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Irritable bowel syndrome


irritable bowel syndrome is the most common condition to affect the gut. At least a third of the population are affected at some time during their life, even if only mildly, and one in seven is affected badly enough to consult their doctor. As many other bowel conditions can cause similar symptoms initially, ibs is not a diagnosis you should make yourself.

What is ibs?
Ibs is a problem of bowel function rather than structure and as a result, there is nothing abnormal to find during investigations. The diagnosis is therefore made on the basis of symptoms alone, using a system known as the rome ii criteria, which were updated in 1999.

For your doctor to diagnose irritable bowel syndrome, you must have had at least 12 weeks, (which need not be consecutive) in the preceding 12 months of abdominal discomfort or pain that has two of three features:

relieved by opening your bowels; and/or
onset associated with a change in frequency of stool; and/or
onset associated with a change in form (appearance) of stool.

The following symptoms also add up to support the diagnosis of ibs:
1. Fewer than three bowel movements a week
2. More than three bowel movements a day
3. Hard or lumpy stools
4. Loose (mushy) or watery stools
5. Straining during a bowel movement
6. Urgency (having to rush to have a bowel movement)
7. Feeling of incomplete bowel movement
8. Passing mucous (white material) during a bowel movement
9. Abdominal fullness, bloating or swelling.

Typically, motions are small, frequent, pencil-like, or resemble rabbit droppings, but those with the diarrhoea-predominant form of ibs have one or more of symptoms 2, 4 or 6 and none of symptoms 1, 3 or 5, while those with the constipation-predominant type have one or more of symptoms 1, 3 or 5 and none of 2, 4 or 6.

Who gets it?
Ibs is traditionally said to affect young and middle-aged adults. Symptoms usually start between the ages of 15 and 40, with the commonest presentation being between the ages of 30 and 40. It can affect anyone at any age however, and recent studies have suggested that more people are affected in the 45-65 age range than in younger age groups. Symptoms can also occur in children.

Ibs is often described as a problem affecting women rather than men. Some studies suggest that twice as many women as men are affected, although others have found that that men are just as likely to have symptoms of ibs as women, but are less likely to consult their doctor. As a result, two out of every three people referred to hospital clinics and diagnosed as having ibs are female. This led many researchers to think ibs was automatically a psychosomatic problem linked with hysteria and neurosis. More enlightened scientists however started wondering about the role of the female hormones, oestrogen and progesterone.

How do symptoms occur?
Ibs seems to be linked with abnormal or exaggerated bowel movements and muscular spasm.

The intestines are a long tube, which contracts rhythmically in order to push food through, while nutrients are absorbed along the way. In ibs, instead of the normal, smooth downward propulsion of bowel contents, their passage is irregular, leading to recurrent symptoms of bloating, wind, constipation, diarrhoea and/or pain.

Imagine the gut as a long, flexible polythene tube filled with porridge, which is closed off at one end. If you picked up the closed end of the tube and squeezed it with both hands, the porridge contents would be forced further down the tube. If you then let go with the hand nearest the closed end, and squeezed on the other side of the hand still gripping the tube, you will force the porridge down even further. If you repeated this movement, systematically releasing one hand at a time and squeezing further and further down the tube, you would eventually end up with a pile of porridge on the floor and a relatively clean, empty tube.

Now imagine a similar tube filled with porridge, again held with both hands near the closed end. Instead of smoothly constricting the tube in an ordered wave down its length, let go of the tube with one hand and squeeze it anywhere you like along its length. Repeat this random squeeze on the tube with alternate hands. You will eventually end up with some porridge on the floor, but the tube is likely to stay relatively full, with porridge built up in some areas, and squeezed out in others to resemble a string of sausages.

In a normally functioning bowel, smooth muscular waves of constriction run down the gut in an ordered fashion. A wave of constriction is preceded by a wave of relaxation and this pushes the bowel contents downwards. This characteristic movement of the bowel is known as peristalsis.

In irritable bowel syndrome, it is thought that peristalsis becomes disordered. Waves of constriction and relaxation become separated and random parts of the bowel may go into cramp. If waves of constriction are speeded up, diarrhoea occurs. If waves of constriction are slowed down, or become irregular, constipation occurs and this is made worse if the bowel goes into cramp. If the bowel stays constricted, and only dilates occasionally, the contents may become concentrated into thin ribbons, or separated into rabbitty pellets. If constriction is persistent, and bowel movements infrequent, the contents harden up as more water than normal is re-absorbed which, not surprisingly, can lead to hardened, concrete-like motions with or without mucous.

If the bowel dilates in-between cramp attacks, two things can happen. If the gut is full, the contents become unusually large and difficult to push out but if the gut is empty, it can fill with wind to cause bloating, stretch pains plus embarrassing rumblings and flatulence.

What are the symptoms of ibs?
The symptoms of ibs vary from person to person and may come and go over a period of time. The bowel symptoms that occur most often include:

lower abdominal pain or discomfort
bloating
wind, with distension, rumbling (borborygmi) and flatulence
constipation
diarrhoea
having to rush to the loo (urgency)
altered stool frequency
altered stool form
altered stool passage with feelings of incomplete emptying
mucous
nausea
upper abdominal pain
rectal pain

researchers at the central middlesex hospital nhs trust have identified three different types of ibs based on the main symptoms experienced by sufferers. These are spastic colon syndrome, functional diarrhoea syndrome and primary foregut motility disorder.

Spastic colon syndrome
spastic colon syndrome is identified where the onset of lower abdominal pain is associated with:

passing looser stools than normal
abdominal distension
relief of symptoms on opening the bowels
feelings of incomplete evacuation of the bowel
mucous in the stools.
Loose motions and constipation tend to alternate. Females suffering from this form of ibs are more likely to report difficulty in passing urine and gynaecological problems, with ibs symptoms being worse at certain times of the menstrual cycle. Spastic colon syndrome is the classic form of ibs, due to abnormal contractility of the large bowel. Constipation is usually a major feature of spastic colon syndrome, and tends to respond to an increased fibre diet. Smooth muscle relaxant drugs and antispasmodics are usually helpful too.

Functional diarrhoea syndrome
functional diarrhoea syndrome is associated with:

increased frequency of bowel movements
urgency (having to rush to the bathroom)
passing several stools in rapid succession often in the morning
stools that characteristically become looser and looser throughout the day.
Sufferers are frequently left exhausted and tired and the rapidity with which the bowels have to be opened can mean that you are housebound or unable to travel far. This form of ibs is likely to be made worse by following a high fibre diet, but will usually to treatment with anti-diarrhoeal drugs such as loperamide or imodium

primary foregut motility disorder
primary foregut motility disorder is linked with:

abdominal pain that is usually right-sided
bloating which may be so severe that you have to wear loose clothing or even wear several different sizes of clothes over several days
feeling full after eating only a small amount of food
poor appetite
sometimes weight loss.
There is usually no significant disturbance of bowel habit in this form of ibs, so that diarrhoea or constipation are not a major problem. This primary motility disorder of the foregut is in fact believed to result from abnormal contraction of the small intestine (ileum - first 40% of small intestine below duodenum and jejunum - lower 60% of small intestine below duodenum) rather than the colon. It seems to affect women more than men. Unfortunately, the condition can be difficult to treat, although drugs that stimulate and regulate intestinal motility may help.

This is not a fool-proof classification of classic ibs types, however. Many people cannot fit their symptoms neatly into one group or another and many people with ibs have symptoms that fall into more than one group or which alternate.

