IBS is the most common of all digestive conditions – more common than gallbladder disease, stomach ulcers, hepatitis, cirrhosis of the liver, ulcerative colitis or Crohn's disease. It occurs in both adults and children, and affects about 15 per cent of the population. About two-thirds of those affected are women. IBS seems to strike across racial, ethnic and national boundaries. It often begins between adolescence and age 40, becoming a chronic or long-term problem for many people.

The good news is that IBS is not associated with serious medical consequences. It does not lead to cancer of the bowel or other serious bowel diseases. Nor does it stress other organs such as the heart, liver or kidneys. It is not a defect in the structure of the intestine. IBS will not shorten your life.

Still, IBS can significantly impact those who have it. It is a disorder affecting how the large intestine works. The resulting group of symptoms (known as a syndrome) can be particularly troublesome. Next to the common cold, IBS is the second most frequent reason for days missed from work. It can significantly change one’s quality of life.

Does IBS occur in children?

Ten to 15 per cent of school age children are believed to show symptoms of IBS. The diagnosis of abdominal pain in children, particularly young children, can be difficult. If your child has chronic abdominal pain, diarrhea or constipation, a thorough assessment is recommended. Your family physician may refer your child to a paediatric gastroenterologist, a doctor for children who have problems of the digestive system.

What are the symptoms of IBS and how is it diagnosed?

There are no specific tests for or symptoms unique to IBS. Your doctor may order tests done to rule out other bowel conditions. The diagnosis of IBS depends on whether or not your symptoms match those that have been established for IBS. It can be diagnosed on the basis of at least 12 weeks of abdominal discomfort in the previous year. These weeks do not need to be all in a row. For the condition to be considered IBS, abdominal discomfort must also have at least two of the three following features.

Abdominal discomfort is relieved by defecation (having a bowel movement).
A change in frequency of bowel movements occurs along with the start of the discomfort.
The start of the discomfort is associated with a change in the appearance of the stool.

Additional symptoms that support the diagnosis of IBS are:

either very few or excessive bowel movements each day
hard or lumpy stools
loose or watery stools
straining during bowel movements
having to rush to the bathroom to have a bowel movement
feeling of incomplete emptying of the bowels
passing mucus (white material) along with a bowel movement
abdominal fullness, bloating or swelling.

If you are experiencing any of the following symptoms, you most likely do not have IBS. See your doctor for further assessment as soon as possible.

Pain that often prevents you from getting to sleep or awakens you
Diarrhea that interferes with your sleep
Blood in your stools
Unexplained weight loss
Fever

What causes IBS?

The exact cause is not known. However, tremendous advances in understanding this condition have been made in the last 10 years. We know what makes the bowel move too quickly (diarrhea) or too slowly (constipation). Recently, certain natural chemicals have been discovered that send signals back and forth between the gut and the brain. A new class of medications have been developed as a result.

In addition, it has become clear that IBS sufferers are hypersensitive to a variety of things that stimulate the bowel. The impact of diet and psychological factors is currently being actively researched. Regardless of the cause, researchers believe that contractions of the bowel lose their natural pattern. Contractions become uncoordinated and more intense. This results in a change in the way food moves through the intestines, perhaps causing the cramps, bloating and other bowel symptoms of IBS (see illustration).

How is IBS treated?

Treatment strategies for IBS should be directed at the main symptoms. Treatment depends on whether diarrhea or constipation is most common. Many different methods of treatment can be tried, which may work for some individuals, but not for others.

Medications

Over the Counter (OTC) - Many doctors have recommended and IBS sufferers have used OTC antidiarrhea drugs for relief of IBS with diarrhea. These drugs can effectively reduce the amount of diarrhea. However, they seldom help with other symptoms such as discomfort and bloating. Generally, OTC drugs for gas relief are safe but not always effective. OTC laxatives are in the same category and should be used with caution. Do not use OTC drugs for prolonged periods of time without consulting your doctor.

Prescription drugs for constipation, diarrhea and bowel spasms have been extensively used, but with varying success. Studies do not show they are effective for every IBS sufferer, though some find them helpful. Tricyclic anti-depressants have been shown to be effective at relieving abdominal pain, but do not relieve other IBS symptoms. You and your doctor should closely monitor the use of anti-depressants because of their potential side effects.

New medications for the treatment of IBS have evolved from our better understanding of the relationship between gut and brain. One now available in Canada is tagaserod (Zelnorm™). It has been approved only for the short-term treatment of women whose main bowel symptom is constipation. It is moderately effective. However, the safety and effectiveness of tagaserod in men with IBS and constipation have not been demonstrated. Another new medication, currently not available in Canada, is alosetron (Lotronex™). It has been approved in the U.S. for treating women with IBS and severe diarrhea.

Medication alone will not successfully treat IBS. In fact, improvement almost always requires patient reassurance and education, as well as attention to diet and psychological factors.

Resources

For further information, contact your doctor. Many communities have local support groups or hospital programs that can provide educational materials for people with IBS. You may find the following Internet sites useful. IBS Association:
www.ibsassociation.org
International
Foundation for Functional
Gastrointestinal Disorders:
www.iffgd.org

Irritable Bowel Syndrome (IBS) Self Help and Support Group:
www.ibsgroup.org

Psychological therapy

IBS is often associated with psychological or psychiatric disorders, especially stress, anxiety and depression. On the other hand, many sufferers do not have any obvious psychological problems. Many who experience abdominal pain and constipation with IBS are tense. IBS is not caused by stress, but many people say it makes their symptoms worse.

Lifestyle changes often help in dealing with chronic medical conditions. This is especially true with IBS. Stress management, relaxation courses, and counselling with respect to anxiety and depression have all helped many IBS sufferers. Keeping mentally and physically active, maintaining a contented environment and healthy relationships are important in controlling IBS.

Diet

Nutrition is a controversial but important aspect of managing IBS. Certain foods may aggravate IBS, and about 75 per cent of patients have pain after eating. Many IBS sufferers describe difficulty with fatty meals, coffee, alcohol, carbonated drinks, and foods that increase gas production such as cabbage and beans. Some IBS patients feel they are affected by food that most other people tolerate well.

A high-fibre diet is often recommended to patients with IBS. Research has not proved that high-fibre diets are always helpful. It does seem to help those whose symptoms consist of alternating constipation and diarrhea. However, adding dietary fibre may make symptoms worse in as many as 25 per cent of patients.

Alternative treatments

Some IBS sufferers turn to alternative therapies to reduce symptoms. Keep in mind that most alternative therapies have not been tested in rigorous clinical trials. Studies on the use of acupuncture, various herbs and hypnosis have so far shown mixed effectiveness. There has been great interest in the use of probiotics (live bacteria cultures) in the treatment of gastrointestinal disorders. However, their role in treating IBS is yet to be determined.

IBS is a complex syndrome that can drastically affect one’s ability to lead a normal life. Managing IBS requires attention to several factors, no one of which is likely to provide complete relief. Its course is unpredictable in both severity of symptoms and how long they last. Still, IBS does not lead to other more serious long-term consequences. Many treatments may relieve or reduce symptoms for most people with IBS.

If you have been diagnosed with IBS, take heart. While there is no cure yet, many ways exist to successfully manage and prevent symptoms. You can control IBS, instead of having it control you!

Irritable Bowel Syndrome Easing a condition that can tie you in knots