibre foods may help move food through your intestines.

In addition, peppermint is a natural antispasmodic that relaxes smooth muscles in the intestines.

A study published in the Journal of Gastroenterology reported that 110 people with IBS who took one entericcoated peppermint capsule 15 to 30 minutes before meals found a moderate reduction in their symptoms.