Ibs and food intolerance
people with ibs often notice that certain foods tend to bring on their symptoms. This is known as food intolerance. A food intolerance is a reproducible, adverse reaction to a specific food or ingredient which occurs whenever that food is eaten – even in a disguised form.

When food is digested, the many proteins it contains are broken down into smaller fragments known as peptides. These peptides are usually broken down into even smaller building blocks, known as amino acids, before they are absorbed into the circulation. Sometimes, however, the larger peptides are themselves absorbed, and proteins from egg yolk and cows' milk have even been found in human breast milk, for example. The immune system is designed to recognise and attack foreign proteins and, in some people, this triggers the production of a type of antibody known as immunoglobulin g (igg). The presence of igg antibodies aimed against certain foods suggests the body has become intolerant to those foods.

Intolerance to foods can be checked for by detecting anti-food igg antibodies in the blood. A clinical study carried out by the university of york investigated the effectiveness of a 3-month exclusion diet, based on the yorktest foodscan test, in 150 people with irritable bowel syndrome. Volunteers were randomised to receive either a diet excluding all foods to which they had igg antibodies, or a sham diet excluding the same number of foods but not those to which they were sensitive. Symptom severity and quality of life were recorded at the beginning and at the end of the 3-month trial. The results showed that the true diet was significantly better than the sham diet in reducing symptom severity scores. Response to the diet was significantly affected by how well people stuck to the diet, and the number of foods to which they were sensitive. When these factors were accounted for effectiveness of the diet was even greater. Reintroduction of the offending foods also led to a greater return of symptoms in the true diet group. The researchers concluded that a clinically significant improvement can be achieved in some patients with ibs using a food elimination diet based on igg food antibodies.

A food intolerance indicator test is available that gives a simple yes/no answer to whether or not someone has a food intolerance. If this shows a raised level of igg antibodies to a pooled sample of food allergens, you can opt whether or not to have the sample tested further to identify the foods responsible for the positive result. If the answer is no, this saves the cost of paying for the full analysis. For more information visit www.Yorktest.Com

important: ibs is not a diagnosis you should make yourself.

Always tell your doctor as soon as possible if you notice:

a change in your usual bowel habit
any blood or blackness in your stools
any unexplained weight loss
or if you are over 45 and develop bowel symptoms for the first time.
*dr sarah brewer is medical director of yorktest laboratories ltd, and co-author of the ibs diet (thorsons, £6.99), which includes 60 recipes by michelle berriedale-johnson (available from the nutri centre )

Diverticulosis

this is a common condition, usually affecting the colon, in which small pockets of the mucosa lining the colon are pushed out to form small sacs called diverticula. These pockets most often occur in the sigmoid colon, and are very common over the age of 40. At the age of 60, more than two-thirds of americans have developed diverticulosis. The presence of these pouches is not in itself dangerous, but if the diverticula become infected or inflamed, diverticulitis results. This condition may be associated with perforation and/or bleeding, and may require strong antibiotics or surgery.

The cause of diverticulosis remains obscure, but genetic and dietary factors are felt to play a part. Populations consuming high fiber diets rarely get diverticulosis, and western diets with refined foods and low fiber content exhibit the highest rates of the condition in the world. Low fiber diets are also associated with chronic constipation, and this may lead to the observed abnormal thickening of the colonic wall which is seen adjacent to the diverticular sacs.

Prevention and treatment of diverticulosis is therefore mainly dietary. Bran cereal, fiber additives such as psyllium, and fresh fruits and vegetables, along with plenty of fluids, are recommended. Foods to avoid include popcorn, seeds, and nuts, which are more difficult to digest and may get trapped in diverticula leading to diverticulitis.

Irritable bowel syndrome

this condition is perhaps the most common disorder seen by the gastroenterologist. Ibs is a "functional" disorder, which means there is abnormal behavior of the intestine without any organic disease. The cause of ibs is unknown, but certain inciting factors are well established. Stress is the most common, leading to tightening and spasm in the intestinal muscles. Patients may feel cramps, bloating, urgency to defecate, nausea, or increased need to pass gas. In others, these symptoms may be precipitated by certain foods, especially dairy products, raw fruits and vegetables, or coffee. Women with ibs may have more symptoms in the week before menstruation and during menopause.

Ibs is a diagnosis of exclusion. All other conditions that may cause similar symptoms must be ruled out. Crohn’s disease, colitis, diverticulosis, and colon cancer at times present with symptoms similar to ibs. Patients may therefore require blood tests, stool analysis, and x-ray or endoscopic studies before a diagnosis of ibs can be assured.

Fortunately, ibs is not life-threatening. Treatment may require dietary adjustments, stress management, or antispasmodic medications.



Ulcerative colitis

ulcerative colitis and crohn’s disease make up the majority of cases of inflammatory bowel disease (ibd). Like crohn’s disease, ulcerative colitis is a chronic inflammatory condition of the bowel which often first occurs in childhood and young adulthood. Unlike crohn’s disease, ulcerative colitis only involves the colon, and typically is most severe in the rectum and less severe higher up in the large intestine. It is also a continuous inflammation, without normal areas of mucosa interspersed amid the disease. About 10% of patients will have one attack and then go into remission for decades, while another 10% will have unrelenting symptoms, some of them developing a toxic form of colitis requiring total proctocolectomy. The majority of patients, however, will have periods of remission and relapse over the years. Extraintestinal manifestations most often involve inflammation in joints, skin, bile ducts, and the eye. Diagnosis is made by colonoscopy with mucosal biopsies. Mild cases of ulcerative colitis, when localized only to the rectum, are referred to as proctitis and may be managed with administration of anti-inflammatory medicine in the form of an enema. More severe cases require oral anti-inflammatory or immunosuppressant therapy. The disease can be cured by removing the colon in cases not responsive to medical therapy. Chronic ulcerative colitis is a risk factor for colon cancer, with the risk directly proportional to the duration and extent of the disease. Surveillance colonscopies at regular intervals are therefore recommended for patients with ulcerative colitis for greater than 7 years and with disease which extends up to and above the splenic flexure.

Treatment of irritable bowel syndrome — there are a number of different treatments and therapies for ibs. Many of these measures can be combined to effectively reduce the pain and other symptoms of ibs. Because of the wide variability of symptoms in people with this condition, different treatments and therapies work for different people. Treatment is usually a long-term process; during this process, it is important to maintain good communication with your doctor about your symptoms, your concerns, and any psychologic and social issues that arise.

Monitoring — the first step in treating ibs may be close monitoring of your symptoms, your daily habits, and any other factors that may affect gastrointestinal function. This step can identify factors that worsen symptoms in some people with ibs, such as lactose or other food intolerances and stress. A daily diary can be helpful.

Dietary modification — as discussed above, people with ibs commonly describe food intolerances. Many have already eliminated or avoid certain foods known to aggravate their symptoms. The systematic elimination of particular foods can be helpful to determine the relationship between the food and symptoms. This strategy may be particularly useful in patients who have eliminated multiple foods, a behavior which in itself can contribute to the decreased quality of life experienced by many people with ibs.

Many doctors recommend the temporary elimination of dairy products, since lactose intolerance is common and can cause symptoms similar to ibs or aggravate ibs. People who avoid lactose should take dietary calcium supplements.

