Dr. Chung Owyang, chief of gastroenterology for the University of Michigan Health System, explains in the 2008 edition of "Harrison's Principles of Internal Medicine" that while irritable bowel syndrome constitutes one of the most common complaints encountered by primary care physicians and gastroenterologists, it remains one of the least understood. Symptoms typically include gas, bloating, cramping, diarrhea and/or constipation. When constipation predominates, clinicians and patients prefer the term irritable bowel syndrome with constipation.
Prevalence
According to Dr. Owyang, 10 to 20 percent of adults and adolescents around the world report symptoms consistent with irritable bowel syndrome (IBS). IBS appears to be more common among women and most people experience a chronic course, with symptoms that wax and wane over time.
Causes
The causes of IBS remain elusive and probably vary by individual. According to Dr. Owyang, current research implicates altered gastrointestinal motility, abnormal pain responses in the bowel, disturbed communication between the brain and the bowel, hormonal and neuronal events, genetics, and environmental and psychosocial factors.
Associated Symptoms
According to the National Institutes of Health, in addition to the major symptoms of IBS discussed in the introduction, patients may also notice whitish mucus in their stool, bloating, an urgent need to defecate and/or the sensation of incomplete defecation. Associated symptoms outside of the gastrointestinal tract include headache, muscle pain, back pain, and genital or urinary problems.
Diagnosis
Clinicians diagnose IBS on the basis of the 2006 Rome Criteria, which include recurrent abdominal pain or discomfort for at least three days per month during at least three of the last six months. In addition, pain must be associated with at least two of the following: improvement with defecation, onset associated with change in the frequency of bowel movements and onset associated with change in the appearance of bowel movements.
Dietary Management
According to the American Academy of Family Physicians, management of IBS with constipation begins with diet changes. Foods that make symptoms worse include fatty foods, milk products, chocolate, alcohol, and caffeinated or carbonated drinks. Foods that lessen symptoms include apples, peaches, raw broccoli, cabbage, raw carrots, peas, kidney and lima beans, and whole grain breads and cereals. A doctor or dietitian will often recommend keeping a food diary to identify individual dietary triggers.
Stress Management
Stress management entails avoiding stressful events and finding a way to manage stressors that cannot be avoided, such as work. According to the National Institutes of Health, meditation, exercise, hypnosis and counseling are good options for many people.
Medications
For IBS with constipation that does not resolve with lifestyle changes, medication may be required. Over-the-counter laxatives treat acute constipation; patients should ask their doctor for a recommendation. In moderate-to-severe cases, a doctor may also prescribe antispasmodics—drugs that help regulate muscle contractions in the colon—or antidepressants—drugs that may help normalize communication between the brain and the colon.
References
- “Harrison’s Principles of Internal Medicine, 17th edition;” A.S. Fauci, E. Braunwald, D.L. Kasper, S.L. Hauser, D.L. Longer, J.L. Jameson and J. Loscalzo (Eds.); 2008
- National Institutes of Health: What I need to know about Irritable Bowel Syndrome
- American Academy of Family Physicians: Irritable Bowel Syndrome: Tips on Controlling Your Symptoms
