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Treating Irritable Bowel Syndrome The potential symptoms of irritable bowel syndrome are many, including constipation, diarrhea, and abdominal pain. Secondary IBS symptoms include abnormal passage of stool, abnormal form of stool, increased amounts of mucus in the stool, and a feeling of abdominal distention (bloating). Irritable bowel syndrome affects up to 20 percent of the American and Canadian populations. Results from the 2002 IBS in Canada Survey revealed that more than 85 percent of IBS sufferers feel that their symptoms are very bothersome, having a moderately or seriously negative impact on daily life, work, travel, and social life. A staggering 45 percent indicated that their IBS symptoms have a severe impact on their overall quality of life. Irritable bowel syndrome is a leading cause of absenteeism. According to the IBS in Canada Survey, 46 percent of sufferers experience IBS symptoms on a daily basis, 27 percent report an occurrence rate of two to three times a week. And unfortunately, over 36 percent consider the pain and discomfort of their IBS to be severe. Having IBS does not predispose one to developing inflammatory bowel disease or bowel cancers. Irritable bowel syndrome is not a life-threatening condition, just an uncomfortable one, sometimes intensely so. Because the cause is as yet unknown, irritable bowel syndrome treatment focuses on minimizing or relieving IBS symptoms. Medications can be used to control constipation, diarrhea, and abdominal pain. Health care providers also may suggest antidepressant medication and psychological treatments. Addressing IBS Symptoms Constipation These are some of the common treatments for constipation associated with irritable bowel syndrome. Diet: Constipation is often caused by lack of fiber in the diet. Increasing dietary fiber by the addition of fruits, vegetables and whole grains is often helpful. Fiber supplements (Metamucil ®, Citrucel ®) are often necessary. Laxatives: These include bulk forming, emollient (stool softening), lubricant, hyperosmolar, saline (milk of magnesia), and stimulant laxatives. Laxatives can have side effects and some can cause a dependency, so their use should be supervised by a physician. Combination products: These have more than one laxative. Some common oral products are senna with docusate (Senokot-S ®), and senna with glycerin (Fletcher's ® Castoria ®). These products should be used with caution, however, as long-term use may result in permanent damage to the colon. Suppositories: These include stimulant suppositories containing bisacodyl, and glycerin suppositories, believed to work by lubricating the rectum. Enemas: Enemas are meant for occasional, rather than regular, use. By distending the rectum, enemas stimulate the colon to contract and eliminate stool. Saline enemas cause water to be drawn into the colon; phosphate enemas stimulate the muscles of the colon; mineral oil enemas lubricate and soften hard stool; and emollient enemas contain agents that soften the stool. Drugs: Zelnorm™ (tegaserod maleate) is the first prescription medication approved by the FDA for the short-term treatment of women with IBS whose primary symptom is constipation. Doctors sometimes prescribe drugs used to treat other conditions, but they cause loose stools as a side effect. Such drugs include colchicine, misoprostil (Cytotec ®), and orlistat (Xenical ®). Biofeedback: People have some degree of voluntary control over most of the muscles surrounding the anus and rectum. Biofeedback training can teach patients with pelvic floor dysfunction how to make their muscles work normally and improve their ability to defecate. Diarrhea The most widely studied drug for the treatment of IBS-associated diarrhea is loperamide (Imodium ®). Loperamide seems to work by slowing down the contractions of the muscles of the small intestine and colon. Loperamide can be a potent anti-diarrheal and can itself cause constipation, so the dose must be individualized for each patient. Abdominal Pain A group of drugs called smooth-muscle relaxants are being studied for the treatment of abdominal pain. Hyoscyamine and methscopolamine are commonly used smooth muscle relaxants. Other drugs combine smooth muscle relaxants with a sedative, but so far no evidence indicates that the addition of a sedative increases the treatment's effectiveness. Conventional Treatment Options In addition to the symptomatic treatments described above, treatment of IBS may involve the use of antidepressant drugs, mental therapy and changes to diet. Antidepressants Patients with irritable bowel syndrome often suffer from depression, but it's unclear whether depression is the cause, the result, or completely unrelated to the disorder. Several trials have shown that antidepressants can help relieve abdominal pain, and possibly diarrhea. Antidepressants used in IBS treatment are taken at relatively low doses that have little or no effect on depression. The medical community believes that antidepressants work for IBS not by combating depression, but through different mechanisms such as modifying nerve activity and providing pain relief. Tricyclic antidepressants are typically prescribed. These include amitriptyline (Elavil ®), clomipramine (Anafranil ®) and notriptyline (Aventyl ® and Pamelor ®). Selective serotonin reuptake inhibitors (SSRIs) also show promise in the treatment of IBS. These include fluoxetine (Prozac ®), sertraline (Zoloft ®) and paroxetine (Paxil ®). Psychological Treatments Psychological treatment is recommended when IBS becomes psychologically distressing to a point where it impairs a patient's quality of life. Treatment may include: cognitive-behavioral therapy psychodynamic or interpersonal psychotherapy hypnosis relaxation or stress management. A few studies have shown that, in addition to reducing anxiety and other mental symptoms, psychological treatments reduce IBS symptoms, particularly pain and diarrhea. Stress and anxiety often intensify IBS symptoms. Dietary Changes Whether diet has much effect on IBS symptoms or not is unclear. Yet patients often associate their condition with certain foods (i.e., coffee, garlic, citrus fruits, chocolate). Although specific foods might aggravate IBS symptoms, they don't cause the disorder. Maintaining a food diary is often helpful in identifying the offending foods. Health care providers often recommend an increase in dietary fiber for patients with IBS. Insoluble fiber (fruits, vegetables, whole wheat, bran) helps treat constipation; soluble fiber (rice, oatmeal, soy) helps to regulate intestinal contractions and is helpful for both constipation and diarrhea. Increasing soluble fiber in the diet can help minimize painful intestinal spasms. Lactose intolerance often is blamed for IBS-related diarrhea. Because lactose intolerance is fairly common, it is more likely that the two conditions simply coexist, and that lactose exacerbates existing IBS. In this situation, a lactose-restricted diet can improve, but not eliminate, the symptoms. Resources Marks, J. W., M.D. (Reviewed 2001). Constipation. Retrieved August 22, 2002, from www.focusondigestion.com/script/main/art.asp?li=MNI& ArticleKey=331&page=5#tocd. Marks, J. W., M.D. (Reviewed 2002). Irritable bowel syndrome (IBS) . Retrieved August 22, 2002, from www.focusondigestion.com/script/main/art.asp? articlekey=396&rd=1. National Digestive Diseases Information Clearinghouse. (1992). Irritable Bowel Syndrome. (NIH Publication No. 97-693). Retrieved September 3, 2002, from www.niddk.nih.gov/health/digest/pubs/irrbowel/irrbowel.htm. Novartis Pharmaceuticals Canada Inc. (2002). Hope for four million Canadian women: First specific treatment for irritable bowel syndrome now available. Retrieved August 23, 2002, from www.newswire.ca/releases/July2002/24/c7364.html. Novartis Pharmaceuticals Corp. (2002). FDA approves Zelnorm, a novel treatment for irritable bowel syndrome in women with constipation. Retrieved August 21, 2002, from www.prnewswire.com/cgi-bin/stories.pl?ACCT=105&STORY= /www/story/07-24-2002/0001770559.

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