IBS has inaccurately been called by many names:
* colitis * mucous colitis * spastic colon * spastic bowel * functional
bowel disease
IBS is called a functional disorder because there is no sign
of disease when the colon is examined.This is a very common condition
with ~20% incidence and more often seen in women many of whom
"worry" or are stressed more readily. Because physicians
have been unable to find an organic cause, IBS often has been
thought to be caused by emotional conflict or stress. While stress
may worsen IBS symptoms, research suggests that other factors
also are important.
IBS often causes a great deal of discomfort and distress, but
it is not believed to:
* cause permanent harm to the intestines. * lead to intestinal
bleeding of the bowel. * or lead to a serious disease such as
cancer.
It has not been shown to
lead to serious, organic diseases nor has a link been established
between IBS and inflammatory bowel diseases such as Crohn's disease
or ulcerative colitis.
How does IBS occur? Colon motility is contraction of intestinal
muscles and movement of its contents. It is controlled by nerves
and hormones, and by electrical activity in the colon muscle.
Movements of the colon propel the contents slowly back and forth
toward the rectum, and several times a day strong muscle contractions
move down the colon pushing fecal material ahead of them,which
can result in a bowel movement.
The person with IBS has a colon that
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 medicines * certain foods
Women with IBS seem to have more symptoms during their menstrual
periods, suggesting that reproductive hormones can increase IBS
symptoms.
What are triggers for IBS? The most likely triggers for IBS are
diet and emotional stress. Scientists have some clues as to why
this happens.
* diet Eating causes contractions of the colon, normally causing
an urge to have a bowel movement within 30 to 60 minutes after
a meal. With IBS, the urge may come sooner, accompanied by cramps
and diarrhea.
* Stress stimulates colonic spasm in people with IBS. Although not completely understood, it is believed to be because the colon is partly controlled by the nervous system. Counseling and stress reduction techniques can help relieve the symptoms of IBS, however this does not mean IBS is the result of a personality disorder. It is at least partly a disorder of colon motility.
What are the symptoms of IBS? The following are
the most common symptoms for IBS, however, each individual may
experience symptoms differently.
IBS symptoms usually include:
* crampy abdominal pain * painful constipation and/or diarrhea.
* alternating constipation and diarrhea * mucus may be in the
bowel movement.
ROME Criteria for IBS
Symptoms for more than 3 months.
1.Abdominal pain / discomfort ( at least one of following)
-relieved with defacation, and/or
-with change in stool frequency, and/ or
-with change in stool consistency
AND
2. Two or more (more than 2 days per week)
- altered stool frequency (greater than 3 stools per day or less than 3 stools per week)
-altered stool form (lumpy/hard or loose/watery)
-altered stool passage ( straining, urgency , or feeling of incomplete evacuation)
- passage of mucous
-bloating or feeling of abdominal distension
Bleeding, fever, weight loss, and
persistent severe pain are not
symptoms of IBS, but indicate
other problems. The symptoms of IBS may resemble other conditions
or medical problems. Consult your physician for a diagnosis. Also
symptoms and signs that alerts to another diagnosis are weight
loss , night symptoms, , occurrence in the older patient (only
10% incidence), abnormal physical findings or abnormal results
What Causes IBS? The colon, which is about 6 feet long,
connects the small intestine with the rectum and anus. The major
function of the colon is to absorb water and salts from digestive
products that enter from the small intestine. Two quarts of liquid
matter enter the colon from the small intestine each day. This
material may remain there for several days until most of the fluid
and salts are absorbed into the body. The stool then passes through
the colon by a pattern of movements to the left side of the colon,
where it is stored until a bowel movement occurs. 
Colon motility (contraction of intestinal muscles and movement of its contents) is controlled by nerves and hormones and by electrical activity in the colon muscle. The electrical activity serves as a "pacemaker" similar to the mechanism that controls heart function.
Movements of the colon propel the contents slowly back and forth but mainly toward the rectum. A few times each day strong muscle contractions move down the colon pushing fecal material ahead of them. Some of these strong contractions result in a bowel movement.
Because doctors have been unable to find an organic cause, IBS often has been thought to be caused by emotional conflict or stress. While stress may worsen IBS symptoms, research suggests that other factors also are important. Researchers have found that the colon muscle of a person with IBS begins to spasm after only mild stimulation. The person with IBS seems to have a colon that is more sensitive and reactive than usual, so it responds strongly to stimuli that would not bother most people.
Ordinary events such as eating and distention from gas or other material in the colon can cause the colon to overreact in the person with IBS. Certain medicines and foods may trigger spasms in some people. Sometimes the spasm delays the passage of stool, leading to constipation. Chocolate, milk products,gum (sorbitol) or large amounts of alcohol are frequent offenders. Caffeine causes loose stools in many people, but it is more likely to affect those with IBS. Researchers also have found that women with IBS may have more symptoms during their menstrual periods, suggesting that reproductive hormones can increase IBS symptoms.
Initial Evaluation by a Doctor will include 1. Getting a good history from patient and examination . Test may include Complete blood count , ESR , Stool testing for blood, ova and parasites , leucocytes and stool culture . Sigmoidoscopy ? Barium Enema
Treatment for IBS: Specific treatment will be
determined by your physician(s) based on:
* your age, overall health, and medical history * extent of the
disease * your tolerance for specific medications, procedures,
or therapies * expectations for the course of the disease * your
opinion or preference
Treatment may include:
Patient education -this condition is frustrating for physician
and patient to deal with!
* changes in diet Eating a proper diet can lessen IBS symptoms.
Keeping a list of foods that cause distress and discussing the
findings with a physician or registered dietitian can help.
* medication Physicians may prescribe fiber supplements or occasional laxatives, and some prescribe antispasmodic drugs or tranquilizers or antidepressants to relieve symptoms.
for pain -antispasmodics, anticholinergics, peppermint oil , Opoid like analgesic,tricyclics antidepressants( ie amitrytilline 10-25 mg bid)
for Diarrhea-loperamide , cholestyramine
-for constipation -fibre (metamucil commonly) Osmotic laxatives , Cisapride/ metaclopramide.Misoprostol, PEG solution (ie GoLytely)
ALOSETRON-(5-Ht antagonist) 1 mg bid a- new mechanism of therapy for ibs.
The major concerns with medications for IBS are the potential for drug dependency and the effects the disorder can have on lifestyle. In an effort to control their bowels or reduce stress, some people become dependent on laxatives or tranquilizers.