Several foods are only partially digested in the intestines. When they reach the colon, further digestion takes place by bacteria, which produce gas as a byproduct of their digestion. As a result, these foods can cause gas and cramps. The most common are the legumes (such as beans) and cruciferous vegetables (ie, vegetables that have a cross at their base) such as cabbage, brussels sprouts, cauliflower, and broccoli. In addition, some patients have trouble with onions, celery, carrots, raisins, bananas, apricots, prunes, sprouts, and wheat.

Increasing dietary fiber — increasing dietary fiber (either by adding certain foods to the diet or using fiber supplements) can relieve symptoms in some people with ibs, particularly people who have combined abdominal pain and constipation. It may also be helpful in people with diarrhea predominant symptoms since it can improve the consistency of stools. It is often helpful to take a dietary fiber supplement (such as psyllium [metamucil] or methylcellulose [citrucel]) since it is difficult to consume enough fiber in the diet, particularly when avoiding foods known to increase intestinal gas. Dietary fiber supplements should be increased to the prescribed dose over several weeks to help reduce the symptoms of excessive intestinal gas, which can occur in some people when beginning fiber therapy. The reasons that fiber helps people with ibs are not completely understood.

Psychosocial therapies — stress and anxiety can worsen ibs in some people. The best approach for reducing stress and anxiety depends upon the individual and the severity of symptoms. You should have an open discussion with your doctor about the possible role that stress and anxiety could be having on your symptoms, and together decide upon the best course of action for you.

Some patients benefit from formal counseling with or without pharmacologic therapy or other treatments such as hypnosis and biofeedback.
Participation in a support group can also be valuable.
Many patients find that daily exercise can be extremely helpful to their sense of well-being. Exercise can also have favorable effects on bowel action.
Drugs — although many drugs are available to treat the symptoms of ibs, these drugs do not cure the condition, and they are used primarily to support other types of treatment. The choice among these drugs depends in part upon whether a person has diarrhea, constipation, or pain predominant ibs. Furthermore, the effectiveness of specific drugs varies from one person to another. As a general rule, drugs are reserved for patients whose symptoms have not adequately responded to more conservative measures such as changes in diet and fiber supplementation.

Anticholinergic drugs — anticholinergic drugs block the nervous system's stimulation of the gastrointestinal tract and thus have an antispasmodic effect, relieving severe cramping and irregular contractions of the colon. Drugs in this category include dicyclomine (bentyl) and hyoscyamine (levsin). These drugs may be particularly helpful when taken prophylactically (ie, before symptoms) and thus are most helpful for patients who can predict the onset of their symptoms. Common side-effects include dry mouth and eyes and blurred vision.

Antidepressants — many antidepressants have a pain relieving effect that is independent of their depression relieving effect. The pain relieving effect can often be observed at doses that are too low to have an antidepressant effect. These drugs can alleviate the abdominal pain of ibs, although they typically require three to four weeks to take effect. One class of antidepressants, tricyclic antidepressants, which includes amitriptyline, imipramine, and nortriptyline, also slow movement of contents through the gastrointestinal tract and may be most helpful in people with diarrhea predominant ibs. Another class of antidepressants, the selective serotonin reuptake inhibitors, including the drugs paroxetine (paxil), fluoxetine (prozac), sertraline (zoloft), and citralopram (celexa), are usually prescribed for people who have both ibs and depression.

Antidiarrheal drugs — the drugs loperamide (imodium) or diphenoxylate with atropine (lomotil) can help slow the movement of contents through the gastrointestinal tract. Loperamide and diphenoxylate/atropine are most helpful in people with diarrhea predominant ibs. However, doctors usually recommend that these drugs should only be used as needed, and rarely on a continuous basis.

Anxiolytic drugs — anxiolytic drugs reduce anxiety. Diazepam (valium) belongs to this class of drugs. Anxiolytic drugs are occasionally prescribed for people with ibs who are experiencing acute anxiety that is worsening their symptoms. However, these drugs should only be taken for short periods of time since they interact with other drugs, and cause addiction and withdrawal syndromes.

Drugs affecting serotonin receptors — serotonin is a hormone that is involved in intestinal contractions and sensation. Drugs that stimulate the serotonin receptors increase intestinal contractions while drugs that block them decrease intestinal contractions.

The blocking category of these drugs is best suited for people with diarrhea-predominant symptoms. The first that received approval from the food and drug administration was alosetron (lotronex). Alosetron was withdrawn from the market soon after its introduction because of concerns related to its safety, but was later reintroduced under tight regulatory control. Whether other drugs in this class will prove to be safer remains to be determined.

Tegaserod (zelnorm) is the first of the stimulating category of drugs to be approved by the food and drug administration. In clinical trials, it appeared to be moderately effective for women with constipation-predominant symptoms.

Drugs in development — several new classes of medications for ibs are currently in development. Their efficacy and safety compared to other treatments that are already available remains to be determined.

Herbs and natural therapies — a number of herbal and natural therapies have been advocated for the treatment of ibs. Unfortunately, evidence supporting their benefit from scientifically conducted studies is lacking. It is important to appreciate that even though small studies exist that support a benefit of many of these therapies, the studies are either too small or have major flaws that make definitive conclusions impossible.

Peppermint oil — there is a small amount of evidence supporting a benefit for peppermint oil, although it is difficult to make definitive conclusions. Peppermint oil can cause or worsen heartburn.

Acidophilus — there is increasing interest in the possible beneficial effects of so called "healthy" bacteria in a variety of intestinal diseases including ibs. Whether supplements containing these bacteria (such as acidophilus with or without "fos" or lactobacillus) are of any benefit is unproven.

Chamomile tea — chamomile tea is of unproven benefit in ibs. Furthermore, chamomile can aggravate allergies in people who tend to be allergic. People allergic to the grass family can have an allergic reaction to chamomile as well.

Evening primrose oil — evening primrose oil, a supplement containing gamma linolenic acid, is of unproven benefit.

Fennel seeds — fennel seeds are of unproven benefit.

Wormwood — wormwood is of unproven benefit and may be unsafe. Wormwood oil can cause damage to the nervous system.

Comfrey — comfrey is of unproven benefit and can cause serious liver problems.

Prognosis — although ibs can produce substantial physical discomfort and emotional distress, studies show that most people with ibs do not develop serious long-term health conditions. Furthermore, the vast majority of patients learn to control their symptoms.

Over time, less than 5 percent of people originally diagnosed with ibs will be diagnosed with some other gastrointestinal condition, so it is important to work with your doctor to monitor your symptoms over time. Further testing might be required if your symptoms have changed. On the other hand, studies also show that ibs does not decrease life expectancy; people with ibs live just as long as people in the general population.

Where to get more information — your doctor is the best resource for finding out important information related to your particular case. Not all patients with ibs are alike, and it is important that your situation is evaluated by someone who knows you as a whole person.

Screening and diagnosis


a diagnosis of irritable bowel syndrome depends largely on a complete medical history and physical exam. Your doctor may also recommend conducting several tests, including stool studies to check for infection or malabsorption problems. Among the tests that you may undergo to rule out other causes for your symptoms are the following:

flexible sigmoidoscopy. This test examines the lower part of the colon (sigmoid) with a flexible, lighted tube (sigmoidoscope).
Colonoscopy. In some cases, your doctor may perform this diagnostic test, in which a small, flexible tube is used to examine the entire length of the colon.
Computerized tomography (ct) scan. Ct scans produce cross-sectional x-ray images of internal organs. Ct scans of your abdomen and pelvis may help your doctor rule out other causes of your symptoms.
Lactose intolerance tests. Lactase is an enzyme you need to digest the sugar found in dairy products. If you lack this enzyme, you may have problems similar to those caused by irritable bowel syndrome, including abdominal pain, gas and diarrhea. To find out if this is the cause of your symptoms, your doctor may order a breath test or ask you to exclude milk and milk products from your diet for several weeks.
Blood tests. Celiac disease (nontropical sprue) is sensitivity to wheat protein that also may cause symptoms like those of irritable bowel syndrome. Blood tests may help rule out that disorder.
Criteria for making a diagnosis
because there are usually no physical signs to definitively diagnose irritable bowel syndrome, diagnosis is often a process of elimination. To help in this process, researchers have developed diagnostic criteria, known as rome criteria, for ibs and other functional gastrointestinal disorders — conditions in which the bowel appears normal but doesn't function normally.

