Irritable Bowel Syndrome




Irritable bowel syndrome (IBS) is an illness characterized by intermittent abdominal cramps and constipation with alternating periods of diarrhea. Frequently the patient will notice mucus mixed in with the stool, but there should be no blood. It is estimated that over 20 million people have IBS. Two thirds of the patients are female.




The exact cause of irritable bowel syndrome is not known. In the past it used to be called spastic colitis or just colitis. These terms are actually incorrect since it is not a true inflammation of the bowel wall. It is said to be made worse by stress, although I frequently see it in people that deny any stress whatsoever. One theory is that it is a result of inadequate fiber in modern day diets. Over the years our colons or large intestines evolved to handle a large amount of fiber. In the last 100 years fiber has been eliminated from our diets through the processing of foods. This lack of fiber causes irregular contractions of the large intestines.


The usual symptoms are alternating diarrhea and/or constipation associated with abdominal cramps. The symptoms will get worse if you eat poorly as we frequently do while on vacation or out of town. Periods of stress seem to worsen the symptoms. The cramps can be located in any part of the stomach. Sometimes the cramps are severe enough to cause a visit to the emergency room. There are many different degrees of severity. There may just be an occasional mild episode, to a debilitating illness that causes frequent absenteeism from work. It is important to realize that this illness will not shorten your life.




Interestingly, there are no anatomical abnormalities noted when the large intestine is evaluated through special test. It is important to check the stool for blood using a special chemical test called the Hemoccult slide. This is very important in the evaluation since irritable bowel syndrome should not be associated with any bleeding. A colonoscopy is also usually performed which is putting a fiber optic tube into the colon and looking for abnormalities. Another test that is sometimes done is a barium enema which is an x-ray of the large intestine. The only reason that these test would be done in general is to rule out other conditions that can mimic the symptoms of irritable bowel syndrome such as Crohn’s disease.




The treatment of irritable bowel syndrome is quite simple, although it is difficult to get patients to comply with this treatment. The first step is to simply add fiber to the diet. This would include not only eating high fiber cereals in the morning and increasing fruits and vegetables in the diet, but also taking commercial brands of fiber. There are numerous different types of fiber products such as Metamucil or Citracil. They all work about the same, but it is probably less expensive to get a generic form of fiber. I usually recommend that patients start with 1 teaspoon every day for 3 days and then increase by 1 teaspoon every 3 days until they are taking the equivalent of 6 to 9 teaspoons. This would be 2 to 3 heaping tablespoons every day. This can be taken all at once or divided into frequent smaller doses. It can be mixed with water, orange juice or anything that you want. This treatment is totally benign and can even be taken when you are pregnant. It has the advantage of possibly reducing the incidence of colon cancer by diluting the cancer causing substances that are frequently found in our diets. This would result in less exposure of the bowel wall to the cancer producing chemicals in our diet. The American Cancer Society recommends that everyone add fiber to their diet. Some physicians say that our large intestines evolved over the years to handle 40-50 grams of fiber everyday. This is probably unrealistic for us to get unless we eat fiber multiple times a day. I have seen numerous patients that have a complete or almost complete remission of their symptoms when they comply with this simple treatment. Side effects are mainly bloating which can be reduced by starting at a low dose and increasing slowly until the 2 to 3 heaping tablespoons are reached. If this treatment does not work or if it does not help at all then I would be inclined to proceed with a diagnostic evaluation to rule out other conditions that may mimic irritable bowel syndrome. Occasionally antispasmodic medication has to be added to the treatment. Drinking plenty of liquids and daily regular exercise are very helpful in reducing symptoms. In fact, exercise alone will usually reduce the severity and frequency of symptoms.



The information provided above is offered as a community service about health-care issues and is not a substitute for individual consultation. Advice on individual problems should be obtained from your personal physician. This information is based on research by the author and represents his interpretation of the literature.


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