Irritable bowel syndrome

Definition

Irritable bowel syndrome (IBS) is a common gastrointestinal condition characterized by abdominal pain and cramps; changes in bowel movements (diarrhea , constipation , or both); gassiness; bloating; nausea ; and other symptoms. There is no cure for IBS; however, dietary changes, stress management, and sometimes medications are often able to eliminate or substantially reduce its symptoms.

Description

IBS is the name people use today for a condition that was once called—among other things—spastic colitis, mucous colitis, spastic colon, nervous colon, spastic bowel, and functional bowel disorder. Some of these names reflected the now outdated belief that IBS is a purely psychological disorder, a product of the patient's imagination. Although modern medicine recognizes that stress, anxiety and depression can trigger IBS attacks, medical specialists agree that IBS is a genuine physical disorder—or group of disorders—with specific identifiable characteristics. IBS is considered a functional disorder because it is thought to result from changes in the activity of the major part of the large intestine (the colon).

Demographics

IBS is one of the most common functional gastrointestinal disorders, affecting 10-20 percent of adults in the United States. Research has demonstrated that symptoms compatible with IBS are about as common in school-age children as in adults. IBS normally makes its first appearance during young adulthood, and symptoms usually begin at about age 20. Women with IBS represent over 70 percent of IBS sufferers. IBS is responsible for more time lost from school and work than any medical problem—other than the common cold . It accounts for a substantial proportion of the patients seen by specialists in diseases of the digestive system (gastroenterologists).

A community-based study of 507 middle school and high school students by Hyams, et al, found that 6-14 percent of the adolescent population had IBS symptoms. Anxiety and depression scores were significantly higher for this group. Eight percent of all the students in the study had seen a physician for abdominal pain in the previous year.

Causes and symptoms

Causes

Although the exact cause or causes of IBS are unknown, research suggests that people with IBS may have a colon that is more sensitive and reactive to certain foods and stress.

After food is digested by the stomach and small intestine, the undigested material passes in liquid form into the colon, which absorbs water, nutrients and salts. Normally, the colon is quiet during most of that period except after meals, when its muscles contract in a series of wavelike movements called peristalsis. Peristalsis helps absorption by bringing the undigested material into contact with the colon wall. It also pushes undigested material that has been converted into solid or semisolid feces toward the rectum, where it remains until a bowel movement occurs.

In IBS, however, the normal rhythm and intensity of peristalsis is disrupted. Sometimes there is too little peristalsis, which can slow the passage of undigested material through the colon and cause constipation. Sometimes there is too much, which has the opposite effect and causes diarrhea. In other cases, peristalsis can be spasmodic, causing sudden strong muscle contractions that come and go.

DIET Some foods and beverages appear to play a key role in triggering IBS attacks. Certain foods and drinks may disrupt peristalsis in IBS patients, which may explain why IBS attacks often occur shortly after meals. Some of the chief culprits include:

• chocolate
• dairy products
• caffeine (in coffee, tea, colas, and other drinks)
• carbonated beverages (colas, pop, soda)
• wheat
• rye
• barley
• excess alcohol

Other foods also have been identified as problems, and the pattern of what can and cannot be tolerated is different for each person.

STRESS Stress—feeling mentally or emotionally tense, troubled, angry or overwhelmed—stimulates colon spasms in people with IBS since there is a close nervous system connection between the brain and the intestines. A large network of nerves control the normal rhythmic contractions of the colon. Although researchers do not yet understand all of the links between changes in the nervous system and IBS, they point out the similarities between mild digestive upsets and IBS. Just as healthy people can feel nauseated or have an upset stomach when under stress, people with IBS react the same way, but to a greater degree.

MENSTRUATION IBS symptoms sometimes intensify during menstruation , suggesting female reproductive hormones may trigger the condition.

Symptoms

The symptoms of IBS tend to rise and fall in intensity, rather than grow steadily worse over time. Symptoms always include:

• abdominal pain, which may be relieved by defecation
• diarrhea
• constipation
• diarrhea alternating with constipation

Other symptoms, which vary from person to person, include:

• cramps
• gassiness
• bloating
• nausea
• passage of mucus during bowel movements
• abnormal stool frequency—defined as greater than three bowel movements per day or less than three bowel movements per week
• abnormal stool form (lumpy, hard, loose, or watery stool)
• abnormal stool passage (straining, urgency, or feeling of incomplete bowel movement)

In general, symptoms are not present all the time and do not interfere with school and other normal activities. IBS symptoms rarely occur at night and disrupt the patient's sleep . Moderate IBS occasionally disrupts normal activities.

When to call the doctor

If a child has the following symptoms, the parent should contact the child's pediatrician or gastroenterologist:

• abdominal pain or diarrhea that wakes the child during the night
• persistent or severe abdominal pain
• unexplained weight loss
• rectal bleeding
• fever
• family history of irritable bowel disease

Diagnosis

The Rome II criteria are the accepted diagnostic criteria for IBS. These criteria were developed by an international group of pediatric gastroenterologists and include:

• Continuous or recurrent abdominal discomfort or pain for at least three months that is: a) Relieved with defecation and/or b) Associated with a change in frequency and/or c) Associated with a change in appearance of stool. Two or three of these features are present with an IBS diagnosis.
• No structural or metabolic abnormalities are present that may be responsible for the IBS symptoms.

The diagnosis of IBS is further supported by the presence of the symptoms listed previously. In addition, the primary pediatrician or gastroenterologist may confirm the diagnosis of IBS after questioning the child (if old enough to provide an accurate history of symptoms) or parent about his or her physical and mental health (the medical history), performing a physical examination, and ordering laboratory tests to rule out other conditions that resemble IBS, such as Crohn's disease and ulcerative colitis.

Diagnostic tests may include stool or blood tests, hydrogen breath test, or an x ray of the bowel, called a barium enema. When symptoms continue even after treatment, endoscopic tests such as a colonoscopy or sigmoidoscopy may be performed. An endoscopic test is an internal examination of the colon using a flexible instrument (a sigmoidoscope or colonoscope) that is inserted through the anus.

A nutritional assessment performed by a registered dietitian may be included in the child's diagnostic evaluation. The nutritional assessment includes a review of the child's fiber intake as well as his or her usual consumption of sugars such as sorbitol and fructose—common culprits of diarrhea.

Treatment

Dietary changes and sometimes medications are considered the keys to successful treatment. Psychosocial difficulties are also addressed and treated with therapy or counseling as needed. Treatment requires a long-term commitment; six months or more may be needed before the child notices substantial improvement.

