Irritable Bowel Syndrome

Irritable bowel syndrome isn't a disease. Rather, it's a collection of persistent, distressing gastrointestinal symptoms: abdominal cramps, bloating, flatulence, and diarrhea or constipation.

When you have irritable bowel syndrome (IBS), you feel as though your gastrointestinal tract is out of control, according to Anne Simons, M.D. It's not only uncomfortable but also unnerving because you never know when symptoms are going to strike.

If you have IBS, you probably first experienced symptoms in your late teens or twenties. And you probably are a woman: An estimated two-thirds of people with IBS are female. The condition seems more common among Whites than among non-Whites.

Doctors describe IBS as a functional problem, a glitch in how your colon works. The muscles that surround your colon contract in waves to move solid wastes into your rectum. These contractions, called peristalsis, are supposed to be gentle and hardly noticeable. But in IBS, they become irregular, poorly coordinated, and at times unusually forceful or lethargic. The result? Pain, cramping, diarrhea, constipation, and other IBS symptoms.

While no one knows exactly what causes IBS, there is evidence that stress aggravates the condition. Your gastrointestinal tract has some 100 million nerve cells-more than even your spinal cord. When you're under stress, these nerve cells become irritated, which can disrupt gastrointestinal function-especially in those with IBS.

For some people, the link between stress and IBS becomes a vicious circle. "Your IBS symptoms may make you anxious because they're painful and unpredictable," explains Alan P. Brauer, M.D. "But your anxiety only aggravates your symptoms because your gastrointestinal tract is so sensitive to stress." This is why stress management plays such an important role in controlling IBS symptoms.

While IBS is persistent, it doesn't steadily worsen over time, says William E. Whitehead, Ph.D., professor of medical psychology at Johns Hopkins University School of Medicine in Baltimore. Nor does it predispose you to other diseases. In one long-term study of 112 people with IBS, only 10 developed other gastrointestinal conditions over a period of 30 years.

If you've been experiencing persistent gastrointestinal distress, you should see your doctor for a proper diagnosis. If you're told that you have IBS, you can use the following remedies to minimize your symptoms.

Best Choices

Nutrition

Eat smaller meals more often. Instead of the standard three squares a day, try eating four or five smaller, snack-size meals. That way, your digestive system won't have to work so hard to process so much food.

Take your time to dine. Make your mealtimes as relaxed as possible. Eat slowly and chew your food thoroughly. Stay focused on your meal-don't read the newspaper, watch TV, or answer the phone.

Eschew fat. In one study, researchers fed a high-fat meal to 16 people who had IBS and to 8 people who didn't. The fatty food caused colon spasms in those with IBS, especially in those whose primary symptom was diarrhea.

Gradually add fiber. Gastroenterologists agree that eating more fiber can help relieve IBS. But you need to add fiber slowly so that your digestive system has time to adjust. Write down how many servings of high-fiber foods-whole grains, beans, fruits, and vegetables-you eat each day for lor 2 weeks. Then add one or two servings a week until you're eating seven to nine servings a day.

Banish bran. One high-fiber food that you may want to avoid is wheat bran. For people with IBS, wheat bran may provide too much of a good thing. Researchers recommend getting fiber from other foods.

Be smart about sugar. At least one study suggests that sugar may raise the risk of IBS symptoms. In the study, researchers had two groups of volunteers follow the same diet for 2 weeks. In addition, one group ate 4 ounces of sugar a day. Among those who ate the sugar, both peristalsis and intestinal gas formation increased significantly.

Avoid other irritants. Anything that irritates your gastrointestinal tract can aggravate your IBS symptoms, says G. Nicholas Verne, M.D., assistant professor of medicine in the division of gastroenterology and hepatology at the Medical University of South Carolina College of Medicine in Charleston. So steer clear of carbonated and caffeinated beverages as well as foods made with the artificial sweetener sorbitol. If you're lactoseintolerant, eliminate milk and other dairy products.

Elimination Diet

Ferret out offending foods. If your IBS symptoms tend to flare up after you eat, they may be triggered by certain foods. To identify the offenders, try following an elimination diet with the guidance of your doctor.

For one study, 113 people with IBS went on a strict elimination diet. Within 3 to 6 weeks, they were able to identify their problem foods. Then they resumed their normal eating habits, minus the foods to which they were sensitive. Over the next year, 88 percent reported less bloating, 85 percent experienced less diarrhea, and 65 percent had less constipation.

Relaxation Therapies

Learn to destress. Researchers at the Center for Stress and Anxiety Disorders at the State University of New York at Albany trained 19 people with IBS in progressive muscle relaxation and biofeedback. The participants also received IBS education. Four years later, 90 percent of those in the program saw more than 50 percent improvement in their symptoms.

