To Your Health

How to keep irritable bowel syndrome under control

Q. My doctor diagnosed me with IBS a few months ago. In spite of treatment it just seems to be getting worse and worse. I have taken a medical leave of absence from work to see if I can get it under control. What else can I do?

A. Irritable bowel syndrome is a common problem, affecting perhaps 20% of Americans, and is more common in women than men. Symptoms usually include abdominal pain, bloating, and constipation or diarrhea or both. IBS is also called functional bowel syndrome, irritable colon, spastic bowel, and spastic colon (the colon is the large intestine).

Even if your primary care physician has made a diagnosis of IBS, you might want to go to a gastroenterologist, a doctor who specializes in the treatment of the gastrointestinal tract, for a second opinion. The diagnosis of IBS is generally made on the basis of symptoms and medical history. Symptoms of IBS generally cannot be traced to a single cause, so there is no specific test for IBS. However, there are tests now available that can distinguish between IBS and ulcerative colitis, Crohn's disease, celiac disease, or bowel cancer, which are intestinal problems with similar symptoms that require different treatment.

Research suggests that people with IBS are more sensitive than others to a variety of things, including certain foods and to stress, and the colon responds to these triggers with pain. The colon has many nerves that connect it to the brain, and it also uses some of the same neurotransmitters, so emotions can strongly affect the workings of the colon.

The colon (large intestine) normally harbors a very large and varied population of bacteria, but abnormal overgrowth of these same bacteria in the small intestine has been found in about three-fourths of patients with IBS. A promising new treatment for IBS is the antibiotic Rifaximin. Unlike most antibiotics that are absorbed by the blood stream and travel to other parts of the body, Rifaximin stays in the gut and kills bacteria in the intestinal tract.

There may be other ways of changing the intestinal bacteria. While the scientific evidence is incomplete, ongoing research indicates that probiotics, the live friendly bacteria that should inhabit only the large intestine, and prebiotics, nondigestible food ingredients that encourage the growth of probiotic organisms, both individually and in combination, improve IBS.

Adding bran as a fiber supplement has been the traditional mainstay in the dietary treatment of IBS, but IBS sufferers often react poorly to such traditional ways of increasing fiber. Calcium polycarbophil, available without prescription as FiberCon, is a more gentle way of adding bulk; it reduces abdominal pain and improves the symptoms in both the diarrhea-predominant type and constipation-predominant type of IBS.

Alternative therapies, such as acupuncture and hypnotherapy, have been clinically tested and can be used alongside conventional medical care. When choosing any alternative therapist, make sure that you ask about their qualifications, experience, and membership in professional bodies.

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