Irritable bowel syndrome

IBS, Irritable Colon, Spastic Colon

What is Irritable bowel syndrome?

Irritable colon is a functional disorder characterized by poorly localized, occasionally intense cramp-like lower abdominal pain. Intestinal tract movement may either be sped up or slowed down resulting in either loose stools or constipation, respectively. Additionally, bloating with increased gas and distention are frequently reported. Irritable colon can be a chronic disorder with symptoms lasting months to years, or symptoms may remit for long periods, only to relapse without warning.

Although abnormalities of bowel muscle activity can be demonstrated in the research setting, no pathologic findings can be identified for irritable colon. Since irritable colon is frequently associated with psychiatric conditions, such as anxiety, depression, and the inability to handle stress, irritable colon is instead thought of as a functional disorder. Besides psychological stress, however, spastic colon may be a result of the ingestion of irritants such as coffee or raw fruits and vegetables or the abuse of laxatives.

Irritable colon may be a symptom of another disease, such as diverticulosis or diverticulitis, colon cancer, or lactose intolerance. It is estimated that approximately twenty percent of adults have symptoms of spastic colon at one time or another during their lives, and more women are affected than men are (at a 4:1 ratio).

How is it diagnosed?

Irritable bowel syndrome symptoms

The following symptoms usually begin in early adult life. Episodes may last for days, weeks or months.

  • Cramp-like pain in the middle or to one side of the lower abdomen. Pain is usually relieved with bowel movements.
  • Nausea.
  • Bloating and gas.
  • Headache.
  • Rectal pain.
  • Backache.
  • Occasional appetite loss that may lead to weight loss.
  • Diarrhea or constipation, usually alternating.
  • Fatigue.
  • Depression.
  • Anxiety.
  • Concentration difficulty.

History: Individuals complain of abdominal pain, constipation, and/or diarrhea. The pain is most frequently felt in the lower left abdominal quadrant. Rarely, abdominal distention and bloating are reported. The diagnosis requires at least six months of continuous or recurring abdominal pain, which is relieved by a bowel movement and associated with either a change in the number of stools or in the consistency of the stool. A thorough patient history is essential for diagnosis and treatment. The individual should be questioned regarding their current level of psychological stress.

Physical exam may reveal an anxious, but otherwise healthy, individual. Although a physician may confirm abdominal distention and diffuse mild to moderate abdominal tenderness to probing, no enlarged organs should be found.

Tests: There are no specific tests that can be used to definitely diagnose this condition. Instead, numerous diagnostic tests and procedures are performed in an effort to rule out other problems or to convince the individual that a more serious malady does not exist. A reasonable evaluation would include a complete blood count (CBC) and blood chemistry panel that would include a thyroid test (TSH) and an amylase test to rule out a pancreas problem.

A urinalysis is usually sufficient to rule out urinary tract problems. A stool test for bacteria and parasites is usually sufficient to rule out infectious causes and to make certain that there is no intestinal bleeding indicated by blood in the stool.

Depending upon the particular presentation of symptoms, more specific diagnostic tests, such as a sigmoidoscopy, colonoscopy, barium enema, or rectal biopsy may be ordered.

How is it treated?

Treatment focuses on eliminating the underlying cause. Once other diseases have been ruled out, treatment consists of educating the individual about his or her disease and providing reassurance that the condition is not life threatening. If the suspected cause of illness is stress, the individual should be instructed regarding the relationship between stress and illness. Behavioral modification and relaxation techniques may prove beneficial, and psychiatric consultation may be warranted to diagnose and treat depression, chronic anxiety, or obsessive-compulsive disorders. Since emotional factors have a great deal to do with this problem, regular exercise to relieve stress is important. Any aerobic type of exercise, such as walking, jogging, swimming, or cross-country skiing is beneficial. Additionally, an exercise program should be one that the person enjoys so that it will be done consistently for thirty minutes or more on a daily basis.

If the suspected cause is an irritant food, attempts should be made to identify the irritant, and the individual should be instructed to avoid this food. Should the cause be related to chronic laxative abuse, bowel training may help to correct the condition and alleviate symptoms. To relieve symptoms, rest and heat applied to the abdomen may be helpful. In some cases, sedatives and antispasmodic drugs may also provide relief, though care must be taken to avoid dependence on these drugs.

Medications

  • Antispasmodics to relieve severe abdominal cramps may be prescribed.
  • Short-term use of tranquilizers to reduce anxiety.
  • Other possibilities include bulk-producing agents, constipating agents, anticholinergics, antiflatulents and lactose for milk intolerance.
Brand Generic Label Rating
generic Elavil Amitriptyline Off-Label
Imodium Loperamide
Tofranil Imipramine
Zelnorm Tegaserod
Xanax Alprazolam

Activity

No restrictions. Regular physical activity improves bowel function and helps reduce stress.

Diet

  • Increase fiber in the diet to promote good bowel function. Add fiber to your diet slowly to give the body time to adjust.
  • Don't eat foods or drinks that aggravate symptoms. Coffee or milk may be a major cause of symptoms in some people. Keep a food diary so you can find out which foods aggravate symptoms.
  • Avoid gas-producing and spicy foods.
  • Avoid large meals, but eat regularly.
  • Limit alcohol consumption.

What might complicate it?

If the diarrhea is severe enough, dehydration and chemical imbalances can occur, but this is rare. Problems in the anal area can occur from tearing due to hard stools or inflammation and irritation from frequent loose stools. Constipation may be prolonged and result in blocked bowel from hard stool. Constipation may become chronic and lifelong. In rare cases, social isolation can result due to an individual's fear of venturing far from toilet facilities.

Predicted outcome

Outcome is usually favorable in all but the rare worst case. Symptoms are usually more of an annoyance than a disability. Although there can be complete recovery, generally intermittent symptoms will last over the course of a lifetime.

Alternatives

Differential diagnoses include depression, rectal prolapse, medication-induced constipation, diverticulitis, colon cancer, hypothyroidism or hyperthyroidism, inflammatory bowel disease, lactose intolerance, intestinal parasite, and malabsorption.

Appropriate specialists

Gastroenterologist, internist, and psychiatrist.

Notify your physician if

  • Fever develops.
  • Stool is black or tarry-looking.
  • Vomiting occurs.
  • Unexplained weight loss of 5 pounds or more occurs.
  • Symptoms don't improve despite treatment.

Last updated 25 November 2011


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