According to Dr. Whitehead, any relaxation therapy can calm your gastrointestinal tract and help relieve IBS symptoms. If progressive muscle relaxation and biofeedback don't appeal to you, try deep breathing, massage, aromatherapy, tai chi, or yoga.

Meditation

Use your mind to master your symptoms. At the University Hospital of Wales in Cardiff, researchers divided 35 people with IBS into two groups. One took antispasmodic drugs to control IBS symptoms. The other enrolled in a class that provided IBS education and training in a meditation-based relaxation routine. Among those who took medication, few experienced any improvement in their symptoms. But two-thirds of the meditators reported that their symptoms had gotten better.

Visualization

Envision your abdomen at ease. If you want to try visualization, here's an exercise from Gerald N. Epstein, M.D., director of the Academy of Integrative Medicine and Mental Imagery in New York City: Begin by closing your eyes. Slowly inhale and exhale three times. As you continue this slow, relaxed breathing, imagine a mermaid with flowing golden hair and a sleek, silvery body and tail. She's swimming rhythmically through your digestive tract, which is calm. Sense her there. Have her swim to any places where you feel pain, cramping, or any other symptoms. Have her touch those areas, gently massaging them until they are healed and you no longer feel discomfort. Then have her complete her swim through your gastrointestinal tract to ensure that everything is in order. When your mermaid is finished, open your eyes. Do this exercise twice a day, morning and evening.

Herbal Medicine

Partake of peppermint. The use of peppermint as a digestive soother dates back to ancient times. Modern research has shown that the herb's oil relaxes the smooth muscle tissue throughout the gastrointestinal tract. This reduces colon spasms, a key component of IBS.

Take one or two enteric-coated peppermint-oil capsules after every meal, recommends Joseph PizzornoJr., N.D. If you can't find entericcoated capsules in a health food store, consult a naturopathic physician.

Take fiber by the spoonful. If you have trouble eating enough fiber-rich foods, James A. Duke, Ph.D., suggests using psyllium seed as a fiber supplement. "Psyllium is a great source of fiber that helps treat the diarrhea and constipation of an irritable bowel," he says. You can find psyllium seed in most health food stores. Take up to 3 tablespoons a day, mixing each dose into 8 ounces of water or juice.

Homeopathy

Assuage your symptoms with Asafoetida. German researchers gave people with IBS either a homeopathic preparation of asafoetida, an Ayurvedic herb, or a placebo. Those who took the homeopathic preparation experienced significantly greater relief from their symptoms.

Asafoetida doesn't work for everyone with IBS, says homeopath Dana Ullman. "Because IBS symptoms vary, you need to consult a homeopath to get the right medicine," he explains. Other medicines that may help include Argentum nitricum, Arsenicum album, and Mercurius.

Chinese Medicine

Harmonize your Spleen and Stomach. Practitioners of Chinese medicine attribute IBS to an imbalance in the Spleen and Stomach organ networks. "The first thing to consider is food sensitivities-lactose intolerance or problems digesting wheat or other grains," says Efrem Komgold, O.M.D., L.Ac. "They're best treated by avoidance."

In addition, Dr. Korngold often treats IBS with prescribed Chinese medicines called Curing Pills and Shen Qu Chao Curing Pills contain a combination of 15 herbs, including atractylodes, poria fungus, and medicated leven (a combination of fermented barley, wheat, and rice sprouts). Shen Qu Cha is a hard square cake that is simmered in hot water and taken as a tea. It consists primarily of medicated leven, with other herbs that help normalize digestion.

Get relief point by point. Dr. Komgold recommends acupuncture as a treatment for IBS. Which points are stimulated depends on your specific symptoms. For treatment, you need to consult a professional acupuncturist.

Other Good Choices

Supplements

Beat IBS with bacteria. Often people with IBS have unusually low levels of beneficial (pro biotic) bacteria in their colons, Dr. Pizzomo says. To correct this problem, he recommends taking 1 teaspoon of supplemental Lactobacillus acidophilus every day.

You can also get L. acidophilus by eating yogurt that contains live bacterial cultures (the label should say so). If you have any serious gastrointestinal problems that require medical attention, check with your doctor before taking L. acidophilus supplements.

Medical Measures

A growing number of mainstream M.D.'s are recommending dietary changes and relaxation therapies as treatments for IBS. They also prescribe various drugs, including antidiarrheals such as loperamide (Imodium), antispasmodics such as dicyclomine (Di-Spaz), and, in severe cases, anti­depressants.

Red Flags

If you experience any of the following, see your doctor right away.

• You pass black or bloody stools.
• Your abdominal pain becomes more severe or changes from periodic to constant.
• Your abdominal pain is accompanied by fever or vomiting.
• Your symptoms don't noticeably improve after 2 weeks of self-care.