What is irritable bowel syndrome (IBS)? This is a National Institute's of Health, NIDDK publication.
Includes information on symptoms, causes, diagnosis and treatment of IBS? The role of diet and stress are also described.
What is irritable bowel syndrome (IBS)? This is a National Institute's of Health, NIDDK publication.
Includes information on symptoms, causes, diagnosis and treatment of IBS? The role of diet and stress are also described.
What is irritable bowel syndrome (IBS)? This is a National Institute's of Health, NIDDK publication.
Includes information on symptoms, causes, diagnosis and treatment of IBS? The role of diet and stress are also described.
Syndrome National Digestive Diseases Information Clearinghouse
What is irritable bowel be mucus in it, which is a fluid that moist
ens and protect passages in the digestive syndrome (IBS)? system. Some people with IBS experience Irritable bowel syndrome is a disorder diarrhea, which is frequent, loose, watery, National characterized most commonly by cramping, Institute of stools. People with diarrhea frequently feel Diabetes and abdominal pain, bloating, constipation, an urgent and uncontrollable need to have Digestive and diarrhea. IBS causes a great deal of a bowel movement. Other people with and Kidney Diseases discomfort and distress, but it does not per IBS alternate between constipation and manently harm the intestines and does not diarrhea. Sometimes people find that their NATIONAL INSTITUTES lead to a serious disease, such as cancer. symptoms subside for a few months and OF HEALTH Most people can control their symptoms then return, while others report a constant with diet, stress management, and pre worsening of symptoms over time. scribed medications. For some people, however, IBS can be disabling. They may be unable to work, attend social events, What causes IBS? or even travel short distances. Researchers have yet to discover any spe cific cause for IBS. One theory is that As many as 20 percent of the adult pop people who suffer from IBS have a colon, ulation, or one in five Americans, have or large intestine, that is particularly sensi symptoms of IBS, making it one of the tive and reactive to certain foods and stress. most common disorders diagnosed by The immune system, which fights infection, doctors. It occurs more often in women may also be involved. than in men, and it begins before the age of 35 in about 50 percent of people.
What are the symptoms
of IBS? Abdominal pain, bloating, and discomfort are the main symptoms of IBS. However, symptoms can vary from person to person. Some people have constipation, which means hard, difficult-to-pass, or infrequent bowel movements. Often these people report straining and cramping when trying to have a bowel movement but cannot eliminate any stool, or they are able to eliminate only a small amount. If they are U.S. Department of Health and able to have a bowel movement, there may Human Services • Normal motility, or movement, may Cells that line the inside of the bowel not be present in the colon of a person work as transporters and carry the who has IBS. It can be spasmodic or serotonin out of the GI tract. People can even stop working temporarily. with IBS, however, have diminished Spasms are sudden strong muscle receptor activity, causing abnormal contractions that come and go. levels of serotonin to exist in the GI tract. As a result, they experience • The lining of the colon called the problems with bowel movement, epithelium, which is affected by the motility, and sensation—having more immune and nervous systems, regu sensitive pain receptors in their GI lates the flow of fluids in and out of tract. the colon. In IBS, the epithelium appears to work properly. However, • Researchers have reported that IBS when the contents inside the colon may be caused by a bacterial infection move too quickly, the colon loses its in the gastrointestinal tract. Studies ability to absorb fluids. The result is show that people who have had gas too much fluid in the stool. In other troenteritis sometimes develop IBS, people, the movement inside the otherwise called post-infectious IBS. colon is too slow, which causes extra • Researchers have also found very mild fluid to be absorbed. As a result, a celiac disease in some people with person develops constipation. symptoms similar to IBS. People with • A person’s colon may respond celiac disease cannot digest gluten, strongly to stimuli such as certain a substance found in wheat, rye, and foods or stress that would not bother barley. People with celiac disease can most people. not eat these foods without becoming very sick because their immune sys • Recent research has reported that tem responds by damaging the small serotonin is linked with normal gastro intestine. A blood test can determine intestinal (GI) functioning. Serotonin whether celiac disease may be present. is a neurotransmitter, or chemical, (For information about celiac dis that delivers messages from one part ease, see the NIDDK’s Celiac Disease of your body to another. Ninety-five fact sheet.) percent of the serotonin in your body is located in the GI tract, and the other 5 percent is found in the brain.
