Pain Under Left Side of Rib Cage

What is giardiasis?
Giardiasis (gee-are-dye-uh-sis) is a diarrheal illness caused by a one-celled, microscopic parasite, giardia intestinalis (also known as giardia lamblia). Once an animal or person has been infected with giardia intestinalis, the parasite lives in the intestine and is passed in the stool. Because the parasite is protected by an outer shell, it can survive outside the body and in the environment for long periods of time.

During the past 2 decades, giardiainfection has become recognized as one of the most common causes of waterborne disease (found in both drinking and recreational water) in humans in the united states . Giardia are found worldwide and within every region of the united states.



How do you get giardiasis and how is it spread?
The giardia parasite lives in the intestine of infected humans or animals. Millions of germs can be released in a bowel movement from an infected human or animal. Giardia is found in soil, food, water, or surfaces that have been contaminated with the feces from infected humans or animals. You can become infected after accidentally swallowing the parasite; you cannot become infected through contact with blood. Giardia can be spread by:

accidentally putting something into your mouth or swallowing something that has come into contact with feces of a person or animal infected with giardia.
Swallowing recreational water contaminated with giardia. Recreational water includes water in swimming pools, hot tubs, jacuzzis, fountains, lakes, rivers, springs, ponds, or streams that can be contaminated with sewage or feces from humans or animals.
Eating uncooked food contaminated with giardia.
Accidentally swallowing giardia picked up from surfaces (such as bathroom fixtures, changing tables, diaper pails, or toys) contaminated with feces from an infected person.


What are the symptoms of giardiasis?
Giardia infection can cause a variety of intestinal symptoms, which include

diarrhea
gas or flatulence
greasy stools that tend to float
stomach cramps
upset stomach or nausea.
These symptoms may lead to weight loss and dehydration. Some people with giardiasis have no symptoms at all.



How long after infection do symptoms appear?
Symptoms of giardiasis normally begin 1 to 2 weeks (average 7 days) after becoming infected.



How long will symptoms last?
In otherwise healthy persons, symptoms of giardiasis may last 2 to 6 weeks. Occasionally, symptoms last longer.



Who is most likely to get giardiasis?
Anyone can get giardiasis. Persons more likely to become infected include

children who attend day care centers, including diaper-aged children
child care workers
parents of infected children
international travelers
people who swallow water from contaminated sources
backpackers, hikers, and campers who drink unfiltered, untreated water
swimmers who swallow water while swimming in lakes, rivers, ponds, and streams
people who drink from shallow wells
contaminated water includes water that has not been boiled, filtered, or disinfected with chemicals. Several community-wide outbreaks of giardiasis have been linked to drinking municipal water or recreational water contaminated with giardia .



What should I do if I think I may have giardiasis?
See your health care provider.



How is a giardia infection diagnosed?
Your health care provider will likely ask you to submit stool samples to check for the parasite. Because giardia can be difficult to diagnose, your provider may ask you to submit several stool specimens over several days.



What is the treatment for giardiasis?
Several prescription drugs are available to treat giardia . Although giardia can infect all people, young children and pregnant women may be more susceptible to dehydration resulting from diarrhea and should, therefore, drink plenty of fluids while ill.



My child does not have diarrhea, but was recently diagnosed as having giardiasis. My health care provider says treatment is not necessary. Is this true?
Treatment is not necessary when the child has no symptoms. However, there are a few exceptions. If your child does not have diarrhea, but is having nausea, fatigue (very tired), weight loss, or a poor appetite, you and your health care provider may wish to consider treatment. If your child attends a day care center where an outbreak is continuing to occur despite efforts to control it, screening and treating children who have no obvious symptoms may be a good idea. The same is true if several family members are ill, or if a family member is pregnant and therefore not able to take the most effective anti- giardia medications.



If I have been diagnosed with giardiasis, should I worry about spreading the infection to others?
Yes, a giardia infection can be very contagious. Follow these guidelines to avoid spreading giardiasis to others:

wash your hands with soap and water after using the toilet, changing diapers, and before eating or preparing food.
Do not swim in recreational water (pools, hot tubs, lakes or rivers, the ocean, etc.) if you have giardia and for at least 2 weeks after diarrhea stops. You can pass giardia in your stool and contaminate water for several weeks after your symptoms have ended. This has resulted in outbreaks of giardia among recreational water users.
Avoid fecal exposure during sexual activity.


How can I prevent a giardia infection?
Practice good hygiene.

Wash hands thoroughly with soap and water.
Wash hands after using the toilet and before handling or eating food (especially for persons with diarrhea).
Wash hands after every diaper change, especially if you work with diaper-aged children, even if you are wearing gloves.
Protect others by not swimming if you are experiencing diarrhea (essential for children in diapers).
Avoid water that might be contaminated.

For information on recreational water-related illnesses, visit cdc's healthy swimming website at http://www.Cdc.Gov/healthysw imming.

Do not swallow recreational water
do not drink untreated water from shallow wells, lakes, rivers, springs, ponds, and streams.
Do not drink untreated water during community-wide outbreaks of disease caused by contaminated drinking water.
Do not use untreated ice or drinking water when traveling in countries where the water supply might be unsafe.
For information on choosing safe bottled water, see the cdc fact sheet entitled “preventing cryptosporidiosis: a guide to water filters and bottled water,” available by visiting http://www.Cdc.Gov/ncidod/dpd/ parasites/cryptosporidiosis/ factsht_crypto_prevent_water.Htm.

In the united states , nationally distributed brands of bottled or canned carbonated soft drinks are safe to drink. Commercially packaged non-carbonated soft drinks and fruit juices that do not require refrigeration until after they are opened (those that are stored unrefrigerated on grocery shelves) also are safe.

If you are unable to avoid using or drinking water that might be contaminated, then you can make the water safe to drink by doing one of the following:

heat the water to a rolling boil for at least 1 minute.
Or
use a filter that has an absolute pore size of at least 1 micron or one that has been nsf rated for "cyst removal."
for information on choosing a water filter, see the cdc fact sheet entitled “preventing cryptosporidiosis: a guide to water filters and bottled water,” available by visiting http://www.Cdc.Gov/ncidod/dpd/ parasites/cryptosporidiosis/ factsht_crypto_prevent_water.Htm.

If you cannot heat the water to a rolling boil or use a recommended filter, then try chemically treating the water by chlorination or iodination. Using chemicals may be less effective than boiling or filtering because the amount of chemical required to make the water safe is highly dependent on the temperature, ph, and cloudiness of the water.
Avoid food that might be contaminated.

Wash and/or peel all raw vegetables and fruits before eating.
Use safe, uncontaminated water to wash all food that is to be eaten raw.
Avoid eating uncooked foods when traveling in countries with minimal water treatment and sanitation systems.
Avoid fecal exposure during sexual activity.



If my water comes from a well, should I have my well water tested?
It depends. You should consider having your well water tested if you can answer “yes” to any of the following questions:

are members of your family or others who use your well water becoming ill? If yes, your well may be the source of infection.
Is your well located at the bottom of a hill or is it considered shallow? If so, runoff from rain or flood water may be draining directly into your well causing contamination.
Is your well in a rural area where animals graze? Well water can become contaminated with feces if animal waste seepage contaminates the ground water. This can occur if your well has cracked casings, is poorly constructed, or is too shallow.
Tests used to specifically identify giardia are often expensive, difficult, and usually require hundreds of gallons of water to be pumped through a filter. If you answered “yes” to the above questions, consider generally testing your well for fecal contamination by testing it for the presence of coliforms or e. Coli instead of giardia . Although tests for fecal coliforms or e. Coli do not specifically tell you whether giardia is present, these tests will show whether your well water has been contaminated by fecal matter.

