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Irritable bowel syndrome

Also listed as: Spastic colon; Mucous colitis; Spastic colitis; Nervous stomach; Irritable colon
Table of Contents > Conditions > Irritable bowel syndrome     Print

Signs and Symptoms
What Causes It?
What to Expect at Your Provider's Office
Treatment
Following Up
Supporting Research

Irritable bowel syndrome (IBS) occurs when muscles in your large intestine contract faster or slower than normal. This causes pain, cramping, gassiness, sudden bouts of diarrhea, and constipation.

People may have alternating bouts of constipation and diarrhea, or diarrhea-predominant IBS or constipation-predominant IBS. Although the symptoms can be hard to live with, IBS doesn’t cause permanent damage to your intestine.

Between 10 - 20% of the population has IBS at some time. IBS also makes up 20 - 50% of visits to gastroenterologists, or doctors dealing with digestive system problems. IBS often starts in teens or young adults, but it can occur at any age and is often associated with stress. It affects almost twice as many women as men. More than 80% of IBS patients in the United States are women, according to the American College of Gastroenterology.

Signs and Symptoms

Symptoms of IBS may include:

  • Cramping pain in your lower abdomen
  • Bloating and gas
  • Diarrhea or constipation, or bouts of both
  • Immediate need to move your bowels when you wake up or during or after meals
  • Relief of pain after bowel movements
  • Feeling of incomplete emptying after bowel movements
  • Mucus in your stool

Up to 60% of people with IBS have psychological symptoms, such as anxiety and depression. Some people with IBS have low levels of the brain chemical serotonin.

IBS may affect how the body is able to absorb nutrients, so that some people may not be getting all of the nutrients they need.

What Causes It?

Researchers don’t know what causes IBS, and the intestines of people with IBS appear normal when examined. It may be caused by a disturbance in the muscle movement of the intestine or a lower tolerance for stretching and movement of the intestine.

Risk factors may include a low-fiber diet, emotional stress, use of laxatives, a bout of infectious diarrhea, or other temporary bowel inflammation.

Diet is also plays a major role in IBS. Some doctors believe that food allergies cause some cases of IBS, although studies have been mixed. Fatty foods, artificial sweeteners (sucralose or Splenda and saccharine or Sweet'N Low), chemical additives (dyes and preservatives), red meat, dairy products (such as milk, cheese, and sour cream), chocolate, alcohol, and carbonated beverages (sodas) may trigger or aggravate episodes in some people. Gluten contained in wheat and barley can also be a problem for some people with IBS.

What to Expect at Your Provider's Office

Your doctor will feel your abdomen to check for signs of pain. Other tests may include a rectal exam, pelvic exam (for women), sigmoidoscopy, stool sample testing, blood and urine tests, ultrasound, and x-rays to rule out other conditions.

Doctors may also check to see if you are lactose intolerant. Lactase is an enzyme the body needs to digest sugars found in dairy products. If a person lacks this enzyme, they may have problems digesting dairy products, causing symptoms similar to IBS. Removing milk and dairy products from the diet for several weeks may help determine if the person is lactose intolerant.

Treatment

The goal of treatment is to relieve symptoms. For some people, changing their diet may reduce symptoms. Adding more fiber and avoiding stimulants such as caffeine may help. Reducing anxiety by getting regular exercise and seeking counseling may also be helpful. Alternative and complementary therapies -- including herbs, supplements, and lifestyle changes -- may help relieve symptoms as well.

Drug Therapies

  • Anticholinergic medications -- help relax the muscles in the intestine and relive pain from bowel spasm. Anticholinergic drugs include hyoscyamine (Levsin and Levsinex) and dicyclomine (Bentyl).
  • Antiflatulents -- reduce gas. Antiflatulents include simethicone (Phazyme or Mylicon).
  • Antidiarrheal medications -- help decrease and stop diarrhea. Antidiarrheal drugs include loperamide (Imodium) and a combination of diphenoxylate & atropine (Lomotil).
  • Fiber supplements -- such as psyllium (Metamucil) may help with diarrhea or constipation.
  • Antidepressants -- may be prescribed to treat pain or depression.

Two drugs are approved specifically to treat IBS. They are used cautiously and only when other treatments have failed.

  • Lubiprostone (Amitiza) -- increases fluid in the intestine to help speed the passage of stool. It is approved only for women with IBS who predominantly have severe constipation and have failed all other treatments.
  • Alosetron (Lotronex) -- helps relax the intestine and slow passage of stool. This drug was removed from the market for a while because it was associated with serious side effects. Now it is allowed to be sold only with restrictions. Your doctor must be enrolled in a special program to prescribe the drug, and it is approved only for women with IBS who predominantly have diarrhea and have failed all other treatments. Alosetron should not be prescribed for men.