Irritable Bowel Syndrome
How is IBS diagnosed? – When it starts, there is a change in the form of the stool or the way If you think you have IBS, seeing your it looks. doctor is the first step. IBS is gener ally diagnosed on the basis of a complete • Certain symptoms must also be medical history that includes a careful present, such as description of symptoms and a physical – a change in frequency of bowel examination. movements – a change in appearance of bowel There is no specific test for IBS, although movements diagnostic tests may be performed to rule – feelings of uncontrollable urgency out other problems. These tests may to have a bowel movement include stool sample testing, blood tests, – difficulty or inability to pass stool and x rays. Typically, a doctor will perform – mucus in the stool a sigmoidoscopy, or colonoscopy, which – bloating allows the doctor to look inside the colon. This is done by inserting a small, flexible • Bleeding, fever, weight loss, and per tube with a camera on the end of it through sistent severe pain are not symptoms the anus. The camera then transfers the of IBS and may indicate other prob images of your colon onto a large screen for lems such as inflammation, or rarely, the doctor to see better. cancer. If your test results are negative, the doctor The following have been associated with a may diagnose IBS based on your symp worsening of IBS symptoms toms, including how often you have had abdominal pain or discomfort during the • large meals past year, when the pain starts and stops in • bloating from gas in the colon relation to bowel function, and how your bowel frequency and stool consistency have • medicines changed. Many doctors refer to a list of • wheat, rye, barley, chocolate, milk specific symptoms that must be present products, or alcohol to make a diagnosis of IBS. • drinks with caffeine, such as coffee, Symptoms include tea, or colas • Abdominal pain or discomfort for at least 12 weeks out of the previous • stress, conflict, or emotional upsets 12 months. These 12 weeks do not Researchers have found that women with have to be consecutive. IBS may have more symptoms during • The abdominal pain or discomfort has their menstrual periods, suggesting that two of the following three features: reproductive hormones can worsen IBS – It is relieved by having a bowel problems. movement. In addition, people with IBS frequently suf – When it starts, there is a change fer from depression and anxiety, which can in how often you have a bowel worsen symptoms. Similarly, the symptoms movement. associated with IBS can cause a person to feel depressed and anxious.
Irritable Bowel Syndrome
What is the treatment A medication available specifically to treat IBS is alosetron hydrochloride (Lotronex). for IBS? Lotronex has been reapproved with sig Unfortunately, many people suffer from nificant restrictions by the U.S. Food and IBS for a long time before seeking medical Drug Administration (FDA) for women treatment. Up to 70 percent of people with severe IBS who have not responded to suffering from IBS are not receiving conventional therapy and whose primary medical care for their symptoms. No cure symptom is diarrhea. However, even in has been found for IBS, but many options these patients, Lotronex should be used are available to treat the symptoms. Your with great caution because it can have seri doctor will give you the best treatments for ous side effects such as severe constipation your particular symptoms and encourage or decreased blood flow to the colon. you to manage stress and make changes to your diet. With any medication, even over-the- counter medications such as laxatives Medications are an important part of and fiber supplements, it is important to relieving symptoms. Your doctor may follow your doctor’s instructions. Some suggest fiber supplements or laxatives for people report a worsening in abdominal constipation or medicines to decrease bloating and gas from increased fiber diarrhea, such as Lomotil or loperamide intake, and laxatives can be habit forming (Imodium). An antispasmodic is commonly if they are used too frequently. prescribed, which helps to control colon muscle spasms and reduce abdominal pain. Medications affect people differently, Antidepressants may relieve some symp and no one medication or combination of toms. However, both antispasmodics and medications will work for everyone with antidepressants can worsen constipation, IBS. You will need to work with your so some doctors will also prescribe medica doctor to find the best combination of tions that relax muscles in the bladder and medicine, diet, counseling, and support to intestines, such as Donnapine and Librax. control your symptoms. These medications contain a mild sedative, which can be habit forming, so they need to be used under the guidance of a physician.