These tests are only useful if your well is not routinely disinfected with chlorine, since chlorine kills fecal coliforms and e. Coli . If the tests are positive, it is possible that the water may also be contaminated with giardia or other harmful bacteria and viruses. Contact your county health department, your county cooperative extension service, or a local laboratory to find out who offers water testing in your area. If the fecal coliform test comes back positive, indicating that your well is fecally contaminated, stop drinking the well water and contact your local water authority for instructions on how to disinfect your well.




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this fact sheet is for information only and is not meant to be used for self-diagnosis or as a substitute for consultation with a health care provider. If you have any questions about the disease described above or think that you may have a parasitic infection, consult a health care provider.

What are the symptoms of ibs? Ibs and canceralthough ibs can be a distressing condition, it never causes bowel cancer or bowel damage.


The symptoms of ibs vary and may occur at any age. They most commonly start in late teenage years or early adulthood. The symptoms will depend on which parts of the gut are involved. There is often overlap between areas of the gut. Some people may experience problems in only one part of the gut, others in several. Symptoms can also vary over time. Oesophagus· a sensation like a golf ball in the throat between meals which does not interfere with swallowing (globus).· heartburn - burning pain often felt behind the breastbone.· painful swallowing (odynophagia), but without hold-up of food.· sticking of food (dysphagia) - this requires investigation.Stomach· non-ulcer dyspepsia (symptoms suggestive of a stomach or duodenal ulcer, but which has not been confirmed on investigation).· feeling full after small meals. This may reach the stage of not being able to finish a meal.· abdominal bloating after meals.Small bowel· increased gurgling noises which may be loud enough to cause social embarrassment (borborygmi).· abdominal bloating which may be so severe that women describe themselves as looking pregnant.· generalised abdominal tenderness associated with bloating.· abdominal bloating of both types usually subsides overnight and returns the following day.Large bowel other symptoms· headaches. · in women, left-sided abdominal pain during sex. · passing urine more often. · fatigue and tiredness. · sleep disturbance. · loss of appetite. · nausea. · depressive symptoms in about a third of patients. · anxiety and stress-related symptoms, which may interact with gut symptoms.


· abdominal bloating of both types usually subsides overnight and returns the following day.· right-sided abdominal pain, either low, or tucked up under the right ribs. Does not always get better on opening the bowels.· pain tucked up under the left ribs (splenic flexure syndrome). When the pain is bad, it may enter the left armpit.· variable and erratic bowel habits alternating from constipation to diarrhoea.· increased gastro-colic reflex. This is an awakening of the childhood reflex where food in the stomach stimulates colonic activity, resulting in the need to open the bowels.· severe, short stabbing pains in the rectum, called proctalgia fugax.What symptoms should not be ascribed to ibs?Because irritable bowel syndrome can mimic so many other intestinal disorders, it's important to identify those symptoms that require you to see your doctor:· difficulty in swallowing when food gets stuck· indigestion-type pain that wakes you up at night· abdominal bloating that does not get better overnight· significant and unexplained weight loss· bleeding from the back passage· chronic, painless diarrhoea.This list is not comprehensive. If there are other symptoms, you should seek further advice.In general, first-time symptoms of ibs in a person over the age of 40 should be assessed by a doctor.What can be done to prevent ibs?Since the cause of ibs is unknown, it's not possible to reliably prevent the condition.How is irritable bowel syndrome diagnosed?There is no single blood test, x-ray or scan that will diagnose ibs.The diagnosis is often made on the basis of the presence of typical symptoms - this is particularly the case in younger patients.Blood tests may be taken to exclude other conditions, and occasionally further investigations are performed.As patients with ibs get older, the diagnosis becomes more one of exclusion (ie excluding other conditions). This means more investigations are performed to ensure the diagnosis is correct. These may include:· gastroscopy: endoscopic examination of the oesophagus, stomach and duodenum· ultrasound · barium studies· colonoscopy: endoscopic examination of the large bowel.Should I change my diet?· drink lots of water, preferably three litres a day. · a high-fibre diet improves digestion. The amount of fibre must be increased gradually to allow the stomach to get used to it.· avoid food or beverages that make the symptoms worse. Coffee and milk are frequent offenders.· it may be helpful to keep a diary in which you note down the foods that seem to upset your stomach.· avoid strong spices and foods that give you wind.· avoid large meals, but eat regularly.· limit your alcohol intake.What else can improve ibs?· physical activity and exercise can improve digestion and reduce stress.· heat treatment with hot packs, hot-water bottles or electric blankets may relieve the symptoms.· try to reduce the number of stressful situations in your life. You might like to experiment with some of the different relaxation techniques, such as meditation.· it may be useful to keep a diary, noting what seems to cause distress in the bowel.· try to keep things in perspective: excessive worrying about digestive problems could lead to social and psychological problems.Which medicines are used?· medicine for stomach cramps (antispasmodics, eg mebeverine, hyoscine). When cramps are a major problem these remedies may be helpful to the patient.· stool-softening laxatives, if constipation is a major problem.· medicine for treatment of gas and stomach rumbling, in cases where these are a major problem.· tricyclic antidepressants are sometimes used to relieve pain in people who have not responded to other treatments.· cholestyramine can help the small proportion of ibs sufferers who have diarrhoea secondary to impaired handling of bile salts within the gut.· antidiarrhoeals such as loperamide, if diarrhoea is a major problem.· several types of serotonin antagonists are under trial in ibs, some with encouraging results.Long-term outlookibs usually occurs periodically throughout life. The symptoms can improve or get worse and may disappear for a while. Irritable bowel syndrome is not a life-threatening condition and cannot result in cancer or serious intestinal disease. Treatment with medicines such as those mentioned above will normally ease symptoms.


Other names for ibssome old-fashioned names for ibs are still in use:· irritable colon · spastic colon · mucous colitis. These are misleading because ibs also affects the remainder of the gut.

Irritable bowel syndrome is characterized by symptoms of abdominal discomfort or pain, usually in the lower abdomen (although the location and intensity are variable, even at different times within the same person), and altered bowel habit (change in frequency or consistency) -- chronic or recurrent diarrhea, constipation, or both in alternation.

Abdominal pain has been reported as primarily crampy or a generalized ache with superimposed periods of abdominal cramps, although sharp, dull, gas-like, or nondescript pains are also common. The abdominal discomfort or pain are usually relieved with a bowel movement.

"irritable bowel" refers to a disturbance in the regulation of bowel function that results in unusual sensitivity and muscle activity.

"syndrome" refers to a number of symptoms and not one symptom exclusively.

Everyone suffers from an occasional bowel disturbance. However, for those with ibs the symptoms are more severe, or occur more often -- either continuously or off and on. Ibs affects men and women of all ages.

Some or all of ibs symptoms can occur at the same time -- some symptoms may be more pronounced than others.

There are no physical findings or diagnostic tests that confirm the diagnosis of ibs. Diagnosis involves identifying certain symptoms consistent with the disorder and excluding other medical conditions that may have a similar clinical presentation. The symptom-based rome ii diagnostic criteria for ibs emphasize a positive diagnosis rather than exhaustive tests to rule out other diseases. These criteria are based on the presentation of a specific set of symptoms. In addition, a detailed history, a physical examination, and limited diagnostic tests help confirm this diagnosis with a high level of confidence. Extensive testing may be reserved for specific situations.

The rome ii diagnostic criteria (a system for diagnosing functional gastrointestinal disorders based on symptoms) for ibs is as follows:

at least 12 weeks or more, which need not be consecutive, in the preceding 12 months of abdominal discomfort or pain that is accompanied by at least two of the following features:
1) it is relieved with defecation, and/or
2) onset is associated with a change in frequency of stool, and/or
3) onset is associated with a change in form (appearance) of stool.

