It’s all too familiar: a big test, a traumatic event or the wrong food throws your gut into high gear, triggering stomach cramps and diarrhea. The crisis passes, and your system returns to normal. But for those with irritable bowel syndrome (IBS) this type of cramping, pain and bowel distress becomes chronic, often interfering with every day work and social activities.
The effect of mood, stress, and your feelings have on control of the intestinal tract is thought to be related to a substance known as serotonin. A well-known neurotransmitter that regulates appetite and mood, serotonin is also produced in the gut. Researchers increasingly believe that disturbances in serotonin levels may be linked to IBS. With too much serotonin, diarrhea is the dominant symptom. Too little serotonin creates the opposite effect, constipation. Both are symptoms of IBS.
IBS is common, affecting an estimated 10 to 15 percent of Americans. IBS is more common in women. There’s no single, identifiable cause, so physicians find it very difficult to pin down and treat. Yet it’s symptoms are no less real.
A diagnosis of IBS requires that a patient has experienced at least 12 weeks of abdominal pain or discomfort over the preceding 12 months with at least two of the three following conditions:
• abdominal pain relieved by a bowel movement;
• a change in the frequency of bowel movements;
• a change in the appearance of stool.
Treatment Requires Patience
IBS is a complex condition. Just as there’s no single treatment, there is no single cause. Patients and physicians need to be willing to work together to identify patterns of illness and potential triggers. Treatment options include changes in lifestyle and overall eating patterns, avoiding specific foods, adding bulking agents to the diet, stress management techniques and, for some patients, medication. Surgery is not a treatment for IBS, although some patients undergo unnecessary surgery when other causes of abdominal pain are wrongly suspected.
Food triggers
For some patients, food seems to play a role. Common offenders are high-fat foods, very large meals, dairy products, caffeine, nicotine, or excessive amounts of alcohol. Foods that create gas such as beans, cabbage, broccoli and cauliflower may also contribute. Chocolate, a comfort food for many, may be a real discomfort for some with IBS. Identifying food triggers requires close attention to dietary intake. A food diary can help if a consistent intake is maintained. With a diet diary, symptoms can be paired with suspected foods. Eliminating only one item at a time helps rule out each suspected item until the culprit is identified. While narrowing down the possible food triggers, it’s essential to maintain a well-balanced diet with adequate bulk. A dietitian can be of great help in this area.
Diet choices
If constipation is a major symptom, it’s important to increase dietary fiber in order to speed the passage of matter through the colon and soften the stool. Gradually increasing the amount of fruits, vegetables, whole grains and bran can help. Some physicians also recommend a soluble fiber supplement such as psyllium (Metamucil) and methylcellulose.
Stress reduction
Stress reduction techniques can help alleviate symptoms triggered by job stress, personal conflict and anxiety. There are many strategies for controlling life stress including exercise, learned relaxation techniques, yoga, meditation and biofeedback. Combining exercise, which helps release stress, with a more inner-directed method such as learned relaxation or meditation can help patients feel more in control of their physical and psychological selves.
Some studies indicate that persons with IBS tend to have a more passive personality style. Learning how to be more assertive in social and work situations may help some patients feel more in control of their lives. Exercise programs including Yoga, Judo, or Karate may help change a persons attitude. Being physically fitter may boost confidence and assertiveness in every day situations. If stress seems to trigger IBS, talk to your physician about treatment options. It’s important to find something that appeals to you.
Medications
Treatments prescribed to treat IBS are targeted to specific symptoms and are believed to be effective in about 25 percent of patients. Antispasmodic drugs such as dicyclomine (Bentyl) and hyosycamine (Levsin) are prescribed to help dampen intestinal spasms that cause pain, bloating and cramps. The medications work best when taken shortly after meals. Studies show they have limited effectiveness.
For patients who suffer from diarrhea, antidiarrheal medications such as loperamide (Imodium) may help. An antidepressant class of drugs known as tricyclic antidepressants, given in low doses are effective for some patients in controlling pain and diarrhea. Another drug approved for women only is alosetron (Lotronex), a serotonin-3 receptor agonist. It is designed to treat severe diarrhea but has to be carefully monitored as a number of severe side effects including hospitalizations and even five deaths have occurred in patients taking Lotronex.
For constipation, tegaserod (Zelnorm), was approved by the FDA in 2002. Zelnorm is approved to treat women only and for short-term use. It is the first in a new class of drugs known as serotonin-4 receptor agonists that are designed to treat gastrointestinal disturbances. Zelnorm has been effective in improving symptoms for women with constipation-predominant IBS. Another option for treatment of constipation is Lubiprostone (Amitiza). Both of these excellent drug choices speed up passage through the bowel, but diarrhea is a common side effect of both.
Although it’s a distressing and frustrating condition, patients with IBS need to understand that it doesn’t cause any permanent damage to the colon. Moreover, IBS is not associated with an increased risk of cancer. Patients with IBS need to find a physician willing to work with them to find the best combination of treatment options to keep IBS under control.
Michelle Herbert, PharmD, CDE
Clinical Director
Richmond Apothecaries, Inc.