Irritable Bowel Syndrome
How does stress affect IBS? Stress—feeling mentally or emotionally What does the colon do? tense, troubled, angry, or overwhelmed— The colon, which is about 5 feet long, can stimulate colon spasms in people with connects the small intestine to the rec IBS. The colon has many nerves that con tum and anus. The major function of nect it to the brain. Like the heart and the the colon is to absorb water, nutrients, lungs, the colon is partly controlled by the and salts from the partially digested autonomic nervous system, which responds food that enters from the small intes to stress. These nerves control the nor tine. Two pints of liquid matter enter mal contractions of the colon and cause the colon from the small intestine each abdominal discomfort at stressful times. day. Stool volume is a third of a pint. People often experience cramps or “but The difference between the amount terflies” when they are nervous or upset. of fluid entering the colon from the In people with IBS, the colon can be overly small intestine and the amount of stool responsive to even slight conflict or stress. in the colon is what the colon absorbs Stress makes the mind more aware of the each day. sensations that arise in the colon, making the person perceive these sensations as Colon motility—the contraction of the unpleasant. colon muscles and the movement of its contents—is controlled by nerves, Some evidence suggests that IBS is affected hormones, and impulses in the colon by the immune system, which fights infec muscles. These contractions move the tion in the body. The immune system is contents inside the colon toward the affected by stress. For all these reasons, rectum. During this passage, water stress management is an important part and nutrients are absorbed into the of treatment for IBS. Stress management body, and what is left over is stool. A options include few times each day contractions push • stress reduction (relaxation) train the stool down the colon, resulting in a ing and relaxation therapies such as bowel movement. However, if the mus meditation cles of the colon, sphincters, and pelvis do not contract in the right way, the • counseling and support contents inside the colon do not move correctly, resulting in abdominal pain, • regular exercise such as walking cramps, constipation, a sense of incom or yoga plete stool movement, or diarrhea. • changes to the stressful situations in your life • adequate sleep
Irritable Bowel Syndrome
Can changes in diet away within a few weeks. (For information about diets for people with celiac disease, help IBS? please see the NIDDK’s Celiac Disease fact For many people, careful eating reduces sheet.) Increasing fiber intake by 2 to 3 IBS symptoms. Before changing your grams per day will help reduce the risk of diet, keep a journal noting the foods that increased gas and bloating. seem to cause distress. Then discuss your findings with your doctor. You may want Drinking six to eight glasses of plain water to consult a registered dietitian who can a day is important, especially if you have help you make changes to your diet. For diarrhea. Drinking carbonated beverages, instance, if dairy products cause your symp such as sodas, may result in gas and cause toms to flare up, you can try eating less of discomfort. Chewing gum and eating too those foods. You might be able to toler quickly can lead to swallowing air, which ate yogurt better than other dairy products also leads to gas. because it contains bacteria that supply Large meals can cause cramping and diar the enzyme needed to digest lactose, the rhea, so eating smaller meals more often, sugar found in milk products. Dairy prod or eating smaller portions, may help IBS ucts are an important source of calcium symptoms. Eating meals that are low and other nutrients. If you need to avoid in fat and high in carbohydrates such as dairy products, be sure to get adequate pasta, rice, whole-grain breads and cere nutrients in the foods you substitute, or als (unless you have celiac disease), fruits, take supplements. and vegetables may help. In many cases, dietary fiber may lessen IBS symptoms, particularly constipation. Is IBS linked to other However, it may not help with lowering pain or decreasing diarrhea. Whole grain health problems? breads and cereals, fruits, and vegetables As its name indicates, IBS is a syndrome—a are good sources of fiber. High-fiber diets combination of signs and symptoms. IBS keep the colon mildly distended, which has not been shown to lead to a serious may help prevent spasms. Some forms disease, including cancer. Through the of fiber keep water in the stool, thereby years, IBS has been called by many names, preventing hard stools that are difficult to among them colitis, mucous colitis, spas pass. Doctors usually recommend a diet tic colon, or spastic bowel. However, no with enough fiber to produce soft, painless link has been established between IBS bowel movements. High-fiber diets may and inflammatory bowel diseases such as cause gas and bloating, although some Crohn’s disease or ulcerative colitis. people report that these symptoms go