Other symptoms that are not essential but support the diagnosis of ibs:

abnormal stool frequency (greater than 3 bowel movements/day or less than 3 bowel movements/week);
abnormal stool form (lumpy/hard or loose/watery stool);
abnormal stool passage (straining, urgency, or feeling of incomplete evacuation);
passage of mucus;
bloating or feeling of abdominal distension.


Upper gi symptoms are commonly reported by ibs patients with 25% to 50% of patients reporting heartburn, early feeling of fullness (satiety), nausea, abdominal fullness, and bloating. Many patients also report intermittent upper abdominal discomfort or pain (dyspepsia). Feelings of urgency, and a feeling of "incomplete" emptying may also be experienced.

Many ibs patients also report non-gastrointestinal symptoms such as fatigue, muscle pain, sleep disturbances, and sexual dysfunction. These symptoms may be due to the coexistence or overlap of ibs with another condition such as fibromyalgia, chronic fatigue syndrome, or interstitial cystitis. Other symptoms such as low back pain or headache may occur and tend to correlate with the severity of the ibs.

Symptoms can vary and sometimes seem contradictory, such as alternating diarrhea and constipation.

The symptoms of ibs are produced by abnormal functioning of the nerves and muscles of the bowel. In ibs there is no evidence of an organic disease, yet, something -- a "dysregulation" between the brain, the gut, and the central nervous system -- causes the bowel to become "irritated," or overly sensitive to stimuli. Symptoms may occur even in response to normal events.

Ibs is not caused by stress. It is not a psychological or psychiatric disorder. It is not, "all in the mind."
ibs is not caused by stress. It is not a psychological or psychiatric disorder. It is not, "all in the mind." because of the connection between the brain and the gut, symptoms in some individuals can be exacerbated or triggered by stress. Dietary and hormonal factors can affect symptoms of ibs.

Ibs is not an indication of another more serious disease, like cancer. Irritable bowel syndrome can, however, seriously compromise a person's quality of life. Chronic and recurrent symptoms can disrupt personal or professional activities, upset emotional well being, and limit individual potential.

A significant proportion -- 35% to 40% -- of individuals who report ibs in the community are male. Approximately 60% to 65% of individuals who report ibs in the community are female.

Ibs is a major women's health issue. Data reveals an increased risk of unnecessary surgery for extra-abdominal and abdominal surgery in ibs patients. For example, hysterectomy or ovarian surgery has been reported in female patients with ibs as high as 47% to 55% and has been performed more often in the ibs patient than in comparison groups.

There is a pressing need to support educational programs about ibs to the public and health care providers.


Anemia, bleeding, unexplained weight loss, or fever are not characteristic of ibs. You should alert your physician immediately if you are experiencing these symptoms. Other factors that may suggest the presence of an organic disease include awakening from sleep at night, family history of colon cancer or inflammatory bowel disease, and onset of symptoms (or change in symptoms) over the age of 50

We all have stomachaches and trouble going to the bathroom once in a while, but for people with ibs, the chronic pain and discomfort can be disabling.

Along with abdominal cramping and discomfort, ibs symptoms include:

bloating
gas
constipation -- the stool comes out either lumpy or hard
diarrhea -- the stool comes out loose or watery
alternating bouts of constipation and diarrhea
bowel movements that feel uncontrollably urgent, difficult to pass, or incomplete
clear or white mucus with the stool

Irritable bowel syndrome
more than 37 million americans suffer from irritable bowel syndrome, or ibs, a condition that affects the movement of food through the intestines. For some, the movement is too slow, causing constipation. For others, the movement is too fast, causing diarrhea. In still others, the movement alternates between too fast and too slow causing both diarrhea and constipation. When there is an infection or damage, or when the intestines become too full from gassy food, the nerve cells are activated and it is felt as pain.

Irritable bowel syndrome affects around 15-22% of the people in the united states. It usually starts in people in their 20s and 30s and tends to affect women more than men. Fortunately, these symptoms are not caused by physical damage to the intestines. Although once thought to be due to stress, it is now known that many factors contribute to ibs, including certain foods, eating habits, and imbalances in intestinal flora. Healthy food choices can be very helpful in alleviating the symptoms of this painful and inconvenient condition.


Eat more
whole grains for their high fiber content
organically grown fruits and vegetables
yogurt
avoid adverse food reactions, caffeine, excessive fructose (sugar from fruit), sorbitol (sugars found in plums, peaches, pears and apples) and lactose found in milk and cheese.

Description
dietary causes
nutrient needs
nutrient excesses
recommended diet
references
description
what is irritable bowel syndrome?
Irritable bowel syndrome affects around 15-22% of the people in the united states. It usually starts in people in their 20s and 30s and tends to affect women more than men.

Ibs accounts for up to 3.5 million doctor visits and 2.2 million prescriptions for medication every year. Although symptoms are not caused by physical damage to the intestines, ibs sufferers are much more likely than others to have had surgeries such as appendectomies and hysterectomies, as well as multiple abdominal surgeries. The good news is that dietary changes can really help to reduce symptoms in ibs sufferers.

Symptoms
ibs typically strikes the small and large intestines, which leads to symptoms that occur in the lower abdominal area of the body. The main symptoms include changes in bowel movements.

Symptoms of irritable bowel syndrome include:
periods of constipation, diarrhea, or switching between the two
crampy lower abdominal pain that is better after bowel movements
excessive amounts of gas
a feeling of fullness or bloating in the lower abdomen
note: if you are experiencing any of the following: severe abdominal pain, pain that is constant and not relieved by bowel movements, pain or diarrhea that wakes you from sleeping, unexplained weight loss, vomiting, bleeding from the bowels or blood in the stools, anemia or general weakness, or bowel changes plus a family history of colon cancer, you may have a more serious condition and should see a doctor for a more thorough evaluation.

The disease process
for many years, doctors believed that ibs was just a psychological condition, or “all in your head.” it is now known that this is not the case. Ibs is a real physical ailment that causes very real suffering.

The good news is that there's nothing physically wrong with the intestines. Basically, there are no lesions or deformities or signs of damage that would explain the problem. Instead, the problems seem to be caused by altered intestinal motility and sensation.

The large and small intestines are like big tubes. The insides of the tubes are where the food passes through. Wrapped around the outside of the tube are many layers of muscles. These muscles contract in a certain pattern in order to help squeeze food through the digestive tract. The contraction of these muscle is referred to as motility. Within the layers of muscle cells are the nerve cells that detect pain in the intestines. This is sensation.

When there is an infection or damage, or when the intestines become too full from gassy food, the nerve cells are activated and it is felt as pain. Normally, the muscle cells move food through the small intestines to the large intestines. When it starts to fill the rectum, the final portion of the large intestine, it signals to the brain that it's time for a bowel movement, and we head to the bathroom.

In people with ibs, however, there are problems with motility and sensation. The muscle cells in the large intestines of some patients don’t contract as well as they should, which leads to constipation. In others, the muscles contract more than they should, causing diarrhea. In still others, the muscles alternate so that there are periods of constipation and periods of diarrhea.

At the same time, the nerve cells seem to be hypersensitive. They feel pain much more easily than the nerve cells of other people, so that even the slightest amount of bloating or gas causes a great deal of discomfort. When the patient has a bowel movement, the rectum is emptied, the intestinal contents shift, and the pain subsides.

Causes
the cause of ibs is still considered to be unknown. Although stress can make the condition worse, it is not the only factor involved. Some cases of ibs occur after a bout of intestinal infection, suggesting that infection may play a role for some. Many women report that their symptoms are worse around their menses, suggesting that hormones may play a role for some.

One factor that seems related for many people is the balance of flora in the gut. The large intestines normally contain a variety of friendly bacteria. These beneficial bacteria live on fiber and undigested food and protect us against harmful bacteria and viruses.

