Treatment for Irritable Bowel Syndrome

Twelve Percent of People Suffer From IBS

IBS

Irritable bowel syndrome (IBS) is a common problem which messes with the large intestine. People with IBS experience bloating, cramping, abdominal pain and variability in bowel habits. This condition affects twice as many women as it does men, and people younger than 45 are most likely to experience IBS.

About 12 percent of all people have IBS. Unfortunately, no diagnostic markers exist that signify this condition.

Thus, there is no single test that will raise a red flag letting you and your physician know that you have IBS. Instead, your physician diagnoses IBS based on a detailed clinical history and a very limited work up that excludes other possible causes.

Three Types of Irritable Bowel Syndrome

People with IBS fall into the following 3 categories:

  • pain that's mostly associated with diarrhea (IBS-Diarrhea or IBS-D)
  • pain that's mostly associated with constipation (IBS-Constipation or IBS-C)
  • pain that's associated with both periods of diarrhea and constipation (IBS-Mixed or IBS-M)

Symptoms of Irritable Bowel Syndrome

Several symptoms are experienced by people with IBS including the following:

  • lower abdominal pain
  • lower abdominal pain relieved by defecation
  • feelings of incomplete bowel evacuation or emptying
  • passage of mucus
  • loose or frequent stools precipitated by abdominal pain

People with IBS don't exhibit "alarm" signs or symptoms that may indicate more serious causes of gastrointestinal illness or disease such as:

  • fever
  • significant weight loss (more than 10 pounds)
  • anemia
  • blood in the feces (fecal occult blood)
  • family history of colorectal cancer
  • history of recent antibiotic use

Diagnosis of Irritable Bowel Syndrome

In people without alarm symptoms but with symptoms suggestive of IBS, there's no need to perform further diagnostic testing, in particular flexible sigmoidoscopy or colonsocopy.

Instead, the only test that is routinely performed in people suspected of having IBS is a CBC or blood test. The reason why a CBC is done is to rule out anemia secondary to a bleed somewhere in your body (think cancer).

On a related note, the prevalence of celiac disease in people with IBS symptoms and no alarm symptoms is similar to the population at large. Thus, further work-up for celiac disease is for the most part unnecessary.

Ultimately, a history of abdominal pain associated with altered bowel movements lasting 3 or more months is usually enough for a physician to diagnose IBS.

Causes of Irritable Bowel Syndrome

We don't understand exactly what causes IBS, which is why there is no way to test for it specifically. Nevertheless, experts think that IBS may be due to the following factors:

  • visceral hypersensitivity
  • autonomic dyfunction
  • altered motility
  • psychological factors

We do know that life and psychological stressors can trigger IBS symptoms.

Treatment for Irritable Bowel Syndrome

A variety of nonspecific and specific treatments have been shown to help with IBS.

Here are some nonspecific treatments for IBS:

  • physical activity;
  • antidepressant medications (SSRIs and tricyclic antidepressants);
  • antispasmodics like peppermint and hyoscine;
  • psychotherapy;
  • limited consumption of apples, cherries, nectarines, cherries, lactose, Brussels sprouts, cauliflower, broccoli, peas and legumes;
  • dietary fiber (mixed support for its efficacy).

Here are some specific treatments for diarrhea predominant IBS (IBS-D):

  • loperamide;
  • probiotics;
  • a short course of the antibiotic rifaximin;
  • Alosetron (treatment with this a 5HT3-receptor antagonist is tightly regulated by the FDA, and you'll need special permission to get it).

Finally, lubiprostone has been shown to be effective in women with constipation predominant IBS (IBS-C). However, this treatment is not yet approved for men and should be avoided in women who are pregnant. In other words, if you're a woman who is of child-bearing age, your physician will have to perform a pregnancy test before you receive lubiprostone.

Selected Sources

Stern SC, Cifu AS, Altkorn D. Abdominal Pain. In: Stern SC, Cifu AS, Altkorn D. eds. Symptom to Diagnosis: An Evidence-Based Guide, 3e. New York, NY: McGraw-Hill; 2014. Accessed January 19, 2016.

 

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