5a: What are the treatments for IBS?
The treatment of IBS is based on the severity and the nature of each person's symptoms and the effect psychosocial factors are having on their illness behavior. Therefore, each person's therapy is tailored to their symptoms and may include one or more of the following: lifestyle changes, pharmacological treatment, and psychological treatment. Therefore, there really is no one good general treatment for IBS. Different things work for different people, and really the only way to know exactly what works for you is by trial-and-error.
5b: What is the role of fiber therapy in IBS?
Fiber is the non-digested part of plant food and adds bulk to the stools by absorbing water. There are two types of fiber: soluble and insoluble. Soluble fiber dissolves in water and is found in oat bran, barley, peas, beans, and citrus fruits. Insoluble fiber are found in wheat bran and some vegetables. Fiber increases the transit time of the colon and decrease the pressures within the colon. However, the role of fiber in the treatment of IBS has not been well established. One study showed that the response to bran in terms of daily stool weight, bowel frequency and symptoms was determined more by pre-existing psychometric variables such as anxiety and depression that the amount or nature of the bulking agent administered. From our experience, however, patients with mild constipation predominant IBS may derive some benefit.
Fiber can be added to the diet through the eating of more fiber-rich foods, or by taking fiber supplements (common brands are Metamucil, Citrucel, and FiberCon).
5c: Is it necessary to make drastic dietary changes?
In some cases, certain foods can aggravate IBS symptoms and should be avoided. In particular, lactose in lactose deficient individuals, gas producing vegetables such as beans and broccoli, fatty foods, and alcohol. It is should be noted however that while these foods can exacerbate IBS symptoms, they are not the sole cause of typical IBS symptoms. To determine which foods trigger which symptoms, one often needs to start with very basic bland diet and gradually add one new food each day and record any symptoms associated with that particular food.
5d: What conventional prescription medications are used to treat IBS?
Conventional medications used in the treatment of IBS include (but are not limited to):
Anti-spasmodic drugs like Bentyl and Levsin are considered to part of the class of anti-cholinergic drugs. Anti-cholinergic drugs act by decreasing the abnormal sensitivity of choninergic (muscarinic M2) receptors in gut smooth muscle. Significant improvement in abdominal pain and rectal urgency have been reported in some studies compared to placebo in short-term trials. However, there is no evidence that anticholinergic are more efficacious than placebo in the longer term.
Antacids/anti-gas medications (e.g. Simethicone or BEANO). There is no current data which supports their use in the treatment of IBS symptoms, though many people report that they aid in the reduction of embarrassing flatulence and the accompanying lower abdominal pain.
Anti-diarrhea medications/Opioid-receptor agonist (e.g. loperamide or "immodium"). Loperamide is an mu opioid receptor agonist which does not cross the blood-brain barrier. It delays small and large bowel transit, increases the frequency of small bowel phase 3 of the migrating motor complexes, decreases intestinal secretory activity, and increases rectal sphincteric muscle tone. Some studies have shown improvement in diarrhea, rectal urgency, and abdominal pain in IBS.
Prokinetic Agents (e.g. Cisapride or "Propulsid"). A prokinetic drug which is a 5HT4 agonist and a 5HT3 antagonist. Cisapride has been reported to help in gastroesophageal reflux disease and dyspepsia related to delayed gastric emptying. Its efficacy in constipation predominant IBS, however, has not been well established.
Antidepressants. Tricyclic antidepressants (e.g. amitriptyline, imipramine, and despramine) or serotonin reuptake inhibitors (e.g. fluoxetine, sertraline, and paroxetine) are commonly used to treat IBS. Although commonly used in IBS patients their efficacy is still being debated. Even though antidepressants are often used in patients with associated depression, antidepressants appear to improve symptoms independent of their antidepressive effects. One study using despramine found this drug to be superior to both atropine (an anticholinergic- which is a common side-effect of the tricyclic antidepressants) and placebo in relieving both gastrointestinal symptoms and depression. Therapeutic effect can take as long as 4-6 weeks and therefore therapeutic trial should continue at least this long.
Smooth muscle relaxants (e.g. mebeverine (not yet available in the U.S.) and peppermint oil) have direct relaxant properties on gut smooth muscle. Placebo controlled trials, however, have not produced any consensus on their efficacy in IBS.
5e: Are there any natural or herbal remedies for treating IBS?
For many reasons, a large percentage of IBS patients find some relief in treatments not considered to be part of "conventional" medicine. Some herbs, such as mint, ginger, chamomile, etc. have been touted as ways to alleviate gastrointestinal distress. Some patients have also benefitted from meditation and relaxation therapy, hypnosis, acupuncture, massage therapy, biofeedback therapy, and the like. Probably the best natural remedy for IBS is through dietary modifications and an increase in exercise level. Some people find that a combination of conventional medication and natural therapies are ideal for controlling their symptoms.