Sometimes, however, more harmful bacteria can start to live in the intestines. These can cause symptoms of diarrhea and can create a lot of gas and bloating. Studies have shown that patients with ibs tend to have more of the harmful bacteria in their intestines than others, which can contribute to symptoms.

Whatever the exact cause of the ibs symptoms, be it past infection, hormones, stress, or flora imbalance, dietary changes can have a significant impact on the pain and discomfort experienced by so many people.

Dietary causes
when constipation is the main symptom of ibs, researchers believe the condition is caused by too little fiber in the diet. It's recommended that people eat from 25-30 grams of fiber a day. Unfortunately, the average american only gets about half of this. Without fiber, there is little bulk to the stools, which makes it more difficult to have a bowel movement.

Sugar maldigestion is another possible dietary cause of ibs. Sugars are normally broken down by specific enzymes in the intestines and then absorbed. Some people, however, don’t produce some of these enzymes, so the sugars don’t get broken down properly. If these sugars wind up in the large intestine, the bacteria there will gobble them up and produce large amounts of gas as a result.

Lactose intolerance, the most common form of sugar maldigestion, occurs in people who can’t digest the lactose sugar found in milk. (milk is the only naturally-occurring food known to contain lactose.) another form is called sorbitol intolerance, which involves the sugar sorbitol. Less common, but still occurring, is fructose intolerance, a condition in which some people have trouble digesting large amounts of fructose at once.

Adverse food reactions may also contribute to irritable bowel syndrome. Some people experience a worsening of their symptoms after they eat certain foods. It is unclear why this happens, but eliminating these certain foods from their diets can do wonders to improve symptoms.

The good news is that simple dietary changes can help to alleviate symptoms of ibs. Eating foods like vegetables, legumes, and whole grains that are rich in fiber or yogurt, which is rich in friendly bacteria, may reduce symptoms like constipation, diarrhea, and bloating. In addition, avoiding certain food items like high-fat meals and caffeine can also have a beneficial effect.

Nutrient needs
foods that may help include:
whole grains
whole grains are much more than a small, flavorless, rock-hard bran muffin. Imagine a plate of hot brown rice under a sizzling baked salmon fillet, or a warm piece of honey whole wheat bread with some fresh pumpkin butter, or a hearty serving of beef and barley stew, or a steaming bowl of oatmeal with raisins, diced apple, and banana slices.

Whole grains can add substance and variety to many different meals. They're high in a number of different vitamins and minerals, as well as health-promoting fiber. The fiber found in whole grains has been shown to have very beneficial effects in people suffering from ibs.

Whole grains can help to relieve the pressure and pain caused by constipation. They also help to feed the friendly bacteria to protect against gas and bloating. Refined grain products like white rice and white bread have been stripped of their vital nutrients and fiber, and are not much help for ibs patients. Replacing these over-processed products with some rich, whole grain foods can turn a fiber and nutrient deficient diet into a healthy one.

Fruits and vegetables
if munching on plain, raw celery all day doesn’t appeal to you, try something different like teriyaki stir-fried vegetables with chicken strips, or a warm bowl of butternut squash soup, or a hot baked potato smothered in spicy chili, or a cool mixed-greens salad with tuna.

Instead of snacking on a low-fat, “diet” cookie, try a juicy orange, or some fresh honeydew melon, or some sweet blueberries. The vast number of different fruits and vegetables available at your local grocery store these days is bound to add some variety to your diet.

Fruits and vegetables are packed with nutrients like vitamin c, vitamin e, folic acid, beta-carotene and many more. Fruits and vegetables also have plenty of fiber, which can help with the symptoms of ibs. Studies have shown that increasing fruit and vegetable fiber intake can significantly reduce abdominal pain and improve the overall sense of well-being. Fresh produce is an exciting and essential part of a healthy, whole foods diet.

Yogurt
have you ever wondered how plain milk becomes rich, creamy yogurt? Well, the secret is a bacterial culture that gets added to the milk. The bacteria eat the milk sugar and give yogurt its tart flavor and thick texture. Even more interesting is that the bacteria used to make yogurt are the same kind as the friendly bacteria found in our digestive tracts.

By eating yogurt, we are helping to replenish the supplies of beneficial bacteria in our own bodies. These bacteria may not only protect us from infections with harmful bacteria, they may also provide relief from some of the symptoms of ibs. Ibs sufferers given foods with these bacteria report less painful bloating and gas than before. Instead of grabbing a sugary snack between meals, try the delicate blend of sweet and sour found in a cup of fruit-enriched yogurt.

Nutrients in food that may help include:
fiber
fiber is an essential part of a healthy diet. Fiber adds bulk to the diet and helps stool move easily out of the body. This is especially helpful for people with constipation. In addition, fiber adds substance to the stool, which can help clear up diarrhea. Friendly bacteria in the intestines love fiber and use it as a food source. A diet high in whole-foods fiber will also help the good bacteria to grow and protect us from the harmful bacteria.

It is important for people with ibs to increase their intake of fiber slowly, or symptoms can get temporarily worse before getting better. It's also very important when increasing fiber to also increase your water intake so that stools remain soft and easy to pass.

Some excellent food sources of fiber include raspberries, mustard greens, turnip greens, collard greens, broccoli, cauliflower, and swiss chard.

Lactobacillus
lactobacillus acidophilus is one of the friendly bacteria that lives in the intestines. It is also one of the main bacteria used in a number of fermented milk products such as yogurt. When ibs patients eat these products and ingest these bacteria, they can travel to the intestines and crowd out the harmful bacteria that may be causing symptoms of painful gas and bloating.

The best sources of these bacteria are yogurts that contain live, active culture. It's important to look for yogurts that specifically say they contain live culture, as many types of yogurts are heat-treated to kill the bacteria before being sold. For people who either can't tolerate dairy or who choose not to eat dairy, a number of very tasty soy-based yogurts are currently available at many health food stores.

Nutrient excesses
substances to avoid
fat
high-fat meals can over-stimulate the large intestine. This results in a need to rush to the bathroom right after eating, which can be very unpleasant and inconvenient. Avoiding high-fat meals and eating smaller meals can help prevent this annoying symptom of ibs.

Caffeine
caffeine in the body is actually considered a type of laxative. Caffeine itself is irritating to the large intestine and can over-stimulate the muscles of the large intestine, leading to painful urgency and diarrhea. It's recommended that patients with ibs limit their use of caffeine products such as soft drinks, chocolate, coffee, and black tea.

Adverse food reactions
for unknown reasons, some people find that their ibs symptoms are worse after they eat certain foods. Allergy avoidance diets have been very helpful at relieving the pain and discomfort of irritable bowel syndrome for many patients. Identifying which specific foods are causing the problem and then eliminating these foods can often provide long-term relief.

Adverse food reactions vary according to the individual. Different people may react poorly to completely different foods. Keeping a food and symptom diary or following an allergy avoidance diet may help identify which foods may be problematic.

Sugar maldigestion
some sufferers of ibs find that they have problems digesting certain sugars. When these undigested sugars reach the large intestine, the bacteria there eat them up very quickly and then produce extra gas as a result.

Sugar maldigestion can therefore lead to symptoms of painful bloating as well as diarrhea. Not all ibs patients have problems with sugar maldigestion, but for those who do, eliminating or limiting the intake of these sugars can really help reduce symptoms.

Lactose intolerance
lactose intolerance is much more common in this country than people think, affecting as many as 25% of americans. Lactose is usually broken down by an enzyme known as lactase. When we are babies and breast feed, lactase is sent to us in our mother's milk to help us break down the milk sugar (lactose) that it contains.

As children, we can produce some lactase of our own, but we tend to lose this ability as we become adults. In many parts of the world such as asia and much of africa, close to 100% of adults have stopped producing lactase. In european countries, however, the percentage of adults who don’t produce lactase is closer to 10%. Some studies have shown that as many as 50% of ibs patients may be lactose intolerant without knowing it. A simple test done in your doctor’s office can help determine whether or not lactose intolerance is a problem for you.