Complementary and Alternative Therapies

Irritable bowel syndrome (IBS) is often treated with alternative therapies. Stress reduction techniques, such as biofeedback, hypnosis, dietary changes, or counseling, may help.

Nutrition and Supplements

Some doctors believe food allergies may be a trigger of IBS, at least for some people. The most common food allergens are dairy products, wheat, corn, peanuts, citrus, soy, eggs, fish, and tomatoes. Your health care provider may recommend an elimination diet, where foods that are suspected of causing an allergic reaction are eliminated from your diet, then gradually added back to see which food trigger symptoms.

Eating a healthy diet that includes mainly fruits, vegetables, and whole grains may help. If gas is a problem, you may want to avoid beans, cabbage, broccoli, cauliflower, apple juice, grape juice, bananas, nuts, and raisins. These tips may also help:

  • Avoid refined foods such as white breads, pastas, and sugar.
  • Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
  • Use healthy cooking oils, such as olive oil or vegetable oil.
  • Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine
  • Take fiber supplements to help reduce pain, cramping, and gas.
  • Avoid caffeine, alcohol, chocolate, and tobacco.
  • Stay away from subar substitutes (such as sorbitol and mannitol), which can trigger symptoms in some people.
  • Drink 6 - 8 glasses of filtered water daily.
  • Exercise 30 minutes daily, 5 days a week.

These supplements may also help relieve IBS symptoms:

  • Probiotic supplement (containing Lactobacillus acidophilus and Bifidobacterium), 5 - 10 billion CFUs (colony forming units) a day. Probiotics, or “friendly” bacteria, help your digestive system function properly. Many studies have found that probiotics may help relieve symptoms of IBS, including abdominal pain and gas, and constipation. Some probiotic supplements may need refrigeration for best results. Check the label carefully.
  • Flaxseed, ground, 6 - 24 grams per day -- to relieve constipation. One study of 55 people with constipation caused by IBS found that those who took used flaxseed reduced constipation, boating, and abdominal discomfort more than those who used psyllium.
  • Melatonin, 2 - 5 mg one hour before bedtime. A few small studies have suggested melatonin may improve IBS symptoms. Ask your health care provider about potential drug interactions before taking melatonin.

Herbs

You can use herbs in the form of dried extracts (such as capsules, powders, and teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink two to four cups per day.

  • Peppermint oil (Mentha piperita) -- enteric-coated, 0.2 - 0.4 ml, 3 times daily. Peppermint oil is used traditionally for digestive problems, and some studies show it may help relieve symptoms of IBS, including gas and cramping. In one study, peppermint oil combined with 50 mg of caraway oil in enteric-coated capsules taken three times daily reduced IBS symptoms.
  • Chinese herbal medicine -- In one study, a standardized Chinese herbal extract containing 20 herbs -- including dan shen (Salvia miltiorrhiza), ginger (Zingiber officinale), wormwood (Artemesia absinthium), and bupleurum -- helped reduce symptoms of IBS. If you are interested in using Chinese herbal medicine for IBS, consult a knowledgeable health care provider to make sure you get the safest and most effective formula for you.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend treatments for IBS based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person’s constitutional type -- your physical, emotional, and intellectual makeup.

Acupuncture

Several small studies suggest that acupuncture may help people who have IBS by improving general well-being and reducing bloating. Large-scale trials are still needed.

Acupuncturists treat people with IBS based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of IBS, an acupuncturist usually detects a qi deficiency in the spleen and lung meridians. Acupuncturists frequently use moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) for treatment of IBS because they believe its effects reach deeper into the body. Because acupuncture is considered safe, and IBS is not easily treated by available conventional methods, people with IBS may wish to try acupuncture therapy to improve symptoms.

Chiropractic

There have been no well-designed studies of chiropractic for IBS. However, chiropractors report that spinal manipulation may improve symptoms of IBS in some people. In these cases, spinal manipulation may have a balancing effect on the nerves that supply impulses to the intestinal tract.

Other Treatments

  • Electric heating pads, hot water bottles, and long hot baths can relieve painful spasms and cramping in the abdomen.
  • Regular exercise, such as walking, can reduce stress and encourage bowel movements if you are constipated.
  • Castor oil packs can soothe cramping muscles and aid detoxification. Apply oil directly to skin, cover with a clean soft cloth and plastic wrap. Place a heat source over the pack, and let it sit for 30 - 60 minutes.
  • Deep breathing reduces stress and may also help with digestion.
  • Therapeutic massage may help reduce stress.
  • Some small studies have suggested that yoga may help relieve pain and other symptoms of IBS.
  • Stress reduction techniques, such as hypnosis, biofeedback, or counseling, may also help.

