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Irritable Bowel Syndrome:
Improving quality of life through management

April 2009 – Vol. 13, No. 4

Editor: Janet M. Pollard, MPH

It is not something most people want to talk about…and that’ s why many people suffer without help, but irritable bowel syndrome (IBS) can be managed to give you a better quality of life. IBS is a chronic, functional disorder characterized by:

• abdominal cramping,
• bloating and gas, and
• diarrhea, constipation, or both.^1,2

IBS is not a disease but a syndrome, which means a group of symptoms.³ It is functional, meaning that the bowel doesn’t work or function correctly (no anatomical or structural problem is evident).⁴ It is chronic, meaning it is a long-term problem or that it can last a long time.^5,6 “IBS is one of the most common disorders doctors see.” As many as 1 in 5 Americans suffers from IBS,² and “only the common cold causes more missed days at work.”⁷ Yet, many people aren’t comfortable talking about it because they feel embarrassed to discuss these types of symptoms.² By identifying whether or not your symptoms are IBS, you can learn how best to manage your symptoms and gain a better quality of life.

Who Gets IBS? Risk factors

“IBS often begins before the age of 35, but it can start at any age. IBS seems to run in families – people with IBS often report having a family member with IBS. Most people diagnosed with IBS (up to 75 percent) are women. But it is not known for sure that IBS affects more women than men. It may be that women are more likely to talk to their doctors about their symptoms.”⁵ Some studies have also shown IBS to be more common among people with a history of abuse (physical or sexual) or other psychological trauma; people who experience depression, migraine headaches, and fibromyalgia; and people with panic disorder or other psychological conditions.⁸

What Causes IBS? Bowel function & sensitivity

IBS is a collection of symptoms that occur when the nerves and muscles in a person’s bowel (also called the colon or large intestine) do not work like they should.⁵ Though the cause is not completely understood, it is theorized that “a ‘dysregulation’ between the brain, the gut, and the central nervous system causes the bowel to become ‘irritated,’ or overly sensitive to stimuli.⁹ “The colon’s main function is to absorb water and nutrients from partially digested food. Anything that is not absorbed is slowly moved through the colon toward the rectum and out of the body as waste in the form of feces (also called stool).”¹⁰ When your bowels work effectively, “muscles in the colon work to get rid of the body’s waste products by contracting and relaxing as they push the undigested food through the large intestine. These muscles must also work together with other muscles in the body to push the waste out of the anus. If the muscles in the colon don’t work at the right speed for proper digestion or if the coordination with muscles in the rectum or pelvis is somehow interrupted, the contents of the colon are not able to move along smoothly. When this happens, a person can feel the abdominal cramps, bloating, constipation, and diarrhea that may be signs of IBS.”¹⁰

IBS Signs & Symptoms? Recurring problems

Everyone has stomach pain or a bout of constipation or diarrhea now and then; but for some people, stomach pain and diarrhea or constipation are a regular occurrence.¹⁰ The symptoms of IBS are usually recurring – meaning that a person will have bouts of symptoms on and off on a regular basis rather than just a few times a year.¹⁰ The main symptoms of IBS include:

• crampy pain in the stomach area,
• chronic or recurrent constipation (i.e., infrequent stools that may be painful, hard, and dry),
• chronic or recurrent diarrhea (i.e., frequent loose stools), and
• both constipation and diarrhea that are either mixed or recur alternately.^5,9

Other symptoms include:

• mucus in the stool,
• swollen or bloated stomach area,
• feeling like you haven’t finished a bowel movement,
• gas,
• heartburn, and
• discomfort in the upper stomach area or feeling uncomfortably full or nauseous after eating a normal size meal.

Women with IBS may have more or different symptoms during their menstrual periods. Constipation may be relieved or diarrhea may occur a day or two before or when their period starts.⁵

Please be aware – “anemia, bleeding, unexplained weight loss, or fever are not characteristic of IBS. You should alert your physician immediately if you are experiencing these symptoms. Other factors that may suggest the presence of an organic disease include awakening from sleep at night, family history of colon cancer or inflammatory bowel disease, and onset of symptoms (or change in symptoms) over the age of 50.”⁹

IBS Diagnosis: Ruling out other illnesses

If you have had changes in bowel habits with the symptoms listed above, see your doctor and talk openly – your conversation is confidential. A general practitioner, family medicine doctor, or internist can diagnose and treat IBS. Your doctor will likely ask you about your medical history, do a physical examination, and use a set of specific criteria to rule out other potential intestinal or underlying illnesses (PDF). If more tests are needed or your symptoms don’t respond to initial therapy, it may be helpful to see a gastroenterologist – a doctor who specializes in digestive system problems.¹¹ Though there is currently no cure for IBS, it will not get worse over time (though symptoms may be better or worse from day to day).⁶ IBS does not cause or increase your risk for serious diseases like cancer or inflammatory bowel disease.⁵ IBS can be managed, however.