Unfortunately, lactose is found in a wide variety of food products such as milk, cheese, yogurt, and ice cream. It may also be hidden in foods such as baked goods, breakfast drink mixes, breakfast cereals, instant potatoes, soups, margarine, breads, non-kosher lunchmeats, salad dressings, candies and snacks, “non-dairy” creamers and whipped toppings, pancake and cake mixes, and some over-the-counter and prescription medications.

People with lactase deficiency must carefully read labels and avoid products that contain milk, powdered milk, milk solids, cheese, and dried milk, as these may contain lactose.

Sorbitol intolerance
sorbitol is a sugar that may cause problems for some people. The sugar itself is named "sorbose," but much more commonly found in food products is an altered form of sorbose, called sorbitol. It's estimated that as much as 43% of caucasians and 55% of non-caucasians are sorbitol intolerant.

Sorbitol is found in high amounts in certain fruits and juices such as peaches, pears, plums, and apple juice. It is also added to many dietetic products such as sugarless chewing gum, diet soft drinks, and dietetic jams. Reducing the intake of these foods can really help to eliminate ibs symptoms in sorbitol intolerant patients.

Fructose intolerance
most people with “fructose intolerance” can eat some fructose, just not in large quantities at once. Fructose is found in most fruits and many other whole foods. It's concentrated in fruit juices and dried fruits, which may be more problematic than fresh fruits. Fructose is especially a problem when it's mixed with sorbitol, as can happen in dietetic jams. Limiting your fruit servings to fresh, whole fruits instead of juices and avoiding foods that mix sorbitol and fructose may be useful for reducing ibs symptoms.

Recommended diet
a diet designed to relieve the symptoms of ibs would contain a wide variety of whole grains, fruits and vegetables, and yogurt.

Refined, nutrient-robbed white flour and rice products would be replaced with hearty, healthy whole grains, perhaps served with tasty sauces, colorful vegetables, or succulent meats. They can add flavor and substance to your diet while also improve your health.

The produce sections of major grocery stores are filled with a wide variety of fresh fruits and vegetables. These add color and flavor as well as a wide range of nutrients and fiber to the diet. Try experimenting with different vegetable dishes or even trying out new vegetables. Fresh fruits can easily take the place of many over-sugared or artificially sweetened diet snacks.

Yogurt is another potential addition to an ibs-friendly diet. Choosing yogurts with live culture and fresh fruit added can get you the benefits of helpful bacteria and nutrient-packed fruit.

Removing certain foods from your diet may seem troublesome. But just think of how many other foods are out there, all of the different grains, vegetables, fruits, legumes, meats, and spices. With a little time and creativity, you won’t even notice that they're gone. But you will notice a large reduction in your ibs symptoms that comes from adopting a healthy foods diet.

The condition specific meal planner for irritable bowel syndrome has menus that cover the nutritional needs of this condition over a four day period.

Irritable bowel syndrome
more than 37 million americans suffer from irritable bowel syndrome, or ibs, a condition that affects the movement of food through the intestines. For some, the movement is too slow, causing constipation. For others, the movement is too fast, causing diarrhea. In still others, the movement alternates between too fast and too slow causing both diarrhea and constipation. When there is an infection or damage, or when the intestines become too full from gassy food, the nerve cells are activated and it is felt as pain.

Irritable bowel syndrome affects around 15-22% of the people in the united states. It usually starts in people in their 20s and 30s and tends to affect women more than men. Fortunately, these symptoms are not caused by physical damage to the intestines. Although once thought to be due to stress, it is now known that many factors contribute to ibs, including certain foods, eating habits, and imbalances in intestinal flora. Healthy food choices can be very helpful in alleviating the symptoms of this painful and inconvenient condition.


Eat more
whole grains for their high fiber content
organically grown fruits and vegetables
yogurt
avoid adverse food reactions, caffeine, excessive fructose (sugar from fruit), sorbitol (sugars found in plums, peaches, pears and apples) and lactose found in milk and cheese.

Description
dietary causes
nutrient needs
nutrient excesses
recommended diet
references
description
what is irritable bowel syndrome?
Irritable bowel syndrome affects around 15-22% of the people in the united states. It usually starts in people in their 20s and 30s and tends to affect women more than men.

Ibs accounts for up to 3.5 million doctor visits and 2.2 million prescriptions for medication every year. Although symptoms are not caused by physical damage to the intestines, ibs sufferers are much more likely than others to have had surgeries such as appendectomies and hysterectomies, as well as multiple abdominal surgeries. The good news is that dietary changes can really help to reduce symptoms in ibs sufferers.

Symptoms
ibs typically strikes the small and large intestines, which leads to symptoms that occur in the lower abdominal area of the body. The main symptoms include changes in bowel movements.

Symptoms of irritable bowel syndrome include:
periods of constipation, diarrhea, or switching between the two
crampy lower abdominal pain that is better after bowel movements
excessive amounts of gas
a feeling of fullness or bloating in the lower abdomen
note: if you are experiencing any of the following: severe abdominal pain, pain that is constant and not relieved by bowel movements, pain or diarrhea that wakes you from sleeping, unexplained weight loss, vomiting, bleeding from the bowels or blood in the stools, anemia or general weakness, or bowel changes plus a family history of colon cancer, you may have a more serious condition and should see a doctor for a more thorough evaluation.

The disease process
for many years, doctors believed that ibs was just a psychological condition, or “all in your head.” it is now known that this is not the case. Ibs is a real physical ailment that causes very real suffering.

The good news is that there's nothing physically wrong with the intestines. Basically, there are no lesions or deformities or signs of damage that would explain the problem. Instead, the problems seem to be caused by altered intestinal motility and sensation.

The large and small intestines are like big tubes. The insides of the tubes are where the food passes through. Wrapped around the outside of the tube are many layers of muscles. These muscles contract in a certain pattern in order to help squeeze food through the digestive tract. The contraction of these muscle is referred to as motility. Within the layers of muscle cells are the nerve cells that detect pain in the intestines. This is sensation.

When there is an infection or damage, or when the intestines become too full from gassy food, the nerve cells are activated and it is felt as pain. Normally, the muscle cells move food through the small intestines to the large intestines. When it starts to fill the rectum, the final portion of the large intestine, it signals to the brain that it's time for a bowel movement, and we head to the bathroom.

In people with ibs, however, there are problems with motility and sensation. The muscle cells in the large intestines of some patients don’t contract as well as they should, which leads to constipation. In others, the muscles contract more than they should, causing diarrhea. In still others, the muscles alternate so that there are periods of constipation and periods of diarrhea.

At the same time, the nerve cells seem to be hypersensitive. They feel pain much more easily than the nerve cells of other people, so that even the slightest amount of bloating or gas causes a great deal of discomfort. When the patient has a bowel movement, the rectum is emptied, the intestinal contents shift, and the pain subsides.

Causes
the cause of ibs is still considered to be unknown. Although stress can make the condition worse, it is not the only factor involved. Some cases of ibs occur after a bout of intestinal infection, suggesting that infection may play a role for some. Many women report that their symptoms are worse around their menses, suggesting that hormones may play a role for some.

One factor that seems related for many people is the balance of flora in the gut. The large intestines normally contain a variety of friendly bacteria. These beneficial bacteria live on fiber and undigested food and protect us against harmful bacteria and viruses.

Sometimes, however, more harmful bacteria can start to live in the intestines. These can cause symptoms of diarrhea and can create a lot of gas and bloating. Studies have shown that patients with ibs tend to have more of the harmful bacteria in their intestines than others, which can contribute to symptoms.

