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Irritable Bowel SyndromeWorking with you as a
partner in health care, your gastroenterologist
at GI Associates will determine the best diagnostic and treatment measures for your unique needs.
©2010 GI Associates & Endoscopy Center. All rights reserved.
Fax 601/352-4882 • 800/880-1231www.msgastrodocs.com
Jackson1421 N. State Street, Ste 203
Jackson, MS 39202601/355-1234
Vicksburg1815 Mission 66
Vicksburg, MS 39180601/638-8801
Madison106 Highland Way
Madison, MS 39110601/355-1234
Albert F. Chiemprabha, M.D.Pierce D. Dotherow, M.D.
Reed B. Hogan, M.D.James H. Johnston, III, M.D.
Ronald P. Kotfila, M.D.Billy W. Long, M.D.Paul B. Milner, M.D.
Michelle A. Petro, M.D.Vonda Reeves-Darby, M.D.
Matt Runnels, M.D.James Q. Sones, II, M.D.
April Ulmer, M.D., Pediatric GIJames A. Underwood, Jr., M.D.
Chad Wigington, D.O.Mark E. Wilson, M.D.
Cindy Haden Wright, M.D.Keith Brown, M.D., Pathologist
Samuel Hensley, M.D., Pathologist
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The information contained in this brochure is intended as an educational tool, not as a substitute for medical care when needed.
Table of Contents
1 IrritableBowlSyndrome
2 Causes
3 Symptoms
5 Treatment
E-42
Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome(IBS)isjustwhatthenameimplies—abowelthatisirritable!Whatdoestheboweldowhenirritated?Itbehavesinadisorderlymannerandmaycauseyouconsiderabledistress! IBSisoneofthemostcommongastrointestinalproblemsseenbygastroenterologists,affectingabout20%oftheadultpopulation.Itaffectsmorewomenthanmen,isusuallyfirstnoticedinyoungadult-hood,andseldombeginsafterage50. IBSisasyndrome,apatternofgastrointestinalsymptomsthataffectsthedigestivetract.WhenapersonhasIBS,theintestinalsystemsimplydoesnotworkinanormal,orderlyfashion.OthernamesforIBSthatyoumayhaveheardarenervous stomach,irritable bowel,unstable colon,spastic colon,spastic bowel, colonic spasm,nervous gut,mucous colitis,spastic colitisorsimply colitis. IBSisnotrelatedtothemoreseriousinflammatory bowel disease (IBD), eventhoughthenamesseemsimilar.AndIBSdoesnotleadtoinflammatory bowel diseaseorulcerative colitis,asfarasweknow.
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Appendix
Rectum
Stomach
Small Intestine
Large Intestine
Flare-upsofIBSarequitecommonandmayberelatedtomanydifferentthings,asmentionedearlier.Althoughitisthoughtthatasmanyas75%ofthosewithIBSdonotseekmedicaladvice,soundmedicalcareisimportanttothosewhoselivesaredisruptedbysymptoms! And,becausethesymptomsofIBScanbethesameassymptomsofmoreseriousillnesses,symptomsthatpersistshouldbecarefullydiagnosedtoruleoutlife-threateningproblems. Workingwithyourgastroenterologist,aplanuniquelydesignedforyoucanbedevelopedsothatyoucanlivewithoutmuchdisruptionfromIBS.
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Will I always have IBS?
• Usuallyitisnotnecessarytoeliminatefoodsfromyourdiet,unlessyouknowthattheycausesymptoms.Forinstance,manypeoplehaveanintoleranceforlactosefoundinmilkandotherdairyproducts.Ifyouknowthatyouaresensitivetoaparticularfoodorfoodgroup,avoidit.
• Avoidchewinggumandcarbonatedbeverages,sincetheyarelikelytoincreasegas.
• Avoidcaffeine,andnicotine(inanyformoftobacco),whichactasstimulantstobowelmuscle.
