July 13, 2007

Irritable Bowel Syndrome (IBS)- Continuation

What is the treatment for IBS?
Unfortunately, many people suffer from IBS for a long time before seeking medical treatment. Up to 70 percent of people suffering from IBS are not receiving medical care for their symptoms. No cure has been found for IBS, but many options are available to treat the symptoms. Your doctor will give you the best treatments available for your particular symptoms and encourage you to manage stress and make changes to your diet.

Medications are an important part of relieving symptoms. Your doctor may suggest fiber supplements or laxatives for constipation or medicines to decrease diarrhea, such as Lomotil or loperamide (Imodium). An antispasmodic is commonly prescribed, which helps to control colon muscle spasms and reduce abdominal pain. Antidepressants may relieve some symptoms. However, both antispasmodics and antidepressants can worsen constipation, so some doctors will also prescribe medications that relax muscles in the bladder and intestines, such as Donnapine and Librax. These medications contain a mild sedative, which can be habit forming, so they need to be used under the guidance of a physician. Medications available specifically to treat IBS are

Alosetron hydrochloride (Lotronex), which has been reapproved with significant restrictions by the U.S. Food and Drug Administration (FDA) for women with severe IBS who have not responded to conventional therapy and whose primary symptom is diarrhea. However, even in these patients, Lotronex should be used with great caution because it can have serious side effects such as severe constipation or decreased blood flow to the colon.

Tegaserod maleate (Zelnorm), which has been approved by the FDA for the short-term treatment of women with IBS whose primary symptom is constipation. Zelnorm is prescribed for a standard 4 to 6 weeks. If a person feels better and experiences a decrease in symptoms, the doctor may prescribe Zelnorm for an additional 4 to 6 weeks.

With any medication, even over-the-counter medications such as laxatives and fiber supplements, it is important to follow your doctor’s instructions. Some people report a worsening in abdominal bloating and gas from increased fiber intake, and laxatives can be habit forming if they are used too frequently.

Medications affect people differently, and no one medication or combination of medications will work for everyone with IBS. You will need to work with your doctor to find the best combination of medicine, diet, counseling, and support to control your symptoms.

How does stress affect IBS?
Stress—feeling mentally or emotionally tense, troubled, angry, or overwhelmed—can stimulate colon spasms in people with IBS. The colon has many nerves that connect it to the brain. Like the heart and the lungs, the colon is partly controlled by the autonomic nervous system, which responds to stress. These nerves control the normal contractions of the colon and cause abdominal discomfort at stressful times. People often experience cramps or “butterflies” when they are nervous or upset. In people with IBS, the colon can be overly responsive to even slight conflict or stress. Stress makes the mind more aware of the sensations that arise in the colon, making the person perceive these sensations as unpleasant.

Some evidence suggests that IBS is affected by the immune system, which fights infection in the body. The immune system is affected by stress. For all these reasons, stress management is an important part of treatment for IBS. Stress management options include

stress reduction (relaxation) training and relaxation therapies such as meditation
counseling and support
regular exercise such as walking or yoga
changes to the stressful situations in your life
adequate sleep

Can changes in diet help IBS?
For many people, careful eating reduces IBS symptoms. Before changing your diet, keep a journal noting the foods that seem to cause distress. Then discuss your findings with your doctor. You may want to consult a registered dietitian who can help you make changes to your diet. For instance, if dairy products cause your symptoms to flare up, you can try eating less of those foods. You might be able to tolerate yogurt better than other dairy products because it contains bacteria that supply the enzyme needed to digest lactose, the sugar found in milk products. Dairy products are an important source of calcium and other nutrients. If you need to avoid dairy products, be sure to get adequate nutrients in the foods you substitute, or take supplements.

In many cases, dietary fiber may lessen IBS symptoms, particularly constipation. However, it may not help with lowering pain or decreasing diarrhea. Whole grain breads and cereals, fruits, and vegetables are good sources of fiber. High-fiber diets keep the colon mildly distended, which may help prevent spasms. Some forms of fiber keep water in the stool, thereby preventing hard stools that are difficult to pass. Doctors usually recommend a diet with enough fiber to produce soft, painless bowel movements. High-fiber diets may cause gas and bloating, although some people report that these symptoms go away within a few weeks. (For information about diets for people with celiac disease, please see NIDDK's Celiac Disease fact sheet.) Increasing fiber intake by 2 to 3 grams per day will help reduce the risk of increased gas and bloating.

Drinking six to eight glasses of plain water a day is important, especially if you have diarrhea. Drinking carbonated beverages, such as sodas, may result in gas and cause discomfort. Chewing gum and eating too quickly can lead to swallowing air, which also leads to gas.

Large meals can cause cramping and diarrhea, so eating smaller meals more often, or eating smaller portions, may help IBS symptoms. Eating meals that are low in fat and high in carbohydrates such as pasta, rice, whole-grain breads and cereals (unless you have celiac disease), fruits, and vegetables may help.

Is IBS linked to other diseases?
As its name indicates, it is a syndrome—a combination of signs and symptoms. IBS has not been shown to lead to a serious disease, including cancer. Through the years, IBS has been called by many names, among them colitis, mucous colitis, spastic colon, or spastic bowel. However, no link has been established between IBS and inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis.

Points to Remember
IBS is a disorder that interferes with the normal functions of the colon. The symptoms are crampy abdominal pain, bloating, constipation, and diarrhea.

IBS is a common disorder found more often in women than men.

People with IBS have colons that are more sensitive and reactive to things that might not bother other people, such as stress, large meals, gas, medicines, certain foods, caffeine, or alcohol.

IBS is diagnosed by its signs and symptoms and by the absence of other diseases.

Most people can control their symptoms by taking medicines (laxatives, antidiarrhea medicines, antispasmodics, or antidepressants), reducing stress, and changing their diet.

IBS does not harm the intestines and does not lead to cancer. It is not related to Crohn’s disease or ulcerative colitis.

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