Following Up

Irritable bowel syndrome itself may cause stress. Following a diet recommended by your doctor is very important.

Supporting Research

Anastasi JK, McMahon DJ, Kim GH. Symptom management for irritable bowel syndrome: a pilot randomized controlled trial of acupuncture/moxibustion. Gastroenterol Nurs. 2009 Jul-Aug;32(4):243-55.

Berardi PR. Safety and tolerability of tegaserod in irritable bowel syndrome management. J Am Pharm Assoc 2004 Jan-Feb;44(1):41-51.

Camilleri M, Andresen V. Current and novel therapeutic options for irritable bowel syndrome management. Dig Liver Dis. 2009 Dec;41(12):854-62.

Camilleri M, Gorman H. Intestinal permeability and irritable bowel syndrome. Neurogastroenterol Motil. 2007;19(7):545-52.

Chang CC, Lin YT, Lu YT, et al. Kiwifruit improves bowel function in patients with irritable boweld syndrome with constipation. Asia Pac J Clin Nutr. 2010;19(4):451-7.

Chang HY, Kelly EC, Lembo AJ. Current gut-directed therapies for irritable bowel syndrome. Curr Treat Options Gastroenterol. 2006;9(4):314-23.

Chang FY, Lu CL. Treatment of irritable bowel syndrome using complementary and alternative medicine. J Chin Med Assoc. 2009 Jun;72(6):294-300. Review.

Chang JY, Talley NJ. An update on irritable bowel syndrome: from diagnosis to emerging therapies. [Review]. Curr Opin Gastroenterol. 2011;27(1):72-8.

Chey WD, Maneerattapron M, Saad R. Pharmacologic and complementary and alternative medicine therapies for irritable bowel syndrome. Gut Liver. 2011;5(3):253-66.

Choi CH, Jo SY, Park HJ, et al. A randomized, double-blind, placebo-controlled multicenter trial of saccharomyces boulardii in irritable bowel syndrome: effect on quality of life. J Clin Gastroenterol. 2011;45(8):679-83.

Chouinard LE. The role of psyllium fibre supplementation in treating irritable bowel syndrome. [Review]. Can J Diet Pract Res. 2011;72(1):e107-14.

Dorn SD, Kaptchuk TJ, Park JB, et al. A meta-analysis of the placebo response in complementary and alternative medicine trials of irritable bowel syndrome. Neurogastroenterol Motil. 2007;19(8):630-7.

Eswaran S, Tack J, Chey WD. Food: the forgotten factor in the irritable boweld syndrome. [Review]. Gastroenterol Clin North Am. 2011;40(1):141-62.

Ford AC. Management of irritable bowel syndrome. Minerva Gastroenterol Dietol. 2009 Sep;55(3):273-87.

Frissora CL. Nuances in treating irritable bowel syndrome. Rev Gastroenterol Disord. 2007;7(2):89-96.

Gawronska A, Dziechciarz P, Horvath A, Szajewska H. A randomized double-blind placebo-controlled trial of Lactobacillus GG for abdominal pain disorders in children. Aliment Pharmacol Ther. 2007;25(2):177-84.

Gaylord SA, Palsson OS, Garland EL, et al. Mindfulness training reduces the severity of irritable bowel syndrome in women: results of a randomized controlled trial. Am J Gastroenterol. 2011;106(9):1678-88. doi: 10.1038/ajg.2011.184.

Grigoleit HG, Grigoleit P. Peppermint oil in irritable bowel syndrome. Phytomedicine. 2005;12(8):601-6.

Grundmann O, Yoon SL. Irritable bowel syndrome: epidemiology, diagnosis and treatment: an update for health-care practitioners. [Review]. J Gastroenterol Hepatol. 2010;25(4):691-9.

Guglielmetti S, Mora D, Gschwender M. Randomised clinical trial: Bifodobacterium bifidum MIMBb75 significantly alleviates irritable bowel syndrome and improves quality-of-life--a double-blind, placebo-controlled study. Aliment Pharmacol Ther. 2011;33(10:1123-32.

Hawrelak JA, Myers SP. Effects of two natural medicine formulations on irritable bowel syndrome symptoms: a pilot sutdy. J Altern Complement Med. 2010;16(10:1065-71.

Hundscheid HW, Pepels MJ, Engels LG, Loffeld RJ. Treatment of irritable bowel syndrome with osteopathy: results of a randomized controlled pilot study. J Gastroenterol Hepatol. 2007;22(9):1394-8.

Kabir MA, Ishaque SM, Ali MS, et al. Role of Saccharomyces boulardii in diarrhea predominant irritable bowel syndrome. Mymensingh Med J. 2011;20(3):397-401.

