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Irritable bowel syndrome

Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine (colon). Irritable bowel syndrome commonly causes cramping, abdominal pain, bloating, gas, diarrhea and constipation. IBS is a chronic condition that you will need to manage long term.

Even though signs and symptoms are uncomfortable, IBS — unlike ulcerative colitis and Crohn's disease, which are forms of inflammatory bowel disease — doesn't cause changes in bowel tissue or increase your risk of colorectal cancer.

Only a small number of people with irritable bowel syndrome have severe signs and symptoms. Some people can control their symptoms by managing diet, lifestyle and stress. Others will need medication and counseling.

Symptoms Causes Risk factors Complications Prevention

The signs and symptoms of irritable bowel syndrome can vary widely from person to person and often resemble those of other diseases. Among the most common are:

  • Abdominal pain or cramping
  • A bloated feeling
  • Gas
  • Diarrhea or constipation — sometimes alternating bouts of constipation and diarrhea
  • Mucus in the stool

For most people, IBS is a chronic condition, although there will likely be times when the signs and symptoms are worse and times when they improve or even disappear completely.

When to see a doctor

Although as many as 1 in 5 American adults has signs and symptoms of irritable bowel syndrome, fewer than 1 in 5 who have symptoms seek medical help. Yet it's important to see your doctor if you have a persistent change in bowel habits or if you have any other signs or symptoms of IBS because these may indicate a more serious condition, such as colon cancer.

Symptoms that may indicate a more serious condition include:

  • Rectal bleeding
  • Abdominal pain that progresses or occurs at night
  • Weight loss

Your doctor may be able to help you find ways to relieve symptoms as well as rule out colon conditions, such as inflammatory bowel disease and colon cancer. Your doctor can also help you avoid possible complications from problems such as chronic diarrhea.

It's not known exactly what causes irritable bowel syndrome, but a variety of factors play a role. The walls of the intestines are lined with layers of muscle that contract and relax in a coordinated rhythm as they move food from your stomach through your intestinal tract to your rectum. If you have irritable bowel syndrome, the contractions may be stronger and last longer than normal, causing gas, bloating and diarrhea. Or the opposite may occur, with weak intestinal contractions slowing food passage and leading to hard, dry stools.

Abnormalities in your gastrointestinal nervous system also may play a role, causing you to experience greater than normal discomfort when your abdomen stretches from gas or stool. Poorly coordinated signals between the brain and the intestines can make your body overreact to the changes that normally occur in the digestive process. This overreaction can cause pain, diarrhea or constipation.

Triggers vary from person to person

Stimuli that don't bother other people can trigger symptoms in people with IBS — but not all people with the condition react to the same stimuli. Common triggers include:

  • Foods. The role of food allergy or intolerance in irritable bowel syndrome is not yet clearly understood, but many people have more severe symptoms when they eat certain things. A wide range of foods has been implicated — chocolate, spices, fats, fruits, beans, cabbage, cauliflower, broccoli, milk, carbonated beverages and alcohol to name a few.
  • Stress. Most people with IBS find that their signs and symptoms are worse or more frequent during periods of increased stress, such as finals week or the first weeks on a new job. But while stress may aggravate symptoms, it doesn't cause them.
  • Hormones. Because women are twice as likely to have IBS, researchers believe that hormonal changes play a role in this condition. Many women find that signs and symptoms are worse during or around their menstrual periods.
  • Other illnesses. Sometimes another illness, such as an acute episode of infectious diarrhea (gastroenteritis) or too many bacteria in the intestines (bacterial overgrowth), can trigger IBS.

Many people have occasional signs and symptoms of irritable bowel syndrome, but you're more likely to have IBS if you:

  • Are young. IBS tends to occur in people under age 45.
  • Are female. Overall, about twice as many women as men have the condition.
  • Have a family history of IBS. Studies suggest that people who have a family member with IBS may be at increased risk of the condition.
  • Have a mental health problem. Anxiety, depression, a personality disorder and a history of childhood sexual abuse are risk factors. For women, domestic abuse may be a risk factor as well.

The influence of family history on IBS risk may be related to genes, shared factors in a family's environment or both.

Diarrhea and constipation, both signs of irritable bowel syndrome, can aggravate hemorrhoids. In addition, if you avoid certain foods, you may not get enough of the nutrients you need, leading to malnourishment.

But the condition's impact on your overall quality of life may be the most significant complication. These effects of IBS may cause you to feel you're not living life to the fullest, leading to discouragement or depression.

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 more often and be more severe. Finding ways to deal with stress may help prevent or ease symptoms:

  • Counseling. In some cases, a psychologist or psychiatrist can help you learn to reduce stress by looking at how you respond to events 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.
  • 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 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. When you exhale, your belly naturally contracts. Deep breathing can also help relax your abdominal muscles, which may lead to more-normal bowel activity.
  • Mindfulness training. This stress-reduction technique helps you focus on being in the moment and letting go of worries and distractions.
  • 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.
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