Irritable Bowel Syndrome (IBS)

What Is Irritable Bowel Syndrome?

Irritable bowel syndrome, or IBS, is a chronic or recurrent gastrointestinal condition characterized by abdominal pain, discomfort and altered bowel habits, i.e., diarrhea and/or constipation. It is considered a “functional” bowel disorder which refers to the fact that these conditions cannot (yet) be reliably diagnosed by blood tests, abdominal imaging studies, tissue samples, or other routine tests; that is, they cannot be easily explained by anatomic or structural abnormalities.

IBS alone accounts for 12% of all medical conditions diagnosed in primary care practices and, along with other functional bowel disorders, accounts for over 40% of diagnoses made by gastroenterologists. IBS can affect up to 10-15% of Americans and has a significant world-wide prevalence. IBS can affect people of all races, and both children and adults. The onset of IBS usually begins to occur in late adolescence or in early adult life. It rarely appears for the first time after age 50. It tends to affect women more than men. While the ratio of women-to-men who report symptoms of IBS in the community is about 1-2:1, women are 2-4 times more likely than men to seek health care for their IBS symptoms. The majority of individuals with IBS symptoms do not seek medical care for their bowel symptoms. For many, the condition is chronic, and symptoms can appear for months, then disappear, then reappear again. For some, the symptoms are mild and for others, the symptoms can be quite severe and even debilitating.

What Are the Symptoms of IBS?
The most common symptoms that IBS patients complain of are any or all of the following:
• abdominal or belly pain (usually in the lower abdomen area)
• mainly diarrhea or constipation, or diarrhea alternating with constipation
• bloating or fullness
• visible abdominal distension (appearance that belly is swollen)
• mucus in the stool
• bowel urgency (having to rush to the bathroom to have a bowel movement)
• bowel incontinence or leakage
• feeling of incomplete evacuation after a bowel movement

What Causes IBS?
Evidence suggests that IBS is a multi-factorial condition, that is, there are several factors that can lead to the development of IBS. Studies have demonstrated that IBS can occur in families, which supports a genetic cause. Chronic stress, particularly early in life, also appears to predispose an individual to developing IBS. In some patients, an intestinal infection, such as food poisoning, can trigger the onset of IBS. Even though the pathophysiology of IBS remains incompletely understood, there is general consensus that a disruption in the communication pathways between the brain and gut results in increased perception of gut signals, and in disturbances in bowel function which include:

• Alterations in intestinal motor function (contraction of intestinal muscles, spasms of the colon, and movement of its contents) that manifests as diarrhea or constipation.
• Increases or decreases in secretion or fluid movement into the intestine that can present with loose and watery stools or hard stools, respectively.
• Increased perception of intestinal activity which can present as abdominal pain, discomfort and bloating.

Food, stress and in women, changes in the menstrual cycle, can trigger worsening of IBS symptoms. Researchers have found that women with IBS may have more symptoms, such as bloating, at the beginning of their menstrual periods, suggesting that reproductive hormones can increase IBS symptoms.

How is IBS diagnosed?
There are currently no definitive tests that can diagnose IBS. It is diagnosed by patient symptoms: the presence of abdominal pain for at least 3 days per month that is improved with bowel movements and associated with diarrhea and/or constipation. The diagnosis can be reliably made based on symptoms and minimal diagnostic testing in the absence of “red flags,” which include blood in the stool, unintentional weight loss, and a family history of colon cancer, celiac disease and inflammatory bowel disease (Crohn’s disease or ulcerative colitis). If “red flags” are present, further diagnostic testing is indicated to determine if a condition other than IBS is causing the symptoms.

What Can I Do to Help My IBS Symptoms?
If you have been diagnosed with IBS by a qualified health care provider, one of the best ways to manage your condition is to learn more about it. Knowing what the symptoms of IBS are, and that they are not the signs of a life threatening illness is the first step in your road to managing this condition. The second is identifying which foods, environmental causes, stresses and other factors may exacerbate or worsen symptoms and what can make it better. Understand that nearly all people with IBS can be helped, but no single treatment works for everyone. Eating, stress, gas, depression, and anxiety can cause the colon to overreact and increase IBS symptoms in some people. Foods such as milk products in lactose-intolerant people, chocolate, alcohol, dietary fats, high fructose containing fruits, gas forming vegetables and wheat, may provoke symptoms. Excessive use of artificial sweeteners such as sorbitol should be avoided as well, particularly in patients with diarrhea or bloating. In many patients, eating smaller, more frequent meals can reduce IBS symptoms.

There is a range of treatments aimed at normalizing bowel movements in patients with more moderate to severe IBS. For constipation, they range from herbal medications, to fiber or bulking agents, probiotics, laxatives and newer agents that affect intestinal fluid contents. Similarly, antidiarrheal medications, antibiotics such as rifixamin, and the serotonin medication alosetron are available to relieve diarrhea symptoms in IBS. Behavioral treatments such as relaxation breathing exercises, hypnosis, mindfulness meditation, stress management and cognitive behavioral therapy have all been shown to be effective, but their success depends on patient’s interest and motivation to pursue regular exercises. You should consult with your health care provider for more information.

What We Are Doing at CNS
Research Studies: Clinical research is essential in advancing our understanding of biological and psychological mechanisms underlying functional gastrointestinal disorders and IBS and to develop more effective treatments. The only way these studies can be performed is when affected patients are willing to participate in them. If you are interested in these studies, Click here for further information.

Links and Information on IBS:
The International Foundation for Functional Gastrointestinal Disorders (IFFGD): is a nonprofit education and research organization founded in 1991. IFFGD addresses the issues surrounding life with gastrointestinal functional and motility disorders and increases the awareness about these disorders among the general public, researchers, and the clinical care community.

UCLA Center for East-West Medicine: The mission of the Center for East-West Medicine is to improve health, well-being and the quality of life by bringing together the best of modern western and traditional Chinese medicine. Dr. Hui and his staff currently apply the principles and practices of modern western and traditional Chinese medicine in the clinic at UCLA. The clinic also serves as the base for the Center.