Disease: Irritable bowel syndrome

    Overview

    Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine. Signs and symptoms include cramping, abdominal pain, bloating, gas, and diarrhea or constipation, or both. IBS is a chronic condition that you'll need to manage long term.

    Only a small number of people with IBS have severe signs and symptoms. Some people can control their symptoms by managing diet, lifestyle and stress. More-severe symptoms can be treated with medication and counseling.

    IBS doesn't cause changes in bowel tissue or increase your risk of colorectal cancer.

    Source: http://www.mayoclinic.com

    Symptoms

    The signs and symptoms of IBS vary. The most common include:

    • Abdominal pain, cramping or bloating that is typically relieved or partially relieved by passing a bowel movement
    • Excess gas
    • Diarrhea or constipation — sometimes alternating bouts of diarrhea and constipation
    • Mucus in the stool

    Most people with IBS experience times when the signs and symptoms are worse and times when they improve or even disappear completely.

    When to see a doctor

    See your doctor if you have a persistent change in bowel habits or other signs or symptoms of IBS. They may indicate a more serious condition, such as colon cancer. More-serious signs and symptoms include:

    • Weight loss
    • Diarrhea at night
    • Rectal bleeding
    • Iron deficiency anemia
    • Unexplained vomiting
    • Difficulty swallowing
    • Persistent pain that isn't relieved by passing gas or a bowel movement

    Source: http://www.mayoclinic.com

    Causes

    The precise cause of IBS isn't known. Factors that appear to play a role include:

    • Muscle contractions in the intestine. The walls of the intestines are lined with layers of muscle that contract as they move food through your digestive tract. Contractions that are stronger and last longer than normal can cause gas, bloating and diarrhea. Weak intestinal contractions can slow food passage and lead to hard, dry stools.
    • Nervous system. Abnormalities in the nerves in your digestive system may cause you to experience greater than normal discomfort when your abdomen stretches from gas or stool. Poorly coordinated signals between the brain and the intestines can cause your body to overreact to changes that normally occur in the digestive process, resulting in pain, diarrhea or constipation.
    • Inflammation in the intestines. Some people with IBS have an increased number of immune-system cells in their intestines. This immune-system response is associated with pain and diarrhea.
    • Severe infection. IBS can develop after a severe bout of diarrhea (gastroenteritis) caused by bacteria or a virus. IBS might also be associated with a surplus of bacteria in the intestines (bacterial overgrowth).
    • Changes in bacteria in the gut (microflora). Microflora are the "good" bacteria that reside in the intestines and play a key role in health. Research indicates that microflora in people with IBS might differ from microflora in healthy people.

    Triggers

    Symptoms of IBS can be triggered by:

    • Food. The role of food allergy or intolerance in IBS isn't fully understood. A true food allergy rarely causes IBS. But many people have worse IBS symptoms when they eat or drink certain foods or beverages, including wheat, dairy products, citrus fruits, beans, cabbage, milk and carbonated drinks.
    • Stress. Most people with IBS experience worse or more frequent signs and symptoms during periods of increased stress. But while stress may aggravate symptoms, it doesn't cause them.
    • Hormones. Women are twice as likely to have IBS, which might indicate that hormonal changes play a role. Many women find that signs and symptoms are worse during or around their menstrual periods.

    Source: http://www.mayoclinic.com

    Diagnosis

    There's no test to definitively diagnose IBS. Your doctor is likely to start with a complete medical history, physical exam and tests to rule out other conditions. If you have IBS with diarrhea, you likely will be tested for gluten intolerance (celiac disease).

    After other conditions have been ruled out, your doctor is likely to use one of these sets of diagnostic criteria for IBS:

    • Rome criteria. These criteria include abdominal pain and discomfort lasting on average at least one day a week in the last three months, associated with at least two of these factors: Pain and discomfort are related to defecation, the frequency of defecation is altered, or stool consistency is altered.
    • Manning criteria. These criteria focus on pain relieved by passing stool and on having incomplete bowel movements, mucus in the stool and changes in stool consistency. The more symptoms you have, the greater the likelihood of IBS.
    • Type of IBS. For the purpose of treatment, IBS can be divided into three types, based on your symptoms: constipation-predominant, diarrhea-predominant or mixed.

    Your doctor will also likely assess whether you have other signs or symptoms that might suggest another, more serious, condition. These signs and symptoms include:

    • Onset of signs and symptoms after age 50
    • Weight loss
    • Rectal bleeding
    • Fever
    • Nausea or recurrent vomiting
    • Abdominal pain, especially if it's not completely relieved by a bowel movement, or occurs at night
    • Diarrhea that is persistent or awakens you from sleep
    • Anemia related to low iron

    If you have these signs or symptoms, or if an initial treatment for IBS doesn't work, you'll likely need additional tests.

    Additional tests

    Your doctor may recommend several tests, including stool studies to check for infection or problems with your intestine's ability to take in the nutrients from food (malabsorption). You may also have a number of other tests to rule out other causes for your symptoms.

    Imaging tests can include:

    • Flexible sigmoidoscopy. Your doctor examines the lower part of the colon (sigmoid) with a flexible, lighted tube (sigmoidoscope).
    • Colonoscopy. Your doctor uses a small, flexible tube to examine the entire length of the colon.
    • X-ray or CT scan. These tests produce images of your abdomen and pelvis that might allow your doctor to rule out other causes of your symptoms, especially if you have abdominal pain. Your doctor might fill your large intestine with a liquid (barium) to make any problems more visible on X-ray. This barium test is sometimes called a lower GI series.