According to these criteria, you must have certain signs and symptoms before a doctor diagnoses irritable bowel syndrome. The most important are abdominal pain and diarrhea or constipation lasting at least 12 weeks, though they don't have to occur consecutively. You also need to have at least two of the following:

a change in the frequency or consistency of your stool. For example, you may change from having one normal, formed stool every day to three or more loose stools daily. Or you may have only one hard stool every three to four days.
Straining, urgency or a feeling that you can't empty your bowels completely.
Mucus in your stool.
Bloating or abdominal distension.

Complications


both diarrhea and constipation can aggravate hemorrhoids. In addition, signs and symptoms of irritable bowel syndrome can interfere with your work, your relationships with friends and family, and your ability to live your life to the fullest. At times, you may feel discouraged or depressed.


Treatment


because it's still not clear what causes irritable bowel syndrome, treatment focuses on the relief of symptoms so that you can live your life as fully and normally as possible.

In most cases, you can successfully control mild symptoms of irritable bowel syndrome by learning to manage stress and making changes in your diet and lifestyle. But if your problems are moderate or severe, you may need more help than lifestyle changes alone can offer. Your doctor may suggest:

fiber supplements. Taking fiber supplements such as psyllium (metamucil) or methylcellulose (citrucel) with fluids may help control constipation.
Anti-diarrheal medications. Over-the-counter medications such as loperamide (imodium) can help control diarrhea.
Eliminating high-gas foods. If you have significant bloating or are passing significant amounts of gas, your doctor may also ask you to cut out such items as carbonated beverages, salads, raw fruits and vegetables, cabbage, broccoli and cauliflower.
Anticholinergic medications. Some people need drugs that affect certain activities of the nervous system (anticholinergics) to relieve painful bowel spasms.
Antidepressant medications. If your symptoms include pain and depression, your doctor may recommend a tricyclic antidepressant or a selective serotonin reuptake inhibitor (ssri). These medications help relieve depression as well as inhibit the activity of neurons that control the intestines. For diarrhea and abdominal pain, your doctor may suggest tricyclic antidepressants, such as imipramine (tofranil) and amitriptyline. Side effects of these drugs include drowsiness and constipation. Ssris such as fluoxetine (prozac, sarafem) or paroxetine (paxil) may be helpful if you're depressed and have pain and constipation.
Counseling. If antidepressant medications don't work, you may have better results from counseling if stress tends to exacerbate your symptoms.
Drugs specifically for ibs
there are currently two drugs available to treat ibs: alosetron (lotronex) and tegaserod (zelnorm).

Alosetron. This drug is a nerve receptor antagonist that's supposed to relax the colon and slow the movement of waste through the lower bowel. But the drug was removed from the market just nine months after its approval when it was linked to at least four deaths and severe side effects in 197 people. In june 2002, the food and drug administration (fda) decided to allow alosetron to be sold again — with restrictions. The drug can be prescribed only by doctors enrolled in a special program and is intended for severe cases of diarrhea-predominant ibs in women who haven't responded to other treatments. Alosetron is not approved for use by men.
Tegaserod. For women who have ibs with constipation, the fda has approved the medication tegaserod (zelnorm). It's approved for short-term use in women and has not been shown to be effective for treating men with ibs. Tegaserod imitates the action of the neurotransmitter serotonin and helps to coordinate the nerves and muscles in the intestine. Some reports have suggested a risk of rare, dangerous side effects similar to those of alosetron, but the drug is still available.
Generally, alosetron and tegaserod should only be used if you have failed usual therapy for your ibs. Additionally, they should only be prescribed by a gastroenterologist with expertise in ibs because of the potential side effects.


Prevention


anyone can experience digestive upset from worry or anxiety. But if you have irritable bowel syndrome, stress-related problems such as abdominal pain and diarrhea tend to occur with greater frequency and intensity. Finding ways to deal with stress can be extremely helpful in preventing or alleviating symptoms:

counseling. In some cases, a health care professional such as a psychologist or psychiatrist can help you learn to reduce stress by looking at how you respond to events in your life and then working with you to modify or change that response.
Biofeedback. This stress-reduction technique helps you reduce muscle tension and slow your heart rate with the feedback help of a machine. You're then taught how to produce these changes yourself. The goal is to help you enter a relaxed state so that you can cope more easily with stress. Biofeedback is usually taught in hospitals and medical centers.
Regular exercise, yoga, massage or meditation. These can all be effective ways to relieve stress. You can take classes in yoga and meditation or practice at home using books or tapes.
Progressive relaxation exercises. These help you relax muscles in your body, one by one. Start by tightening the muscles in your feet, then concentrate on slowly letting all of the tension go. Next, tighten and relax your calves. Continue until the muscles in your body, including those in your eyes and scalp, are completely relaxed.
Deep breathing. Most adults breathe from their chests. But you become calmer when you breathe from your diaphragm, the muscle that separates your chest from your abdomen. When you inhale, allow your belly to expand with air; when you exhale, your belly naturally contracts. Deep breathing can also help relax your abdominal muscles, which may lead to more-normal bowel activity.
Hypnosis. Hypnosis may reduce abdominal pain and bloating. A trained professional teaches you how to enter a relaxed state and then guides you as you imagine your intestinal muscles becoming smooth and calm.
Other techniques. Set aside at least 20 minutes a day for any activity you find relaxing — listening to music, reading, playing computer games or just soaking in a warm bath.

Self-care


in many cases, simple changes in your diet and lifestyle can provide relief from irritable bowel syndrome. Although your body may not respond immediately to these changes, your goal is to find long-term, not temporary, solutions:

experiment with fiber. When you have irritable bowel syndrome, fiber can be a mixed blessing. Although it helps reduce constipation, it can also make diarrhea, gas and cramping worse. The best approach is to gradually increase the amount of fiber in your diet over a period of weeks. Examples of foods that contain fiber are whole grains, fruits, vegetables and beans. If your signs and symptoms remain the same or worse, tell your doctor. You may also want to talk to a dietitian. If you take a fiber supplement, such metamucil or citrucel, be sure to introduce it gradually and drink plenty of water every day to minimize gas, bloating and constipation. If you find that taking fiber helps your ibs, use it on a regular basis for best results.
Avoid problem foods. If certain foods make your signs and symptoms worse, don't eat them. Common culprits include alcohol, chocolate, caffeinated beverages such as coffee and sodas, medications that contain caffeine, dairy products, and sugar-free sweeteners such as sorbitol or mannitol. For some people, fats such as butter and margarine or foods high in fat such as mayonnaise, nuts, cream, ice cream and red meat also may aggravate symptoms. Be careful that your diet doesn't become too restricted, though. If you need help, talk to a dietitian. Large meals also may make your symptoms worse.
Eat at regular times. Don't skip meals, and try to eat about the same time each day to help regulate bowel function. If you have diarrhea, you may find that eating small, frequent meals makes you feel better. But if you're constipated, eating larger amounts of high-fiber foods may help move food through your intestines.
Take care with dairy products. If you're lactose intolerant, try substituting yogurt for milk. Or use an enzyme product, such as lactaid, to help break down lactose. Consuming small amounts of milk products or combining them with other foods to slow digestion also may help. In some cases, though, you may need to eliminate dairy foods completely. If so, be sure to get enough protein, calcium and b vitamins from other sources.
Drink plenty of liquids. Try to drink plenty of fluids every day. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, and carbonated drinks can produce gas.
Exercise regularly. Exercise helps relieve depression and stress, stimulates normal contractions of your intestines and can help you feel better about yourself. If you've been inactive, start slowly and gradually increase the amount of time you exercise.
Use anti-diarrheal medications and laxatives with caution. If you try over-the-counter anti-diarrheal medications, such as imodium or kaopectate, use the lowest dose that helps. In the long run, these medications can cause problems if you don't use them appropriately. The same is true of laxatives. If you have any questions about them, check with your doctor.

