www.patientedu.orgwww.patientedu.org/ibs

written byHarvard Medical School

written byHarvard Medical School

Irritable Bowel Syndrome

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I rritable bowel syndrome (IBS) is a common and frustrating condition. Symptoms often interfere with work and other activities. Some IBS sufferers

avoid leaving the house because they’re embarrassed or don’t want to be very far from a bathroom.

SymptomsSymptoms of IBS include:

• Recurrent diarrhea.

• Recurrent constipation.

• Recurrent diarrhea alternating with constipation.

• Cramps, bloating, and gas.

People with IBS often have pain or discomfort in the belly (abdomen). This pain often gets better after a bowel movement or passing gas.

While some people have symptoms all or most of the time, others go long stretches without symptoms at all. This can make it harder to tell whether someone has IBS or just an occasional stomach upset.

Diagnosing IBSThere are no specific tests for IBS, so your doctor will look carefully at the pattern of your symptoms. A physical exam and some routine laboratory tests—including a stool sample—are likely to be part of your visit.

Your doctor will also ask if your symptoms started after a bout of the stom-ach flu, or if they seem connected to specific foods or medications, particularly milk products and foods and beverages that contain fructose or sorbitol. You may need

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to keep a food diary for a few weeks to help identify foods that provoke symptoms.

Emotional and psychological triggers are also impor-tant factors. It’s not unusual for a stressful event, such as divorce or the loss of a job, to cause belly problems.

Do You Have IBS?According to standard guidelines, you have IBS if you have had recurrent abdominal pain or discomfort at least 3 days a month in the past 3 months, beginning at least 6 months ago, and two or more of the following:

• Improvement in symptoms after a bowel movement.

• A change in the frequency of stool along with the onset of pain or discomfort.

• A change in the form (appearance) of stool along with the onset of pain or discomfort.

The following additional symptoms can help support the diagnosis and may also be used to identify certain types of IBS:

• Abnormal stool frequency (more than 3 bowel movements per day

or less than 3 per week).

• Abnormal stool form (hard or loose stool) more than 1 in every 4 times.

• Trouble passing stool (straining, urgency, or the feeling of incomplete evacuation) more than 1 in 4 times.

• Passage of mucus in more than 1 in every 4 bowel movements.

• Bloating or the sensation of having a distended abdomen on more than 1 out of every 4 days.

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What Causes IBS?Experts aren’t sure exactly what causes IBS. The condition is usually described as a problem with how the digestive tract (or “gut”) works. Theories include:

• Problems with the nerves and muscles of the gut.

• A glitch in how the gut and brain communicate.

• Gut infections may be a trigger of symptoms.

• Overgrowth of bacteria that normally live in the gut.

• A colon (large intestine) that is more sensitive and likely to cramp with little cause.

• Unusual sensitivity to pain and gut sensations.

• Hormones.

• Something in the diet that triggers symptoms.

• Emotional factors like stress often worsen symptoms.

Eliminate triggers. Look for dietary and emotional triggers and try to eliminate them. Begin your search by keeping track of how events, foods, beverages, and drugs affect symptoms.

Try heat. For people who experience IBS symptoms only from time to time, a home heating

pad can be a simple and inexpensive way of soothing abdominal pain.

Drinking a warm, non-caffeinated tea, such as chamomile, may

help reduce discomfort.

Managing IBSThere is no cure, but these tips may reduce symptoms:

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Foods That May Trigger IBS SymptomsApples & other raw fruits

Beans

Broccoli

Cabbage

Caffeine

Cauliflower

Chocolate

Orange & grapefruit juices

Dairy products

Fatty foods

Items sweetened with fructose or sorbitol

Margarine

Nuts

Wheat products

Try cutting out one food at a time to see which ones give you trouble. Keeping a food diary—in which you track what you eat and your symptoms—can help.

TherapyFor many people, anxiety or stress can trigger or worsen IBS symptoms. Cognitive behavioral therapy that helps reframe negative thoughts into more positive, productive ways of thinking can improve symptoms and quality of life.

Eat fiber. Research suggests that fiber seems to relieve constipation and may ease abdominal pain. It can sometimes even improve diarrhea. However, a high-fiber diet doesn’t always improve bowel symptoms, and for a few people, it may at least temporarily increase bloating or gas. You can increase the fiber in your diet by eating whole grains, bran cereals, and plenty of fresh fruits and vegetables. You can also try a fiber supplement containing psyllium or methylcellulose.

Managing IBSThere is no cure, but these tips may reduce symptoms:

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Medications for IBSWhile medications can’t cure IBS, they may ease the symptoms.

Drugs that reduce cramping. These medications may provide some temporary relief of mild abdominal pain by reducing bowel spasms.

Antibiotics. Many people with IBS have an overgrowth of bacteria in their small intestines. Treatment with antibiotics to eliminate this overgrowth may help improve symptoms.

Antidepressants. Doctors may prescribe certain types of antidepressants that also treat IBS pain. Some of these drugs are not helpful for people whose IBS includes constipation.

Drugs that reduce diarrhea. If diarrhea is one of your IBS symptoms, these medications can help. Some are available over-the-counter and some need a prescription.

Laxatives. Before using a laxative to relieve constipa-tion, talk with your doctor. Laxatives should be used carefully and some cause cramping.

Prescription medications. These drugs are not a cure, but can help manage IBS symptoms.

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Alternative treatmentsPeople with IBS often look to alternative treatments to help relieve symptoms.

Relaxation response training and meditation. These techniques are simple and easy to learn and help reduce nervous system activity and relax muscles.

Yoga. Yoga, like meditation, can serve as a form of self-relaxation.

Hypnosis. Increasing evidence suggests that this mind-relaxation technique might help.

Acupuncture. This system of applying small needles to prescribed points on the body has been used for treatment of IBS symptoms.

Biofeedback is a mind-body technique in which partic-ipants use a machine to see and learn to control their body’s response to input. Some patients have been able to improve their control using these techniques.

Herbal remedies. One possible remedy is peppermint oil, which may help relax the colon.

It’s important to learn how best to control your symp-toms. It may take some trial and error and perhaps use of several approaches together. But with some effort, you can manage IBS and regain control over your life.

About This Brochure: This brochure was written by practicing physicians from Harvard Medical School. It is part of a series developed and distributed by the Patient Education Center.

All the information in this brochure and on the associated Web site (www.patientedu.org) is intended for educational use only; it is not intended to provide, or be a substitute for, professional medical advice, diagnosis, or treatment. Only a physician or other qualified health care professional can provide medical advice, diagnosis, or treatment. Always consult your physician on all matters of your personal health.

Harvard Medical School, the Patient Education Center, and its affiliates do not endorse any products.

Consulting Physician: Anthony L. Komaroff, MD Editorial Director: Keith D’Oria

Creative Director: Jon Nichol

© Copyright Harvard Medical School.

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To learn more about irritable bowel syndrome, visit the Patient Education Center at www.patientedu.org/ibs.