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Irritable Bowel Syndrome (IBS)

What Is an Irritable Bowel?

Medically, irritable bowel syndrome (IBS) is also known as: spastic colon, spastic colitis, mucous colitis and nervous or functional bowel. Usually, it is a disorder of the large intestine (colon), although other parts of the intestinal tract—even up to the stomach—can be affected.

The colon, the last five feet of the intestine, serves two functions in the body. It dehydrates and stores the stool so that, normally, a well-formed soft stool occurs. Second, rhythmic contractions of the colon quietly propel the stool from the right side over to the rectum, storing it there until it can be evacuated.

When lBS occurs, the colon does not contract normally. Instead, it seems to contract in a disorganized, at times violent, manner. The contractions may be terribly exaggerated and sustained, lasting for prolonged periods of time. One area of the colon may contract with no regard to another. At other times, there may be little bowel activity at all. These abnormal contractions result in changing bowel patterns with constipation being most common.

A major symptom of lBS is bloating. Bloating is a very real phenomenon. People at times can literally look (and feel) pregnant. We believe the bloating occurs because of abnormal contractions of bowel with trapping of air.

A final major feature of lBS is abdominal discomfort or pain. This may move around the abdomen rather than remain localized in one area. This pain is often relieved with a bowel movement.

These disorganized, exaggerated and painful contractions lead to certain problems. The pattern of bowel movements is often altered. Diarrhea may occur, especially after meals, as the entire colon contracts and moves liquid stool quickly into the rectum. Or, localized areas of the colon may remain contracted for a prolonged time. When this occurs, which often happens in the section of colon just above the rectum, the stool may be retained for a prolonged period and be squeezed into small pellets. Excessive water is removed from the stool and it becomes hard.

Also, air may accumulate behind these localized contractions, causing the bowel to swell. So bloating and abdominal distress may occur.

Some patients see gobs of mucous in the stool and become concerned. Mucous is a normal secretion of the bowel, although most of the time it cannot be seen. lBS patients sometimes produce large amounts of mucous, but this is not a serious problem.

The cause of most lBS symptoms—diarrhea, constipation, bloating, and abdominal pain—are due to this abnormal physiology.

Although the symptoms of lBS may be severe, the disorder itself is not a life-threatening one. There is no actual disease present in the colon. In fact, an operation performed on the abdomen would reveal a perfectly normal appearing bowel.

Rather, it is a problem of abnormal function. The condition usually begins in young people, usually below 40 and often in the teens. The symptoms may wax and wane, being particularly severe at some times and absent at others. Over the years, the symptoms tend to become less intense.

lBS is extremely common and is present in perhaps half the patients that see a specialist in gastroenterology. It tends to run in families. The disorder does not lead to cancer. Prolonged contractions of the colon, however, may lead to diverticulosis, a disorder in which balloon-like pockets push out from the bowel wall because of excessive, prolonged contractions.

While our knowledge is still incomplete about the function and malfunction of the large bowel, some facts are well-known. Certain foods, such as coffee, alcohol, spices, raw fruits, vegetables, and even milk, can cause the colon to malfunction. In these instances avoidance of these substances is the simplest treatment.

Infections, illnesses, travel, and even changes in the weather somehow can be associated with a flare-up in symptoms. So can the premenstrual cycle in the female.

By far, the most common factor associated with the symptoms of lBS are the interactions between the brain and the gut. The bowel has a rich supply of nerves that are in communication with the brain. Virtually everyone has had, at one time or another, some alteration in bowel function when under intense stress, such as before an important athletic event, school examination, or a family conflict.

People with lBS seem to have an overly sensitive bowel, and perhaps a super abundance of nerve impulses flowing to the gut, so that the ordinary stresses and strains of living somehow result in colon malfunction.

These exaggerated contractions can be demonstrated by placing pressure- sensing devices in the colon. Even at rest, with no obvious stress, the pressures tend to be higher than normal. With the routine interactions of daily living, these pressures tend to rise dramatically. When an emotionally charged situation is discussed, they can reach extreme levels not found in people without lBS. These symptoms are due to real physiologic changes in the gut—a gut that tends to be inherently overly sensitive, and one that overreacts to the stresses and strains of ordinary living.

The diagnosis of lBS often can be suspected just by a review of the patient’s medical history. In the end it is a diagnosis of exclusion; that is, other conditions of the bowel need to be ruled out before a firm diagnosis of lBS can be made.

A number of diseases of the gut, such as inflammation, cancer, and infection, can mimic some or all of the lBS symptoms. Certain medical tests are helpful in making this diagnosis, including blood, urine and stool exams, x-rays of the intestinal tract and a lighted tube exam of the lower intestine. This exam is called endoscopy, sigmoidoscopy or colonoscopy.

Additional tests often are required depending on the specific circumstances in each case. If the proper medical history is obtained and if other diseases are ruled out, a firm diagnosis of lBS then can usually be made.

Patients with lBS can be assured that nothing serious is wrong with the bowel. Prevention and treatment may involve a simple change in certain daily habits, reduction of stressful situations, eating better and exercising regularly.

Perhaps the most important aspect of treatment is reassurance. For most patients, just knowing that there is nothing seriously wrong is the best treatment of all, especially if they can learn to deal with their symptoms on their own.

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