Coping skills


living with irritable bowel syndrome presents daily challenges. It may be painful or embarrassing and can seriously affect the quality of your life. These suggestions may help you cope more easily:

learn as much about ibs as you can. Talk to your doctor, look for information on the internet from reputable sources such as the national institutes of health and major medical centers or medical schools, and read books and pamphlets. Being informed about your condition can help you take better charge of it.
Identify the factors that trigger ibs. This is a key step both in managing your condition and in helping you feel you have control of your life.
Seek out others with ibs. Talking to people who know what you're going through can be reassuring. Try internet chat rooms or ibs support groups in your community. Your doctor may be able to refer you to a support group, or you may find one through your local paper or on internet sites.

Complementary and alternative medicine


the following nontraditional therapies may help relieve symptoms of irritable bowel syndrome:

acupuncture. Researchers at the national institutes of health (nih) have found that acupuncture can provide relief from chronic pain. Although study results on the effects of acupuncture on symptoms of irritable bowel syndrome have been mixed, some people use acupuncture to help relax muscle spasms and improve bowel function.
Herbs. Peppermint is a natural antispasmodic that relaxes smooth muscles in the intestines. Study results haven't been consistently encouraging, but if you'd like to try peppermint be sure to use enteric-coated capsules. Peppermint may aggravate heartburn. Before taking any herbs, check with your doctor to be sure they won't interact or interfere with other medications you may be taking.
Probiotics. Probiotics are "good" bacteria that normally live in your intestines and are found in certain foods, such as yogurt, and in dietary supplements. It's been suggested that people with irritable bowel syndrome may not have enough good bacteria, and that adding probiotics to your diet may help ease your symptoms. Some studies have shown that probiotics can decrease ibs exacerbations. Not all studies on probiotics have had positive results, however.

Lol...I hope I am not scaring everyone off this site with my many postings--i feel like I writing to a person of one now (me)--:( anyhow, I just wanted to inform people that I called my doctor's office today to see if I can get a prescription for bentyl (it is an antispasmodic type of drug). I'm a little iffy on the side effects but how many drugs out there have a lot of "out there" side effects that seem to make the actual symptom seem minor in comparison. I will be starting it tomorrow and will let all (if anyone is still on this site know how it works out). I may have to give it a week or two--just to see if it kicks in and helps this out---

i read up on ibs (and as you saw in my 20-30 postings on here)--posted it to save everyone the work--i don't have constipation (except twice) and never if rarely ever get the big d--ibs always seems to relate to the urgency of one---and having to always find the restroom--something which doesn't seem to fit what I am feeling. I'm only getting the pain under the left rib---muscle spasm type of pain around the abdomen/under the ribcage--that is what is personally making me feel uncomfortable but I just thought I would lay out the information on this site to see if others might relate to it or not.

The key here isn't self diagnosis. If you haven't had any medical tests done and have these symptoms, don't just assume it is ibs. Get an endoscopy, colonoscopy, abdominal/pelvic ct scan (blood work) done to rule out/eliminate anything potentially life threatening before diagnosing it as ibs. I went the westernized (and expensive-:( ) route of having medical tests done to rule out everything before coming to this diagnosis.

I also, from trying this after being diagnosed-notice that caffeine is a big culprit (especially coffee). I don't drink regular coffee (more like those little mocha frappacino's from the store) but I cut back on those and noticed that the symptoms don't flare up as much. I've also been incorporating more fiber in my diet (like for breakfast--i have yogurt or maybe some raisin bran). I think milk is an irritant--so I may go organic if it does. I'm also going to cut back on dairy, chocolate (which is killer because I love chocolate), carbs (which I also love especially pasta), and eat smaller meals throughout the day (instead of 3 meals--like breakfast, lunch, and dinner). I think it is also good to pay attention to how fast you are eating your meal (i know that can be hard during the day because a lot of what we do revolves around time schedules--but if that is the case--it doesn't hurt to try to eat smaller meals (portion yourself) instead of big meals and cut back on anything heavy, spicy, greasy, or fattening (basically fast food--probably isn't that great unless you make conscious decisions on what foods will work and what won't).

I've had this pain for over two and a half years---and had these tests done in between so I know that it will probably take me a while to see what will work best for me and my digestive system. I know part of me wants fast answers (just to deal with it and move on)--but instead of focusing, i'm just going to make conscious choices and incorporate that into my daily life. It might take a while for the body to adjust to it. Good luck to all on here. I'll keep you up to date on how the bentyl works out (good/bad)

Hey all
when the pain you all are talking about started was it just sometimes????? Did you notice anything that brought it on.. After talking to others..

See I just noticed this past friday... I have been watching what I eat and exercising regualry for over two months now. I don't know....

Any ideas???

Irritable bowel syndrome: a tcm perspective
by toni balfour, l.Ac., dipl. Ac. & c.H.

Http://www.Balf ourhealing.Com/treatment-ibs.Html

irritable bowel syndrome in western medicine

irritable bowel syndrome (ibs) is an intestinal disorder causing a variety of symptoms which may include cramping, abdominal pain, gas, bloating, and irregular bowels. Some people with ibs have diarrhea with frequent loose stools, while others have constipation causing infrequent bowel movements that are difficult to pass. Still other ibs patients will suffer from alternating diarrhea and constipation. Symptoms are frequently triggered by stress, emotional factors, or the ingestion of food.

Ibs is the most common gastrointestinal disease seen by general practitioners and makes up 30-50% of all referrals to gi specialists. Women are affected three times more than men, with the average age of onset being between 20 and 40.

Ibs is described as a 'functional' illness -- the small and large intestines aren't functioning appropriately although there is no structural damage found through diagnostic testing. No anatomic defect can be found in ibs patients, and the cause of the illness is not known. What is known is that there is a link between the onset of symptoms and emotional triggers.

There are two major clinical types of ibs described in western medicine: diarrhea-predominant ibs and constipation-predominant ibs.

Diarrhea-predominant ibs is characterized by diarrhea which occurs immediately after waking up or immediately after eating. Other common symptoms include pain, bloating, urgency, and urinary incontinence.

Constipation-predominant (or 'spastic colon' type) ibs manifests with pain over at least one area of the colon and periodic constipation. This pain may be continuous or it may come in bouts, and is frequently relieved by moving the bowels. There may be constipation alternating with normal stools or constipation alternating with diarrhea. The stool often contains mucus. Associated symptoms include bloating, gas, nausea and dyspepsia. Eating can commonly trigger these symptoms.

