IRRITABLE BOWEL SYNDROME What is irritable bowel syndrome (IBS)?

Irritable bowel syndrome (IBS) is a collection of symptoms that occur when the nerves and muscles in a person's bowel (the colon, or large intestine) do not work like they should. With IBS, a person's bowel is extra sensitive, causing discomfort and changes in bowel activity. IBS is a chronic condition, meaning it lasts a long time.

Symptoms of IBS may include:

• cramping
• pain in the stomach area
• bloating
• gas
• mucus in the stool
• changes in bowel habits

Some people with IBS have constipation--infrequent stools that may be hard, dry, and painful. Others have diarrhoea--frequent loose stools. Some people have both. Sometimes a person with IBS has a crampy urge to empty the bowels but cannot do so.

IBS is not a disease and it does not cause cancer. IBS is a "functional" disorder, which means that the bowel doesn't work as it should. The cause of IBS is not known, and there is no cure for IBS. But, there are things you can do to feel better.

For some people, IBS is simply a bother. For others, it keeps them from going out, going to work, or even traveling short distances. Most people with IBS, however, can ease their symptoms by eating better, reducing stress, or taking medicine.

What causes IBS?

The cause of IBS is not known, and there is no cure for IBS. But, there are things you can do to feel better.

Who gets IBS?

Up to one in five Americans has IBS. 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.

What are the symptoms of IBS?

The main symptoms of IBS include:

• crampy pain in the stomach area
• painful constipation - infrequent stools that may be hard and dry
• painful diarrhoea - frequent loose stools

Most people have either diarrhoea or constipation, but some people have both.

Other symptoms include:

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

Some women with IBS have more or different symptoms during their menstrual periods. Constipation may be relieved or diarrhoea may occur in the day or two before or when their period starts.

How is IBS diagnosed?

If you think you may have IBS, see your doctor. Your doctor will take a medical history and ask about your symptoms. Then your doctor will perform some medical tests.

There are no tests that can show for sure that you have IBS. But your doctor may do some medical tests to make sure you don't have any other diseases that could cause your symptoms. Other possible causes include polyps, inflammation, or intolerance of foods containing a protein called gluten. Medical tests that may be done include:

• physical exam
• blood tests
• x-ray of the bowel: This x-ray test is called a barium enema or lower GI (gastrointestinal) series. Barium is a thick liquid that makes the bowel show up better on the x-ray. Before taking the x-ray, the doctor will put barium into your bowel through the anus.
• endoscopy: The doctor inserts a thin tube into your bowel. The tube has a camera in it, so the doctor can look at the inside of the bowel to check for problems.

Sometimes other tests need to be done to check how fast or slow content moves through the colon, or to check to see if the anal muscles are working right.

What is the treatment for IBS?

There is no cure for IBS, but there are things you can do to feel better. Treatment may include:

Diet changes

Some foods make IBS worse:

• milk products, like cheese or ice cream (people who have trouble digesting lactose, or milk sugar could be extra sensitive)
• chocolate
• alcohol
• caffeine (found in coffee, tea, and some sodas)
• carbonated drinks like soda
• Sorbitol, a sweetener found in dietetic foods and in some chewing gums
• gas-producing foods including beans and certain vegetables like broccoli or cabbage

="margin-left: 2em;">To find out which foods are causing your symptoms, write down:

• what you eat during the day
• what symptoms you have
• when symptoms occur
• what foods always make you feel bad

="margin-left: 2em;">Try not to eat foods that cause IBS symptoms. Or try eating less of those foods.

Some foods make IBS better:

Fiber lessens IBS symptoms--mainly constipation because it makes stool soft, bulky, and easier to pass. Fiber is found in bran, bread, cereal, beans, fruits, and vegetables.

Here are some examples of foods with fiber:

Fruits	Vegetables	Breads, cereals, and beans
Apples Peaches	Broccoli, raw Cabbage Carrots, raw Peas	Kidney beans Lima beans Whole-grain bread Whole-grain cereal

Add foods with fiber to your diet a little at a time to let your body get used to them. Too much fiber all at once might cause gas, which can trigger symptoms in a person with IBS. If you have constipation, start by adding 12 grams of fiber per day. You may have to raise or lower the amount of fiber to a maximum of 30 grams per day, based on how fiber affects your bowel function and gas production.

Besides telling you to eat more foods with fiber, your doctor might also tell you to get more fiber by taking a fiber pill or drinking water mixed with a special high-fiber powder.

How much you eat matters, too.

Large meals can cause cramping and diarrhoea in people with IBS. If this happens to you, try eating four or five small meals a day. Or, have your usual three meals, but eat less at each meal.

Medicine

If necessary, your doctor may give you medicine to help with symptoms:

• laxatives: to treat constipation
• antispasmodics: to slow contractions in the bowel, which may help with diarrhoea and pain
• antidepressants: to help with severe pain

Take your medicine exactly as your doctor tells you to. Some medicines, including laxatives, can be habit-forming, and all drugs have side effects. Remember to tell your doctor about any over-the-counter medicines you are taking.

Stress relief

Stress does not cause IBS, but it can worsen your symptoms. Learning to reduce stress can help. With less stress, you may find that you have less cramping and pain.

Meditation, yoga, massage, exercise, hypnotherapy, and counseling are some things that might help. You may need to try different activities to see what works best for you.

Other things that may help:

• Drink 6 to 8 glasses of water each day.
• Exercise can help with constipation and improve your overall health. Exercise helps relieve stress and depression and helps your bowel function as it should.