• Somepeoplemayfindithelpfultoavoidbeer,wine,liquorandotheralcoholicbeverages.Suchbeveragesmayactasirritantsandmayworsensymptoms.
Lifestyle Change
• Exercise,relaxationtechniques,andadditionalsleep/restareafewlifestylechangesthatmayhelpthosewithIBS.Somepeoplebenefitbysimplifyingtheirlivesandreducingstress.Rethinkingprioritiesandmakingneededchangeswillhelpcontrolsymptoms.Oftenfriendsandfamilycanhelp,andinextremecases,psychotherapymayalsobeusefultodealwithmoredifficultissues.Yourgastroenterologistcanreferyoutoaqualifiedmentalhealthprofessional.
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What causes it? Noonefullyunderstandswhatcausesirritablebowelsyndrome.Inthepast,sincenotruecauseofIBShadbeenfound,IBSwasthoughttobecausedbystressof“nerves”,andattimes,justnottakenveryseriously.But,extensivestudyoftheproblemhasfoundthatthosepersonswithIBShavecolontissuethatisnormallymoresensitive,thatrespondsmorestronglytostimuli.
OftenIBSsymptomsarenotrelatedtostressatall.But,weknowthatthesymptomsofIBSmaybeworsenedbystressinsomeindividuals.Everyonehasadifferenttolerancelevelforstress.
What is normal or orderly bowel function? Normally,theamountoftimeneededforfoodtopassthroughtheentireGItractisaboutthreedays.Thatperiodoftimeisknownastransit time,whichvariesalotfrompersontoperson.
Thedigestiveprocessitselfisacombinationofmechanicalandchemicalprocessingthatoccursallalongthedigestivetract.TheactualmovementoffoodthroughtheGItractishelpedbycontinuouswavesofmuscularcontractionsknownasperistalsis. Foodentersthedigestivesystemthroughthemouth,whereitischewedandmixedwithsaliva.Itthenenterstheesophagus,whichisthetube
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The digestive
process itself is
a combination
of mechanical
and chemical
processing that
occurs all
along the
digestive tract.
STRESSSTRESSThe Role Of
leadingfromthemouthtothestomach.Whileinthestomach,thefoodisfurtherprocessed,bothmechanically(byachurningmotion)andchemically(bydigestivejuicesthatarepresentinthestomach). Thecontentsofthestomachthenemptyintothesmall intestineswherenutrientsareabsorbedthroughtheintestinalwallintothebloodstream.Theremainingmaterialpassesintothecolon,whereliquidsareabsorbedfromthewastematter,makingitdrierandmoresolid. Asthewastecontinuesonthroughthecolon,liquidscontinuetobeabsorbeduntilwasteispassedfromthebodythroughtherectumandanus.
Is IBS a problem of motility? Motility isatermusedtodescribethenaturalrateatwhichfoodmovesthroughthedigestivesystem(asdescribedintheprecedingsection).Motilityisverycomplex—wearejustnowbeginningtounderstandallthefactorsthataffectmotilityrate.Weknowthathormones,nerves,andelectricalimpulsescontrolcolonmuscle.Theelectricalactivityinthecolonissimilartotheelectricalimpulsesintheheart.Inaddition,motilitycanbeaffectedbythetypeoffoodyoueat,howmuchfoodyoueat,howfastyoueatandstress. Iffoodmovesthroughthesystemtoofast,liquiddoesnothavetimetobeabsorbedinthecolon,sostoolislooseandmoreliquid.Iffoodmovestooslowlythroughthecolon,toomuchliquidisabsorbedandconstipationistheresult.Therateatwhichfoodmovescanalsocausegas,crampingandpain.
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Motility is a term used
to describe the
natural rate at
which food
moves through
the digestive
system.
manytimesitwillhelpcontrolsymptoms.SomeofthemedicationsoftenhelpfulforIBSinclude:
• Anticholinergics:Suchasatropine andbelladonna actbyblockingthenervesthatcausethecontractionswithintheintestines.