IBS Treatment – Management: What makes IBS better? Worse?

If you find out you have IBS, the next step is to find the best way(s) to manage it. Most people diagnosed with IBS can control their symptoms with diet, lifestyle-change strategies (including stress management), and medicine;¹² however, there is no single treatment that works for everyone. It will likely require some trial and error on your part and good communication with your doctor to get the best management of your symptoms.

Knowing what triggers your symptoms can help you develop good management strategies.¹³ Some possibilities of IBS symptom triggers can be:

• the type of food you eat,
• the amount of food you eat,
• stressful events or situations,
• medicines you take,
• your menstrual cycle, and
• your environment.¹³

Keeping an IBS symptom journal may help you identify what is triggering your symptoms. Write down your symptoms, as well as life events that occur with them and foods and medicines taken before the symptoms occurred. This information can help clarify the connection between symptoms, stressful occasions,¹⁴ foods, and medicines. Additionally, make note of anything that seems to make your symptoms better. After you have identified your IBS triggers, you can begin to develop ways of dealing with these situations.

Diet: Consider what & how you eat

There is no single dietary recommendation that works for everyone with IBS. Here are some things to think about when considering your diet:

• Try to limit gas-producing foods such as beans, onions, broccoli, and cabbage. Carbonated drinks (colas, sodas, pop) also introduce gas into the intestines, as can chewing gum, because you may swallow air.¹⁵
• Limit foods that may make diarrhea worse, including caffeine and alcohol (which stimulates the intestine),^2,12 milk products, foods high in sugar, fatty foods, gas-producing foods, and the artificial sweeteners sorbitol and xylitol (often used in sugarless gum and sugarless candy).¹⁶
• To reduce constipation, consider adding fiber to your diet, which may reduce the constipation associated with IBS because it makes stool soft and easier to pass.³ Whole grain breads and cereals, beans, and fresh fruits and vegetables are usually good sources of fiber; however, consult your doctor about what type of fiber and how much is best to add to your diet. In recent research, “insoluble fiber such as bran was not effective. Instead, only soluble fiber, such as ispaghula husk, reduced symptoms.”¹⁷ Ispaghula, also called psyllium, contains a high level of soluble dietary fiber and is the chief ingredient in many commonly used bulk laxatives, including products such as Metamucil and Serutan.¹⁸ Recommendations include soluble fiber in the form of dietary supplements, such as ispaghula powder or foods high in soluble fiber, such as oats.¹⁹ Soluble fiber adds bulk to the colon and can help prevent spasms. Always start slowly, adding foods with fiber to your diet a little at a time to let your body get used to it³ and to avoid bloating, cramping, or gas.²⁰
• Drink plenty of water (6–8 glasses a day). Fiber absorbs water, and water keeps stools soft.¹⁶ Drinking plenty of water can help with constipation and improve your overall health.⁵
• Consider eating 4–5 small meals per day rather than less frequent, large meals. Large meals can cause cramping and diarrhea.³
• Eat slowly, and have meals in a quiet, relaxing environment.¹⁶
• Consider probiotics. Probiotics are tiny living organisms (in most cases, bacteria) that are similar to beneficial microorganisms found in the human gut. “They are also called ‘friendly bacteria’ or ‘good bacteria.’”²¹ When administered in adequate amounts, probiotics may provide a health benefit.²¹ Probiotics are available to consumers mainly in the form of dietary supplements (capsules, tablets, and powders) and foods (e.g., yogurt, fermented and unfermented milk, miso, tempeh, and some juices and soy beverages). In probiotic foods and supplements, the bacteria may have been present originally or added during preparation.²¹ “Most often, the bacteria come from two groups, Lactobacillus or Bifidobacterium.”²¹ Recent guidelines suggest the most beneficial probiotics are of the Bifidobacterium species. Lactobaccili do not appear effective.²² Recommendations in the British Medical Journal (March 8, 2008) advise physicians not to discourage people from trying specific probiotics for at least four weeks;¹⁹ however, more data are needed on probiotics.²³

Note: According to the latest guidelines on IBS from the American College of Gastroenterology, there is no good research to support a link between food allergies and IBS; excluding foods or food groups completely should only be used within the context of a research trial.^22,23,24 If you are considering limiting or eliminating foods in your diet, consult with your doctor for potential clinical trials, and see a registered dietician who can help you balance your nutrient and mineral intake so you get proper nutrition.¹⁹

Lifestyle: Exercise, sleep, stress, communication

Considering your diet is just one part of managing your IBS. Taking care of yourself in other ways can also help. Key factors may also include:

• sleep,
• exercise,
• stress management, and
• communication.