Western medicine treats ibs with anti-spasmodic or anti-diarrhea medication, diet modification and stress reduction techniques.

What is traditional chinese medicine?

Traditional chinese medicine (tcm) is a holistic medical system which combines the use of acupuncture, chinese herbs, nutrition, massage, and movement exercises (known as tai chi or qi gong) to bring the body into balance.

Whereas western medicine looks closely at a symptom and tries to find an underlying cause, traditional chinese medicine looks at the body as a whole. Each symptom is looked at in relationship to all other presenting symptoms. The goal of the tcm practitioner is to assess the entire constitution of the patient -- considering both physiological and psychological aspects.

The practitioner first observes the general characteristics of the patient, then tries to discern a relationship between symptoms in order to establish what is called a "pattern of disharmony". Treatment is aimed at restoring harmony and bringing the body into balance.

The fundamental tcm theory used to determine the pattern of disharmony is the theory of "yin and yang". Yin and yang are terms used to describe two polar opposites. Each body part, each organ, and even each symptom in the body can be described in terms of yin and yang. Levels of yin and yang are constantly changing in the body and there are four possible states of imbalance:

excess of yin
excess of yang
deficiency of yin
deficiency of yang
it is rare for one of these states of imbalance to exist by itself. Excesses and deficiencies of yin and yang almost always appear in combination. For example, in irritable bowel syndrome the symptom of loose stools shows an excess of yin; but if the patient feels a burning sensation along with the loose stools, this indicates an additional excess of yang.

In treating the overall pattern of disharmony, the tcm practitioner uses acupuncture and chinese herbs to address all imbalances of yin and yang.

To look at the body as an integrated whole, one also looks at the theory of the 'internal organs'. The tcm definition of an internal organ is very different from the western concept. In western medicine, an organ is a material-anatomical structure. In chinese medicine each internal organ encompasses much more. There can be an anatomical structure, but there is also a corresponding emotion, tissue, sensory organ, color and element.

In addition, 12 of the internal organs correspond to the 12 main acupuncture meridians (or channels) that run through the body. There is qi (or energy) flowing through each meridian. If an internal organ is out of balance, the qi of that organ will be damaged.

Therefore, the chinese large intestine (which is capitalized to distinguish it as the chinese organ) shouldn't be equated with the western organ.

Irritable bowel syndrome affects the large and small intestines in western medicine, but in chinese medicine, the spleen, liver, kidney, and large intestine can all play a role in the pattern of disharmony.

Common patterns of disharmony in irritable bowel syndrome

spleen qi deficiency

in tcm the spleen is considered to be the key organ to regulate digestion. Keep in mind, this is not the same as the western spleen. Its functions actually have a closer connection to the western pancreas.

Ibs patients with a pattern of spleen qi deficiency will suffer from fatigue and diarrhea which is worse when they are overexerting themselves. This is often accompanied by abdominal pain which may be relieved by exerting pressure over the painful area. Patients may also have gas and bloating. Hemorrhoids are an additional indication of spleen qi deficiency.

Acupuncture points are chosen which will help nourish the spleen qi. There are also specific techniques used in needling that strengthen the body when the patient is deficient.

Another important part of treatment is the chinese herbal formula. In chinese herbalism, a group of herbs is combined together to specifically address a person's unique constitution. This is one way in which treatment is very individualized -- a master herbalist treats no two patients with the same combination of herbs.

Most herbalists use a "classical formula" as a foundation. Many classical formulas written up to 2,000 years ago are still commonly used today. Groups of herbs can be added or taken out of classical formulas to customize them for patients.

One classical formula used for spleen qi deficiency is called bu zhong yi qi tang. By adding and subtracting herbs from this formula, it can be individualized to fit the precise needs of the patient.



Spleen distressed by dampness

in this pattern, the patient may experience symptoms of spleen qi deficiency along with a feeling of nausea or heaviness. Bowel movements may feel incomplete, or the patient may even have constipation lined with mucus.

This condition is often caused by eating too much fried or greasy food, but may also be caused by emotional factors such as over-thinking or over-worrying.

Acupuncture points are chosen to nourish the spleen and eliminate dampness. The classical herbal formula to address this pattern is called shen ling bai zhu san.

Patients are additionally advised to keep a very clean diet. In chinese medicine dairy foods and excessive sugar intake create dampness, so these foods should be avoided altogether.



Excess cold in the spleen

an excess of cold in the spleen causes severe pain. The patient may be "doubling over" in pain, feeling as if curling up will somehow offer relief. Here the patient cannot tolerate being touched. This pain may be accompanied by constipation.

Acupuncture is given to warm the spleen, and the classical formula da jian zhong tang may be prescribed, although in severe cases of constipation additional herbs need to be added to give a laxative effect.



Spleen and kidney yang deficiency

yang energy provides warmth to the body and a deficiency of spleen and kidney yang may result in feeling cold or having cold hands and feet. Ibs patients with spleen and kidney yang deficiency will have diarrhea first thing in the morning which may contain undigested food particles. Other symptoms include chronic low back pain, low libido, frequent urination, or in severe cases, urinary incontinence.

Acupuncture treatment focuses on building up this deficient yang energy, and the classical formula si shen wan can be used along with additions and subtractions to suit the exact needs of the patient.



Liver qi stagnation

the chinese liver is the organ most affected by stress, aggravation, and anger. The liver is frequently involved in modern disease, most commonly when its qi becomes stagnant or stuck. There may be depression, moodiness, or simply a feeling of being 'wound up'. Women may suffer from irregular or painful periods.

The ibs patient with liver qi stagnation may have pellet shaped stools and distending pain, particularly in the area below the ribs. There may also be nausea, belching, or acid reflux. Symptoms can be triggered or aggravated by stress.

Acupuncture is very effective at restoring the smooth flow of liver qi, as are movement exercises such as tai chi or qi gong. The classical formula of choice for the ibs patient with liver qi stagnation is liu mo tang.



Liver/spleen disharmony

disharmony between the liver and spleen causes irritability along with abdominal distension and pain. The ibs symptom of alternating constipation and diarrhea is common in a liver/spleen disharmony. Stress, frustration, and anger aggravate the condition.

Xiao yao wan is a very commonly used classical formula for liver/spleen disharmony, but does need to be modified in most ibs cases. Tong xie yao fang is another classical formula used for liver/spleen disharmony and is the best choice when diarrhea is prevalent.

Acupuncture treatment will focus on soothing the liver and nourishing the spleen.



Damp-heat in the large intestine

abdominal pain and diarrhea with a sense of urgency are key symptoms indicating damp-heat in the large intestine. The diarrhea is commonly yellow and explosive with a strong odor and a sensation of burning. This heat indicates that there may be a low grade infection, although this type of chronic infection may not show up on lab tests. In addition, there may be a feeling of heaviness of the body and limbs and stuffiness in the chest.

Acupuncture is used to clear heat and eliminate dampness and a commonly used classical formula is ge gen huang qin huang lian tang.

Irritable bowel syndrome is clearly a complicated illness in both western and chinese medicine. Its many manifestations require very different treatment approaches in traditional chinese medicine. The patterns of disharmony mentioned above may even appear in combination and treatment must be adjusted appropriately. In any severe case of ibs, tcm treatment will be customized for the individual and classical herbal formulas will be modified for the patient.