    Laboratory tests can include:

    • Lactose intolerance tests. Lactase is an enzyme you need to digest the sugar found in dairy products. If you don't produce lactase, you may have problems similar to those caused by IBS, including abdominal pain, gas and diarrhea. Your doctor may order a breath test or ask you to remove milk and milk products from your diet for several weeks.
    • Breath test for bacterial overgrowth. A breath test also can determine if you have bacterial overgrowth in your small intestine. Bacterial overgrowth is more common among people who have had bowel surgery or who have diabetes or some other disease that slows down digestion.
    • Upper endoscopy. A long, flexible tube is inserted down your throat and into the tube connecting your mouth and stomach (esophagus). A camera on the end of the tube allows the doctor to inspect your upper digestive tract and obtain a tissue sample (biopsy) from your small intestine and fluid to look for overgrowth of bacteria. Your doctor might recommend endoscopy if celiac disease is suspected.
    • Stool tests. Your stool might be examined for bacteria or parasites, or a digestive liquid produced in your liver (bile acid), if you have chronic diarrhea.

    Source: http://www.mayoclinic.com

    Complications

    Chronic constipation or diarrhea can cause hemorrhoids.

    In addition, IBS is associated with:

    • Poor quality of life. Many people with moderate to severe IBS report poor quality of life. Research indicates that people with IBS miss three times as many days from work as do those without bowel symptoms.
    • Mood disorders. Experiencing the signs and symptoms of IBS can lead to depression or anxiety. Depression and anxiety also can make IBS worse.

    Source: http://www.mayoclinic.com

    Prevention

    Finding ways to deal with stress may help prevent or ease symptoms of IBS. Consider trying:

    • Counseling. A counselor can help you learn to modify or change your responses to stress. Studies have shown that psychotherapy can provide significant and long-lasting reduction of symptoms.
    • Biofeedback. Electrical sensors help you receive information (feedback) on your body's functions. The feedback helps you focus on making subtle changes, such as relaxing certain muscles, to ease symptoms.
    • Progressive relaxation exercises. These exercises help you relax muscles in your body, one by one. Start by tightening the muscles in your feet, then concentrate on slowly letting all of the tension go. Next, tighten and relax your calves. Continue until the muscles in your body, including those in your eyes and scalp, are relaxed.
    • Mindfulness training. This stress-reduction technique helps you focus on being in the moment and letting go of worries and distractions.

    Source: http://www.mayoclinic.com

    Alternative medicine

    The role of alternative therapies in relieving IBS symptoms is unclear. Ask your doctor before starting any of these treatments. Alternative therapies include:

    • Hypnosis. A trained professional teaches you how to enter a relaxed state and then guides you in relaxing your abdominal muscles. Hypnosis may reduce abdominal pain and bloating. Several studies support the long-term effectiveness of hypnosis for IBS.
    • Mindfulness training. Mindfulness is the act of being intensely aware of what you're sensing and feeling at every moment, without interpretation or judgment. Research indicates that mindfulness can ease symptoms of IBS.
    • Acupuncture. Researchers have found that acupuncture may help improve symptoms for people with IBS.
    • Peppermint. Peppermint is a natural antispasmodic that relaxes smooth muscles in the intestines. It might provide short-term relief of IBS symptoms, but study results have been inconsistent.
    • Probiotics. Probiotics are "good" bacteria that normally live in your intestines and are found in certain foods, such as yogurt, and in dietary supplements. Recent studies suggest that certain probiotics may relieve IBS symptoms, such as abdominal pain, bloating and diarrhea.
    • Stress reduction. Yoga or meditation can help relieve stress. You can take classes or practice at home using books or videos.

    Source: http://www.mayoclinic.com

    Lifestyle and home remedies

    Simple changes in your diet and lifestyle often provide relief from IBS. Your body will need time to respond to these changes. Try to:

    • Experiment with fiber. Fiber helps reduce constipation but also can worsen gas and cramping. Try slowly increasing the amount of fiber in your diet over a period of weeks with foods such as whole grains, fruits, vegetables and beans. A fiber supplement might cause less gas and bloating than fiber-rich foods.
    • Avoid problem foods. Eliminate foods that trigger your symptoms.
    • Eat at regular times. Don't skip meals, and try to eat at about the same time each day to help regulate bowel function. If you have diarrhea, you may find that eating small, frequent meals makes you feel better. But if you're constipated, eating larger amounts of high-fiber foods may help move food through your intestines.
    • Exercise regularly. Exercise helps relieve depression and stress, stimulates normal contractions of your intestines, and can help you feel better about yourself. Ask your doctor about an exercise program.

    Source: http://www.mayoclinic.com

    Risk factors

    Many people have occasional signs and symptoms of IBS. But you're more likely to have the syndrome if you:

    • Are young. IBS occurs more frequently in people under age 50.
    • Are female. In the United States, IBS is more common among women. Estrogen therapy before or after menopause also is a risk factor for IBS.
    • Have a family history of IBS. Genes may play a role, as may shared factors in a family's environment or a combination of genes and environment.
    • Have a mental health problem. Anxiety, depression and other mental health issues are associated with IBS. A history of sexual, physical or emotional abuse also might be a risk factor.

    Source: http://www.mayoclinic.com

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