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Cause, Cure for Irritable Bowel Syndrome Elusive

Breaking News - April 2006 - Week 2

(Apr 12, 2006)

Healthcare in  the News

-- If you have irritable bowel syndrome (IBS), you are not alone - nine percent to 23 percent of the world's population is estimated to have the condition.

Picture of a woman at a desk

IBS is one of the most common disorders diagnosed by physicians, with as many as one in five Americans suffering from the pain, bloating, and embarrassment the condition causes.

In an effort to bring attention to the symptoms and difficulties associated with IBS, the International Foundation for Functional Gastrointestinal Disorders (IFFGD) has designated April as IBS Awareness Month.

Looking for A Cause

IBS is called a functional disorder because there is no sign of disease when the colon is examined. But little else is known about the disorder.

Physicians have been unable to pinpoint one specific cause, or find any cure. However, several theories have gained recognition.

Dr. Lin Chang, an associate professor at the University of California, Los Angeles' Division of Digestive Diseases and School of Medicine, theorizes that IBS could be initially triggered by some sort of serious physical or psychological problem, such as a runaway infection, a major surgery, or a deep depression.

With IBS, the colon is more sensitive and reactive than usual, so it responds strongly to stimuli that would not affect others.

The colon muscle of a person with IBS begins to spasm after only mild stimulation or ordinary events such as eating, distention from gas or other material in the colon, certain medications, and certain foods.

Women with IBS seem to have more symptoms during their menstrual periods, suggesting that reproductive hormones can increase IBS symptoms.

More and more, research is focusing on the effect that the mind may have on the function of the gut. Many physicians believe that the link between brain and body might be the key to effective treatment of IBS.

"It's really a brain-gut disorder," says Dr. Chang. "We're gaining more information from many different aspects, but I don't think we have the whole story down yet."

Abdominal pain, bloating, cramping, constipation, and diarrhea are the main symptoms of IBS, according to the National Institutes of Health (NIH). But specific symptoms vary from person to person.

Some have constipation, while others experience diarrhea. Some find that their symptoms wax and wane, subsiding for a few months and then returning, while others say their symptoms get worse as time passes.

Embarrassment Affects Treatment Seeking

Awareness of IBS has grown over the past decade, says Dr. Chang, who is also director of the Women's Digestive Health Center at UCLA's Digestive Diseases Research Center. "Most people may not understand what the symptoms are, but they recognize the name."

However, it remains a highly embarrassing and taboo disorder. Many people are ashamed of their symptoms, and find it hard to confide even in their family physician.

Up to 70 percent of people suffering from IBS are not receiving medical care for their symptoms, according to federal statistics.

"The majority of patients with IBS don't seek medical treatment," Dr. Chang says. "I wouldn't say this is an easy topic to talk about at all."

The Mind and Body Connection

During IBS Awareness Month, doctors are taking the opportunity to share information about how the mind can create - or heal - problems in the digestive tract.

Once IBS has been triggered, a number of mental and physical occurrences have been associated with a worsening of symptoms, according to the NIH.

Interestingly, physicians have found that psychological treatments like hypnosis, relaxation training, or psychotherapy provide the same amount of relief - or even more relief - than drug therapy.

"Treating the patient really requires a holistic approach where you treat both the body and the mind," says Dr. Charles Gerson, co-director of the Mind-Body Digestive Center in New York City and an associate clinical professor of gastroenterology at the Mount Sinai School of Medicine.

"In the short term, therapy has proven more effective than medicine. Western medicine has forgotten how much the mind and body interact," Dr. Gerson adds.

A vicious circle can develop with IBS when the patient's body and mind interact in a way to make the disorder grow worse, Dr. Gerson says.

For example, the gut can cause discomfort that makes the patient feel depressed or anxious. That depression or anxiety can then turn around and make the discomfort even more severe, he says.

"It just keeps going around and around," Dr. Gerson says. "You have to treat both sides of the circle to see positive benefit."

Antidepressant drugs are typically used to treat flare-ups of IBS and provide some relief to patients.

Fiber supplements or laxatives for constipation, medicines to decrease diarrhea, or antispasmodic drugs to control colon muscle spasms and reduce abdominal pain also are commonly prescribed.

Research has shown that IBS is affected by the immune system, which is affected by stress. Because of that, stress management is an important part of IBS treatment. Patients are urged to deal with stress through counseling, regular exercise, and a healthy amount of sleep.

On the physical side, careful eating has been shown to reduce IBS symptoms.

With advice from a physician or dietitian, persons with IBS have been able to reduce their discomfort by removing problem foods from their diet such as dairy products, or by increasing their fiber intake.

Always consult your physician for more information.

For more information on health and wellness, please visit health information modules on this Web site.

IBS in Children

Thirty-three percent of adults who have irritable bowel syndrome can trace their symptoms back to childhood.

One of the difficulties in identifying Irritable bowel syndrome (IBS) is that it can mask itself as many other gastrointestinal conditions. This is especially true with children.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) offers the following information for the diagnosing and treatment of IBS in young people.

IBS may be a cause of recurring abdominal pain in children. The diagnosis of IBS is based on having abdominal pain or discomfort plus any two of the following:

  • The pain is relieved by having a bowel movement.
  • The onset of pain is associated with a change in the frequency of stools.
  • The onset of pain is associated with a change in stool consistency.

The symptoms must be present for at least 12 weeks in the preceding 12 months, and there should be no other diseases that might cause the symptoms.

In children and adolescents, IBS affects girls and boys equally and may be diarrhea-predominant, constipation-predominant, or have a variable stool pattern.

Children with IBS may also have headache, nausea, or mucus in the stool. Weight loss may occur if a child eats less to try to avoid pain.

Some children first develop symptoms after a stressful event, such as teething, a bout with the flu, or problems at school or at home. Stress does not cause IBS, but it can trigger symptoms.

To diagnose IBS, the physician will ask questions about symptoms and examine the child to rule out more serious problems or diseases.

IBS is not a disease - it is a syndrome, or group of symptoms that occur together. It does not damage the intestine, so if the physical exam and other tests show no sign of disease or damage, the doctor may diagnose IBS.

In children, IBS is treated mainly through changes in diet - eating more fiber and less fat to help prevent spasms - and through bowel training to teach the child to empty the bowels at regular, specific times during the day.

Medications like laxatives are rarely prescribed because children are more susceptible to addiction than adults. When laxatives are necessary, parents must follow the doctor's instructions carefully.

Learning stress management techniques may also help some children.

Most children with IBS continue to grow and develop normally.

Its greatest morbidity resides in the fact that it affects normal daily activity of the child, affecting school and peer relations.

Always consult your physician for more information.

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