Alternative treatment

Alternative and complementary therapies include approaches that are considered to be outside the mainstream of traditional health care. Alternative and traditional approaches to IBS treatment overlap to a certain extent. Like traditional doctors, alternative practitioners advise a high-fiber diet to reduce digestive system irritation. They also suggest avoiding caffeine and fatty, gassy, or spicy foods, as well as alcohol. Recommended stress management techniques include yoga , meditation, guided imagery, hypnosis, biofeedback, and reflexology. Reflexology is a foot massage technique that is thought to relieve diarrhea, constipation, and other IBS symptoms.

The list of alternative treatments for IBS is quite long. It includes aromatherapy, homeopathy, hydrotherapy, juice therapy, acupuncture, chiropractic, osteopathy, naturopathic medicine, and Chinese traditional herbal medicine.

Before learning or practicing any particular technique, it is important for the parent/caregiver and child to learn about the therapy, its safety and effectiveness, potential side effects, and the expertise and qualifications of the practitioner. Although some practices are beneficial, others may be harmful to certain patients.

Relaxation techniques and dietary supplements should not be used as a substitute for medical therapies prescribed by a doctor. Parents should discuss these alternative treatments with the child's doctor to determine the techniques and remedies that may be beneficial for the child.

Nutritional concerns

Dietary changes, including a low-fat, high-fiber diet, may help decrease IBS symptoms. The addition of wheat bran or other fiber may be suggested to decrease symptoms. The formula for determining the recommended fiber intake for children, as advised by the American Dietetic Association, is to take the child's age plus five to equal the grams of dietary fiber the child should consume daily. Fiber should be added gradually to the child's diet.

The doctor may recommend a lactose-free diet for two or three weeks to determine if lactose intolerance is causing the symptoms. Lactose is the milk sugar found in dairy products. Lactose intolerance is a common condition in up to 40% of patients with IBS. During the lactose-free period, the child should avoid all products containing lactose. The parent and child are asked to record the intake of all foods and beverages and note when symptoms occur after eating or drinking.

To identify other problem-causing foods or beverages, it is helpful for the parent and child to keep a diary of symptoms for two or three weeks, including daily activities, meals, symptoms and emotions. The doctor can then review the diary with the parent and child to identify possible problem areas.

In addition to lactose, known problem-causing substances include caffeine, beans, onions, cabbage, cucumbers, broccoli, fatty foods, alcohol, and certain medications. Once the specific substances that trigger symptoms are identified, they should be avoided. A registered dietitian can help the parent and child make specific dietary changes.

If lactose intolerance is a problem, the child may need to take calcium supplements or choose other foods high in calcium to meet the recommended daily requirement. If lactose intolerance is not a problem, the child can still have milk or milk products.

Medications

Medications affect each child differently, and no one medication works for every child with IBS. The child and parent will need to work with the doctor to find the best combination of medicine, diet, counseling and support to manage symptoms.

Stool softeners such as polyethelene glycol (Miralax) or an over-the-counter laxative may be recommended for constipation. Mineral oil also may be helpful. However, it is important not to use over-the-counter remedies without first consulting with the child's doctor.

Tricyclic antidepressants in low doses may be prescribed for pain relief. Antidepressants work by blocking pain transmission from the nervous system. Antispasmodic medications can slow bowel contractions and decrease diarrhea. Anticholinergics may help control intestinal cramping. Keep in mind that the effectiveness of these drugs to treat IBS has not been studied extensively in children.

KEY TERMS

Anus —The opening at the end of the intestine through which solid waste (stool) passes as it leaves the body.

Barium enema —An x ray of the bowel using a liquid called barium to enhance the image of the bowel. This test is also called a lower GI (gastrointestinal) series.

Colonoscopy —An examination of the lining of the colon performed with a colonoscope.

Constipation —Difficult bowel movements caused by the infrequent production of hard stools.

Crohn's disease —A chronic, inflammatory disease, primarily involving the small and large intestine, but which can affect other parts of the digestive system as well.

Defecation —The act of having a bowel movement or the passage of feces through the anus.

Diarrhea —A loose, watery stool.

Endoscopy —Visual examination of an organ or body cavity using an endoscope, a thin, tubular instrument containing a camera and light source. Many endoscopes also allow the retrieval of a small sample (biopsy) of the area being examined, in order to more closely view the tissue under a microscope.

Feces —The solid waste, also called stool, that is left after food is digested. Feces form in the intestines and pass out of the body through the anus.

Gastroenterologist —A physician who specializes in diseases of the digestive system.

Hydrogen breath test —A test used to determine if a person is lactose intolerant or if abnormal bacteria are present in the colon.

Lactose —A sugar found in milk and milk products.

Peristalsis —Slow, rhythmic contractions of the muscles in a tubular organ, such as the intestines, that move the contents along.

Sigmoidoscopy —A procedure in which a thin, flexible, lighted instrument, called a sigmoidoscope, is used to visually examine the lower part of the large intestine. Colonoscopy examines the entire large intestine using the same techniques.

Ulcerative colitis —A form of inflammatory bowel disease characterized by inflammation of the mucous lining of the colon, ulcerated areas of tissue, and bloody diarrhea.

Counseling and support

Psychological counseling or behavioral therapy may be recommended for some patients to reduce anxiety and stress and to learn to cope with the symptoms of IBS. Biofeedback, guided imagery, relaxation therapy, hypnosis, and cognitive-behavioral therapy are examples of behavioral therapy. An ongoing and supportive doctor-patient relationship is also very important. The child and family must be reassured that although IBS causes symptoms that are uncomfortable and sometimes painful, it is not a harmful condition and does indicate a serious problem.

Prognosis

IBS is not a life-threatening condition. It is not an anatomical or structural defect, nor an identifiable physical or chemical disorder. IBS does not cause intestinal bleeding or inflammation, nor does it cause other gastrointestinal diseases or cancer . Although IBS can last a lifetime, in up to 30% of cases the symptoms eventually disappear. Even if the symptoms cannot be eliminated, with appropriate treatment they usually can be managed enough so IBS becomes merely an occasional inconvenience.

