If you’re among the estimated one in six American adults who suffers from chronic abdominal pain or discomfort due to irritable bowel syndrome (IBS), you know that effective, long-lasting treatment remains elusive.
Good news: The American College of Gastroenterology recently published a review of the most effective treatments, including dietary approaches, nondrug therapies and medications, that should finally give relief to people with IBS.
A disorder of the digestive tract, irritable bowel syndrome (IBS) affects about 35 million Americans. Symptoms include bloating, abdominal pain and changes in bowel function (constipation and/or diarrhea). The cause of the condition is unknown, but genetics may play a role. IBS symptoms can be triggered or worsened by such factors as diet and emotional upset.
With IBS, the nerves that control the gastrointestinal tract are hypersensitive — that is, sensations that other people wouldn’t notice, including those produced by the ordinary process of digestion, are amplified and often painful.
Research has shown that many times IBS begins after a severe bout of digestive upset caused by a bacterial or viral infection, such as “stomach flu” or “traveler’s diarrhea” — perhaps because such infections temporarily or permanently affect nerves in the gastrointestinal tract.
What most people don’t know: Researchers have found that people with a history of abuse (physical, emotional or sexual) are at heightened risk for IBS — probably due to stress on the intestinal nervous system.
Diagnosis of IBS can be tricky because symptoms, including abdominal pain, bloating and troublesome bowel patterns (frequent or persistent bouts of diarrhea, constipation or both, generally occurring at least three days a month), often wax and wane in severity. So-called “flares” (episodes of severe symptoms) may occur weeks, months — or even years — apart.
IBS symptoms that may be missed: Mucus in the stool or straining during, or a feeling of incomplete evacuation after, a bowel movement.
If you think you may have IBS: See your primary care doctor. IBS almost always can be identified with a standard history and physical exam.
Lactose intolerance (the inability to digest dairy sugar) can lead to misdiagnosis because its classic symptoms — bloating and diarrhea — mimic those caused by IBS.
My advice: If your digestive problems seem to worsen when you consume dairy products, follow an elimination diet.
What to do: Go without all dairy products for seven to 10 days — and slowly reintroduce each type of dairy product, such as yogurt or cheese, to see how much you can tolerate before symptoms return.
IBS food triggers that often are overlooked — try the elimination diet (as described above) with each…
Soft drinks and other high-fructose drinks and foods. Fructose — a sugar commonly added to carbonated soft drinks and sports drinks and naturally occurring in fruit juices and high-sugar fruits (such as dried fruits) — can cause bloating, gas and diarrhea in people with IBS.
Caffeine. It stimulates the digestive tract and may cause cramps and more frequent bowel movements in people with IBS.
For many people with IBS — especially those with recurrent constipation — adequate fiber intake (25 mg to 30 mg per day) helps relieve symptoms. If you are not consuming this much fiber, increase your intake of fruits and whole grains or take a fiber supplement containing psyllium (such as Metamucil or Konsyl).
Fiber-rich foods I recommend most often: Raspberries, artichokes, green peas, almonds, oatmeal, oat bran and whole-grain bread.
Important: IBS patients who have recurrent diarrhea should limit fiber intake to about 10 g daily and avoid leafy greens and cruciferous vegetables (such as cauliflower) because high-fiber foods can worsen symptoms in these patients.
If dietary changes (described above) do not relieve IBS symptoms, there is credible scientific evidence to support the use of two natural remedies for IBS…
Peppermint oil. In enteric-coated capsule form, peppermint oil appears to relax smooth muscle in the gastrointestinal tract and therefore reduce IBS abdominal pain caused by muscle spasms. For dosage, follow label instructions.
Probiotics. Probiotics augment the “friendly” bacteria in the large intestine. Probiotic dietary supplements containing the Bifidobacterium species are worth trying when bloating and diarrhea are prominent. Look for probiotic supplements providing at least 100 million colony-forming units per dose. Be patient — it may take up to three months to produce substantial benefits.
If your IBS persists, there are medication options for…
Diarrhea. Try an antidiarrheal medication, such as the over-the-counter (OTC) product loperamide (Imodium) or the prescription drug diphenoxylate and atropine (Lomotil). For diarrhea and abdominal pain, consider adding a low-dose of a tricyclic antidepressant, such as imipramine (Tofranil) or amitriptyline (Elavil). These antidepressants may affect how the brain interprets pain.
Pain and bloating. A tricyclic antidepressant often reduces discomfort and other symptoms, including diarrhea, pain and bloating, to a tolerable level. If the drug causes side effects, such as dry mouth or dizziness, a selective serotonin reuptake inhibitor (SSRI), such as citalopram (Celexa) or fluoxetine (Prozac), can be used, but there is less proof that SSRIs are effective for IBS symptoms.
Constipation. If you’re consuming adequate levels of fiber (described earlier) but still have constipation, you may want to try an OTC laxative, such as polyethylene glycol (Miralax) or Milk of Magnesia for seven to 14 days. (See your doctor if symptoms persist after that trial period.) For more extended use, the prescription medication lubiprostone (Amitiza) has been shown to be effective for IBS with constipation.
