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Living with Irritable Bowel Syndrome

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Irritable bowel syndrome (IBS) affects as much as 20% of the population and remains one of the most common gastrointestinal complaints that cause people to seek advice from a health care provider. Although the condition does not lead to more serious problems it can be an embarrassing and very frustrating problem to manage. The good news is that it need not be. The common pattern of bloating, abdominal cramping, diarrhea, and constipation can be controlled with some simple measures and consistency in diet and lifestyle.

Initial steps should include evaluation to rule out other causes of bowel disease that share these same symptoms. Usually colonoscopy is needed to exclude other types of inflammatory bowel disease as IBS is a diagnosis of exclusion. IBS often starts before the age of 35 and is twice as common in women as men. Although not a hereditary condition, someone in your immediate family with IBS may increase your own risk of developing problems. The exact cause of IBS remains unclear. In sensitive individuals triggers include stress, certain foods, and other illnesses. The consequences of IBS certainly can interfere with work or lifestyle. It can be both embarrassing and depressing when struggling with intestinal symptoms more frequently than the average person.

Treatment is aimed at understanding the problem and recognizing how individual triggers can be managed or avoided. The cornerstone of managing symptoms also relies on consistency in diet. A diet high in fiber and staying well hydrated are important. Use of over-the-counter fiber supplements is helpful. Other forms of soluble fiber such as oats, oatmeal, and bran cereal are usually well tolerated. Fresh fruits and raw vegetables that are particularly gas-producing such as salads, cabbage, cauliflower, or broccoli may need to be avoided. Caffeine, alcohol, and carbonated beverages are typically problematic.

Episodes of diarrhea can be managed with cautious use of loperamide (Immodium) which is available without prescription. If diarrhea is more chronic your health care provider can prescribe other antispasmodic medication as needed. Antidepressants are also part of a regimen to control intestinal spasm and secondary depression that is associated with the condition. There are two newer medications that have been useful in selected patients with IBS. Unfortunately they seem to have limited application and are not successful for everyone. Counseling and understanding the condition, managing stress and lifestyle remain the most important tools. Stress management through yoga, biofeedback, talk therapy, even hypnosis or other relaxation techniques has proven to be helpful for some people with IBS.

Alternative medicines have somewhat inconsistent results. Probiotics, restoring normal bacteria to the intestine, is advocated by some but scientific studies are discouraging that it is of any use. Peppermint oil is a natural antispasmodic. It has been useful in some individuals but should be used cautiously as it can be very irritating to the stomach, worsening symptoms of heartburn and gastric reflux or can interfere with other medications. Consult your health care provider to see if it might be useful for your symptoms.

Remember that understanding and regularity of your daily routine are most helpful. Support groups and on-line chat groups on IBS are community resources that can be helpful and supportive. Don’t be hesitant to discuss your individual situation with your health care provider. These are common problems that are challenging but manageable.

About Bruce Kaler M.D.