At the Institute of Biobehavioral Medicine (IBBMed) we believe, the mind, body and spirit are intimately connected. And our multi-disciplinary approach integrates the fields of psychiatry, psychology, neuroscience and spirituality. Our holistic approach to mental and physical health combines ancient wisdom with the latest innovations in medical science and psychology. Our goal is to restore health and balance by promoting the natural healing processes of nature. Disorders such as, Chronic Pain, Fibromyalgia, Irritable Bowel and Chronic Fatigue share four important factors:
- Stress as a predetermining factor
- Neuronal sensitization
- Response to antidepressant medications
- Response to stress reduction and self-care.
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. Fortunately, unlike more-serious intestinal diseases such as ulcerative colitis and Crohn’s disease, irritable bowel syndrome doesn’t cause inflammation or changes in bowel tissue or increase your risk of colorectal cancer.
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 (flatulence)
- Diarrhea or constipation — sometimes alternating bouts of constipation and diarrhea
- Mucus in the stool
For reasons that still aren’t clear, if you have IBS you probably react strongly to stimuli that don’t bother other people. Triggers for IBS can range from gas or pressure on your intestines to certain foods, medications or emotions. For example:
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. Carbonated beverages and some fruits and vegetables may lead to bloating and discomfort in some people with IBS. The role of food allergy or intolerance in irritable bowel syndrome has yet to be clearly understood. 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 IBS, 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.
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), can trigger IBS.
Risk Factors
Many people have occasional signs and symptoms of irritable bowel syndrome, but you’re more likely to have IBS if you:
- Are young. IBS begins before the age of 35 for 50 percent of people.
- Are female. Overall risk is about twice for women as men.
- Have a family history of IBS. Studies have shown that people who have a first-degree relative — such as a parent or sibling — with IBS are at increased risk of the condition.
Treatment:
Because it’s not clear what causes irritable bowel syndrome, treatment focuses on the relief of symptoms so that you can live as normally as possible:
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 bothersome bloating or are passing considerable amounts of gas, your doctor may suggest that you cut out such items as carbonated beverages, salads, raw fruits and vegetables, especially cabbage, broccoli and cauliflower.
Anticholinergic medications: Some people need medications that affect certain activities of the autonomic nervous system (anticholinergics) to relieve painful bowel spasms. These may be helpful for people who have bouts of diarrhea, but can worsen constipation.
Antidepressant medications: If your symptoms include pain or 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. If you have diarrhea and abdominal pain without depression, your doctor may suggest a lower than normal dose of 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.
Antibiotics: It’s unclear what role, if any, antibiotics might play in treating IBS. Some people whose symptoms are due to an overgrowth of bacteria in their intestines may benefit from antibiotic treatment. But more research is needed.
Psychotherapy: If antidepressant medications don’t work, you may have better results from counseling if stress tends to worsen your symptoms.
Two medications are currently approved for specific cases of IBS:
Alosetron (Lotronex): Alosetron is a nerve receptor antagonist that’s designed to relax the colon and slow the movement of waste through the lower bowel. The drug was removed from the market soon after its original approval because it was linked to serious complications. The Food and Drug Administration (FDA) has since allowed 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.
Generally, alosetron should only be used if usual therapy for IBS has failed. Additionally, it should only be prescribed by a gastroenterologist with expertise in IBS because of the potential side effects.
Lubiprostone (Amitiza): Lubiprostone is approved for women age 18 and older who have IBS with constipation. Its effectiveness in men is not proved. Lubiprostaone is a chloride channel activator that you take twice a day. It works by increasing fluid secretion in your small intestine to help with the passage of stool. Common side effects include nausea, diarrhea and abdominal pain. More research is needed to fully understand the effectiveness and safety of lubiprostone. Currently, the drug is generally prescribed only for women with IBS and severe constipation for whom other treatments haven’t been successful.