Prevention

Nutritional concerns

To help prevent or decrease the child's symptoms, parents can:

• help the child identify and avoid problematic foods
• work with a registered dietitian to facilitate specific dietary changes
• incorporate changes in the child's diet gradually so his or her body has time to adjust
• establish set times for meals; not allowing the child to skip a meal
• encourage the child to drink at least eight 8-ounce glasses of water per day
• serve small portions during meals
• teach the child to eat slowly, to avoid swallowing too much air that can produce excess gas
• try offering smaller, more frequent meals
• keep a regular schedule for bathroom visits

Parental concerns

Parents should reinforce with the child that IBS is not a life-threatening condition and that dietary changes and stress reduction can help reduce symptoms. Remind the child that six months or more may be needed before he or she notices substantial improvement in symptoms.

Resources

BOOKS

Goldberg, Burton, John W. Anderson, and Larry Trivieri. Alternative Medicine: The Definitive Guide, 2nd Edition. Berkeley, CA: Ten Speed Press, 2002.

Lynn, Richard B., and Lawrence S. Friedman. "Irritable Bowel Syndrome." In Harrison's Principles of Internal Medicine, 16th Edition. Anthony S. Fauci, et al. New York: McGraw-Hill Professional, 2004.

Van Vorous, Heather. Eating for IBS Diet and Cookbook. New York, NY: Marlowe & Company, 2000.

PERIODICALS

Dalton, Christine B., and Douglas A. Drossman. "Diagnosis and Treatment of Irritable Bowel Syndrome." American Family Physician (Feb. 1997): 875+.

Hyams, J.S., et al. "Abdominal Pain and Irritable Syndrome in Adolescents: A Community-Based Study." Journal of Pediatrics (Aug. 1996): 220+.

Jarrett, Monica, et al. "Recurrent Abdominal Pain in Children: Forerunner to Adult Irritable Bowel Syndrome." Journal for Specialists in Pediatric Nursing (July-Sept. 2003): 81+.

ORGANIZATIONS

American College of Gastroenterology (ACG). P.O. Box 3099, Alexandria, VA 22302. (703) 820-7400. Web site: <http://www.acg.gi.org/patientinfo/cgp/cgpvol2.html>.

American Gastroenterological Association. 4930 Del Ray Ave., Bethesda, MD 20814. (301) 654-2055. Web site: <http://www.gastro.org/clinicalRes/brochures/ibs.html>.

International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217-8076. (888) 964-2001. E-mail: iffgd@iffgd.org. Web site: <http://www.iffgd.org>.

Irritable Bowel Syndrome (IBS) Association. 1440 Whalley Ave., #145, New Haven, CT 06515. E-mail: ibsa@ibsassociation.org. Web site: <http://www.ibsassociation.org>.

Irritable Bowel Syndrome Self Help and Support Group. 1440 Whalley Ave., #145 New Haven, CT 06515. E-mail: ibs@ibsgroup.org. Web site: <http://www.ibsgroup.org>.

National Digestive Diseases Information Clearinghouse (NDDIC). 2 Information Way, Bethesda, MD 20892-3570. (800) 891-5389. E-mail: nddic@info.niddk.nih.gov. Web site: <http://www.niddk.nih.gov/health/digest/nddic.htm>.

WEB SITES

About IBS. Available online at <http://www.aboutibs.org.>

Howard Baker

Irritable bowel syndrome

Definition

Irritable bowel syndrome (IBS) is a common intestinal condition characterized by abdominal pain and cramps; changes in bowel movements (diarrhea, constipation, or both); gassiness; bloating; nausea ; and other symptoms. There is no recognized cure for IBS. Much about the condition remains unknown or poorly understood; however, dietary changes, drugs, and psychological treatment are often able to eliminate or substantially reduce its symptoms.

Description

IBS is the name people use today for a condition that was once called colitis, spastic colon, nervous colon, spastic bowel, and functional bowel disorder. Some of these names reflected the now-outdated belief that IBS is a purely psychological disorder and a product of the patient's imagination. Although modern medicine recognizes that stress can trigger IBS attacks, medical specialists agree that IBS is a genuine physical disorder or group of disorders with specific identifiable characteristics.

No one knows for sure how many Americans suffer from IBS. Surveys indicate a range of 10-20%, with perhaps as many as 30% of Americans experiencing IBS at some point in their lives. IBS normally makes its first appearance during young adulthood, and in half of all cases, symptoms begin before age 35. Women with IBS outnumber men by two to one, for reasons not yet understood. IBS is responsible for more time lost from work and school than any medical problem other than the common cold . It accounts for a substantial proportion of the patients seen by gastroenterologists, who are specialists in diseases of the digestive system. Yet only half—possibly as few as 15%—of IBS sufferers ever consult a doctor.

Causes & symptoms

The symptoms of IBS tend to rise and fall in intensity rather than grow steadily worse over time. They always include intestinal (abdominal) pain that may be relieved by defecation; diarrhea or constipation; or diarrhea alternating with constipation. Other symptoms, which vary from person to person, include cramps, gassiness, bloating, nausea, a powerful and uncontrollable urge to defecate (urgency), passage of a sticky fluid (mucus) during bowel movements, or the feeling after finishing a bowel movement that the bowels are still not completely empty. The accepted diagnostic criteria, known as the Rome criteria, require at least three months of continuous or recurrent symptoms before IBS is diagnosed. According to Christine B. Dalton and Douglas A. Drossman in the American Family Physician, an estimated 70% of IBS cases can be described as "mild"; 25% as "moderate"; and 5% as "severe." In mild cases the symptoms are slight. As a general rule, they are not present all the time and do not interfere with work and other normal activities. Moderate IBS disrupts normal activities and may cause some psychological problems. People with severe IBS may constantly fear the unpredictable need for a bathroom. They often find living a normal life impossible and experience crippling psychological problems as a result. For some, the physical pain is constant and intense.

Causes

Researchers remain unsure about the cause or causes of IBS. It is called a functional disorder because it is thought to result from changes in the activity of the major part of the large intestine (the colon). After food is digested by the stomach and small intestine, the undigested material passes in liquid form into the colon, which absorbs water and salts. This process may take several days. In a healthy person the colon is quiet during most of that period except after meals, when its muscles contract in a series of wavelike movements called peristalsis. Peristalsis helps absorption by bringing the undigested material into contact with the colon wall. It also pushes undigested material that has been converted into solid or semisolid feces toward the rectum, where it remains until defecation. In IBS, however, the normal rhythm and intensity of peristalsis is disrupted. Sometimes there is too little peristalsis, which can slow the passage of undigested material through the colon and cause constipation. Sometimes there is too much, which has the opposite effect and causes diarrhea. A Johns Hopkins University study found that healthy volunteers experienced six to eight contractions of the colon each day, compared with up to 25 contractions a day for volunteers suffering from IBS with diarrhea, and an almost complete absence of contractions among constipated IBS volunteers. In addition to differences in the number of contractions, many of the IBS volunteers experienced powerful spasmodic contractions affecting a larger-than-normal area of the colon—"like having a Charlie horse in the gut," according to one of the investigators.

