2nd September 19:48
Merck Manual..a better explanation of IBS & Treatment
I saw this on the Merck Manual and thought it was a much better explanation
of IBS and treatment. It still focuses too much on emotion, but puts in a
lot of inf. on diet change and other issues. Mainly it shows that there are
different causes for different people with IBS.
I hope this helps some.
Irritable Bowel Syndrome
Irritable bowel syndrome is a disorder of motility of the entire digestive
tract that causes abdominal pain, constipation, or diarrhea.
In this disorder, the digestive tract is especially sensitive to many
stimuli. Stress, diet, drugs, hormones, or minor irritants may cause the
digestive tract to contract abnormally, usually leading to diarrhea. Periods
of constipation may occur between bouts of diarrhea. Irritable bowel
syndrome affects women 3 times more often than men.
The brain has enormous control over the digestive system. Stress, anxiety,
depression, fear, and virtually any strong emotion can lead to diarrhea,
constipation, and other changes in bowel function and can further worsen a
flare-up (bout or attack) of irritable bowel syndrome.
During a flare-up, the contractions of the digestive tract become stronger
and more frequent, and the resulting rapid transit of food and stool through
the large intestine often leads to diarrhea. Crampy pain seems to result
from the strong contractions of the large intestine and increased
sensitivity of the receptors in the large intestine that sense stretching
and pressure. Flare-ups almost always occur when a person is awake; they
rarely wake a person from sleep.
For some people, high-calorie meals or a high-fat diet may be to blame. For
other people, wheat, dairy products, coffee, tea, or citrus fruits appear to
aggravate the symptoms, but it is not clear whether these foods are actually
the cause. Others find that eating too quickly or eating after too long a
period without food stimulates a flare-up of irritable bowel syndrome.
Symptoms are commonly triggered by eating, often by eating too quickly or
too much. A few minutes later, diarrhea with pain occurs. The diarrhea may
begin very suddenly and with extreme urgency. Sometimes the urgency is so
strong that the person loses control and cannot reach a bathroom in time.
Diarrhea during the night is rare. Sometimes constipation and diarrhea
alternate. Mucus often appears in the stool. The pain may come in bouts of
continuous dull aching or cramps, usually over the lower abdomen. The person
may experience bloating, gas, nausea, headaches, fatigue, depression,
anxiety, and difficulty concentrating. Having a bowel movement often
relieves the pain. Periods of stress may worsen symptoms.
Most people with irritable bowel syndrome appear healthy. A physical
examination generally does not reveal anything unusual except sometimes
tenderness over the large intestine. Doctors generally perform some
tests--for example, blood tests, a stool examination, and a
sigmoidoscopy--to differentiate irritable bowel syndrome from Crohn's
disease, ulcerative colitis, collagenous and lymphocytic colitis, and the
many other diseases that can cause abdominal pain and changes in bowel
habits. These test results are usually normal, although the stool may be
watery. The results of a sigmoidoscopy, which may cause spasms and pain, are
normal. Sometimes other tests--such as abdominal ultrasound, x-rays of the
intestines, or a colonoscopy--are used.
The treatment for irritable bowel syndrome differs from person to person.
People who can identify particular foods or types of stress that bring on
the problem should avoid them if possible. For most people, especially those
who tend to be constipated, regular physical activity helps keep the
digestive tract functioning normally.
In general, a normal diet is best. Many people do better eating frequent,
smaller meals rather than less frequent, larger meals (for example, five or
six small meals rather than three large meals a day). People with abdominal
expansion (distention) and increased gas (flatulence) should avoid beans,
cabbage, and other foods that are difficult to digest. Sorbitol, an
artificial sweetener used in dietetic foods and in some drugs and chewing
gums, should not be consumed in large amounts. Fructose, a common
constituent of fruits, berries, and some plants, should be eaten only in
small amounts. A low-fat diet helps some people. People who have both
irritable bowel syndrome and lactase deficiency should not eat dairy
Some people with irritable bowel syndrome can improve their condition by
eating more fiber. They can take a tablespoon of raw bran with plenty of
water and other fluids at each meal, or they can take psyllium mucilloid
supplements with two glasses of water. However, increasing the dietary fiber
may aggravate some symptoms, such as flatulence and bloating.
Antispasmodic drugs, which slow the function of the digestive tract, are
frequently prescribed but have not been proved effective in all people with
irritable bowel syndrome. Antidiarrheal drugs help people with diarrhea.
Aromatic oils, such as oil of peppermint, often help symptoms of flatulence
If an emotional disorder is identified as the cause, treatment of the
disorder may relieve irritable bowel syndrome symptoms. Such treatment may
include the use of antidepressants, mild tranquilizers, psychotherapy,
hypnosis, and behavior modification techniques.