Irritable bowel syndrome (IBS) occurs when muscles in your intestines
contract faster or slower than normal. This causes pain, cramping, gassiness,
sudden bouts of diarrhea, and constipation.
Two types of IBS exist. In spastic colon IBS, you experience constipation,
diarrhea, or both, and you often have pain after eating. Painless diarrhea IBS
involves the sudden onset of diarrhea during or after meals, or upon waking.
Between 10 and 20 percent of the population has IBS at some time. The syndrome
often starts in adolescents or young adults. It affects three times as many
women as men and is often associated with stress.
Signs and Symptoms
Cramping pain in your lower abdomen
Bloating and gassiness
Changes in your bowel habits
Diarrhea or constipation, or both alternately
Immediate need to move your bowels when you wake up or during or
Relief of pain after bowel movements
Feeling of incomplete emptying after bowel movements
Mucus in your stool
What Causes It?
The underlying cause remains unknown. But the syndrome has no relation to
actual disease, and it does not lead to other diseases.
What to Expect at Your Provider's Office
Your health care provider will feel your abdomen to check for signs of pain.
He or she will place a gloved finger in your rectum to check its condition. If
you're female, you may have a pelvic examination. The provider may use a
sigmoidoscope—a flexible instrument inserted into the
rectum—to examine your lower colon. You may be asked to
provide three days' worth of stool samples. Your provider may also want samples
of your blood and urine. The provider may also want an ultrasound or X
Try to avoid stressful situations or foods that have triggered IBS in the
past. Monthly hormonal changes and some drugs can affect your condition.
Establishing regular bowel habits can be helpful. Your health care provider may
prescribe medications to help you with the symptoms.
Anticholinergic agents—reduce the pain from
Antidiarrheal medication—such as Loperamide
Bulk-producing agents—such as psyllium
(Metamucil) and other fiber supplements can help with diarrhea or
Complementary and Alternative Therapies
IBS has many underlying causes that can often be successfully treated with
alternative therapies. Stress reduction techniques through biofeedback,
hypnosis, or counseling can help you deal with stress.
Removal of known food allergens or irritants is important. The most
common food allergens are dairy products, wheat, corn, peanuts, citrus, soy,
eggs, fish, and tomatoes. An elimination/challenge trial may help uncover
sensitivities. Eliminate all suspected allergens from the diet for two weeks.
Add back one food every three days and wait for reaction to the
If you suffer from gassiness, eliminate beans, cabbages, and other
"gassy" vegetables from your diet, as well as apple juice, grape juice, bananas,
nuts, and raisins.
Fiber supplementation can help reduce pain, cramping, and gas.
Supplements include psyllium, flaxmeal, slippery elm (Ulmus fulva)
powder, and marshmallow root (Althaea officinalis) powder.
Digestive enzymes taken 20 minutes before meals can help enhance
digestion and normalize bowel function.
One teaspoon of raw bran with each meal, supplemented by extra
fluids, provides fiber reliably.
Pro-flora supplements such as acidophilus and lactobacillus species
taken two to three times per day can help to rebalance normal bowel bacteria and
reduce gas and bloating.
Magnesium (200 mg two to three times per day) and B-complex (50 to
100 mg per day) with extra B5 (pantothenic acid; 100 mg per day) may help reduce
the effects of stress.
Low-fat diets may relieve abdominal pain following
Herbs may be used as dried extracts (capsules, powders, teas), glycerites
(glycerine extracts), or tinctures (alcohol extracts). Unless otherwise
indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep
covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots.
Drink 2 to 4 cups per day.
Enteric-coated peppermint oil: one to two capsules (0.2 ml peppermint
oil per capsule) three times a day after meals
A tea of fennel seed (Foeniculum vulgare) or ginger root
(Zingiber officinale) taken after meals promotes good
A tincture of equal parts of the following before meals (30 drops
three times per day): valerian (Valeriana officinalis), passionflower
(Passiflora incarnata), anise seed (Pimpinella anisum) extract,
meadowsweet (Filipendula ulmaria), wild yam (Dioscorea villosa),
and milk thistle (Silybum
Homeopathy may be useful as a supportive therapy.
Electric heating pads, hot water bottles, and long hot baths can
relieve painful spasms and cramping in the abdomen.
Regular exercise, such as walking, can reduce stress and encourage
bowel movements if you are constipated.
Castor oil pack. Apply oil directly to skin, cover with a clean soft
cloth and plastic wrap. Place a heat source over the pack and let sit for 30 to
Abdominal breathing helps to induce the relaxation response and may
aid normal physiological functioning (such as
Several small studies suggest that acupuncture may be of value for IBS. A
preliminary study of seven people with IBS, for example, found that acupuncture
improved general well-being and symptoms of bloating. No firm conclusions can be
drawn about acupuncture's value in treating IBS, however, until larger clinical
trials are conducted.
Acupuncturists treat people with IBS based on an individualized assessment of
the excesses and deficiencies of qi located in various meridians. In the case of
IBS, a qi deficiency is usually detected in the spleen and lung meridians.
Moxibustion (a technique in which the herb mugwort is burned over specific
acupuncture points) is frequently used for treatment of IBS because its effect
is thought to reach deeper into the body. Because acupuncture is considered
safe, and IBS is not easily treated by currently available conventional methods,
people with IBS may wish to try acupuncture therapy to improve
No well-designed studies have evaluated the effect of chiropractic on
individuals with IBS, but chiropractors report that spinal manipulation may
improve symptoms of the condition in some individuals. It is speculated that, in
these cases, spinal manipulation may have a balancing effect on the nerves that
supply impulses to the intestinal tract.
Therapeutic massage may help in reducing the effects of
Be aware that the syndrome itself may cause you stress.
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Review Date: August 1999
Reviewed By: Participants in the review process include: Lawrence J. Cheskin, MD, FACP,
Director, The Johns Hopkins Weight Management Center, Lutherville, MD; Gary
Guebert, DC, DACBR, (Chiropractic section October 2001) Login Chiropractic
College, Maryland Heights, MO; Lonnie Lee, MD, Internal Medicine, Silver
Springs, MD; Richard A. Lippin, MD, President, The Lippin Group, Southampton,
PA; Joseph Trainor, DC, (Chiropractic section October 2001) Integrative
Therapeutics, Inc., Natick, MA; Marcellus Walker, MD, LAc, (Acupuncture section
October 2001) St. Vincent's Catholic Medical Center, New York, NY; Ira Zunin,
MD, MPH, MBA, (Acupuncture section October 2001) President and Chairman, Hawaii
State Consortium for Integrative Medicine, Honolulu,
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