Irritable Bowel Syndrome -- The "Official Dogma"
[Karl Note: This is one of the always-available "standard descriptions" of any type of "disease" or health situation. Pages such as this are usually accurate as to the mechanical description of the situation, but widely off when it comes to causes and remedies. You can read this for the technical description, but don't heed the advice on treatment.]
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What Is Irritable Bowel Syndrome? |
Irritable bowel
syndrome (IBS) is a common disorder of the intestines
that leads to crampy pain, gassiness, bloating, and
changes in bowel habits. Some people with IBS have
constipation (difficult or infrequent bowel
movements); others have diarrhea (frequent loose
stools, often with an urgent need to move the
bowels); and some people experience both. Sometimes
the person with IBS has a crampy urge to move the
bowels but cannot do so.
Through the years, IBS has been called by many names--colitis, mucous colitis, spastic colon, spastic bowel, and functional bowel disease. Most of these terms are inaccurate. Colitis, for instance, means inflammation of the large intestine (colon). IBS, however, does not cause inflammation and should not be confused with another disorder, ulcerative colitis. The cause of IBS is not known, and as yet there is no cure. Doctors call it a functional disorder because there is no sign of disease when the colon is examined. IBS causes a great deal of discomfort and distress, but it does not cause permanent harm to the intestines and does not lead to intestinal bleeding of the bowel or to a serious disease such as cancer. Often IBS is just a mild annoyance, but for some people it can be disabling. They may be unable to go to social events, to go out to a job, or to travel even short distances. Most people with IBS, however, are able to control their symptoms through medications prescribed by their physicians, diet, and stress management.
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What Causes IBS? |
The colon, which is
about 6 feet long, connects the small intestine with
the rectum and anus. The major function of the colon
is to absorb water and salts from digestive products
that enter from the small intestine. Two quarts of
liquid matter enter the colon from the small
intestine each day. This material may remain there
for several days until most of the fluid and salts
are absorbed into the body. The stool then passes
through the colon by a pattern of movements to the
left side of the colon, where it is stored until a
bowel movement occurs.
Movements of the colon propel the contents slowly back and forth but mainly toward the rectum. A few times each day strong muscle contractions move down the colon pushing fecal material ahead of them. Some of these strong contractions result in a bowel movement. Because doctors have been unable to find an organic cause, IBS often has been thought to be caused by emotional conflict or stress. While stress may worsen IBS symptoms, research suggests that other factors also are important. Researchers have found that the colon muscle of a person with IBS begins to spasm after only mild stimulation. The person with IBS seems to have a colon that is more sensitive and reactive than usual, so it responds strongly to stimuli that would not bother most people. Ordinary events such as eating and distention from gas or other material in the colon can cause the colon to overreact in the person with IBS. Certain medicines and foods may trigger spasms in some people. Sometimes the spasm delays the passage of stool, leading to constipation. Chocolate, milk products, or large amounts of alcohol are frequent offenders. Caffeine causes loose stools in many people, but it is more likely to affect those with IBS. Researchers also have found that women with IBS may have more symptoms during their menstrual periods, suggesting that reproductive hormones can increase IBS symptoms.
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What Are the Symptoms of IBS? |
If you are concerned
about IBS, it is important to realize that normal
bowel function varies from person to person. Normal
bowel movements range from as many as three stools a
day to as few as three a week. A normal movement is
one that is formed but not hard, contains no blood,
and is passed without cramps or pain.
People with IBS, on the other hand, usually have crampy abdominal pain with painful constipation or diarrhea. In some people, constipation and diarrhea alternate. Sometimes people with IBS pass mucus with their bowel movements. Bleeding, fever, weight loss, and persistent severe pain are not symptoms of IBS but may indicate other problems.
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How Is IBS Diagnosed? |
IBS usually is
diagnosed after doctors exclude the presence of
disease. To get to that point, the doctor will take a
complete medical history that includes a careful
description of symptoms. A physical examination and
laboratory tests will be done. A stool sample will be
tested for evidence of bleeding. The doctor also may
do diagnostic procedures such as x-rays or endoscopy
(viewing the colon through a flexible tube inserted
through the anus) to find out if there is disease.
