Irritable Bowel Syndrome

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Irritable bowel syndrome is a disorder of motility of the entire gastrointestinal tract that produces abdominal pain, constipation, or diarrhea.

Irritable bowel syndrome affects women three times more often than men. In this syndrome, the gastrointestinal tract is especially sensitive to many stimuli. Stress, diet, drugs, hormones, or minor irritants may cause the gastrointestinal tract to contract abnormally.

Periods of stress and emotional conflict that cause depression or anxiety frequently exacerbate episodes of irritable bowel syndrome. Some people with the syndrome appear to be much more aware of their symptoms, evaluate them more seriously, and experience greater disability than others. Other people with irritable bowel syndrome who experience similar stress and emotional conflicts either develop less severe gastrointestinal symptoms or react to them with less concern and disability.

During an episode, the contractions of the gastrointestinal tract become stronger and more frequent, and the resulting rapid transit of food and feces through the small intestine often leads to diarrhea. Crampy pain seems to result from the strong contractions of the large intestine and in-creased sensitivity of the pain receptors in the large intestine. Episodes almost always occur when a person is awake; they rarely wake a person from sleep.

For some people, high-calorie meals or a high-fat diet may be to blame. For other people, wheat, dairy products, coffee, tea, or citrus fruits appear to aggravate the symptoms, but it's not clear that these foods are actually the cause.

Symptoms
There are two major types of irritable bowel syndrome. The spastic colon type, which is commonly triggered by eating, usually produces periodic constipation or diarrhea with pain. Sometimes constipation and diarrhea alternate. Mucus often appears in the stool. The pain may come in bouts of continuous dull aching or cramps, usually over the lower abdomen. The person may experience bloating, gas, nausea, headaches, fatigue, depression, anxiety, and difficulty concentrating. Having a bowel movement often relieves the pain.

The second type mainly produces painless diarrhea or relatively painless constipation. The diarrhea may begin very suddenly and with extreme urgency. Typically, the diarrhoea follows soon after a meal, although it can sometimes occur immediately upon awakening. Sometimes the urgency is so strong that the person loses control and can't reach a bathroom in time. Diarrhea during the night is rare. Some people have bloating and constipation with relatively little pain.

Diagnosis
Most people with irritable bowel syndrome appear to be healthy. A physical examination generally doesn't reveal anything unusual except tenderness over the large intestine. Doctors generally perform some tests-for example, blood tests, a stool examination, and a sigmoidoscopy - to differentiate irritable bowel syndrome from inflammatory bowel disease and the many other conditions that can cause abdominal pain and changes in bowel habits. These test results are usually normal, although the stool may be watery. A sigmoidoscopy (an examination of the sigmoid colon using a flexible viewing tube) may cause spasms and pain, but the test results are otherwise normal. Sometimes other tests-such as abdominal ultrasound, X-rays of the intestines, or a colonoscopy (an examination of the large intestine using a flexible viewing tube) are used.

Treatment
The treatment for irritable bowel syndrome differs from person to person. People who can identify particular foods or types of stress that bring on the problem should avoid them if possible. For most people, especially those who tend to be constipated, regular physical activity helps keep the gastrointestinal tract functioning normally.

In general, a normal diet is best. People with abdominal distention and increased gas (flatulence) should avoid beans, cabbage, and other foods that are difficult to digest. Sorbitol, an artificial sweetener used in dietetic foods and in some drugs and chewing gums, should not be consumed in large amounts. Fructose (a common constituent of fruits, berries, and some plants) should be eaten only in small amounts. A low-fat diet helps some people. People who have both irritable bowel syndrome and lactase deficiency shouldn't eat dairy products.

Some people with irritable bowel syndrome can improve their condition by eating more fiber, especially if the main problem is constipation. They may take a tablespoon of raw bran with plenty of water and other fluids at each meal, or they can take psyllium mucilloid supplements with two glasses of water. Increasing the dietary fiber may aggravate some symptoms, such as flatulence and bloating.

Drugs that slow the function of the gastrointestinal tract and are considered to be antispasmodics, such as propantheline, have not been proved effective, although they are frequently prescribed. Antidiarrhoeal drugs, such as diphenoxylate and loperamide, help people with diarrhea. Antidepressant drugs, mild tranquilizers, psychotherapy, hypnosis, and behaviour modification techniques may help some people with irritable bowel syndrome.

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