Irritable Bowel Syndrome
Irritable bowel syndrome, causes and treatment.
What is it?
If you have symptoms of abdominal pain with constipation or diarrhea or alternating periods of each and no other cause can be found after an exhaustive evaluation, your physician will probably diagnose you as having irritable bowel syndrome (IBS). As many as one in five people qualify for this label, although fewer than half seek medical attention for it.
How bad is it?
IBS is neither life-threatening nor progressive. But it is a distressing and chronic condition - the second highest cause of absenteeism after the common cold.
What causes it?
The cause of IBS is unknown. Many theories have been proposed, from stress and/or underlying emotional disorders to physical traits in the intestines that may make them hypersensitive to stimulation.
How do I know I have it?
Only after your physician has looked for every identifiable cause of your symptoms and has come up empty-handed, can you be sure that this is what you have.
What can I do about it?
A close relationship with your physician is the foundation for dealing with perplexing symptoms of abdominal pain with altered bowel function. Expect a lengthy and thorough evaluation including x-rays, endoscopies and batteries of laboratory tests.
While the evaluation is proceeding, there are a number of general measures you can take to improve bowel function. Managing your diet is key to controlling IBS, as certain foods can trigger IBS flare-ups. These include fatty foods (deep-fried or very oily foods), sodas, caffeine, chocolate, artificial sweeteners, and dairy products.
Controlled trials suggest that fiber supplements like Metamucil are effective in constipation-predominant IBS. Medications such as Immodium AD control symptoms in diarrhea-predominant IBS. In pain-predominant IBS, antispasmodics may be tried, and the tricyclic antidepressants are effective in reducing pain. Antispasmodics prevent or treat painful muscular spasms of hollow tubes within the body, such as the gut. If the gut goes into spasm, severe intermittent pains can develop in the abdomen.
Anyone being treated with antidepressants, particularly people being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. Bring up your concerns immediately with your doctor.
IBS is three times more common in women than men. Lotronex (alosetron hydrochloride), a new medication in its class, had been approved by the Food and Drug Administration (FDA) for women with diarrhea-predominant IBS. However, the drug was withdrawn from the market because of adverse side effects, including severe constipation and ischemic colitis, which is an area of inflammation caused by interference with blood flow to the large intestine. Alosetron was recently re-introduced to the market at a lower dosage and with several safeguards to limit adverse effects.
Physicians who prescribe alosetron will have to:
- Enroll in a prescribing program by attesting to their qualifications.
- Educate patients in the risks and benefits of therapy and provide patients with a copy of the FDA approved medication guide.
- Obtain a written agreement from patients before the initial prescription.
- Affix a sticker on the prescription indicating that the patient is enrolled in a special program to use alosetron. Pharmacists will not dispose the medication unless the sticker is on the prescription.
A second new medication, Zelnorm (tegaserod maleate), for constipation-predominant IBS, had been FDA-approved and released onto the market, but was withdrawn in the spring of 2007 because of an increased risk of heart attack and stroke in some patients taking it. If you have been taking Zelnorm, talk with your doctor about other IBS treatments. Patients taking Zelnorm should seek emergency medical care right away if they experience severe chest pain, shortness of breath, dizziness, sudden onset of weakness, difficulty walking or talking, or other symptoms of a heart attack or stroke.
Points to remember
- Irritable bowel syndrome is the most common complaint seen by physicians who specialize in digestive diseases.
- Only after every other cause of your symptoms has been excluded can you be sure this is the right diagnosis.
- IBS is not life-threatening or progressive.
- There are many possible ways to manage IBS. Working closely with your physician is fundamental to good treatment.