To My Patients,

Update on Irritable Bowel Syndrome

Definition:
The term "irritable bowel syndrome" (often called IBS) refers to a collection of symptoms with no obvious cause. It is not a disease, but a syndrome -- a group of symptoms that occur together. People with IBS seem to have perfectly healthy digestive systems, but they frequently develop cramping pain in the lower abdomen along with either diarrhea or constipation (sometimes alternating bouts of both). Typically, the pain flares up after a meal and goes away after defecation. Many people also experience gas, bloating, small stools, or mucus in the stool. The symptoms tend to come and go and can occur in any combination.

Causes:
Stress and anxiety may not cause irritable bowel syndrome, but they can definitely make symptoms worse. Some people also react strongly to certain foods and drinks, especially fatty foods, dairy products, and drinks with alcohol or caffeine. Researchers now suspect the problem springs from a communication breakdown between the nerves and muscles that control the colon.

Diagnosis:
Doctors can usually diagnose irritable bowel syndrome by taking an inventory of a patient's symptoms and performing a physical exam. They may also want to check the blood or stool for other possible causes of the symptoms, such as parasitic infections or diabetes. Some patients, particularly those over age 50, also need to have their colon examined with a sigmoidoscope or colonoscope to rule out colon cancer and other diseases.

Treatments:
Doctors used to recommend high-fiber diets for all patients with irritable bowel syndrome, but there's little evidence this helps with anything other than constipation. In fact, a high-fiber diet may worsen gas, bloating, and stomach pain. If your bouts of IBS seem to go hand-in-hand with stress and anxiety, you may need to learn how to relax and cope with your feelings

If necessary, your doctor can prescribe medications to help control your symptoms. The drugs hyoscyamine (Anaspaz, Cystospaz, Levsin) and dicyclomine (Bentyl) can all ease pain and diarrhea by relaxing the colon. If your pain is intense, or if you also have depression, your doctor may prescribe an antidepressant. When given in smaller doses than those used to treat depression, these medications can help block pain.
The drug Zelnorm has also been approved to treat IBS symptoms in women on a short-term basis. Studies of Zelnorm show it helps women whose primary IBS symptom is constipation. It works by increasing the movement of stool through the bowels. Use of Zelnorm also reduces bloating as well as pain and discomfort in the abdominal area. The drug loperamide (Imodium A-D) may help relieve diarrhea. If you have constipation, you may be able to take over-the-counter laxatives once in a while.

Bottom Line:
Eat well, exercise, and utilize stress reduction before taking medications. Also, patients over fifty years of age should have routine colonoscopies every five years.