5f: What are some of the psychological treatments available?
Psychological treatments should be considered symptoms are severe and are associated with psychological distress. Some of the treatments which have been used successfully include but are not limited to cognitive-behavioral therapy, biofeedback therapy, relaxation therapy, and hypnotherapy.
The core of cognitive-behavioral therapy is the way a person thinks about their bowel symptoms. For example, thoughts or cognitions such as "there must be more stool in my rectum to evacuate" can lead to anxiety or attention which, in turn, can lead to increased IBS symptoms such as sensations of incomplete evacuation. During cognitive-behavioral therapy patients learn exercises and strategies to control their symptoms. Therefore, cognitive-behavioral therapy retrains patients' cognitions about their illness beliefs as it pertains to their gastrointestinal symptoms. Several studies have found cognitive-behavioral therapy to be superior to control treatment.
Biofeedback and relaxation training for IBS is designed to increase the awareness and control of physical and emotional responses, and is particularly useful in helping patients control the physiological consequences of stress. The gastrointestinal system is particularly sensitive to stress and for many patients stress leads to an exacerbation of their IBS symptoms. Typical techniques used in biofeedback and relaxation therapy include breathing and muscle relaxation, hypnosis or imagery techniques, or a combination of these.
Hypnotherapy uses techniques aimed at increasing suggestibility in patients. Whorwell and colleagues were the first to report it to be an effective treatment in IBS. In particular they found that patients who received hypnotherapy to have more improvement in gastrointestinal symptoms including abdominal pain and diarrhea in comparison to placebo.
5g: How can keeping a record of my symptoms and triggers be helpful?
This will help you to identify foods, activities, or stressors that were previously not considered as triggering factors. By identifying inciting factors lifestyle modifications can be made to reduce symptom exacerbation.
5h: With all these different treatments, how do I know which will work for me?
The only way to know for sure which treatment will work best for you is to consult your doctor and discuss which method of treatment would be best for you. Sometimes, one has to try several different treatments before finding the one that will work the best. The important thing is not to get discouraged -- there is something that is right for you.
Anxiety symptoms with IBS can be considered as a triggering factor for anxiety and panic attacks, the bloating, presser with pain on both the upper and lower abdominal and pain caused by IBS stresses can and do trigger Anxiety in people with this disorder is not uncommon with gastrointestinal symptoms as people that are more in tune with the way that there body feel, causing them to overreact thinking of impending doom like that of a heart attack sending them to the ER for help from the feeling from the intense heart beating from the presser of IBS
But by learning more about IBS and anxiety triggers can help one to bypass this as a trigger for A/P but one should always consult with your doctor first and by having the proper testing done to help rule out any heart problems or other things
Kitt has posted some very good info on this and how to keep a record on tracking both foods and stressors that can help one with identifying the causes of IBS and things that maybe triggers for A/P's and is posted under this part
Why Worry? Stress and anxiety do have their place. They push us to make necessary changes in our lives. They signal when we may be in danger, and inspire us to take action to get ourselves out of danger. (This danger can be any type of threat to our physical or emotional well-being, from not doing well on a test to losing a job to losing a friend.) In this way, feelings of stress and anxiety are healthy and necessary; without them, we may not act in our own best interest.
How Much Stress and Anxiety is Too Much? The point at which worry and anxiety become unhealthy is when they stop pushing us to act. This can either be because we are worried about things that are not under our control or that have not happened yet, or because we are immobilized by the stress and anxiety we feel, rather than being inspired to act. Whatever the reason, this worry and anxiety can cause a lot of stress on our minds and bodies, and affect our health.
Dealing With Anxiety So now that you understand the nature of stress and anxiety a little better, we can focus on eliminating them. The best remedy for anxiety is self-examination and action. Here are some easy steps to follow:
If you still find yourself concerned on a constant basis, you may want to talk to someone about it, either a friend, or a professional, depending on how severe your worry is and how much it is affecting your overall stress level. Please print this and put it somewhere close by so you can review it when you start to feel anxious or stressed.Sources:Reduction Program in the Treatment ofAnxietyDisorders."American Journal of Psychiatry 1992
I wish you peace and happiness,Kitt
Hay D I'm glad you brought is up, I have been doing a lot of reading on this but was short on time, and I have read a lot about Anxiety causing a disress with the intestinal track both the pro's and con's of it and how some of the medical field findings that anxiety disorders can excalabrate it to a disorder of A/P while others tend to feel that it is more of a disease of the gasterintestal track, but at the same time A/P is still apart of it all.