Whatever the exact cause of the ibs symptoms, be it past infection, hormones, stress, or flora imbalance, dietary changes can have a significant impact on the pain and discomfort experienced by so many people.

Dietary causes
when constipation is the main symptom of ibs, researchers believe the condition is caused by too little fiber in the diet. It's recommended that people eat from 25-30 grams of fiber a day. Unfortunately, the average american only gets about half of this. Without fiber, there is little bulk to the stools, which makes it more difficult to have a bowel movement.

Sugar maldigestion is another possible dietary cause of ibs. Sugars are normally broken down by specific enzymes in the intestines and then absorbed. Some people, however, don’t produce some of these enzymes, so the sugars don’t get broken down properly. If these sugars wind up in the large intestine, the bacteria there will gobble them up and produce large amounts of gas as a result.

Lactose intolerance, the most common form of sugar maldigestion, occurs in people who can’t digest the lactose sugar found in milk. (milk is the only naturally-occurring food known to contain lactose.) another form is called sorbitol intolerance, which involves the sugar sorbitol. Less common, but still occurring, is fructose intolerance, a condition in which some people have trouble digesting large amounts of fructose at once.

Adverse food reactions may also contribute to irritable bowel syndrome. Some people experience a worsening of their symptoms after they eat certain foods. It is unclear why this happens, but eliminating these certain foods from their diets can do wonders to improve symptoms.

The good news is that simple dietary changes can help to alleviate symptoms of ibs. Eating foods like vegetables, legumes, and whole grains that are rich in fiber or yogurt, which is rich in friendly bacteria, may reduce symptoms like constipation, diarrhea, and bloating. In addition, avoiding certain food items like high-fat meals and caffeine can also have a beneficial effect.

Nutrient needs
foods that may help include:
whole grains
whole grains are much more than a small, flavorless, rock-hard bran muffin. Imagine a plate of hot brown rice under a sizzling baked salmon fillet, or a warm piece of honey whole wheat bread with some fresh pumpkin butter, or a hearty serving of beef and barley stew, or a steaming bowl of oatmeal with raisins, diced apple, and banana slices.

Whole grains can add substance and variety to many different meals. They're high in a number of different vitamins and minerals, as well as health-promoting fiber. The fiber found in whole grains has been shown to have very beneficial effects in people suffering from ibs.

Whole grains can help to relieve the pressure and pain caused by constipation. They also help to feed the friendly bacteria to protect against gas and bloating. Refined grain products like white rice and white bread have been stripped of their vital nutrients and fiber, and are not much help for ibs patients. Replacing these over-processed products with some rich, whole grain foods can turn a fiber and nutrient deficient diet into a healthy one.

Fruits and vegetables
if munching on plain, raw celery all day doesn’t appeal to you, try something different like teriyaki stir-fried vegetables with chicken strips, or a warm bowl of butternut squash soup, or a hot baked potato smothered in spicy chili, or a cool mixed-greens salad with tuna.

Instead of snacking on a low-fat, “diet” cookie, try a juicy orange, or some fresh honeydew melon, or some sweet blueberries. The vast number of different fruits and vegetables available at your local grocery store these days is bound to add some variety to your diet.

Fruits and vegetables are packed with nutrients like vitamin c, vitamin e, folic acid, beta-carotene and many more. Fruits and vegetables also have plenty of fiber, which can help with the symptoms of ibs. Studies have shown that increasing fruit and vegetable fiber intake can significantly reduce abdominal pain and improve the overall sense of well-being. Fresh produce is an exciting and essential part of a healthy, whole foods diet.

Yogurt
have you ever wondered how plain milk becomes rich, creamy yogurt? Well, the secret is a bacterial culture that gets added to the milk. The bacteria eat the milk sugar and give yogurt its tart flavor and thick texture. Even more interesting is that the bacteria used to make yogurt are the same kind as the friendly bacteria found in our digestive tracts.

By eating yogurt, we are helping to replenish the supplies of beneficial bacteria in our own bodies. These bacteria may not only protect us from infections with harmful bacteria, they may also provide relief from some of the symptoms of ibs. Ibs sufferers given foods with these bacteria report less painful bloating and gas than before. Instead of grabbing a sugary snack between meals, try the delicate blend of sweet and sour found in a cup of fruit-enriched yogurt.

Nutrients in food that may help include:
fiber
fiber is an essential part of a healthy diet. Fiber adds bulk to the diet and helps stool move easily out of the body. This is especially helpful for people with constipation. In addition, fiber adds substance to the stool, which can help clear up diarrhea. Friendly bacteria in the intestines love fiber and use it as a food source. A diet high in whole-foods fiber will also help the good bacteria to grow and protect us from the harmful bacteria.

It is important for people with ibs to increase their intake of fiber slowly, or symptoms can get temporarily worse before getting better. It's also very important when increasing fiber to also increase your water intake so that stools remain soft and easy to pass.

Some excellent food sources of fiber include raspberries, mustard greens, turnip greens, collard greens, broccoli, cauliflower, and swiss chard.

Lactobacillus
lactobacillus acidophilus is one of the friendly bacteria that lives in the intestines. It is also one of the main bacteria used in a number of fermented milk products such as yogurt. When ibs patients eat these products and ingest these bacteria, they can travel to the intestines and crowd out the harmful bacteria that may be causing symptoms of painful gas and bloating.

The best sources of these bacteria are yogurts that contain live, active culture. It's important to look for yogurts that specifically say they contain live culture, as many types of yogurts are heat-treated to kill the bacteria before being sold. For people who either can't tolerate dairy or who choose not to eat dairy, a number of very tasty soy-based yogurts are currently available at many health food stores.

Nutrient excesses
substances to avoid
fat
high-fat meals can over-stimulate the large intestine. This results in a need to rush to the bathroom right after eating, which can be very unpleasant and inconvenient. Avoiding high-fat meals and eating smaller meals can help prevent this annoying symptom of ibs.

Caffeine
caffeine in the body is actually considered a type of laxative. Caffeine itself is irritating to the large intestine and can over-stimulate the muscles of the large intestine, leading to painful urgency and diarrhea. It's recommended that patients with ibs limit their use of caffeine products such as soft drinks, chocolate, coffee, and black tea.

Adverse food reactions
for unknown reasons, some people find that their ibs symptoms are worse after they eat certain foods. Allergy avoidance diets have been very helpful at relieving the pain and discomfort of irritable bowel syndrome for many patients. Identifying which specific foods are causing the problem and then eliminating these foods can often provide long-term relief.

Adverse food reactions vary according to the individual. Different people may react poorly to completely different foods. Keeping a food and symptom diary or following an allergy avoidance diet may help identify which foods may be problematic.

Sugar maldigestion
some sufferers of ibs find that they have problems digesting certain sugars. When these undigested sugars reach the large intestine, the bacteria there eat them up very quickly and then produce extra gas as a result.

Sugar maldigestion can therefore lead to symptoms of painful bloating as well as diarrhea. Not all ibs patients have problems with sugar maldigestion, but for those who do, eliminating or limiting the intake of these sugars can really help reduce symptoms.

Lactose intolerance
lactose intolerance is much more common in this country than people think, affecting as many as 25% of americans. Lactose is usually broken down by an enzyme known as lactase. When we are babies and breast feed, lactase is sent to us in our mother's milk to help us break down the milk sugar (lactose) that it contains.

As children, we can produce some lactase of our own, but we tend to lose this ability as we become adults. In many parts of the world such as asia and much of africa, close to 100% of adults have stopped producing lactase. In european countries, however, the percentage of adults who don’t produce lactase is closer to 10%. Some studies have shown that as many as 50% of ibs patients may be lactose intolerant without knowing it. A simple test done in your doctor’s office can help determine whether or not lactose intolerance is a problem for you.

