# Health Notes from your Family Doctor - IBS



## Jeffrey Roberts (Apr 15, 1987)

Developed by The College of Family Physicians of Canada IRRITABLE BOWEL SYNDROME Tips on controlling your symptoms What is irritable bowel syndrome? Partly digested food normally leaves the stomach and passes into the small intestine and then into the large intestine. The large intestine makes food move with gentle squeezing motions. The large intestine is also called the large bowel or colon. In irritable bowel syndrome (IBS), the intestines squeeze too hard or not hard enough and cause food to move too fast or too slowly through your system. IBS is also called functional bowel syndrome, irritable colon, spastic bowel and spastic colon. It's not the same as inflammatory bowel diseases, like ulcerative colitis. What are the symptoms of IBS? IBS can cause diarrhea, constipation or a mixture of both. It can also cause pain in your abdomen that either comes in short bouts or lasts longer. The pain of IBS may go away when you pass gas or have a bowel movement. Some people may have diarrhea right after they awaken in the morning. Diarrhea may also happen during or right after eating. The symptoms may get worse when you're under stress, such as when you travel, attend social events or change your daily routine. Your symptoms may also get worse if you don't eat properly or after you've eaten a big meal. Women who have IBS may notice symptoms during menstrual periods. Signs of IBS Bloating and gas Constipation Diarrhea Feeling like you still need to have a bowel movement after you've already had one Feeling a strong urge to have a bowel movement Pain and cramping How is IBS diagnosed? Your doctor may start asking you questions about your symptoms. If your symptoms have had a pattern over time, the pattern may make it clear to your doctor that IBS is the cause. If your symptoms have just started, something else may be the cause. Your doctor may need to do some tests to make sure that your symptoms aren't caused by something other than IBS.  How is IBS treated? The best way to handle IBS is to eat a high-fibre diet, avoid foods that seem to make you feel worse and find ways to handle your stress. There are also some new medications which improve IBS symptoms which your doctor may suggest (some examples are Dicetel, Modulon). Why may fibre be helpful? Fibre can be helpful because it improves how the intestines work, whether you have diarrhea, constipation or both. Fibre also may reduce bloating, pain and other symptoms of IBS. It does this by bulking the stools and making them softer. What foods are high in fibre? Fibre is in fruits, vegetables, whole grain breads and cereals. Eating any of these things will add fibre to your diet. You can also add fibre to your diet by eating bran. If you eat bran, start with a small amount, like one teaspoon a day. Slowly increase the amount you eat, up to nine to 12 teaspoons. Increase the fibre in your diet slowly. Some people feel bloated and have gas if they increase how much fibre they eat too quickly. Gas and bloating usually improve as your system gets used to the new amounts of fibre you're eating. When you start eating more fibre, drink more water too. The fibre needs to absorb water to work. It may take a while for you to feel better after you've started eating more fibre. Don't be discouraged if you don't feel better right away. What else can I do to add fibre to my diet? Taking psyllium (a natural vegetable fibre) may also help reduce your symptoms. You can buy psyllium (some examples are Metamucil, Prodiem, Novo-Mucilax, Fibyrax) at the store. Take it with one or two glasses of water. Do certain foods cause IBS? No. Foods don't cause IBS. But some foods may make you feel worse. Keeping a diary of what you eat and what your symptoms are for a few weeks may be a good way to find out if a food bothers you. If you think a food makes you feel worse, try not eating it for awhile. But don't cut out foods unless they have caused you problems more than once. Some people with IBS avoid foods that they don't really need to avoid. This can hurt more than help because it reduces the variety of food you eat. What foods may make symptoms worse? Foods that may make symptoms worse include foods that are high in fat or caffeine. Fat and caffeine can cause your intestines to contract or spasm, which may cause cramping. Foods that contain sorbitol (an artificial sweetener often used in sugar-free candy and gum) can cause diarrhea. Antacid tablets that contain magnesium can also cause diarrhea. If gas is a problem for you, you might want to avoid foods that tend to make gas worse. These include beans, cabbage, some fruits, and sodas. You also may want to avoid apple juice and grape juice, and you may want to eat fewer bananas, nuts and raisins. If you have pain after eating, you might want to try a low-fat diet with extra protein. What about milk and milk products? If milk and other dairy products bother you, you may have lactose intolerance. Lactose intolerance means that your body  can't digest the sugar in milk. This is called lactose. Dairy products may seem to make IBS symptoms worse if you're lactose intolerant. If this seems to be the case, you may need to limit the amount of milk and milk products in your diet. You may also try taking lactase (which helps you digest lactose) in a pill or liquid. You can buy lactase (an example is Lactaid) at the store. Talk to your family doctor if you think you have trouble digesting dairy products. If you must avoid dairy products, eat lots of dark green leafy vegetables or take a calcium pill to get enough calcium. Getting enough calcium is especially important for teens and women. How can I deal with stress? Talk to your family doctor about ways to deal with stress, such as exercise, relaxation training or meditation. He or she may have some suggestions or may refer you to someone who can give you some ideas. Your doctor may also suggest that you talk to a counselor about things that are bothering you. Can my doctor prescribe other treatments for IBS? Generally, medicines aren't given to prevent IBS because you'll have to deal with IBS throughout your life. But if you're having a bad attack, your doctor may prescribe medicine depending on your main symptom. For example, antispasmodic medicines are often prescribed to reduce cramping if your main symptom is pain. When diarrhea is a frequent problem, medicine such as loperamide (an example is Imodium) may be helpful. Tranquilizers or sedatives can be given for short periods to treat anxiety that may be making your symptoms worse. Your doctor may prescribe an antidepressant for you if your symptoms are severe and you can't find relief and are feeling depressed. Antidepressants have been helpful in improving the symptoms of IBS, as well as the depressed mood that some people have along with IBS. Some antidepressants are actually good for treating pain and may be helpful even if you are not depressed. Tips on controlling IBS Eat a varied diet. Drink plenty of water. Avoid foods that are high in fat. Try eating six small meals a day rather than three larger ones. Learn new and better ways to deal with your stress. Avoid using laxatives. You may become dependent on them and your intestines may become weakened. Will IBS get worse over time? No. While IBS will probably recur throughout your life, it won't get worse. It doesn't cause cancer or require surgery, and it won't shorten your life. What if IBS interferes with my daily activities? IBS may have caused you to avoid doing certain things, like going out or going to work or school. While it may take some time for your efforts to pay off, you may find new freedom by following a plan that includes a healthy diet, learning new ways to deal with your stress and avoiding foods that may make symptoms worse. The College of Family Physicians of Canada This information provides a general overview on this topic and may not apply to everyone. To find out if this information applies to you and to get more information on this subject, talk to your family doctor. This health education material has been favorably reviewed by the Patient Education Review Committee of the College of Family Physicians of Canada.







The College of Family Physicians of Canada, one of the nation's largest medical specialty groups, is committed to promoting and maintaining high standards for family doctors the doctors who give ongoing, comprehensive care to people of all ages. This patient education information was developed by The College of Family Physicians of Canada in cooperation with the American Academy of Family Physicians.


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## JeanG (Oct 20, 1999)

Great article, Jeff!







JeanG


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