Kline RM, Kline JJ, Di Palma J, Barbero GJ. Enteric-coated, pH-dependent peppermint oil capsules for the treatment of irritable bowel syndrome in children. J Pediatr. 2001;138(1):125-8.

Kuttner L, Chambers CT, Hardial J, et al. A randomized trial of yoga for adolescents with irritable bowel syndrome. Pain Res Manag. 2006;11(4):217-23.

Lahmann C, Rohrict F, Sauer N, et al. Functional relaxation as complementary therapy in irritable bowel syndrome: a randomized, controlled clinical trial. J Altern Complement Med. 2010;16(1):47-52.

Lim B, Manheimer E, Lao L, Ziea E, Wisniewski J, Liu J, Berman B. Acupuncture for treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2006;(4):CD005111.

Lindfors P, Unge P, Arvidsson P, Nyhlin H, Björnsson E, Abrahamsson H, Simrén M. Effects of Gut-Directed Hypnotherapy on IBS in Different Clinical Settings-Results From Two Randomized, Controlled Trials. Am J Gastroenterol. 2011. doi: 10.1038/ajg.2011.340. [Epub ahead of print]. 

Ljótsson B, Hedman E, Andersson E, Hesser H, Lindfors P, Hursti T, Rydh S, Rück C, Lindefors N, Andersson G. Internet-delivered exposure-based treatment vs. stress management for irritable bowel syndrome: a randomized trial. Am J Gastroenterol. 2011;106(8):1481-91. doi: 10.1038/ajg.2011.139. 

Locke GR, Yawn BP, Wollan PC, Melton LJ, Lydick E, Talley NJ. Incidence of a clinical diagnosis of the irritable bowel syndrome in a United States population. Aliment Pharmacol Ther 2004 May 1;19(9):1025-1031.

Magge S, Lembo A. Complementary and alternative medicine for the irritable bowel syndrome. [Review]. Gastroenterol Clin North Am. 2011;40(1):245-53. 

McFarland LV. Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. [Review]. World J Gastroenterol. 2010;16(18):2202-22.

Merat S, Khalili S, Mostajabi P, Ghorbani A, Ansari R, Malekzadeh R. The Effect of Enteric-Coated, Delayed-Release Peppermint Oil on Irritable Bowel Syndrome. Dig Dis Sci. 2009 Jun 9. [Epub ahead of print].

Nahas R. Irritable bowel syndrome: common integrative medicine perspectives. [Review]. Chin J Integr Med. 2011;17(6):410-3.

Ringel-Kulka T, Palsson OS, Maier D, Carroll I, Galanko JA, Leyer G, Ringel Y. Probiotic bacteria Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 versus placebo for the symptoms of bloating in patients with functional bowel disorders: a double-blind study. J Clin Gastroenterol. 2011;45(6):518-25.

Ruepert L, Quartero AO, de Wit NJ, van der Heijden GJ, Rubin G, Muris JW. Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome. [Review]. Cochrane Database Syst Rev. 2011;(8):CD003460.

Saha L, Malhotra S, Rana S, Bhasin D, Pandhi P. A preliminary study of melatonin in irritable bowel syndrome. J Clin Gastroenterol. 2007;41(1):29-32.

Shinozaki M, Kanazawa M, Kano M, Endo Y, Nakaya N, Hongo M, Fukudo S. Effect of autogenic training on general improvement in patients with irritable bowel syndrome: a randomized controlled trial. Appl Psychophysiol Biofeedback. 2010;35(3):189-98.

Simrén M, Ohman L, Olsson J, Svensson U, Ohlson K, Posserud I, Strid H. Clinical trial: the effect of a fermented milk containing three probiotic bacteria in patients with irritable bowel syndrome (IBS) - a randomized, double-blind, controlled study. Aliment Pharmacol Ther. 2009 Oct 26. [Epub ahead of print]

Sun JH, Wu XL, Xia C, et al. Clinical evaluation of Soothing Gon and invigorating Pi acupuncture treatment on diarrhea-predominant irritable bowel syndrome. Chin J Integr Med. 2011;17(10:780-5.

Talley NJ, Kellow JE, Boyce P, Tennant C, Huskic S, Jones M. Antidepressant Therapy (Imipramine and Citalopram) for Irritable Bowel Syndrome: A Double-Blind, Randomized, Placebo-Controlled Trial. Dig Dis Sci. 2007; [Epub ahead of print].

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SWilson S, Maddison T, Roberts L, Greenfield S, Singh S. Systematic review: the effectiveness of hypnotherapy in the management of irritable bowel syndrome. Aliment Pharmacol Ther. 2006;24(5):769-80.

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Review Date: 1/20/2012
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
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