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How Do Diet and Stress Affect IBS? |
The potential for
abnormal function of the colon is always present in
people with IBS, but a trigger also must be present
to cause symptoms. The most likely culprits seem to
be diet and emotional stress. Many people report that
their symptoms occur following a meal or when they
are under stress. No one is sure why this happens,
but scientists have some clues.
Eating causes contractions of the colon. Normally, this response may cause an urge to have a bowel movement within 30 to 60 minutes after a meal. In people with IBS, the urge may come sooner with cramps and diarrhea. The strength of the response is often related to the number of calories in a meal and especially the amount of fat in a meal. Fat in any form (animal or vegetable) is a strong stimulus of colonic contractions after a meal. Many foods contain fat, especially meats of all kinds, poultry skin, whole milk, cream, cheese, butter, vegetable oil, margarine, shortening, avocados, and whipped toppings. Stress also stimulates colonic spasm in people with IBS. This process is not completely understood, but scientists point out that the colon is controlled partly by the nervous system. Stress reduction (relaxation) training or counseling and support help relieve IBS symptoms in some people. However, doctors are quick to note that this does not mean IBS is the result of a personality disorder. IBS is at least partly a disorder of colon motility.
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How Does a Good Diet Help IBS? |
For many people, eating
a proper diet lessens IBS symptoms. Before changing
your diet, it is a good idea to keep a journal noting
which foods seem to cause distress. Discuss your
findings with your doctor. You also may want to
consult a registered dietitian, who can help you make
changes in your diet. For instance, if dairy products
cause your symptoms to flare up, you can try eating
less of those foods. Yogurt might be tolerated better
because it contains organisms that supply lactase,
the enzyme needed to digest lactose, the sugar found
in milk products. Because dairy products are an
important source of calcium and other nutrients that
your body needs, be sure to get adequate nutrients in
the foods that you substitute.
Dietary fiber may lessen IBS symptoms in many cases. Whole grain breads and cereals, beans, fruits, and vegetables are good sources of fiber. Consult your doctor before using an over-the-counter fiber supplement. High-fiber diets keep the colon mildly distended, which may help to prevent spasms from developing. Some forms of fiber also keep water in the stools, thereby preventing hard stools that are difficult to pass. Doctors usually recommend that you eat just enough fiber so that you have soft, easily passed, and painless bowel movements. High-fiber diets may cause gas and bloating, but within a few weeks, these symptoms often go away as your body adjusts to the diet. Large meals can cause cramping and diarrhea in people with IBS. Symptoms may be eased if you eat smaller meals more often or just eat smaller portions. This should help, especially if your meals are low in fat and high in carbohydrates such as pasta, rice, whole-grain breads and cereals, fruits, and vegetables.
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Can Medicines Relieve IBS Symptoms? |
Your doctor may
prescribe fiber supplements or occasional laxatives
if you are constipated. Some doctors prescribe drugs
that control colon muscle spasms, drugs that slow the
movement of food through the digestive system,
tranquilizers, or antidepressant drugs, all of which
may relieve symptoms.
It is important to follow the physician's instructions when taking IBS medications--particularly laxatives, which can be habit forming if not used carefully.
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Is IBS Linked to Other Diseases? |
IBS has not been shown
to lead to any serious, organic diseases. No link has
been established between IBS and inflammatory bowel
diseases such as Crohn's disease or ulcerative
colitis. IBS does not lead to cancer. Some patients
have a more severe form of IBS, and the pain and
diarrhea may cause them to withdraw from normal
activities. These patients need to work with their
physicians to find the best combination of medicine,
diet, counseling, and support to control their
symptoms.
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Additional Readings |
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National Digestive Diseases Information Clearinghouse
The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NIDDK is part of the National Institutes of Health under the U.S. Public Health Service. Established in 1980, the clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. NDDIC answers inquiries; develops, reviews, and distributes publications; and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases. Publications produced by the clearinghouse are reviewed carefully for scientific accuracy, content, and readability. This e-text is not copyrighted. The clearinghouse encourages users of this e-pub to duplicate and distribute as many copies as desired.
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NIH Publication No.
97-693 October 1992 e-text posted: February 1998 |
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Colon motility (contraction of intestinal muscles and
movement of its contents) is controlled by nerves and
hormones and by electrical activity in the colon
muscle. The electrical activity serves as a
"pacemaker" similar to the mechanism that controls
heart function.