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Women's Health

Irritable Bowel Syndrome (IBS) and Women

NetWellness experts receive many questions about Irritable Bowel Syndrome or IBS, the most commonly diagnosed gastrointestinal condition. Women are twice as likely to be diagnosed with IBS than men, but this may be due to the fact that women are more likely to seek medical care than men. Younger people are also more likely to be diagnosed with IBS.

The common features of IBS are chronic abdominal pain and a change in bowel habits. The specific cause of irritable bowel syndrome is uncertain, but it is believed that the intestines of patients with irritable bowel syndrome may be more sensitive to stimulation than other people.

Symptoms

Symptoms of IBS include:

Many people who suffer from IBS are embarrassed and reluctant to discuss their symptoms with their doctor. Although this is understandable, it is important to communicate with your healthcare provider. An accurate and detailed description of your symptoms will help your healthcare provider detect other conditions that mimic IBS as well as help them recommend the best treatment of your symptoms.

Triggers

It is helpful to become aware of some of the triggers of IBS. They include the following:

Food - Some people find that their symptoms become worse when they eat certain foods. For instance, beans, dairy products, and some vegetables are commonly associated with an exacerbation of irritable bowel syndrome. Temporarily eliminating foods that seem to aggravate IBS may be helpful for determining if symptoms are indeed secondary to IBS or another medical condition such as lactose intolerance.

Stress - If you are like most people with IBS, you probably find that your symptoms become worse or more frequent during stressful events such as a change in your daily routine or family arguments. While anxiety and stress may aggravate symptoms, they are probably not the cause of them.

Other illnesses - Sometimes other illnesses, such as an acute episode of infectious diarrhea (gastroenteritis) can trigger IBS.

Treatment

There are different treatment options available for IBS depending on the predominant symptoms. Currently, there are no drugs available that cure IBS. There are however, numerous medications available to treat the predominant symptoms. Some people can eliminate or minimize their symptoms by becoming aware of the triggers and managing their diet. Other individuals, however, require medical assistance. Some of the current options for treatment include the following:

Fiber supplements - Fiber supplements such as psyllium (Metamucil) or methylcellulose (Citrucel) with fluids may improve constipation.

Anti-diarrheal medications - Over-the-counter medications such as loperamide (Imodium) can help control diarrhea.

Diet modification - Foods such as beans, cabbage, broccoli and cauliflower may cause bloating and cramping. Since these are foods that typically are associated with gas production in the intestines, patients that minimize eating these foods may have less intestinal symptoms.

Anticholinergic medications - Drugs such as hyoscyamine and dicyclomine can be used for individuals with abdominal cramping and spasms as the predominant symptoms of their IBS. Some of the side effects of these medications include difficulty urinating and blurry vision.

Antidepressant medications - If your symptoms include pain and depression, your doctor may recommend a tricyclic antidepressant (TCA) 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 patients with IBS and diarrhea, your healthcare provider may suggest antidepressants such as imipramine or amitriptyline. Antidepressants such as fluoxetine or paroxetine may be helpful for patients with abdominal pain and constipation.

Drugs specifically for IBS

There are currently two drugs available to treat IBS: tegaserod (Zelnorm*), and alosetron (Lotronex).

Tegaserod - For women who have IBS with constipation, the Food and Drug Administration (FDA) has approved the medication tegaserod (Zelnorm). It is approved for short-term use in women. The efficacy of tegaserod in men with IBS has not been established. It imitates the action of the neurotransmitter serotonin and helps coordinate the nerves and muscles in the intestine. Individuals with a history of bowel obstruction or gallbladder disease should not take this medication.

Alosetron - This drug relaxes the colon and slows the movement of waste through the lower bowel, thereby treating diarrhea. Alosetron was removed from the market nine months after its initial approval when it was linked to four deaths and side effects including severe constipation and ischemic colitis. In 2002, FDA decided to allow alosetron to be sold again - with restrictions. The drug can only be prescribed by doctors enrolled in a special program. It is only approved for use in women with severe cases of diarrhea-predominant IBS who have not responded to other treatments. Alosetron is not approved for use by men.

Stress Management

People frequently experience worsening of their digestive symptoms when worried or anxious. The following are recommendations for managing stress, anxiety and depression, all of which may exacerbate IBS symptoms.

Counseling - Health care professionals such as psychologists and psychiatrists can help identify sources of stress in your life, and provide guidance on ways to respond to these stressful situations. There are also support groups available in most communities for people with irritable bowel syndrome.

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. Relaxation exercises and deep breathing (as described in the next section) are a primary focus in yoga, massage and meditation.

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 releasing the tension in your feet. 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. Try breathing from the diaphragm (the muscle separating 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..

Hypnosis - Hypnosis may reduce abdominal pain and bloating. A trained professional can teach you how to enter a relaxed state and help you to imagine your intestinal muscles becoming smooth and calm.

Biofeedback - This stress-reduction technique helps reduce muscle tension and slow your heart rate with the feedback help of a machine. You are then taught to produce these changes yourself without a machine. 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.

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.

Talk to Your Doctor

Irritable Bowel Syndrome is extremely common. Each person with IBS has different symptoms that occur with variable frequency and intensity. It is important to communicate with your healthcare provider. An accurate and detailed description of your symptoms will not only help your healthcare provider detect other conditions that mimic IBS, but also help them recommend the best treatment for your symptoms.

* Learn important new information concerning the medication Zelnorm (tegaserod maleate)

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Last Reviewed: Sep 21, 2006

Julia Gore Thornton, MD Julia Gore Thornton, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University