If you're among the estimated one in six American adults who suffers from chronic abdominal pain or discomfort due to irritable bowel syndrome (IBS), you know that effective, long-lasting treatment remains elusive.
Good news: The American College of Gastroenterology recently published a review of the most effective treatments, including dietary approaches, non-drug therapies and medications, that should finally give relief to people with IBS.
Do You Have IBS?
With IBS, the nerves that control the gastrointestinal tract are hypersensitive—that is, sensations that other people wouldn't notice, including those produced by the ordinary process of digestion, are amplified and often painful.
Research has shown that many times IBS begins after a severe bout of digestive upset caused by a bacterial or viral infection, such as "stomach flu" or "traveler's diarrhea"-perhaps because such infections temporarily or permanently affect nerves in the gastrointestinal tract.
What most people don't know: Researchers have found that people with a history of abuse (physical, emotional or sexual) are at heightened risk for IBS-probably due to stress on the intestinal nervous system.
Diagnosis of IBS can be tricky because symptoms, including abdominal pain, bloating and troublesome bowel patterns (frequent or persistent bouts of diarrhea, constipation or both, generally occurring at least three days a month), often wax and wane in severity. So-called "flares" (episodes of severe symptoms) may occur weeks, months—or even years—apart.
IBS symptoms that may be missed: Mucus in the stool or straining during, or a feeling of incomplete evacuation after, a bowel movement.
If you think you may have IBS: See your primary care doctor. IBS almost always can be identified with a standard history and physical exam.
When Food Is The Trigger
Lactose intolerance (the inability to digest dairy sugar) can lead to misdiagnosis because its classic symptoms—bloating and diarrhea—mimic those caused by IBS.
My advice: If your digestive problems seem to worsen when you consume dairy products, follow an elimination diet.
What to do: Go without all dairy products for seven to 10 days—and slowly reintroduce each type of dairy product, such as yogurt or cheese, to see how much you can tolerate before symptoms return.
IBS food triggers that often are overlooked—try the elimination diet as described above) with each...
- Soft drinks and other high-fructose drinks and foods. Fructose—a sugar commonly added to carbonated soft drinks and sports drinks and naturally occurring in fruit juices and high-sugar fruits (such as dried fruits) ---can cause bloating, gas and diarrhea in people with IBS.
- Caffeine. It stimulates the digestive tract and may cause cramps and more frequent bowel movements in people with IBS.
The Fiber Factor
For many people with IBS-especially those with recurrent constipation-adequate fiber intake (25 milligrams (mgl to 30 mg per day) helps relieve symptoms. If you are not consuming this much fiber, increase your intake of fruits and whole grains or take a fiber supplement containing psyllium (such as Metamucil or Konsyl).
Fiber-rich foods I recommend most often: Raspberries, artichokes, green peas, almonds, Oatmeal, oat bran and whole-grain bread.
Important: IBS patients who have recurrent diarrhea should limit fiber intake to about 10 grams daily and avoid leafy greens and cruciferous vegetables (such as cauliflower) because high-fiber foods can worsen symptoms in these patients.
Best Alternative Approaches
If dietary changes (described above) do not relieve IBS symptoms, there is credible scientific evidence to support the use of two natural remedies for IBS...
- Peppermint oil. In enteric-coated capsule form, peppermint oil appears to relax smooth muscle in the gastrointestinal tract and therefore reduce IBS abdominal pain caused by muscle spasms. For dosage, follow label instructions.
- Probiotics. Probiotics augment the "friendly" bacteria in the large intestine. Probiotic dietary supplements containing the Bifidobacterium species are worth trying when bloating and diarrhea are prominent. Look for probiotic supplements providing at least 100 million colony-forming units per dose. Be patient—it may take up to three months to produce substantial benefits.
Best IBS Medications
If your IBS persists, there are medication options for…
- Diarrhea. Try an antidiarrheal medication, such as the over-the-counter OTC) product loperamide (Imodium) or the prescription drug dipbenoxylate and atropine (Lomotil). For diarrhea and abdominal pain, consider adding a low-dose of a tricyclic antidepressant, such as imipramine (Tofranil) or amitriptyline (Elavil. These antidepressants may affect how the brain interprets pain.
- Pain and bloating. A tricyclic antidepressant often reduces discomfort and other symptoms, including diarrhea, pain and bloating, to a tolerable level. If the drug causes side effects, such as dry mouth or dizziness, a selective serotonin reuptake inhibitor (SSRI), such as citalopram (Celexa) or fluoxetine (Prozac), can be used, but there is less proof that SSRIs are effective for IBS symptoms.
- Constipation. If you're consuming adequate levels of fiber (described earlier) but still have constipation, you may want to try an OTC laxative, such as polyethylene glycol (Miralax) or Milk of Magnesia for seven to 14 days. (See your doctor if symptoms persist after that trial period.) For more extended periods of treatment, the prescription medication lubiprostone (Amitiza) has been shown to be effective for IBS with constipation.
Click Your Way to a Great Night's Sleep
For five weeks, 118 adults with chronic T insomnia received either no treatment or online cognitive behavioral therapy (CBT), which included multiple strategies, such as modifying anxiety-provoking thoughts about sleep.
Result: 81% of the CBT participants reported at least mild improvement in sleep, and 35% of participants rated their insomnia as much or very much improved.
Theory: CBT teaches strategies for coping with worries and an overactive mind.
If you suffer from chronic insomnia: Ask your doctor about CBT. Online insomnia treatment is available at http://healtbcoachmyselfhelp.com for $20 a month. Click on "Sleep better."
Better Sleep, Better Marriage
When 29 couples were tracked for seven days, the women's negative feelings about interactions with their partners during the day were associated with poor sleep that night for themselves and their partners. For men, poor sleep was associated with negative feelings about interactions with their partners the next day.
Theory: Daytime interactions both affect and are affected by-sleep quality.
Self-defense: Avoid disputes on days when you or your partner have not slept well the night before.
Breaking Up Is Hard On Your Health
Compared with married people, middle-aged divorced or widowed people had 20% more chronic health conditions (including heart disease, diabetes and cancer)...those who had divorced and remarried had 12% more chronic conditions.
Implication: Some health problems may reflect stressors, such as a divorce or death of a spouse.
Kiss to Lower Stress
When couples kiss, it sets off a multitude of W chemical reactions, including a reduction in levels of the stress hormone cortisol.
Also effective: Holding hands while talking together.