Unfortunately, lactose is found in a wide variety of food products such as milk, cheese, yogurt, and ice cream. It may also be hidden in foods such as baked goods, breakfast drink mixes, breakfast cereals, instant potatoes, soups, margarine, breads, non-kosher lunchmeats, salad dressings, candies and snacks, “non-dairy” creamers and whipped toppings, pancake and cake mixes, and some over-the-counter and prescription medications.

People with lactase deficiency must carefully read labels and avoid products that contain milk, powdered milk, milk solids, cheese, and dried milk, as these may contain lactose.

Sorbitol intolerance
sorbitol is a sugar that may cause problems for some people. The sugar itself is named "sorbose," but much more commonly found in food products is an altered form of sorbose, called sorbitol. It's estimated that as much as 43% of caucasians and 55% of non-caucasians are sorbitol intolerant.

Sorbitol is found in high amounts in certain fruits and juices such as peaches, pears, plums, and apple juice. It is also added to many dietetic products such as sugarless chewing gum, diet soft drinks, and dietetic jams. Reducing the intake of these foods can really help to eliminate ibs symptoms in sorbitol intolerant patients.

Fructose intolerance
most people with “fructose intolerance” can eat some fructose, just not in large quantities at once. Fructose is found in most fruits and many other whole foods. It's concentrated in fruit juices and dried fruits, which may be more problematic than fresh fruits. Fructose is especially a problem when it's mixed with sorbitol, as can happen in dietetic jams. Limiting your fruit servings to fresh, whole fruits instead of juices and avoiding foods that mix sorbitol and fructose may be useful for reducing ibs symptoms.

Recommended diet
a diet designed to relieve the symptoms of ibs would contain a wide variety of whole grains, fruits and vegetables, and yogurt.

Refined, nutrient-robbed white flour and rice products would be replaced with hearty, healthy whole grains, perhaps served with tasty sauces, colorful vegetables, or succulent meats. They can add flavor and substance to your diet while also improve your health.

The produce sections of major grocery stores are filled with a wide variety of fresh fruits and vegetables. These add color and flavor as well as a wide range of nutrients and fiber to the diet. Try experimenting with different vegetable dishes or even trying out new vegetables. Fresh fruits can easily take the place of many over-sugared or artificially sweetened diet snacks.

Yogurt is another potential addition to an ibs-friendly diet. Choosing yogurts with live culture and fresh fruit added can get you the benefits of helpful bacteria and nutrient-packed fruit.

Removing certain foods from your diet may seem troublesome. But just think of how many other foods are out there, all of the different grains, vegetables, fruits, legumes, meats, and spices. With a little time and creativity, you won’t even notice that they're gone. But you will notice a large reduction in your ibs symptoms that comes from adopting a healthy foods diet.

The condition specific meal planner for irritable bowel syndrome has menus that cover the nutritional needs of this condition over a four day period.

Topic: should I have tests for irritable bowel syndrome (ibs)?

Introduction

this information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision
there are no tests that can definitively diagnose irritable bowel syndrome (ibs). Instead, experts have developed a set of criteria, called the rome ii criteria, that help your doctor decide whether you may have ibs. Your doctor will likely ask you a lot of questions about your symptoms and see how well your symptoms match these criteria. Consider the following when making your decision:

if you have ibs, test results will be normal.
An abnormal test result may mean you have a problem other than ibs.
If your tests are all normal and your symptoms match the symptom criteria common in people with ibs, you probably do not have a serious disorder. You and your doctor can then focus on managing your symptoms so that they do not interfere with your life.
In general, weigh the likelihood that you may have a more serious problem against the risks, discomfort, and costs of more testing. Testing is the only way to be completely certain that you do not have a more serious problem, but if your symptoms match the criteria for ibs and your doctor is confident that you do not have a more serious problem, further testing is probably not necessary.


Medical information

what is irritable bowel syndrome (ibs)?
Irritable bowel syndrome (ibs) is a common digestive problem. Many people have symptoms of ibs (such as diarrhea, constipation, bloating, or abdominal pain) and never see a doctor about them. Other people may choose to see a doctor because they are concerned about their symptoms or because the symptoms are affecting their life.

The goal of managing ibs is to improve your quality of life by reducing the symptoms. However, even with good treatment, you may still have some symptoms. Doctors do not fully understand all the factors that may cause ibs. They know that ibs does not lead to other, more serious problems. However, some people may have both ibs and another digestive disorder.

What can tests for other digestive system disorders show?
In general, if you have ibs, all of your test results will be normal. If your symptoms match those of other people who have ibs, you and your doctor may feel confident about the diagnosis.

The tests your doctor may do depend in part on your most bothersome symptoms. For example, diarrhea may be a symptom of infection with a parasite, such as giardiasis. If you have diarrhea, your doctor may do a stool analysis to check for this kind of problem. The doctor also may do a flexible sigmoidoscopy or colonoscopy to look at the mucous lining of the colon and may take a sample of the lining to check for inflammation (colitis).

If you have an abnormal test result, it may mean you have a problem other than ibs. You also may have both ibs and another problem.

Blood tests can show signs that you may have another illness or infection.
Stool analysis can show infection with bacteria or parasites (such as giardiasis).
A test for blood in the stool may show blood, which means there may be inflammation or bleeding in some part of the digestive tract.
Tests for lactose intolerance, which may include a breath test or trial of a lactose-free diet, may show that you have trouble digesting lactose. For more information, see the topic lactose intolerance.
Sigmoidoscopy may show colon diseases such as inflammatory bowel disease, colon polyps, or diverticulosis.
Colonoscopy or a barium enema may show problems in the colon, such as inflammatory bowel disease, polyps, or diverticulosis.
Depending on your age and history and your doctor's preferences for testing for bowel problems, these tests may be recommended at your first visit for symptoms of ibs.

What can you do with the information you get from these tests?
If your tests are all normal and your symptoms match the symptom criteria common in people with ibs, you may feel reassured that you do not have a serious disorder. You and your doctor can then focus on managing your symptoms so that they do not interfere with your life.

In general, consider the likelihood that you may have a more serious problem compared with the risks, discomfort, and costs of more testing. Without testing, you cannot be completely certain that you do not have a more serious problem. However, if your symptoms match the criteria for ibs and your doctor feels confident that you do not have a more serious problem, more testing is probably not necessary.

What new problems could develop if you have tests?
Most tests have some risks, although the likelihood of a serious complication caused by testing is low. Some of the tests, such as flexible sigmoidoscopy or colonoscopy, may be uncomfortable. In fact, people with ibs may find flexible sigmoidoscopy more uncomfortable than do people who do not have this disorder.

What are the risks of not having tests?
There is generally little risk in not having tests for other possible causes of symptoms if your symptoms match those of ibs. The symptom criteria for diagnosing this condition can help doctors distinguish between people who have ibs and people who have other problems. The more of these symptoms that are present, the more likely it is that you have ibs.1

if you have a more serious problem, your symptoms often will become worse. The presence of "alarm symptoms" also may indicate a more serious problem. Alarm symptoms include fever, unexplained weight loss, blood in your stools, anemia, or a family history of colon cancer or inflammatory bowel disease. Additional tests will usually be recommended in either case.

If you need more information, see the topic irritable bowel syndrome (ibs).


Your information

this information will be helpful if you have symptoms that your doctor believes are caused by irritable bowel syndrome. Your doctor may have done some tests, such as blood tests and a stool analysis, and now you are considering whether to have an image test, such as a flexible sigmoidoscopy, barium enema, or colonoscopy.

This information may not apply to you if:

you are over age 50.
You have blood or pus in your stool.
Your symptoms have come on quickly over the past few weeks to months.
You have had unexplained weight loss, fever, or diarrhea at night.
Your pain wakes you up at night.
In these situations, your doctor will generally want to do more tests to rule out a possibly more serious problem.