• Antispasmotics:SuchasBentylandLevsinalsoblocknerveactivitythatcausesGImusclecontractions/spasms.
• Prokinetics:SuchasReglan helpregulatemuscleactivityinpartsoftheGItract.
• Bulk agents:SuchasCitrucil,Metamucil, and Benefibermaybehelpfultorelieveconstipation.
• Antidiarrheals:SuchasLomotil andImodium, maybeprescribedtocontroldiarrhea.
• AntidepressantsandMood-elevators:SuchasElavil andProzacmaybehelpfulinalimitednumberofpatientswhodon’timprovewiththetreatmentsdescribedabove.RecentstudiessuggestthatthemedicationsPaxilandZoloft helpeveninIBSpatientswhoarenotdepressed.
Diet• Provideregularmealtimes
foryourselfthatallowyoutoenjoyeatingslowlyandtoavoidgulpingfoodandswallowingair.Itishelpfultoavoideatinginthecar,whenyouaredistracted,hurriedandtryingtoavoidtraffic.
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What are the symptoms of IBS? ApersonwithIBSmayhaveoneormanyofthesymptomslistedbelow.Oftentheyoccurinapatternandmayhavebeenpresentforalongtime. Symptomsmaybemildlyuncomfortabletoextremelypainful.Sometimessymptomsdonotinterferewithdailyactivitiesorthesymptomsmaydisruptlifeinamajorway.
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Abdominal pain•Thatmaygetbetter
afterhavingabowelmovementorexpellinggas
•Thatisusuallyexperiencedlowandontheleftsideoftheabdomen,butmaybelocatedinotherareas.
•Maybedullorsharp,steadyorcramp-like.
Diarrhea •Looserand/ormore
frequentbowelmovements
•Withorwithoutpain
Constipation•Withorwithoutpain•Mayalternatewith
diarrhea
Bloating or a swollen-feeling abdomen
•Belchingwhentryingtorelievefeelingsofexcessgas.
•Asensationoffullness, evenafterabowelmovement.
Mucus in bowel movements
•Withanappearancethatisclearandslimy
•Maybepresentinsmallamountsorcoatallofthestool
Heartburn •Regurgitationof
stomachcontentsintotheesophaguscausedbyabdominaltensionanddiscomfort.
Emotional distress •Symptomscanbe
disruptivetolife•Thesamestresses
thatcauseIBSmayalsocauseemotionaldistress
How is IBS diagnosed? BecausethesymptomsofIBSareverymuchlikesymptomsofmoreseriousdiseases,diagnosisinvolvesmanydifferentteststoruleoutlife-threateningproblems.Also,itisveryimportanttodescribeyoursymptomscarefullytoyourgastroenterologist,sothatheorshewillhaveanaccuratedescription. Diagnosiswillbebasedonyourhistory,aphysicalexamination,bloodtests,andstoolsamplestocheckforthepresenceofblood(fecal occult blood).Basedonthoseresults,additionaltestsmaybeordered.Additionally,acolonoscopy maybeorderedsothatyourgastroenterologistcanactuallyviewtheinsideofyourcolon.
What is the treatment for IBS ItwillbereassuringforyoutoknowyouhaveIBSandnotamoreseriousillness.Afteradiagnosishasbeenmade,treatmentisbasedonrelievingyoursymptomssothatyoucanenjoylifetothefullest.Treatmentmayincludemedication,changesindietandmodifyinglifestyletoreducestress(ifthatseemstobeafactor).Workingwithyouasateam,yourgastroenterologistwilldevelopatreatmentplanthatworksforyouandmayincludeoneormoreoftheoptionslistedbelow.
Medication
Yourgastroenterologistmayrecommendmedicationtohelpminimizeyoursymptoms.Itmayberecommendedonlyasneededforflare-upsorforregularuseuntilyougetbetter.AlthoughmedicationcannotcureIBS,
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