DIET. Some kinds of food and drink appear to play a key role in triggering IBS attacks. Food and drink that healthy people can ingest without any trouble may disrupt peristalsis in IBS patients, which probably explains why IBS attacks often occur shortly after meals. Chocolate, milk products, caffeine (in coffee, tea, colas, and other drinks), and large quantities of alcohol are some of the chief culprits. Other kinds of food have also been identified as problems, however, and the pattern of what can and cannot be tolerated is different for each person. Characteristically, IBS symptoms rarely occur at night and disrupt the patient's sleep.

In 2002 a research study reported that some children had trouble absorbing certain sugars from some fruit juices, particularly apple and pear juices. When children with IBS went off these juices for one month, 46% saw improvement in their IBS symptoms. Apple and pear juice contain more fructose than glucose sugar, which may be the cause of the poor absorption in IBS sufferers' intestines. Yet white grape juice, which contains almost equal portions of fructose and glucose, is more easily absorbed.

STRESS. Stress is an important factor in IBS because of the close nervous system connections between the brain and the intestines. Although researchers do not yet understand all of the links between changes in the nervous system and IBS, they point out the similarities between mild digestive upsets and IBS. Just as healthy people can feel nauseated or have an upset stomach when under stress, people with IBS react the same way, but to a greater degree. Finally, IBS symptoms sometimes intensify during menstruation , which suggests that female reproductive hormones are another trigger. In fact, a study published in 2002 confirmed that IBS symptoms worsened in women and that rectal sensitivity changed with the menstrual cycle in women with IBS. It also was the first study to contrast these changes with those in healthy women.

Diagnosis

Diagnosing IBS is a fairly complex task because the disorder does not produce changes that can be identified during a physical examination or by laboratory tests. When IBS is suspected, the doctor (a family doctor or a specialist) needs to determine whether the patient's symptoms satisfy the Rome criteria. The doctor rules out other conditions that resemble IBS, such as Crohn's disease and ulcerative colitis. These disorders are ruled out by taking a standard medical history, performing a physical examination, and ordering laboratory tests. The patient may be asked to provide a stool sample that can be tested for blood and intestinal parasites. In some cases x rays, bowel studies, or an internal examination of the colon using a flexible instrument inserted through the anus (a sigmoidoscope or colonoscope) is necessary.

Patients may also be asked to keep a diary of symptoms for two or three weeks, covering daily activities including meals and emotional responses to events. The doctor can then review the diary with the patient to identify possible problem areas.

Treatment

Dietary adjustments are critical to controlling IBS. For some patients, a high-fiber diet including whole grain breads and cereals, dried and fresh fruits, spinach, and oat bran can reduce digestive system irritation. For others, a high-fiber diet aggravates the symptoms. Many patients with IBS also find that avoiding alcohol, caffeine, sugar, and fatty, gas -producing, or spicy foods can prevent symptoms.

To control IBS symptoms that are triggered or made worse by stress, several stress management therapies may be helpful. These include yoga, meditation , hypnosis, biofeedback, exercise , muscle relaxation training, aromatherapy, hydrotherapy , and reflexology . Reflexology is a foot massage technique that focuses on manipulating different regions of the foot in order to bring harmony to specific organs and body systems. Hydrotherapy is the therapeutic use of water, as in a whirlpool bath.

Biofeedback, which teaches an individual to control muscle tension and any associated pain through thought and visualization techniques, is also a treatment option for IBS. In biofeedback treatments, sensors placed on the forehead of the patient are connected to a special machine that allows the patient and healthcare professional to monitor a visual and/or audible readout of the level of muscle tension and stress in the patient. Through relaxation and visualization exercises, the patient learns to relieve tension and can actually see or hear the results of his or her efforts instantly through a sensor readout on the biofeedback equipment. Once the technique is learned and the patient is able to recognize and differentiate between the feelings of muscle tension and muscle relaxation, the biofeedback equipment itself is no longer needed and the patient has a powerful, portable, and self-administered treatment tool to deal with pain and tension.

To soothe an irritated or inflamed digestive tract, an herbalist or holistic healthcare practitioner may recommend one or more herbs, including comfrey root (Symphytum officinale ), hops (Humulus lupulus ), Iceland moss (Cetraria islandica ), Irish moss (Chondrus crispus ), marsh mallow root (Althaea officinalis ), oats (Avena sativa ), quince seed (Cydonia oblonga ), and slippery elm (Ulmus rubra ).

Herbs that relieve gas associated with IBS (known as carminatives) include angelica (Angelica archangelica ), aniseed (Pimpinella anisum ), caraway (Carum carvi ), cayenne (Capsicum annuum ), German chamomile (Matricaria recutita ), ginger (Zingiber officinale ), thyme (Thymus vulgaris ), and peppermint (Menthapiperata ).

An infusion of meadowsweet (Filipendula ulmaria ) may be helpful in treating diarrhea related to IBS, and herbs such as barberry (Berberis vulgaris ), psyllium ovata seed, dandelion root (Taraxacum officinale ), licorice (Glycyrrhiza glabra ), and yellow dock (Rumex crispus ) have laxative properties that can help to relieve constipation. More powerful laxative herbs, such as rhubarb root (Rheum palmatum ), buckthorn (Rhamnus catharticus ), and cascara (Rhamnus purshiana ) should only be taken under the direction of a healthcare professional.

Individuals with cramp-like pains, or colic , can benefit from antispasmodic herbs such as German chamomile (Matricaria recutita ), Valerian (Valeriana officinalis ), lemon balm (Melissa officinalis ), ginger (Zingiber officinale ), and wild yam (Dioscorea villosa ).

Homeopathy uses highly-diluted remedies that cause similar effects to the symptoms they are intended to treat in an effort to stimulate the body's natural immune response. A homeopathic physician might recommend a remedy of belladonna , colocynthis (bitter cucumber), phosphate of magnesia (Magnesia phosphorica), or wild hops (Bryonia alba ) to relieve abdominal pain and cramping associated with IBS. As with all homeopathic remedies, the prescription depends on the individual's overall symptoms, mood, and temperament.