Research on ibs & chinese herbs

an australian study published in 1998 in the journal of the american medical association lends strong scientific support to treating ibs with chinese herbs. In this double-blind study, 116 patients with irritable bowel syndrome were divided into three groups. One group was given a standard chinese herbal preparation, a second group was given customized herbal formulas (individually written for each patient), and a third group was given a placebo. Each patient had regular consultations with both a chinese herbal-medicine practitioner and a gastroenterologist. Both groups taking the chinese herbs showed significant improvement over the patients taking the placebo. Positive results were reported by both the patients themselves and the gastroenterologists. Although there was improvement in both groups of patients taking herbs, it is important to note that the positive effects were shown to last longer in the group that was given individualized formulas. Only these patients had maintained improvement on a follow-up consultation 14 weeks after completing the treatment.

This study clearly shows that chinese herbalism is most effective when each patient is treated not only for their condition, but also for their bodily constitution and other presenting symptoms. According to the principles of chinese medicine, each patient must be treated as an individual. Optimal results will be obtained with both herbs and acupuncture when specific treatments are customized for each patient.



References:

beers, mark & berkow, robert (editors). The merck manual of diagnosis and therapy, 17th ed.. Merck research laboratories, whitehouse station, n.J. 1999.

Bensoussan a, talley nj, hing m, menzies r, guo a, ngu m. Treatment of irritable bowel syndrome with chinese herbal medicine. Journal of the american medical association 1998; 280(18): 1585-1589.

Bensky, dan & barolet, randall. Chinese herbal medicine formula & strategies, eastland press, inc., seattle, washington 1990.

Kaptchuk, ted. The web that has no weaver. Congdon and weed, chicago, illinois 1983.

Maciocia, giovanni. The foundations of chinese medicine, churchill livingstone, new york 1989.









Please email questions here.

Copyright (c) 2000 antonia balfour

Condition: irritable bowel syndrome

description:
irritable bowel syndrome (ibs) is a fairly common disorder of the intestines that can range from mildly annoying to severe and disabling. It is typically a chronic condition that comes and goes at different times, disabling the sufferer and then disappearing entirely. According to recent studies, two thirds of its sufferers are women. Today, nearly 20 million women have this condition.

How does irritable bowl syndrome develop?
Modern medical practioners have not been able to identify a reason for its onset, and, thus, have not found a cure. Although research is ongoing, ibs is believed to be the result of an overly sensitive colon. Ibs patients have stomach contractions that are stronger and last longer and than those of non-sufferers. Some doctors believe that the two major causes of ibs are stress and diet. Afflicted individuals often notice the syndrome after meals during times of stress. Stress, which operates through the nervous system, also triggers the colon into action. Others feel that since two thirds of sufferers are women, hormonal changes may play a major role, and that the condition may be more of an emotional or phycholocial problem.

Natural medicine practitioners, on the other hand, agree that ibs is often related to diet, but find that the "leaky gut" at the root this condition can be the result of an excessive use of antibiotics or other medications or an untreated yeast infection, problems that can usually be resolved.

What are the symptoms of irritable bowel syndrome?
Afflicted individuals often describe cramping pains, gaseousness, bloating and irregular bowel action. Ibs can manifest itself in any number of ways including constipation, diarrhea, both, or no bowel movements at all. It can either be painful or painless. If diarrhea is a symptom, it may begin very suddenly and with extreme urgency, typically follows soon after a meal, although it can also occur immediately upon awakening. Diarrhea during the night is rare. Some individuals experience bloating, gas and cramping throughout the lower abdomen. Other symptoms of ibs include nausea, headaches, fatigue, depression, anxiety and difficulty concentrating.

Conventional medical treatments may help relieve the symptoms of irritable bowel syndrome, but they do not address the root of the problem. By assessing the root of the problem, as natural medicine therapies do, irritable bowel syndrome can be alleviated permanently.

Discover why we believe that natural medicine treatments are the best way to treat ibs.


Learn about the treatments for irritable bowel syndrome


this information is provided for informational purposes only. It is essential to have your condition evaluated by your own personal physician. For an appointment with one of the natural medicine specialists at caring medical, please call 708-848-7789.

Treatment of irritable bowel syndrome:


the response of modern medicine
since the cause of irritable bowel syndrome (ibs) appears to be unknown, the modern medical community concedes that there is no standard or consistently effective treatment, and that results vary from individual to individual with those treatments that are tried. In addition to lifestyle modifications such as stress reduction, visualization and biofeedback, medications are usually prescribed, including analgesics, antidepressants, antihistamines, anticholinergics (to slow the bowel spasms) and pain pills. But the success rate at curing ibs with modern pharmaceuticals is modest at best. The problem with all of these approaches is not only that they do nothing to get at the root cause of ibs, and thus ultimately do not alleviate the pain, discomfort and frustration that individuals with this condition experience, but long-term use of certain drugs can lead to additional problems, including addiction.

The natural medicine approach to irritable bowel syndrome
for a person suffering from a chronic condition like irritable bowel syndrome, only natural medicine offers hope for a cure. A natural medicine practitioner will look for the underlying cause of the condition and use a variety of appropriate natural medicine treatments, including natural supplements.

The symptoms of irritable bowel syndrome are very similar to interstitial cystitis. Both conditions involve significant amounts of chronic abdominal pain and can mimic each other with menstral irregularities, painful menstruation, pain on urination, pain with bowel movements, diarrhea, and/or constipation. In the case of ibs, substances that normally pass through the intestines get “soaked up” into the wall of the bowel, leading to irritation and inflammation.

Like all conditions treated by natural medicine, it is important to determine when the condition started. If the ibs began to be symptomatic after a surgical procedure, such as a laparoscopy for endometriosis, then neural therapy, a gentle healing technique developed in germany that involves injecting local anesthetics into autonomic ganglia, peripheral nerves, scars, glands, acupuncture points, trigger points, skin and other tissues, should be considered. Neural therapy would be used to treat the scars from the surgery as well as the pelvic sypathetic ganglion.

If the condition started after a yeast infection, the possiblity of candida lingering in the intestines must be considered and treated if found. Gastrointestinal infections, such as candida, have the potential to damage the lining of the intestines and the bladder. This sets up a condition in which the bowel walls become leaky and irritable, which characterizes ibs.

This concept is important to understand because both the bowel and the bladder are lined with prostaglandins and glycosaminoglycans to protect them from injury. Once these layers are destroyed via infection, medication, or chemicals, there is a greater likelihood that toxic substances will be absorbed into the system. The significant incidence of fibromyalgia in women often results from these “leaky gut” and “leaky bladder” syndromes. Also, because the most common substance in the digestive tract is food, nonabsorbable food substrates now become “absorbable” due to the increase in the intestinal permeability. This causes an immune reaction in the gut-associated lymphatic tissue (galt) and the development of food allergies. As a result, natural medicine physicians commonly check for food allergies in women suffering from ibs and ic. Staying away from the reactive foods gives the bowel and bladder a chance to heal.

Thus, to cure ibs, treatment of candidiasis and other microorganisms may need to be started. Various medications including diflucan, nystatin, lamasil, and nizoral can be prescribed, or aggressive natural nutriceuticals can be given to fight the fungal infection. Generally, acidophilus and bifidobacteria are also used along with substances that help heal the leaky bowel, including glutamine, biotin, gamma oryzanol, tumeric, horsetail, and bladderwack.