Irritable Bowel Syndrome
Hope Through Research Points to Remember The NIDDK conducts and supports • IBS is a disorder that interferes with research into many kinds of digestive the normal functions of the colon. disorders including IBS. Researchers The symptoms are crampy abdominal are studying gastrointestinal motility and pain, bloating, constipation, and diar sensitivity to find possible treatments for rhea. IBS. These studies include the structure and contraction of gastrointestinal muscles, • IBS is a common disorder found as well as the mechanics of fluid movement more often in women than men. through the intestines. Understanding the • People with IBS have colons that are influence of the nerves, hormones, and more sensitive and reactive to things inflammation in IBS may lead to new treat that might not bother other people, ments to better control the symptoms. such as stress, large meals, gas, medicines, certain foods, caffeine, or alcohol. The U.S. Government does not endorse or favor any specific commercial product or company. Trade, • IBS is diagnosed by its signs and proprietary, or company names appearing in this symptoms and by the absence of document are used only because they are considered other diseases. necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory. • Most people can control their symp toms by taking medicines such as laxatives, antidiarrhea medicines, antispasmodics, or antidepressants; reducing stress; and changing their diet. • IBS does not harm the intestines and does not lead to cancer. It is not related to Crohn’s disease or ulcerative colitis.
Irritable Bowel Syndrome
For More Information National Digestive Diseases International Foundation for Functional Information Clearinghouse Gastrointestinal Disorders P.O. Box 170864 2 Information Way Milwaukee, WI 53217–8076 Bethesda, MD 20892–3570 Phone: 1–888–964–2001 Phone: 1–800–891–5389 Fax: 414–964–7176 Fax: 703–738–4929 Email: iffgd@iffgd.org Email: nddic@info.niddk.nih.gov Internet: www.iffgd.org Internet: www.digestive.niddk.nih.gov The National Digestive Diseases Information Clearinghouse (NDDIC) You may also find additional information on this topic is a service of the National Institute using the following databases: of Diabetes and Digestive and Kidney The NIDDK Reference Collection is a collection Diseases (NIDDK). The NIDDK is part of of thousands of materials produced for patients and health care professionals, including fact sheets, bro the National Institutes of Health under chures, and audiovisual materials. Visit the U.S. Department of Health and www.catalog.niddk.nih.gov/resources. Human Services. Established in 1980, the MedlinePlus brings together a wealth of information Clearinghouse provides information about from the National Library of Medicine, the National Institutes of Health, and other government agencies digestive diseases to people with digestive and health-related organizations. MedlinePlus offers disorders and to their families, health easy access to medical journal articles, a medical dictionary and medical encyclopedia, health informa care professionals, and the public. The tion in Spanish, hospital and physician directories, NDDIC answers inquiries, develops and drug and supplement lists, interactive patient tutori distributes publications, and works closely als, links to hundreds of clinical trials, and the latest health news. Visit www.medlineplus.gov. with professional and patient organizations and Government agencies to coordinate resources about digestive diseases. This publication may contain information about medications used to treat a health condition. When this publication was prepared, the NIDDK included This publication is not copyrighted. The Clearing the most current information available. Occasion house encourages users of this fact sheet to duplicate ally, new information about medication is released. and distribute as many copies as desired. For updates or for questions about any medications, please contact the U.S. Food and Drug Administra This fact sheet is also available at tion at 1–888–INFO–FDA (463–6332), a toll-free call, www.digestive.niddk.nih.gov. or visit their website at www.fda.gov. Consult your doctor for more information.