In general, your choices are:

accept a diagnosis of irritable bowel syndrome. Try treatment for your most bothersome symptom. Reassess your symptoms in several weeks. If they are improving, you and your doctor may feel reassured that you have ibs rather than another problem.
Have more tests to rule out a more serious problem.
Doctors have different ways of working with people who have symptoms of irritable bowel syndrome. No single approach is correct in all situations.

The decision whether to have tests for irritable bowel syndrome takes into account your personal feelings and the medical facts.

Reasons to have tests for ibs
reasons to not have tests for ibs

you have one or more "alarm symptoms," which include blood in stools, fever, unexplained weight loss, and family history of colon cancer.
Your symptoms don't match up well with the symptom criteria for ibs.
Simple home treatments, including changes to diet and lifestyle, have not helped to relieve your symptoms.
You are over age 50.
Your symptoms do not change in response to stress.
Are there other reasons you might want to have tests for ibs?
You do not have any of the "alarm symptoms."
your symptoms match the criteria for ibs, which include abdominal pain that lasts for 12 or more weeks and that fits at least two of the following: pain that is relieved after a bowel movement, that is associated with a change in how often you pass stools, or that is associated with a change in the consistency of stools.
Your symptoms improved with home treatment, including changes to diet and lifestyle.
Your symptoms are closely linked to stress.
Are there other reasons you might not want to have tests for ibs?


These personal stories may help you make your decision.


Wise health decision

use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about having tests for irritable bowel syndrome. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I have one or more "alarm symptoms," which include blood in my stools, fever, unexplained weight loss, and family history of colon cancer. Yes no unsure
my symptoms very closely match the criteria for ibs. Yes no unsure
home treatment has relieved my symptoms. Yes no na*
i am over age 50. Yes no na
my symptoms have come on quickly, over the past few weeks. Yes no unsure
my pain wakes me up at night. Yes no na
i am willing to try changes in diet and lifestyle before having further tests done. Yes no unsure

*na=not applicable

use the following spaces to list any other important concerns you have about this decision.












What is your overall impression?
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have tests done for irritable bowel syndrome (ibs).

Check the box below that represents your overall impression about your decision.

Leaning toward having tests
leaning toward not having tests



return to the topic irritable bowel syndrome (ibs).


References

citations
talley nj (2000). Treatment of the irritable bowel syndrome. In mm wolfe et al., eds., sleisenger and fordtran's therapy of digestive disorders, pp. 477–490. Philadelphia: w.B. Saunders.


Credits

author christopher hess
editor geri metzger
associate editor tracy landauer
associate editor terrina vail
primary medical reviewer patrice burgess, md
- family medicine
specialist medical reviewer jerome b. Simon, md, frcpc, facp
- gastroenterology
last updated july 12, 2004



go back to:
irritable bowel syndrome (ibs)


------------------------------------------ --------------------------------------

author: christopher hess last updated july 12, 2004
medical review: patrice burgess, md - family medicine
jerome b. Simon, md, frcpc, facp - gastroenterology


© 1995-2006, healthwise, incorporated, p.O. Box 1989, boise, id 83701. All rights reserved.

This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information. For more information, click here.












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Topic: irritable bowel syndrome (ibs)

topic overview

what is irritable bowel syndrome (ibs)?
Irritable bowel syndrome (ibs) is an intestinal disorder that causes abdominal pain or discomfort, cramping or bloating, and diarrhea or constipation. Irritable bowel syndrome is a long-term but manageable condition.

What causes ibs?
The cause of irritable bowel syndrome is not well understood. In ibs, the movement of the digestive tract is impaired, but doctors can find no change in physical structure, such as inflammation or tumors. The symptoms of ibs are thought to be related to faulty communication between the brain and the intestinal tract, which causes abnormal muscle contractions in the intestines.

What are the symptoms?
The main symptoms of irritable bowel syndrome are abdominal pain or discomfort that occurs along with constipation or diarrhea. Other common symptoms are bloating, mucus in the stools, or a sense that you have not completely emptied your bowels.

Many people with ibs have alternating periods of constipation and diarrhea, but often one problem is more common than the other. A given episode may be milder or more severe than the one before it, but the disorder itself does not become worse over time. Irritable bowel syndrome does not lead to more serious diseases, such as inflammatory bowel disease or cancer.

Ibs is one of the most common intestinal disorders. Most people's symptoms are so mild that they never see a doctor for treatment. However, some people may have troublesome symptoms, especially abdominal cramps, bloating, and diarrhea.

How is ibs diagnosed?
Irritable bowel syndrome can usually be diagnosed from symptoms. Your health professional will conduct a medical history and physical examination. In most cases, a few additional tests—such as stool analysis or a sigmoidoscopy, which allows a doctor to examine the inside of the lower part of the intestine (colon)—are needed. Ibs is diagnosed when a person has the typical symptoms of the disorder and routine tests have ruled out other possible causes.

How is it treated?
Irritable bowel syndrome is a long-term but manageable condition. Active involvement in treatment is important to managing it successfully. Treatment is adapted to fit individual needs and usually focuses on changes in diet and lifestyle, avoiding foods that trigger symptoms, and managing stress. Medications may also be used.

What is ibs?
Irritable bowel syndrome, or ibs, is a problem that affects mainly the bowel,* which is also called the large intestine. The bowel is the part of the digestive system that makes and stores stool. The word syndrome means a group of symptoms. Ibs is a syndrome because it can cause several symptoms. For example, ibs causes cramping, bloating, gas, diarrhea, and constipation.

*linked terms are defined in the glossary.


Ibs is not a disease. It's a functional disorder, which means that the bowel doesn't work as it should.

With ibs, the nerves and muscles in the bowel are extra-sensitive. For example, the muscles may contract too much when you eat. These contractions can cause cramping and diarrhea during or shortly after a meal. Or the nerves can be overly sensitive to the stretching of the bowel (because of gas, for example). Cramping or pain can result.



Ibs can be painful. But it does not damage the bowel or cause any other diseases.

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does stress cause ibs?
Emotional stress will not cause a person to develop ibs. But if you already have ibs, stress can trigger symptoms. In fact, the bowel can overreact to all sorts of things, including food, exercise, and hormones.



Foods that tend to cause symptoms include milk products, chocolate, alcohol, caffeine, carbonated drinks, and fatty foods. In some cases, simply eating a large meal will trigger symptoms.

Women with ibs often have more symptoms during their menstrual periods.

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what are the symptoms of ibs?
The main symptoms of ibs are

crampy pain in the stomach area (abdomen)


painful diarrhea or constipation


most people have either diarrhea or constipation, but some people have both.

Other symptoms are

mucus in the stool


swollen or bloated abdomen


the feeling that you have not finished a bowel movement


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how is ibs diagnosed?
The doctor will suspect that you have ibs because of your symptoms. But the doctor may do medical tests to make sure you don't have any other diseases that could cause the symptoms.


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medical tests for ibs
physical exam


blood tests


x ray of the bowel: this x-ray test is called a barium enema or lower gi (gastrointestinal) series. Barium is a thick liquid that makes the bowel show up better on the x ray. Before taking the x ray, the doctor will put barium into your bowel through the anus.


Endoscopy: the doctor inserts a thin tube into your bowel. The tube has a camera in it, so the doctor can look at the inside of the bowel to check for problems.


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what is the treatment?
Ibs has no cure, but you can do things to relieve symptoms. Treatment may involve

diet changes
medicine
stress relief
you may have to try a combination of things to see which works best for you.


Diet changes
some foods make ibs worse.

Here are some foods that may cause symptoms:

fatty foods like french fries
milk products like cheese or ice cream
chocolate
alcohol
caffeine (found in coffee and some sodas)
carbonated drinks like soda

these foods may make ibs worse.


If certain foods cause symptoms, you should eat less of them