Dr. Simeon Margolis
Living with Irritable Bowel Syndrome
by Simeon Margolis
Irritable bowel syndrome (IBS) is a chronic disorder that affects 10 to 15 percent of Americans — women twice as often as men. The symptoms of IBS are crampy abdominal pain along with diarrhea, constipation, or alternating diarrhea and constipation. IBS can produce troublesome physical discomfort and emotional distress, but it rarely leads to serious long-term health problems. Although IBS can't be cured, the vast majority of people learn to control their symptoms of IBS.
The effects of dietary modifications vary from individual to individual; some may help, others have no effect, and some may even worsen symptoms. So, each IBS sufferer needs to experiment with the various dietary changes that have been recommended. During these experiments it's a good idea to record in a daily diary the effects of any dietary changes on your symptoms and bowel habits.
The first step is to eliminate foods that may aggravate IBS symptoms:
- Eliminate lactose containing products such as milk, ice cream, and cheeses for a two week period. If IBS symptoms improve, you should continue avoiding lactose. You could resume eating lactose containing foods if symptoms do not improve.
- A similar time-frame of two weeks might be tried with gas-producing foods. This includes beans, cabbage, cauliflower, broccoli, brussels sprouts, and even onions, raisins, prunes, bananas, and carrots.
- Some people with IBS benefit from reducing their intakes of wheat and other carbohydrates.
If you are especially troubled by constipation, some, but not all, experts recommend increasing dietary fiber either by adding fiber-rich foods or by taking fiber supplements like psyllium or methylcellulose. Fiber intake must be increased slowly to avoid excessive bloating and gas, and fiber may worsen diarrhea or constipation in some.
Though their benefits are not proven, some people with IBS benefit from peppermint oil, chamomile tea, or probiotics.
Many drugs are available for treatment of IBS. They should be used only to relieve specific symptoms. The choice of drugs depends on whether symptoms are predominantly pain, diarrhea, or constipation.
- For pain:
Anticholinergic medications, such as dicyclomine (Bentyl) and hyoscyamine (Levsin), can alleviate severe cramping. Dry mouth, dry eyes, and blurred vision may be side effects. A variety of antidepressants (for example, amitriptyline. Prozac, Zoloft, Paxil, and Cymbalta) can relieve pain.
- For diarrhea:
Used only when needed, loperamide (Imodium®) or diphenoxylate with atropine (Lomotil) can combat diarrhea. Alosetron (Lotronex) is an effective treatment of diarrhea in women. It was temporarily removed from the market because of dangerous side effects and can only be prescribed by following certain guidelines.
- For constipation:
Lubiprostone (Amitiza) can be used to treat severe constipation in women. In August 2012, the FDA approved linaclotide (Linzess) for the treatment of IBS with constipation. The medication is taken once daily at least 30 minutes before the first meal of the day. Diarrhea is the most common side effect.