Sleep.

Do you have trouble falling asleep? Is your sleep restless or regularly disturbed? Do you have early awakenings or insomnia? If you aren’t getting a good night’s sleep, you may find your IBS symptoms are more severe. Lack of sleep and stress can exacerbate IBS symptoms.⁷ Results of a study published in Digestive Diseases and Sciences indicated that for women with IBS (only women were studied), a poor night’s sleep leads to more gastrointestinal symptoms.²⁵ For information on sleep, health, and tips for getting more quality sleep, see HealthHints: “Sleep: Your health & performance depends upon it” – Part I & Part II (PDF).

Exercise.

Regular, gentle exercise, such as walking, cycling, or swimming, can help maintain bowel regularity.¹⁶ “Exercise can help with constipation and improve your overall health. Exercise helps relieve stress and depression and helps your bowel to function as it should.”⁵

Stress Management.

“Learning to reduce stress can help with IBS.”³ “Emotional stress does not cause IBS. But people with IBS may have their bowels react more to stress. So, if you already have IBS, stress can make your symptoms worse.”³ In IBS, there seems to be an increased sensitivity of the gut to distress (PDF).⁷ For this reason, it can be helpful to learn techniques for managing stress. With less stress, you may find you have less cramping and pain and are better able to manage your symptoms.³ According to the most recent guidelines, psychological counseling (i.e., psychotherapy) may be a helpful option, including:

• cognitive behavioral therapy,
• dynamic psychotherapy, and
• hypnotherapy.

Relaxation therapy alone had no significant benefit.²²

Other ways to reduce stress may include participating in regular exercise and/or a hobby you enjoy.¹⁵ Regular sleep, exercise, and a healthy diet can help relieve tension.²⁶ Some people may find that simply talking with a friend, reading a book, listening to music, or going out to doing a little shopping or other activity may relieve their stress.²⁶

Communication.

Though it may be the last thing you want to do, talking about your condition can help…and not just with your doctor. Start with family and friends. Provide them some written materials, if needed. Help them to understand that this is a real problem – not just something in your head. Once they understand the problem, they can better understand how it affects your life – and theirs. Brainstorm ideas for how to handle IBS symptoms when they flare up unexpectedly. Always allow extra time to get ready for an event – just in case. Let your family and friends know you may be late occasionally, but you are making every effort to manage your IBS. Let them know your management plan (e.g., medications, diet, exercise, stress reduction, etc.). You may find that once they understand, your family and friends can be very supportive.²⁷

Next, talk with your employer or supervisor and any colleagues you work with closely – those you feel need to know or could be supportive. Be honest with your supervisor. Let him/her know you have IBS without giving too many personal details. Let him/her know you don’t always have control over your symptoms and may have to leave a meeting unexpectedly; explain that you will be able to do your job after the discomfort subsides. Emphasize that you are a dedicated worker and will deal with situations accordingly – doing the best you can to manage your symptoms. Most of the time, you will find bosses and co-workers sympathetic. If your supervisor is not sympathetic, consider asking your doctor to write a note explaining that IBS is a real illness and that certain symptoms may occur.²⁸ If lifestyle changes alone do not help relieve your IBS symptoms, your doctor may give you medicine to help with symptoms. See current drug options and published medicine recommendations here (PDF).

Health-Related Quality of Life & IBS

“Overall, the prognosis for irritable bowel syndrome is excellent. Patients suffering from IBS should not be worried about it leading to other serious diseases. The major problem with IBS is not because it causes death or serious disease but because it changes the quality of life for the patient. In the last 20 years, we have come to understand how important quality of life is for patients suffering from health problems (called ‘health related quality of life’, HRQOL for short). We now understand that the severity of all diseases, not just IBS, cannot be measured only with tests or how severe symptoms are. Rather, we have begun to understand that the true measure of the impact of any disorder is the negative impact on a patient’s HRQOL.”²⁹

“The world of IBS is changing quickly because of more therapies and an increased awareness. It is considered a ‘real disease’…. A lot of new drugs are being developed, and a lot of work still needs to be done.”²³ The good news is that “as people get older, their symptoms of IBS tend to get better. And over time, about 3 out of 10 people will stop having symptoms all together.”³⁰

In the meantime, if you have IBS symptoms, see your doctor and build the best management plan that you can. Don’t give up if the first strategy doesn’t work. It is likely going to take some trial and error. Keep working with your doctor until you find a management plan that works well to improve your quality of life with IBS.

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This document is meant for educational purposes only and is not intended to replace the advice of your doctor or other health care provider.

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References:

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