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Irritable bowel syndrome (IBS) is a term used to describe discomfort in the bowel (the colon, or large intestine). Symptoms of IBS may include crampy pain, bloating, gas, mucus in the stool, and changes in bowel habits. Some people with IBS have constipation infrequent stools that may be hard, dry and painful. Others have diarrhea frequent loose stools. Some people having alternating constipation and diarrhea. Sometimes a person with IBS has a crampy urge to move the bowels but cannot do so.
You may have heard IBS referred to as "spastic colon" or "spastic bowel." Sometimes IBS is confused with inflammatory bowel diseases such as ulcerative colitis. But IBS is not a disease and does not cause inflammation, bleeding, damage to the bowel, or cancer or other serious diseases. It is called a functional disorder, which means that there is no sign of disease when the colon is examined, but the bowel doesn't work as it should. The cause of IBS is not known, and as yet there is no cure.
Often IBS is just a mild annoyance, but for some people it can be disabling. They may be unable to go to social events, to go out to a job, or to travel even short distances. Most people with IBS, however, are able to control their symptoms through diet, stress management, and medicines.
IBS is a common problem, affecting up to one in five people. However, estimates of the number of people with IBS vary. The majority of people with IBS (perhaps 75 percent) are women. IBS often begins in the teen years or young adulthood but can affect people of any age.
Symptoms of IBS may include:
The colon or large intestine is a muscular tube about 6 feet long. It connects the small intestine with the rectum and anus.
The colon absorbs water and salts from digested food after it has traveled from the stomach through the small intestine. The muscles of the colon contract (tighten or squeeze) and gradually move the material toward the rectum. Strong contractions then lead to a bowel movement. Colon contractions are controlled by nerves, hormones, and by electrical activity in the muscles.
Researchers have found that, for unknown reasons, the colons of people with IBS are more sensitive than usual, and react to things that would not bother other people. For example, the muscles may contract too much after eating. These contractions can cause cramping and diarrhea during or shortly after a meal. The nerves can be overly sensitive to the stretching of the bowel (because of gas, for example), causing cramping or pain. Diet and stress play a role in IBS for many people, causing symptoms or making them worse.
In women, IBS symptoms may be worse during their menstrual periods, so hormone changes may be involved. Sometimes IBS symptoms appear after another illness.
IBS usually is diagnosed after bowel disease has been ruled out. Your doctor will probably take a complete medical history, do a physical exam, and check for blood in your stool. Other diagnostic tests such as blood tests, x-rays or a colonoscopy (viewing the colon through a flexible tube inserted through the anus) may be done if needed.
In people with IBS, diet and stress often seem to cause symptoms. Many people report that their symptoms occur after a meal or when they are under stress. No one is sure why this happens, but scientists have some clues.
Eating causes contractions or spasms of the colon. Normally, this response may cause an urge to have a bowel movement within 30 to 60 minutes after a meal. In people with IBS, the urge may come sooner with cramps and diarrhea. Contractions may be stronger after a large meal or a meal with a lot of fat in it. Many people with IBS learn to avoid certain foods, beverages, and medicines that seem to make their symptoms worse.
Stress can cause contractions of the colon in people with IBS. The reasons for this are not clear, but scientists point out that the colon is controlled partly by the nervous system. Learning relaxation methods and other ways to reduce stress can be helpful. Counseling and support help relieve IBS symptoms in many people.
Some foods that may cause symptoms include:
You may want to keep a journal keeping track of the foods that seem to cause trouble. If certain foods cause your symptoms to flare up, you can try eating less of those foods. Discuss your findings with your doctor. You also may want to consult a registered dietitian, who can help you make changes in your diet.
Drinking lots of water and increasing your fiber intake may help, especially if constipation is a problem. Fiber is found in bran, bread, cereal, beans, fruits, and vegetables. It's a good idea to increase the fiber in your diet gradually to avoid causing gas and pain. Many people with IBS also use a fiber supplement to add soluble fiber, often from psyllium seeds, to the diet.
Regular exercise can help with constipation and improve your health in other ways. Look into support groups, stress reduction methods or counseling if you think they might be helpful. Be careful about using laxatives, anti-diarrhea or other over-the-counter medicines to treat yourself. They can cause problems if misused. Other kinds of medicines sometimes make IBS symptoms worse, too.
Medicines sometimes used for IBS symptoms include:
Be sure to follow your doctor's instructions for use of all medicines. Some medicines including laxatives can be habit-forming, and all drugs have side effects. Tell your doctor about any over-the-counter medicines that you use. New drugs are being developed for IBS ask your doctor about new treatment options.
Inflammatory bowel disease (IBD) is a
chronic disorder that causes an inflamed and swollen digestive tract
or intestinal wall. When the digestive tract becomes inflamed or swollen with IBD, sores (ulcers)
form and bleed. This in turn, can cause abdominal pain, watery
diarrhea, blood in the stool,
fatigue, reduced appetite, weight loss, or fever. The two most common forms of IBD are
ulcerative colitis (UC) and Crohn's disease (CD).
A healthy digestive system removes nutrients from food so they can be absorbed into the bloodstream. It then stores the unwanted waste until it passes out of the body. Food moves from the esophagus to the small intestine, where the nutrients are absorbed. The leftover water and waste move to the large intestine (colon), then through the rectum and out the anus.
IBD affects millions of people throughout the world, but is more common in people who live in regions farther away from the equator (like North America, Europe, and Australia). Estimates from 1994 show 1 million cases in the United States alone. The disease most often develops during the second and third decades of life in both men and women. The average age of diagnosis is 27. A second, but much smaller, peak of new cases occur in people after age 65. Overall, women and men are equally affected by IBD. In the past, whites have been shown to have the highest risk for the disease, especially people of Jewish and European descent.
The most recent data shows that rates of IBD are similar in whites and Americans of African descent, but the disease is rare in Africa itself, which points to the role of the environment. Some of the environmental factors linked to IBD are a lifestyle with little activity, higher socioeconomic status, and living in a more developed country.
Besides the environment, IBD can also run in families. About 15 to 30 percent of people with IBD have a relative with the disease. Studies are looking at whether a certain gene or group of genes makes a person more likely to get IBD. In 2001, the first gene for CD was found. An abnormal form of the gene known as Nod2 occurs twice as often in persons with CD as in the general population. In the abnormal form of this gene, some of the body's power to fight bacteria is missing, and it has been known for a long time that there is a link between bacteria in the gut and CD.
Stress does not cause IBD. As with other illnesses though, stress can worsen the symptoms of IBD. There also is no known link between eating certain kinds of foods and getting IBD, but changing your diet can help reduce symptoms and replace lost nutrients.
Ulcerative colitis (UC) causes inflammation and sores called ulcers in the top layers of the inner lining of the large intestine (colon) or rectum. It most often occurs in the lower part of the colon and rectum, but may affect the whole colon. When it is located only in the rectum, it is called proctitis. It most often occurs in young people between the ages of 15 and 40.
The most common symptom is diarrhea because the inflammation keeps water from being absorbed into the bloodstream and makes the colon empty often. Inflammation also kills healthy colon lining cells, which causes ulcers to form and bleed, and make pus and mucus. Other symptoms include bloody diarrhea, severe abdominal cramps, nausea, and frequent fever. Most people with UC have times when they feel well (remission) and times when they feel sick (relapse). About half of the people with UC only have mild symptoms. In severe cases, people can become malnourished and may need to have a special diet or be fed fluids through a vein.
UC also can cause problems like arthritis, inflammation in the eye, liver disease, skin rashes, anemia, and kidney stones. No one knows why these problems occur outside of the colon. They may occur when the immune system triggers inflammation in other parts of the body. These problems are usually mild and go away when the colitis is treated. Osteoporosis can occur due to low Calcium and vitamin D intake through dairy products, poor absorption of nutrients in the body, inflammation, and use of corticosteroids (for treatment of UC).
In order to find out if you have UC, your doctor will examine you and may order blood tests or samples of a bowel movement to check for blood or germs. She also may give you a barium enema, which is an x-ray of the colon, or a flexible sigmoidoscopy or colonoscopy, screening tests that allow the doctor to see the inside lining of the colon.
Disease UC CD
Symptoms Diarrhea Diarrhea
Bloody Diarrhea Rectal bleeding
Pus or mucus in the stool Weight loss
Severe abdominal cramps Pain & tenderness in abdomen, especially the lower right side
Nausea Low-grade fever
Frequent fever Anemia
Sometimes constipation because of a blockage
Slowed growth and delayed sexual development in some childhood cases
Parts of
digestive system Only the top layers of the Deep in the lining of the walls of the colon
affected walls of the colon or rectum and/or small intestine; any part of the digestive
(most often in the lower part tract from mouth to anus
of the colon and rectum)
Crohn's disease (CD) most commonly causes inflammation deep in the lining of the walls of the large intestine (colon) and/or the small intestine, but also can affect any part of the digestive tract from the mouth to the anus. Sometimes CD can affect other parts of the upper digestive tract with ulcers forming in the stomach, upper small intestine, or the esophagus. About one-third of cases of CD affect the small bowel, usually involving the ileum (the last portion of the small intestine that connects to the large intestine or colon). Nearly half of all cases involve both small and large bowel. About 20 percent of cases are in the colon alone. Lesions near the anus occur in about one-quarter to one-third of persons with CD but are rarely the only sole site of CD. Like UC, CD also is an illness that brings periods of remission and relapse.
The earliest most common symptoms are pain in the abdomen, especially the lower right side, tenderness, and often diarrhea. Constipation, weight loss, rectal bleeding, and low-grade fever also may occur. Bleeding may be bad enough to cause anemia or an unhealthy, low level of iron in the blood. Children with CD may have slowed growth and delayed sexual development in some cases.
The most common problem with CD is blockage of the intestine. Because swelling and scar tissue thicken the bowel wall, the intestine passage can become closed off. Fistulas, or abnormal connections between the intestine and other organs, can form from ulcers in the intestine, breaking through into other parts of the intestines or surrounding tissues of the bladder, vagina, or skin. They often form around the anus and rectum.
Nutrition problems are common with CD. Many people have deficiencies of proteins, calories, and vitamins. These can be caused by not eating enough, loss of protein within the intestine, or poor absorption. Osteoporosis also is a threat because of low calcium and vitamin D intake through dairy products, poor absorption of nutrients in the body, or the use of corticosteroids (for treatment of CD or inflammation itself). Some persons with CD have problems with arthritis, their skin, inflammation in the eyes or mouth, kidney stones, gallstones, or other diseases of the liver. Some of these problems get better during treatment for disease in the digestive system, but some are treated separately.
In order to find out if you have CD, your doctor will examine you and may order blood tests to check for anemia (low iron levels) which could be a sign of bleeding in the intestine, or samples of a bowel movement to check for blood or germs. She also may do an upper gastrointestinal (GI) series to look at the small intestine. This is an x-ray that can show inflammation or other problems in the intestine. You also could have a barium enema, which is an x-ray of the colon, or the same screenings tests used to diagnose UC, flexible sigmoidoscopy or colonoscopy. These tests allow the doctor to view the lining of the colon. A CT scan may also be used to look for inflammation inside and outside the bowel.
UC and CD are different from irritable bowel syndrome (IBS), that is a condition that includes a group of symptoms mainly affecting the colon, or large intestine. Symptoms of IBS may include crampy pain, bloating, gas, mucus in the stool, and changes in bowel habits. IBS is also called spastic colon or spastic bowel. IBS is not a disease and does not cause inflammation, bleeding, damage to the bowel, or cancer or other serious diseases. It is called a functional disorder, which means that there is no sign of disease when the colon is examined, but the bowel doesn't work as it should. There is no direct relationship between IBS and either UC or CD, although some people with UC or CD also have IBS.
See your health care provider if you see blood in the stool, have a change in bowel habits lasting longer than 10 days, or if you have any of the following symptoms that do not improve with over-the-counter medicines:
Although UC and CD usually are not fatal, they can cause serious problems. Sometimes symptoms are bad enough that a person has to be hospitalized. For example, a person may have severe diarrhea that causes dehydration and needs to be treated with fluids through his/her vein.
Because no one knows exactly what causes IBD, it is hard to try to prevent. But, if you have IBD, you can make changes in your diet and lifestyle to control your symptoms. You might need to limit dairy products, try low-fat foods, experiment with how much protein and fiber you eat, avoid problem "gassy" foods, and eat smaller and more frequent meals. It also is important to get enough rest and avoid stress since being tired or overly upset can make your symptoms worse. Your health care provider can tell you the things to try to make you feel better.
While there is no cure for IBD, treatments can help control symptoms. Besides changing diet and lifestyle to control symptoms, most people with UC and CD are treated with medications. In severe cases of disease, a person may need surgery to remove the diseased colon.
Treating IBD with drugs is complicated and might require several "trial runs." It is very important to keep track of how well the drugs are working, what side effects you are having, and report all details to your health care provider.
Most people who have mild to moderate disease are first treated with drugs called aminosalicylates. These medications are aspirin-like medications such as 5-ASA agents (a combination of the drugs sulfonamide, sulfapyridine, and salicylate). They can be given either orally or rectally to help control inflammation. Side effects can include heartburn, nausea, vomiting, diarrhea, and headache. These drugs include mesalamine and sulfazalazine, which have fewer side effects and can relieve symptoms in more than 80 percent of people with UC in the lower colon and rectum. A newer drug form of mesalamine called Colazal is reported to have even fewer side effects.
People with more severe IBD also can be treated with corticosteroids, such as prednisone and hydrocortisone, to reduce inflammation. Side effects of these drugs can include weight gain, acne, facial hair, high blood pressure, mood swings, and a higher risk of infection. A newly approved drug called Entocort EC is a steroid therapy that causes fewer side effects in people with mild to moderate CD in the ileum (the last portion of the small intestine that connects to the large intestine or colon).
Drugs that block the immune system's reaction to inflammation are also used to treat CD. Side effects can include nausea, vomiting, diarrhea, and higher risk of infection. People with moderate to severe CD who do not respond to 5-ASA agents, corticorsteroids, or immune system drugs, or who have open, draining fistulas may be given a drug called infliximab (Remicade). This is the first treatment approved for CD and works to remove a protein produced by the immune system that may cause inflammation. Studies are looking at its long-term safety and effectiveness. Azathioprine and 6-mercaptopurine (6-MP) also can be used with steroids, and seem to be the most effective immunosuppressive drugs for the long-term management of both CD and UC. They are proven effective for steroid-dependent, chronically active, and steroid-resistant disease.
Antibiotics also are used to treat disease and heal fistulas in the small intestine. Drugs like antidiarrheals, laxatives, and pain relievers also can be given to help relieve symptoms. Every person should talk with her doctor first before taking these drugs since some may be too harsh for the system or can make symptoms worse.
There are different types of surgery used to treat IBD. For CD, surgery is necessary at some point in the lifetime of about half of persons with this disease. Surgery can relieve symptoms or correct problems like blockages or bleeding in the intestine. Surgery to remove part of the intestine can help CD but cannot cure it. The inflammation tends to return next to the area of intestine that has been removed. Therefore, people considering surgery should carefully weigh the risks and benefits compared to other treatments.
Types of surgery for CD include:
For UC, persons with severe cases of this disease may need surgery to remove the diseased colon. Some of the IBD-related problems that cause health care providers to consider surgery include growth retardation, steroid dependency, serious medication side effects, cancer or pre-cancerous changes, disease that is unresponsive to medication, narrowing of the colon, and extra-intestinal disease (disease caused by IBD in areas outside of the digestive tract).
Types of surgery for UC include:
Nothing could be further from the truth. Surgery for IBD often is viewed as a "failure" by both the person who has IBD and her doctor. But surgery, in combination with pre- and post- operative medical therapy, can lead to the best results for the person's health and quality of life.
Studies are looking at the use of human growth hormone (HGH) combined with a high-protein diet to treat CD. In a clinical trial, people treated this way had fewer symptoms after one month, and the benefits continued. The long-term risks and benefits are still being studied. Studies also are looking at the use of a gene-based drug to help growth of healthy tissue in people with UC, as well as new medications to use against factors that cause or promote inflammation.
Is there a link between IBD and colon cancer?
Having IBD can increase your chances for getting colon cancer. The risk of cancer gets higher the longer and the more the colon is involved. For example, if only the lower colon and rectum are involved, the risk of cancer is not higher than normal. But, if the whole colon is involved, the risk of cancer may be as great as 32 times the normal rate.
People who have had IBD throughout their colon for at least eight years, or IBD in only the left colon for at least 15 years should have a screening colonoscopy every 1 to 2 years to check for precancerous changes in the cells of the colon lining. This screening won't reduce the risk for getting colon cancer, but can help find cancer early when it is easier to treat.
Some studies have found that persons with IBD have a much higher risk for other cancers for reasons not yet known. For CD, these include skin and bladder cancers. For UC, there have been reports of increased risk for connective-tissue and brain cancers, nonmelanoma skin cancers, and bone and endometrial cancers.
The most widely available test to find pre-cancerous or cancerous tissues at an early, curable stage in persons with IBD is endoscopy with biopsy of the colon. An endoscope is a device with a flexible tube and light that allows your doctor to see parts of your digestive system. The tube is inserted through the
mouth or anus while you are sedated. A colonoscopy shows the entire colon, a sigmoidoscopy shows the two feet of the colon closest to the anal opening only. A biopsy is when your doctor takes small samples of tissue during the endoscopy to study under a microscope.
Women with UC or inactive CD do not seem to have related fertility problems, but women with active CD or women with UC who have had an IPAA do experience more problems with fertility. Women who have inactive disease at the time of conception are no more likely to have a flare of their disease during pregnancy than if they were not pregnant. Flares are more likely to occur in the first trimester and right after the baby is born.
Pregnancy and delivery can be relatively normal in women with IBD. Even so, women with IBD should discuss their illness with their health care providers before pregnancy. Most medications used for IBD are safe or likely safe in pregnancy. Surgery, if necessary, is safest in the second trimester. Pre-term birth or early delivery has been reported to be increased 2 to 3-fold in women with IBD, although most children born to women with IBD are unaffected.
American Gastroenterological Association
Phone Number(s): (301) 654-2055
Internet Address: www.gastro.org
American Society of Colon and Rectal Surgeons
Phone Number(s): (847) 290-9184
Web Site: http://www.fascrs.org/
Crohn's & Colitis Foundation of America, Inc.
Phone Number(s): (800) 932-2433 or (212) 685-3440
Internet Address: www.ccfa.org
National Digestive Diseases Information Clearinghouse, NIDDK, NIH HHS
Phone Number(s):(301) 654-3810, (800) 891-5389
Web Site: http://www.niddk.nih.gov/health/digest/nddic.htm
National Library of MedicineMedlineplus
Web site: http://www.nlm.nih.gov/medlineplus/irritablebowelsyndrome.html
North American Society for Pediatric Gastroenterology, Hepatology and Nutrition
Phone Number(s): (215) 233-0808
Internet Address: www.naspgn.org
Pediatric Crohn's & Colitis Association, Inc.
Phone Number(s): (617) 489-5854
Internet Address: http://pcca.hypermart.net
Social Security Administration Information on Disability Benefits
Phone Number(s): (800) 772-1213
Internet Address: www.ssa.gov
The American College of Gastroenterology
Phone Number(s): (703) 820-7400
Internet Address: www.acg.gi.org/