Acupuncture and guided imagery may be useful tools in treating IBS symptoms. Acupuncture involves the placement of thin needles into the skin at targeted locations on the body known as acupoints in order to harmonize the energy flow within the human body. An acupuncturist may also use moxibustion , which involves applying a heat source such as warm herbs to the acupoint, to treat IBS symptoms. Guided imagery techniques teach the patient to visualize a peaceful, soothing scene or situation to relax the body and better cope with the discomfort caused by IBS.

Allopathic treatment

Dietary changes, sometimes supplemented by drugs or psychotherapy , are considered the key to successful treatment. A drug called alosetron (Lotronex) was approved by the Food and Drug Administration (FDA) in 2002 for limited marketing for treating women with diar-rhea-prominent IBS after some controversy in 2000 because of serious side effects from the drug. Its use should be limited to only those patients suffering from severe, chronic diarrhea-predominant IBS who have failed to respond to conventional therapy.

An individualized diet, low in saturated fats and foods that trigger the patient's reaction, can reduce symptoms for many IBS sufferers. Caffeine sources, sugar, and alcohol usually worsen symptoms. Bran or 15-25 grams a day of an over-the-counter psyllium laxative may also help both constipation and diarrhea. The patient can have milk or milk products if lactose intolerance is not a problem. Establishing set times for meals and bathroom visits may help people with irregular bowel habits, especially for constipated patients.

Although a high-fiber diet remains the standard treatment for constipated patients, such laxatives as lactulose or sorbitol may be prescribed. Loperamide and cholestyramine are suggested for diarrhea. Abdominal pain after meals can be reduced by taking antispasmodic drugs such as hyoscyamine or dicyclomine before eating.

Psychological counseling or behavioral therapy may be useful for some patients to reduce anxiety and to learn to cope with the pain and other symptoms of IBS. Relaxation therapy, hypnosis, biofeedback, and cognitive-behavioral therapy are examples of behavioral therapy.

When IBS produces constant pain that interferes with everyday life, antidepressant drugs can help by blocking pain transmission from the nervous system.

Expected results

IBS is not a life-threatening condition. It does not cause intestinal bleeding or inflammation, nor does it cause other bowel diseases or cancer . Although IBS can last a lifetime, in up to 30% of cases the symptoms eventually disappear. Even if the symptoms cannot be eliminated, with appropriate treatment they can usually be decreased so that IBS becomes merely an occasional inconvenience. Treatment requires a long-term commitment, however; six months or more may be needed before the patient notices substantial improvement.

Resources

BOOKS

Lynn, Richard B., and Lawrence S. Friedman. "Irritable Bowel Syndrome." In Harrison's Principles of Internal Medicine, edited by Anthony S. Fauci, et al. New York: McGraw-Hill, 1998.

PERIODICALS

"Can Fruit Juices Cause Irritable Bowel Syndrome?" Child Health Alert (June 2002):1.

Dalton, Christine B., and Douglas A. Drossman. "Diagnosis and Treatment of Irritable Bowel Syndrome." American Family Physician (February 1997): 875+.

Elliott, William T., and James Chan. "Alosetron Hydrochloride Tablets (Lotronex ™ GlaxoSmithKline) Reintroduction." Internal Medicine Alert (June 29, 2002): 94.

Houghton L.A. et al. "The Menstrual Cycle Affects Rectal Sensitivity in Patients with Irritable Bowel Syndrome but not Healthy Volunteers." Gut (April 2002): 471-474.

"Irritable Bowel Syndrome: Treating the Mind to Treat the Body." Tufts University Health & Nutrition Letter (September 1997): 4+.

Maxwell, P. R., M. A. Mendall, and D. Kumar. "Irritable Bowel Syndrome." The Lancet 350 (1997): 1691+.

ORGANIZATIONS

International Foundation for Functional Gastrointestinal Disorders. PO Box 17864, Milwaukee, WI 53217. (888) 964-2001. http://www.execpc.com/iffgd.

National Digestive Diseases Information Clearinghouse. 2 Information Way, Bethesda, MD 20892-3570. http://www.niddk.nih.gov/health/digest/nddic.htm.

Paula Ford-Martin

Teresa G. Odle

Irritable Bowel Syndrome

Definition

Irritable bowel syndrome (IBS) is a common intestinal condition characterized by abdominal pain and cramps; changes in bowel movements (diarrhea, constipation, or both); gassiness; bloating; nausea ; and other symptoms. There is no cure for IBS. Much about the condition remains unknown or poorly understood; however, dietary changes, drugs, and psychological treatment are often able to eliminate or substantially reduce its symptoms.

Description

IBS is the name people use today for a condition that was once called—among other things—colitis, mucous colitis, spastic colon, nervous colon, spastic bowel, and functional bowel disorder. Some of these names reflected the now outdated belief that IBS is a purely psychological disorder, a product of the patient's imagination. Although modern medicine recognizes that stress can trigger IBS attacks, medical specialists agree that IBS is a genuine physical disorder—or group of disorders—with specific identifiable characteristics.

No one knows for sure how many Americans suffer from IBS. Surveys indicate a range of 10-20%, with perhaps as many as 30% of Americans experiencing IBS at some point in their lives. IBS normally makes its first appearance during young adulthood, and in half of all cases symptoms begin before age 35. Women with IBS outnumber men by two to one, for reasons that are not yet understood. IBS is responsible for more time lost from work and school than any medical problem other than the common cold. It accounts for a substantial proportion of the patients seen by specialists in diseases of the digestive system (gastroenterologists). Yet only half-possibly as few as 15%—of IBS sufferers ever consult a doctor.

Causes and symptoms

Symptoms

The symptoms of IBS tend to rise and fall in intensity rather than growing steadily worse over time. They always include abdominal pain, which may be relieved by defecation; diarrhea or constipation; or diarrhea alternating with constipation. Other symptoms—which vary from person to person—include cramps; gassiness; bloating; nausea; a powerful and uncontrollable urge to defecate (urgency); passage of a sticky fluid (mucus) during bowel movements; or the feeling after finishing a bowel movement that the bowels are still not completely empty. The accepted diagnostic criteria—known as the Rome criteria—require at least three months of continuous or recurrent symptoms before IBS can be confirmed. According to Christine B. Dalton and Douglas A. Drossman in the American Family Physician, an estimated 70% of IBS cases can be described as "mild;" 25% as "moderate;" and 5% as "severe." In mild cases the symptoms are slight. As a general rule, they are not present all the time and do not interfere with work and other normal activities. Moderate IBS occasionally disrupts normal activities and may cause some psychological problems. People with severe IBS often find living a normal life impossible and experience crippling psychological problems as a result. For some the physical pain is constant and intense.

Causes

Researchers remain unsure about the cause or causes of IBS. It is called a functional disorder because it is thought to result from changes in the activity of the major part of the large intestine (the colon). After food is digested by the stomach and small intestine, the undigested material passes in liquid form into the colon, which absorbs water and salts. This process may take several days. In a healthy person the colon is quiet during most of that period except after meals, when its muscles contract in a series of wavelike movements called peristalsis. Peristalsis helps absorption by bringing the undigested material into contact with the colon wall. It also pushes undigested material that has been converted into solid or semisolid feces toward the rectum, where it remains until defecation. In IBS, however, the normal rhythm and intensity of peristalsis is disrupted. Sometimes there is too little peristalsis, which can slow the passage of undigested material through the colon and cause constipation. Sometimes there is too much, which has the opposite effect and causes diarrhea. A Johns Hopkins University study found that healthy volunteers experienced 6-8 contractions of the colon each day, compared with up to 25 contractions a day for volunteers suffering from IBS with diarrhea, and an almost complete absence of contractions among constipated IBS volunteers. In addition to differences in the number of contractions, many of the IBS volunteers experienced powerful spasmodic contractions affecting a larger-than-normal area of the colon—"like having a Charlie horse in the gut," according to one of the investigators.

DIET. Some kinds of food and drink appear to play a key role in triggering IBS attacks. Food and drink that healthy people can ingest without any trouble may disrupt peristalsis in IBS patients, which probably explains why IBS attacks often occur shortly after meals. Chocolate, milk products, caffeine (in coffee, tea, colas, and other drinks), and large quantities of alcohol are some of the chief culprits. Other kinds of food have also been identified as problems, however, and the pattern of what can and cannot be tolerated is different for each person. Characteristically, IBS symptoms rarely occur at night and disrupt the patient's sleep.

STRESS. Stress is an important factor in IBS because of the close nervous system connections between the brain and the intestines. Although researchers do not yet understand all of the links between changes in the nervous system and IBS, they point out the similarities between mild digestive upsets and IBS. Just as healthy people can feel nauseated or have an upset stomach when under stress, people with IBS react the same way, but to a greater degree. Finally, IBS symptoms sometimes intensify during menstruation, which suggests that female reproductive hormones are another trigger.

Diagnosis

Diagnosing IBS is a fairly complex task because the disorder does not produce changes that can be identified during a physical examination or by laboratory tests. When IBS is suspected, the doctor (who can be either a family doctor or a specialist) needs to determine whether the patient's symptoms satisfy the Rome criteria. The doctor must rule out other conditions that resemble IBS, such as Crohn's disease and ulcerative colitis. These disorders are ruled out by questioning the patient about his or her physical and mental health (the medical history), performing a physical examination, and ordering laboratory tests. Normally the patient is asked to provide a stool sample that can be tested for blood and intestinal parasites. In some cases x rays or an internal examination of the colon using a flexible instrument inserted through the anus (a sigmoidoscope or colonoscope) is necessary. The doctor also may ask the patient to try a lactose-free diet for two or three weeks to see whether lactose intolerance is causing the symptoms.

Treatment

Dietary changes, sometimes supplemented by drugs or psychotherapy, are considered the key to successful treatment. The following approach, offered by Dalton and Drossman, is typical of the advice found in the medical literature on IBS. The authors tie their approach to the severity of the patient's symptoms:

Mild symptoms

Dalton and Drossman recommend a low-fat, high-fiber diet. Problem-causing substances such as lactose, caffeine, beans, cabbage, cucumbers, broccoli, fatty foods, alcohol, and medications should be identified and avoided. Bran or 15-25 grams a day of an over-the-counter psyllium laxative (Metamucil or Fiberall) may also help both constipation and diarrhea. The patient can still have milk or milk products if lactose intolerance is not a problem. People with irregular bowel habits—particularly constipated patients—may be helped by establishing set times for meals and bathroom visits.

Moderate symptoms

The advice given by Dalton and Drossman in mild cases applies here as well. They also suggest that patients keep a diary of symptoms for two or three weeks, covering daily activities including meals, and emotional responses to events. The doctor can then review the diary with the patient to identify possible problem areas.

Although a high-fiber diet remains the standard treatment for constipated patients, such laxatives as lactulose (Chronulac) or sorbitol may be prescribed. Loperamide (Imodium) and cholestyramine (Questran) are suggested for diarrhea. Abdominal pain after meals can be reduced by taking antispasmodic drugs such as hyoscyamine (Anaspaz, Cystospaz, or Levsin) or dicyclomine (Bemote, Bentyl, or Di-Spaz) before eating.

Dalton and Drossman also suggest psychological counseling or behavioral therapy for some patients to reduce anxiety and to learn to cope with the pain and other symptoms of IBS. Relaxation therapy, hypnosis, biofeedback, and cognitive-behavioral therapy are examples of behavioral therapy.

Severe symptoms

When IBS produces constant pain that interferes with everyday life, antidepressant drugs can help by blocking pain transmission from the nervous system. Dalton and Drossman also underscore the importance of an ongoing and supportive doctor-patient relationship.

Alternative treatment

Alternative and mainstream approaches to IBS treatment overlap to a certain extent. Like mainstream doctors, alternative practitioners advise a high-fiber diet to reduce digestive system irritation. They also suggest avoiding alcohol, caffeine, and fatty, gassy, or spicy foods. Recommended stress management techniques include yoga, meditation, hypnosis, biofeedback, and reflexology. Reflexology is a technique of foot massage that is thought to relieve diarrhea, constipation, and other IBS symptoms.

Alternative medicine also emphasizes such herbal remedies as ginger (Zingiber officinale ), buckthorn (Rhamnus purshiana ), and enteric-coated peppermint oil. Enteric coating prevents digestion until the peppermint oil reaches the small intestine, thus avoiding irritation of the upper part of the digestive tract. Chamomile (Matricaria recutita ), valerian (Valeriana officinalis ), rosemary (Rosemarinus officinalis ), lemon balm (Melissa officinalis ), and other herbs are recommended for their antispasmodic properties. The list of alternative treatments for IBS is in fact quite long. It includes aromatherapy, homeopathy, hydrotherapy, juice therapy, acupuncture, chiropractic, osteopathy, naturopathic medicine, and Chinese traditional herbal medicine.

