DEAR MAYO CLINIC: I was diagnosed with irritable bowel syndrome and my primary care doctor recommended that I manage the condition without medication. Is that typical or will I also need medication to control my symptoms?
ANSWER: As with many things, managing a health condition is often personal.Not everyone with irritable bowel syndrome (IBS) needs medication. Particularly if you are someone who has mild symptoms, lifestyle adjustments like diet modification, stress management, and regular exercise can sufficiently improve symptoms. However, for those with moderate to severe symptoms, medications may be needed when lifestyle changes fail to provide adequate improvement of symptoms.
The walls of the intestines are lined with layers of muscle that contract and relax in a coordinated rhythm as they move food through the digestive tract. In addition, there is a vast network of nerves that control movement of the digestive tract, but also send sensory signals to the brain, which can be interpreted as pain or discomfort. It is believed that when the communication between the brain and the digestive tract becomes altered, irritable bowel syndrome develops. This can lead to sensations of abdominal cramping and pain, due to heightened nerve sensitivity, as food, gas or stool passes through the intestines. Irritable bowel syndrome also is associated with bowel irregularity, such as diarrhea or constipation, due to alterations in motility (movement of the digestive tract).
For those suspected of having irritable bowel syndrome, it is important to be aware that some abdominal symptoms are not associated with this disorder and could signal another underlying problem. In particular, symptoms that require prompt medical attention include: blood in the stool, unexplained or rapid weight loss, unrelenting or severe abdominal pain, unexplained vomiting, significant pain with or difficulty swallowing, or an abdominal mass or lump.
Irritable bowel syndrome is a chronic condition, and symptoms can wax and wane over time. There’s no cure, but symptoms often can be eased with diet, lifestyle and stress management.
More than 60% of people who have irritable bowel syndrome say their symptoms are connected to food in some way. However, because symptoms vary significantly from one person to another, it’s difficult to give specific dietary advice that works for everyone with this disorder.
In general, however, eating high-fiber foods (particularly soluble fiber, such as psyllium husk) and drinking plenty of fluids are beneficial for many people with irritable bowel syndrome. It is best to avoid foods and beverages that contribute to gas and bloating. Carbonated and alcoholic beverages; caffeine; raw fruit; and vegetables such as cabbage, broccoli and cauliflower, should be avoided. Reducing or eliminating gluten may also ease diarrhea in some patients with irritable bowel syndrome..
Research has shown that certain carbohydrates known as fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) can lead to abdominal pain, bloating and gas in people with irritable bowel syndrome. These are found in certain fruits and vegetables; wheat; rye; legumes; foods that contain lactose, such as milk, cheese and yogurt; and artificial sweeteners.
Following a diet low in FODMAPs can ease symptoms of irritable bowel syndrome. But because so many foods contain these compounds, it can be difficult for patients to create such a diet on their own, as the initial phase of the diet can be quite restrictive, and it is important to re-introduce foods in a systematic manner. Finding a dietitian familiar with irritable bowel syndrome can help. A dietitian can review a patient’s symptoms and dietary needs, discuss recommended changes and develop an individualized food plan to ease symptoms.
Stress also affects irritable bowel syndrome, with episodes of higher stress associated with an increase in symptoms. Using stress reduction techniques and participating in activities that relieve stress, such as yoga and meditation, may decrease stress-related flare-ups. Working with a therapist or counselor experienced in stress management, mindfulness and behavior modification also may help those with irritable bowel syndrome better control stress and thereby ease symptoms.
Regular exercise is recommended for people who have irritable bowel syndrome. Daily physical activity relieves stress, stimulates normal contractions of the intestines and promotes overall wellness.
If lifestyle changes alone aren’t enough to keep irritable bowel syndrome from disrupting daily life, talk to your health care provider about medication options. A wide variety of prescription and nonprescription medications are available to treat irritable bowel syndrome. — Dr. David J. Cangemi, Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida