Irritable Bowel Syndrome

• Abdominal pain or cramping
• A bloated feeling
• Gas (flatulence)
• Diarrhea or constipation — people with IBS may also experience alternating bouts of constipation and diarrhea
• Mucus in the stool

• Foods. Many people find that their signs and symptoms worsen when they eat certain foods. For instance, chocolate, milk and alcohol might cause constipation or diarrhea. A survey found that almost two out of three people with Irritable bowel syndrome felt a dietary allergy or intolerance was to blame for their IBS. The role of food allergy or intolerance in irritable bowel syndrome hasn't been well studied. And some researchers suspect that rather than food being a trigger, the actual process of eating may be the trigger because chewing stimulates the colon. If you experience cramping and bloating mainly after eating dairy products, food with caffeine, or sugar-free gum or candies, the problem may not be irritable bowel syndrome. Instead, your body may not be able to tolerate the sugar (lactose) in dairy products, caffeine or the artificial sweetener sorbitol.
• Stress. If you're like most people with Irritable bowel syndrome, you probably find that your signs and symptoms are worse or more frequent during stressful events, such as a change in your daily routine or family arguments. But while stress may aggravate symptoms, it doesn't cause them.
• Other illnesses. Sometimes another illness, such as an acute episode of infectious diarrhea (gastroenteritis) can trigger Irritable bowel syndrome.

• Fiber supplements. Taking fiber supplements such as psyllium (Metamucil) or methylcellulose (Citrucel) with fluids may help control constipation.
• Anti-diarrheal medications. Over-the-counter medications such as loperamide (Imodium) can help control diarrhea.
• Eliminating high-gas foods. If you have significant bloating or are passing significant amounts of gas, your doctor may also ask you to cut out such items as carbonated beverages, salads, raw fruits and vegetables, cabbage, broccoli and cauliflower.
• Anticholinergic medications. Some people need drugs that affect certain activities of the nervous system (anticholinergics) to relieve painful bowel spasms.
• Antidepressant medications. If your symptoms include pain and depression, your doctor may recommend a tricyclic antidepressant or a selective serotonin reuptake inhibitor (SSRI). These medications help relieve depression as well as inhibit the activity of neurons that control the intestines. For diarrhea and abdominal pain, your doctor may suggest tricyclic antidepressants, such as imipramine (Tofranil) and amitriptyline. Side effects of these drugs include drowsiness and constipation. SSRIs such as fluoxetine (Prozac, Sarafem) or paroxetine (Paxil) may be helpful if you're depressed and have pain and constipation.
• Counseling. If antidepressant medications don't work, you may have better results from counseling if stress tends to exacerbate your symptoms.

• Alosetron. This drug is a nerve receptor antagonist that's supposed to relax the colon and slow the movement of waste through the lower bowel. But the drug was removed from the market just nine months after its approval when it was linked to at least four deaths and severe side effects in 197 people. In June 2002, the Food and Drug Administration (FDA) decided to allow alosetron to be sold again — with restrictions. The drug can be prescribed only by doctors enrolled in a special program and is intended for severe cases of diarrhea-predominant IBS in women who haven't responded to other treatments. Alosetron is not approved for use by men.
• Tegaserod. For women who have Irritable bowel syndrome with constipation, the FDA has approved the medication tegaserod (Zelnorm). It's approved for short-term use in women and has not been shown to be effective for treating men with IBS. Tegaserod imitates the action of the neurotransmitter serotonin and helps to coordinate the nerves and muscles in the intestine. Some reports have suggested a risk of rare, dangerous side effects similar to those of alosetron, but the drug is still available.

• Counseling. In some cases, a health care professional such as a psychologist or psychiatrist can help you learn to reduce stress by looking at how you respond to events in your life 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. Biofeedback is usually taught in hospitals and medical centers.
• Regular exercise, yoga, massage or meditation. These can all be effective ways to relieve stress. You can take classes in yoga and meditation or practice at home using books or tapes.
• 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 completely 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 with air; when you exhale, your belly naturally contracts. Deep breathing can also help relax your abdominal muscles, which may lead to more-normal bowel activity.
• Hypnosis. Hypnosis may reduce abdominal pain and bloating. A trained professional teaches you how to enter a relaxed state and then guides you as you imagine your intestinal muscles becoming smooth and calm.
• 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.