Prognosis

IBS is not a life-threatening condition. It does not cause intestinal bleeding or inflammation, nor does it cause other bowel diseases or cancer. Although IBS can last a lifetime, in up to 30% of cases the symptoms eventually disappear. Even if the symptoms cannot be eliminated, with appropriate treatment they can usually be brought under control to the point where IBS becomes merely an occasional inconvenience. Treatment requires a long-term commitment, however; six months or more may be needed before the patient notices substantial improvement.

Resources

ORGANIZATIONS

International Foundation for Functional Gastrointestinal Disorders. P.O. Box 17864, Milwaukee, WI 53217. (888) 964-2001. 〈http://www.iffgd.org〉.

National Digestive Diseases Information Clearinghouse. 2 Information Way, Bethesda, MD 20892-3570. (800) 891-5389. 〈http://www.niddk.nih.gov/health/digest/nddic.htm〉.

KEY TERMS

Anus— The opening at the lower end of the rectum.

Crohn's disease— A disease characterized by inflammation of the intestines. Its early symptoms may resemble those of IBS.

Defecation— Passage of feces through the anus.

Feces— Undigested food and other waste that is eliminated through the anus. Feces are also called fecal matter or stools.

Lactose— A sugar found in milk and milk products. Some people are lactose intolerant, meaning they have trouble digesting lactose. Lactose intolerance can produce symptoms resembling those of IBS.

Peristalsis— The periodic waves of muscular contractions that move food through the intestines during the process of digestion.

Ulcerative colitis— A disease that inflames and causes breaks (ulcers) in the colon and rectum, which are parts of the large intestine.

irritable bowel syndrome (IBS), condition characterized by frequently alternating constipation and diarrhea in the absence of any disease process. It is usually accompanied by abdominal pain, especially in the lower left quadrant, bloating, and flatulence. Other symptoms, such as heartburn, lower back pain, and agitation, may be present concurrently. The cause of irritable bowel syndrome is unknown; on examination there are no physical abnormalities. The symptoms result from a disturbance of the normal peristaltic movements of the lower intestine. IBS is the most common gastrointestinal complaint in the United States. It affects twice as many women as it does men. In some individuals it is made worse by emotional stress, spicy foods, or excessive caffeine consumption. Symptoms can be minimized by a high-fiber diet and antispasmodic drugs. Acupuncture is helpful in many cases.

IRRITABLE BOWEL SYNDROME

DEFINITION

Irritable bowel syndrome (IBS) is a common intestinal condition. Its cause is unknown and there is currently no cure. IBS is characterized by abdominal pain, changes in bowel movements, gassiness, nausea, and other symptoms.

DESCRIPTION

Irritable bowel syndrome is a poorly understood condition even though, by some estimates, as many as 30 percent of Americans have had IBS at one time in their life. IBS is responsible for more time lost at work and school than any other medical problem except the common cold. It is a major reason that patients see gastroenterologists (doctors who specialize in the digestive system; pronounced GAS-troe-EN-tuh-ROL-uh-jist). Yet no more than half of the people who experience IBS ever see a doctor.

IBS normally does not appear until after adolescence. It affects women about twice as often as men. Researchers do not know the reason for these patterns.

CAUSES

The food a person eats passes through various stages of digestion. In the stomach and small intestine, food is changed into a liquid. In the large intestine (colon), water and salts in this liquid pass through the walls of the colon into the bloodstream. The semisolid material that remains is passed on to the rectum.

Food is passed through the digestive system by means of peristalsis (pronounced per-i-STOL-sis). Peristalsis is a wave-like series of movements made by muscles in the walls of the digestive system. Peristalsis in the colon usually occurs only after meals.

In people who have IBS, peristalsis occurs in unusual patterns. It may go on for extended periods of time, or it may take place much more slowly than usual. In the first case, watery solids are continually passed to the rectum, which results in diarrhea. In the second case, very dry solids are passed to the rectum, which leads to constipation. Irritable bowel syndrome is any condition in which the colon does not function normally.

Certain foods seem to cause IBS in some people. They include chocolate, milk products, caffeine, and large quantities of alcohol. Some individuals are affected by very specific foods. Stress is also related to IBS. People who have IBS are likely to develop symptoms when they feel anxious. Researchers do not yet know why this connection exists.

Irritable Bowel Syndrome: Words to Know

Peristalsis:

Periodic waves of muscular contractions that move food through the digestive system.

Rectum:

The lower part of the digestive system from which solid wastes are excreted.

SYMPTOMS

Some typical symptoms of IBS include the following:

• Abdominal pain
• Diarrhea and/or constipation
• Cramps
• Gassiness
• Bloating

• Nausea
• A strong desire to defecate (have a bowel movement)
• A feeling that the bowels are not empty after a bowel movement

DIAGNOSIS

Many medical conditions produce symptoms similar to irritable bowel syndrome. A doctor needs to make sure that another condition is not causing the patient's symptoms. Eliminating other causes usually requires taking a medical history and conducting a general physical examination. Laboratory tests may also be needed. A stool sample can be tested for the presence of blood or parasites that may be causing an infection in the colon.

When other possible causes have been eliminated, a doctor may diagnose IBS. A positive diagnosis is based on a set of standards known as the Rome criteria. According to the Rome criteria an individual must have experienced continuous or recurrent symptoms for a period of three months. The diagnosis may also rate one of three levels for the disorder: mild, moderate, or severe.

About 70 percent of all patients have mild IBS. The symptoms of mild IBS are slight and do not interfere with the patient's daily life. Moderate IBS may interfere with some normal activities. It may also cause the patient some psychological problems. This level of IBS is seen in about 25 percent of all patients. Severe IBS causes a severe disruption of a patient's life. In some cases, patients suffer constant and intense pain. They usually cannot live normal lives or hold regular jobs. About 5 percent of all patients with IBS have this form of the disorder.

TREATMENT

The treatment recommended for IBS depends on the severity of the disorder. Patients with mild or moderate symptoms should identify foods that lead to the symptoms of IBS and avoid them. Over-the-counter medications can be used to control both diarrhea and constipation. If those medications do not work, other drugs can be prescribed. Drugs are also available to control the abdominal pain that often accompanies IBS. People with constipation can sometimes be helped by setting specific times for meals and bowel movements.

