When You Gotta Go: Living with IBS

What You Need to Know About IBS

Some diseases are relatively simple. A doctor will say, "This is what you have, this is why it's happening, and here's what to do to make it go away." But for the estimated one in 10 Americans who have irritable bowel syndrome (two-thirds of them are women), getting relief can be a lot more complicated than that.

Just the symptoms are confusing enough: abdominal pain, bloating, and cramping combined with either diarrhea or constipation -- or sometimes alternating bouts of both, says gastroenterologist William Chey, MD, professor of internal medicine at the University of Michigan Health System in Ann Arbor. And the causes and remedies can be equally perplexing. "What causes my IBS might be completely different from what causes yours, even if our symptoms are the same, and so the ways we choose to treat IBS can be totally different, too," he says. But there are some strategies that can help.

Tracking your diet and avoiding foods that bring on symptoms are two mainstays of IBS treatment. The most common offenders are fatty foods, milk products, chocolate, alcohol, caffeine, and carbonated drinks. But evidence is also emerging that a gluten-free diet helps relieve symptoms even if you don't have celiac disease. "IBS patients who go on a gluten-free diet might see improvements not just in abdominal pain and bloating but also in other symptoms, such as fatigue," says Dr. Chey.

Soluble fiber supplements (such as psyllium or methylcellulose) can help regulate bowel movements, both by bulking up loose poops and softening small, hard stools. "Soluble fiber is usually better tolerated than insoluble fiber, such as bran, since that can sometimes increase gas and bloating," says Dr. Chey.

Antidepressants can help ease severe symptoms, but not because you're depressed. "Tricyclic antidepressants like amitriptyline and desipramine in low doses work on chemical receptors in the gut that send pain signals to the brain," says gastroenterologist Lauren Gerson, MD, associate professor of medicine at the Stanford University School of Medicine. Antispasmodics and medications for constipation are prescribed for severe cases or when dietary changes and over-the-counter treatments aren't effective, says Dr. Gerson. A course of antibiotics is an option when IBS is caused by an overgrowth of bacteria in the gut. The theory is that a previous infection, food poisoning, abdominal surgery, or some other event causes high levels of bacteria to flourish in the small intestine and this leads to diarrhea, constipation, and other IBS symptoms. A gastroenterologist can confirm the diagnosis with a simple breath test.

The Low-FODMAP diet, developed by doctors in Australia, is one of the newest treatment approaches to IBS. It stands for "fermentable oligo-, di- and monosaccharides and polyols" -- all carbohydrates that our bodies don't digest well. "When these carbs reach the colon, they interact with bacteria and begin to ferment, which can bring on IBS symptoms," says Dr. Chey, a leading expert on the FODMAP diet. The idea is that avoiding high-FODMAP foods -- a long list including certain dairy products, grains, sweeteners, fruits, and vegetables -- leads to fewer IBS flare-ups. But don't just google it and try the diet on your own, Dr. Chey says. "It's restrictive, so you need to follow it under the guidance of a registered dietitian who's knowledgeable about it." To find one, go to IBSfree.net and click on "FODMAPs-Friendly Dietitian Directory."
-- Madonna Behen

Before diagnosing you with IBS, your doctor will want to rule out other gastrointestinal problems that can have similar symptoms, including celiac disease, Crohn's disease, ulcerative colitis, and colon cancer.

The Most Common Warning Signs of a More Serious GI Problem Are:

• Blood in the stool (visible as either red blood or black tarry stools)
• Unexplained weight loss
• Diarrhea at night
• Symptoms that get progressively worse