In addition, almost all individuals with irritable bowel syndrome, interstitial cystitis, bladder pain or urinary tract pain have urine that is too acidic. Acidic urine can be the result of eating too many carbohydrates, drinking too much coffee or alcohol, or even taking too many rounds of antibiotics.As a result of these observations, natural medicine doctors check the urine ph of patients, and if it is too acidic, will alkalize it by recommending the patient drink lime water and start on natural supplements like potassium citrate and deeper greens. In addition, patients are encouraged to eat fewer simple carbohydrates and replace them with more complex ones such as vegetables. The combination of all these treatments as needed is very effective at helping to cure ibs.

If you are interested in more information about natural medicine treatments, or to schedule an appointment with one of our natural medicine specialists, please contact caring medical at 708-848-7789 or online using our contact form.

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Products:
resources:
articles
hauser diet
interstitial cystitis
yeast infection
what we do for irritable bowel syndrome

the treatment regimens suggested here are based on the experience of the natural medicine specialists at caring medical. They do not apply to every case or condition. A person using these recommendations without the aid of a personal physician does so at their own risk.

I am a 24 year old, fit male who has had similar symptoms for the past 3 years:

- mild to intense pain in upper left abdomen, just behind rib cage
- mild to intense pain on corresponding position in my back
- when intense, pain feels as if it penetrates through my body
- pain comes only during or after sleeping at night
- pain comes generally with gas
- pain intensity may be higher when larger quantity of food is eaten
- stretching and physical activity alleviates the pain more quickly

i have not been to see a doctor about this. From my first experiences with the pain, I associated the pain with lots-o-gas. At the time, I had just moved to guinea, africa, so I associated the increased gas with the change of diet. However, since returning home about 9 months ago, I still have had lots-o-gas, and a couple of nights each week the pain returns. I'm now used to it however, so it doesn't really affect my lifestyle.

After looking through the web pages, I think this may be splenic flexure syndrome. But, I can't be sure, there is hardly any info available on the web.

If anyone has stumbled across an effective treatment, please let us know.

Whirlygirly,

when you find information that you believe is applicable to this forum, please only post the link. All of your lengthy postings make it hard to find useful information on this forum. Most of the info in your postings is irrelevant or only indirectly relevant at best.

Thanks,
misterogers

I'm sorry you feel that way mr.Rogers. I apologize that some of this information may be irrelevant to you and to others (i don't know). Your irrelevance was my two year journey in finding answers. I finally found my answers after two irrelevant years of a long-haul search. I apologize that some of the information is long (and I apologize that it may be irrelevant to you/and I apologize that some of the same information did post over and over which was an accident). I had googled this site while I was going to my doctor to try to find answers. I actually found this site while googling irrelvant key words like "pain under left rib", stomach tenderness and so forth and low and behold--google "irrelvant encylopedia of garbage that I found on it" actually led me to this wonderful forum which I am very glad that I found. After trying to find my own answers to my own "irrelevant" symptoms and going to my doctor "who may have found it irrelevant too" because I had to have many tests to finally get a diagnosis--i researched myself on here to learn more--and wanted to post that information for others to read as well. Many of the postings that I read on here were very similar to mine--having numerous tests done (endoscopy, colonoscopy, ct scans, blood work) and everything was coming back normal. I'm sorry to you if you find my postings mere ramblings of what you consider irrelevance but this is what I was diagnosed with--"ibs" and I was posting what you considered irrelevant for others who have the same pain as i--i'm not sure what your relevance on this site is "you didn't seem to post anything relevant other than telling me not to post as much. I had pain under my left rib, stomach pain, and many of the symptoms others were experiencing. I finally got a diagnosis--and posted a lot of information on ibs to help/guide people into researching more on it themselves or to ask their doctors questions if they might have it, and save them the money, frustration, and the run around they may feel when everything is coming back normal on tests from their doctor.

I apologize for this great annoyance (i'm done posting all of my irrelevant "encylopedic garbage" but this garbage is what I was diagnosed with and I didn't know that much about it--which is why I was going to the gastro doctor, and thinking it was my esophagus or spleen. I don't consider research mere garbage--i found this site very useful and others postings useful in helping me research and understand my problems more. A lot of people who have the very symptoms on here--get sent to the gastro doctor (as my doctor did). In researching ibs, I found out that many people who indeed have ibs spent most of their dollars on gastro doctors,tests, and medicines/prescriptions, antacids--and some even have unneccessary surgery when it is ibs--ibs is long term/not cancerous--and can be with a person the rest of their lives. This, my friend, is not irrelevant---it can affect a person's daily life every single day and that is very relevant (because someone has to live with it and learn how to deal with it). This is a forum/like a support group for people who are going through this every day and seeking answers. I'm sorry if I posted enough to make you so annoyed that you had to take a shot at me that way--but I should never feel bullied through words to stop posting at all on this forum.

I was trying to spread the message of what ibs was and in researching it==i learned a little more about it as well. It is very misunderstood and most of the time people a lot of the symptoms overlap with other problems (ibs is the not just the bowel--its the entire digestive system--colon, intestines, stomach--the pressure on the colon---can place pressure under the ribs/stomach).

Next time instead of writing your critique on what you considered irrelevant on my postings, why don't you share something "relevant" yourself. This isn't a forum to bash other people's postings but to post information that could be useful for others. Why don't you try doing something like that.
Thanks.

Irrelvant information on celiac disease--which plays a role in food sensitivity--which is associated with ibs--i am posting it--its useful to understanding it and reading it.

What is celiac disease?
Celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten, found in wheat, rye, and barley. Gluten is found mainly in foods, but is also found in products we use every day, such as stamp and envelope adhesive, medicines, and vitamins.


Intestine

villi on the lining of the small intestine help absorb nutrients.

When people with celiac disease eat foods or use products containing gluten, their immune system responds by damaging the small intestine. The tiny, fingerlike protrusions lining the small intestine are damaged or destroyed. Called villi, they normally allow nutrients from food to be absorbed into the bloodstream. Without healthy villi, a person becomes malnourished, regardless of the quantity of food eaten.

Because the body's own immune system causes the damage, celiac disease is considered an autoimmune disorder. However, it is also classified as a disease of malabsorption because nutrients are not absorbed. Celiac disease is also known as celiac sprue, nontropical sprue, and gluten-sensitive enteropathy.

Celiac disease is a genetic disease, meaning it runs in families. Sometimes the disease is triggered-or becomes active for the first time-after surgery, pregnancy, childbirth, viral infection, or severe emotional stress.

[top]

what are the symptoms of celiac disease?
Celiac disease affects people differently. Symptoms may occur in the digestive system, or in other parts of the body. For example, one person might have diarrhea and abdominal pain, while another person may be irritable or depressed. In fact, irritability is one of the most common symptoms in children.

Symptoms of celiac disease may include one or more of the following:

gas
recurring abdominal bloating and pain
chronic diarrhea
pale, foul-smelling, or fatty stool
weight loss / weight gain
fatigue
unexplained anemia (a low count of red blood cells causing fatigue)
bone or joint pain
osteoporosis, osteopenia
behavioral changes
tingling numbness in the legs (from nerve damage)
muscle cramps
seizures
missed menstrual periods (often because of excessive weight loss)
infertility, recurrent miscarriage
delayed growth
failure to thrive in infants
pale sores inside the mouth, called aphthous ulcers
tooth discoloration or loss of enamel
itchy skin rash called dermatitis herpetiformis
a person with celiac disease may have no symptoms. People without symptoms are still at risk for the complications of celiac disease, including malnutrition. The lon