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Irritable bowel syndrome is an abdominal disorder that involves pain and cramping of the abdomen with either constipation or diarrhoea. Sometimes you get alternating constipation and diarrhoea. This is a different disease from inflammatory bowel diseases such as Crohn's colitis and ulcerative colitis.
There are a lot of possible causes of irritable bowel syndrome but no one knows the exact cause of the disease. Some have problems with the smooth muscle tone of the intestinal wall so that the intestinal wall is too tight or too loose. The intestinal wall can be too sensitive to movement or stretching and can become irritable. A biopsy of the intestinal wall and the rest of the intestines is usually completely normal.
Exactly who gets irritable bowel syndrome and who doesn't is unclear. It can follow an intestinal infection but there are other triggers possible. Stress can make IBS worse as can depression. There is a connectivity between the brain and the autonomic nervous system so that during stress, the brain can send stressful signals down from deep within the brain and can activate the autonomic nerves, leading to bowel dysfunction.
IBS can come on at any age but usually begins in the teen years or in early adulthood. IBS is much more common in women than in men. It is a disease that occurs in about 1 in 6 Americans. This makes it the most common reason why a person sees a gastroenterologist.
Symptoms of irritable bowel syndrome can be mild or very severe. Most people are not too severely affected. The major symptoms include a six month or more history of abdominal pain, gas in the abdomen and bloating of the abdomen. This occurs after meals and often are symptoms that come and go. The symptoms tend to reduce or go away completely after a successful bowel movement. Constipation and diarrhoea can alternate but most people have either constipation or diarrhoea but not both. Those with diarrhoea have frequent watery or loose stools along with an urgency to have a bowel movement and difficulty controlling bowel movements. Those with constipation need to strain at stooling and will feel have a decreased frequency of bowel movements and cramps when having a bowel movement. They often eliminate a small amount of stool at a time. In both cases, there can be decreased appetite and weight loss.
Doctors can determine if the problem is irritable bowel syndrome by doing a complete history and physical examination. Often no major tests are done. Doctors can ask you to eat a lactose-free diet and a gluten-free diet for a couple of weeks each to see if these are a problem causing the symptoms. Blood tests will check for anaemia and stool for blood and cultures can be done to make sure there isn't another problem.
Some patients will require a sigmoidoscopy and colonoscopy that involves a biopsy of the affected tissue to see if it is something else besides irritable bowel syndrome. This is especially true if you are over fifty at the time of diagnosis. If you have blood in the stools or loss in weight, you should have a colonoscopy or flexible sigmoidoscopy. Doctors will look for celiac disease, ulcerative colitis, colon cancer or Crohn's disease.
The treatment of irritable bowel syndrome is completely symptomatic. Lifestyle differences can make a difference in some cases. You need to get better sleep and regular exercise to reduce the associated anxiety and depression. You may need to adjust your diet but the changes differ from person to person. Some foods that make IBS worse include large meals, foods that stimulate the intestines (caffeine-containing beverages), barley, wheat, rye, chocolate, alcohol, and milk products. Dietary fibre is important and should be increased. Fibre supplements, however, can worsen the symptoms and laxatives can become addicting.
Medications that work for IBS can include anticholinergic medications, loperamide (for diarrhoea), tricyclic antidepressants (to reduce pain and cramping) and lubiprosone to treat constipation.
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