Psychological counseling may also be helpful. The purpose of counseling is to help patients reduce anxiety and learn to deal with the pain and other symptoms of IBS. Patients with severe symptoms need more aggressive treatment. They may be given antidepressant drugs to help reduce the worst pain associated with the disorder.

Alternative Treatment

Alternative practitioners recommend a variety of techniques to help patients deal with stress. These techniques include yoga, meditation, hypnosis biofeedback, and reflexology. Reflexology is a form of foot massage that some people think relieves diarrhea, constipation, and other symptoms of IBS.

Certain herbal remedies are also thought to be helpful in controlling the symptoms of IBS. For example, ginger, buckthorn, and peppermint oil are recommended to avoid irritation in the upper part of the digestive tract. Chamomile, valerian, rosemary, and lemon balm are thought to calm the digestive system and prevent abnormal peristaltic movements.

PROGNOSIS

Irritable bowel syndrome is not a life-threatening disorder. Nor is it likely to lead to more serious medical conditions, such as cancer (see cancer entry). In the majority of patients, the symptoms of IBS never disappear. However, those symptoms can usually be treated effectively and the condition is viewed as a temporary, if annoying, inconvenience.

PREVENTION

While there is no single known cause of IBS, there are some habits that an individual can develop to maintain good digestive health. Specifically, a well-balanced diet, low in fats, is recommended. Ensuring that your diet includes enough fiber is also a positive step; this means monitoring your intake of fresh fruits and vegetables, whole grains, and bran. Regular exercise, quitting smoking, and avoiding excessive amounts of caffeine are also encouraged.

FOR MORE INFORMATION

Books

Peikin, Steven R. Gastrointestinal Health: A Self-Help Nutritional Program to Prevent, Cure, or Alleviate Irritable Bowel Syndrome, Ulcers, Heartburn, Gas, and Constipation, revised edition. New York: HarperCollins, 1999.

Organizations

International Foundation for Functional Gastrointestinal Disorders. PO Box 17864, Milwaukee, WI 53217. (888) 964-2001. http://www.iffgd.org.

National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health. 2 Information Way, Bethesda, MD 20892-3570. http://www.niddk.nih.gov.

Irritable Bowel Syndrome

Georgia Goes Solo

What Is Irritable Bowel Syndrome?

How Is IBS Diagnosed and Treated?

Resources

Irritable bowel syndrome (IBS) is a chronic (long-lasting) disorder that occurs when the intestines do not function correctly. A person with IBD may experience abdominal pain that often is accompanied by alternating episodes of constipation and diarrhea.

KEYWORDS

for searching the Internet and other reference sources

Functional bowel disease

Gastrointestinal system

Spastic colon

Georgia Goes Solo

Playing the flute was Georgia’s favorite activity. When she got to college, Georgia majored in music and performed regularly with the college orchestra. Until her senior year, Georgia always was healthy and able to make it to concerts, but then she began to have problems with her bowel movements. Either she was running to the bathroom constantly because she had diarrhea, or she suffered from constipation. Her symptoms began to interfere with rehearsals and concerts, so she went to the college health center. The doctor was able to rule out inflammatory bowel disease, but did diagnose irritable bowel syndrome. The doctor prescribed medication for Georgia and referred her to a nutritionist and a stress management program. By graduation, Georgia was able to play a flute solo without having to worry about rushing off to the bathroom.

What Is Irritable Bowel Syndrome?

Irritable Bowel Syndrome is a disorder in which the nerves that control the muscles of the intestine are unusually sensitive, causing the bowels to function improperly. The result is abdominal discomfort and an altered pattern of bowel movements (either diarrhea or constipation). IBS also is called spastic colon or spastic bowel.

IBS is not a disease, and it cannot be caught from another person. Although a person with IBS may experience considerable distress and discomfort from abdominal cramping, gas, constipation, and/or diarrhea, IBS is not medically serious and does not lead to other intestinal diseases such as cancer or ulcerative colitis.

The cause of IBS is unknown. Symptoms may be triggered by diet, by drugs, by stress, or by emotional factors. Triggers vary from person to person. The syndrome is about twice as common in women as men and usually begins in early adulthood.

How Is IBS Diagnosed and Treated?

Diagnosis

To diagnose a person as having IBS, the doctor must determine through medical history, physical examination, and diagnostic tests that the patient does not have a disease such as Crohn’s disease, ulcerative colitis, or an infection that might be causing the symptoms. Typically, a person with IBS will report some or all of the following symptoms to the doctor:

• abdominal pain or cramping
• constipation*
• diarrhea (may alternate with constipation)
• a feeling that the bowel movement is incomplete
• mucus in the stool
• bloated feeling in the abdomen
• a lot of gas

* constipation

is the sluggish movement of the bowels, usually resulting in infrequent, hard stools.

Treatment

While there is no cure for IBS, the symptoms often can be controlled. Medications may be prescribed to relieve diarrhea and constipation. Changes in diet help many people control their symptoms. People with IBS often benefit from practicing stress reduction techniques, since stress triggers symptoms in some people. Other people with IBS help manage their condition by seeking supportive psychological counseling.

See also

Colitis

Constipation

Diarrhea

Gastroenteritis

Inflammatory Bowel Disease

Resources

U.S. National Digestive Diseases Information Clearinghouse, 2 Information Way, Bethesda, MD 20892-3570. The National Digestive Diseases Information Clearinghouse is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). It publishes brochures and posts the fact sheets Irritable Bowel Syndrome and Irritable Bowel Syndrome in Children at its website. http://www.niddk.nih.gov/health/digest/pubs/irrbowel/irrbowel.htm http://www.niddk.nih.gov/health/digest/summary/ibskids/index.htm

International Foundation for Functional Gastrointestinal Disorders, P.O. Box 17864, Milwaukee, WI 53217. Telephone 414-241-9479 http://www.execpc.com/iffgd

irritable bowel syndrome (IBS, spastic colon, mucous colitis) (i-ri-tă-bŭl) n. a common condition in which recurrent abdominal pain with constipation and/or diarrhoea continues for years without any general deterioration in physical health or detectable structural disease.

irritable bowel syndrome Also known as spastic colon or mucous colitis. Abnormally increased motility of the large and small intestines, leading to pain and alternating diarrhoea and constipation; often precipitated by emotional stress.