Irritable Bowel Syndrome

Irritable Bowel Syndrome

Help for the Sensitive Gut

The report is due on your boss's desk by 10:00 a.m., and already your insides are starting to churn.

The morning's stress has met up with last night's meat loaf and rumba-ed down your intestinal tract. Now, just when mind and body need to focus on your work with total concentration, the unholy alliance between meat loaf and stress is promising explosive results. You jump up from your desk and run for the bathroom, where, just in time, you groan, "Why me?"

Everyone has a bout of diarrhea once in a while, particularly when they're under pressure, says Douglas A. Drossman, M.D., professor of medicine and psychiatry in the Division of Digestive Diseases and Nutrition at the University of North Carolina School of Medicine at Chapel Hill. But days of painful diarrhea frequently alternating with days of painful constipation are something else entirely.

When this bouncing from one intestinal extreme to the other is uncomfortable enough that you consult a doctor, says Dr. Drossman, the diagnosis you're likely to hear is irritable bowel syndrome.

How Women Cope

Irritable bowel is the most common reason women are referred to gastroenterologists. It affects approximately 20 percent of all Americans--60 to 65 percent of them women--although no one has a clue as to its cause. Its symptoms range from an occasional bout of after-dinner cramps to chronic constipation or diarrhea with severe pain. Either constipation or diarrhea can predominate, doctors say, although women are more likely to have constipation.

Seventy percent of those who have the problem have such mild symptoms that they generally can handle it themselves with an over-the-counter drug to control diarrhea or constipation. Twenty-five percent have symptoms so severe that they interfere with their daily activities. And 1 to 5 percent will experience such pain and daily disruption that they'll do little with their lives other than visit doctors.

Why such a wide range of symptoms?

Because how you feel depends on how you cope with the condition, doctors say.

"Let's say two women have the same amount of bowel disturbance causing pain," says Dr. Drossman. "One woman has no current life stress and has good coping skills, and the other is experiencing psychological distress at work and home and has poor coping skills." The first woman talks about her feelings, is assertive and takes responsibility for her health, and the second is passive, doesn't talk about her feelings and expects her doctor to resolve her problems.

Because of the complex connection between brain and gut, the psychological distress can cause the second woman's intestines to react even more, says Dr. Drossman. That means that her intestines may move food through so quickly that she has diarrhea or so slowly that she becomes constipated. Poor coping skills may also lower her pain threshold so that it takes less of anything--stress, food or hormones--to trigger pain than it does in someone who copes well. In a sense, she becomes oversensitive to everything--even a normal stool pressing against the bowel wall.

Preventing Irritable Bowel Symptoms

There is no cure for irritable bowel syndrome. People may find short-term relief by using an over-the-counter drug such as Imodium to stop diarrhea, a laxative to relieve constipation or a prescription antispasmodic to relieve pain, says Dr. Drossman. But relying solely on medication is not enough. He advises women with irritable bowel to learn to prevent the onset of symptoms. Here's how.

Learn to relax. Stress is a killer for anyone with irritable bowel. It stimulates various neurochemicals in the brain and sends them skittering down the nervous system pipeline to the gut. There they can aggravate the gut's already overreactive tendencies and trigger a bout of misery.

"Our thinking is that stress accounts for 10 to 15 percent of flare-ups," says William E. Whitehead, Ph.D., research professor of medicine at the University of North Carolina School of Medicine in Chapel Hill. He encourages people to learn a relaxation technique to help control it.

"The simplest one for Americans seems to be progressive relaxation," he adds. It involves focusing on each group of muscles from head to toe, then consciously tensing and relaxing each group. He says it's more acceptable to Americans than meditation, a relaxation technique in which you focus your mind on a single thought or word and simply sit.

"Americans like to relax by trying harder," Dr. Whitehead says, chuckling. "And progressive relaxation meets that need."

Know what pushes your buttons. Progressive relaxation can be particularly effective when you also learn to identify what pushes your stress button and what goes on inside the body when it gets stressed, adds Dr. Whitehead.

In a study of 13 women and 6 men with irritable bowel, researchers at the State University of New York at Albany found that 12 one-hour training/education sessions over an eight-week period significantly reduced symptoms.

Use the side effects of antidepressants. Antidepressants are sometimes prescribed to alleviate abdominal pain in women with irritable bowel, says Dr. Whitehead.

This is not because people with irritable bowel are depressed but because one of the side effects of antidepressants is that they reduce the amount of a brain chemical known to stimulate contractions in the bowel. "Antidepressants also lower the sensitivity to pain, which is caused by distention of the bowel with gas or food residue," Dr. Whitehead says.

Get up and go. "We also recommend exercise," says Dr. Whitehead, because it can prevent the constipation associated with irritable bowel, probably the most difficult symptom to overcome.

In a study of ten men and women who jogged, Dr. Whitehead and his colleagues found that even a single hour of this intense exercise stimulated the bowel so that it literally doubled the number of contractions it normally generated to push food residue through the intestine.

Lift weights. Strength training three days a week cut the amount of time it took for food to pass through the bowel by about 56 percent, according to a 13-week joint study conducted by Dr. Whitehead and researchers at Johns Hopkins University and the University of Maryland, both in Baltimore.

Study participants warmed up on a stationary bike for three minutes, did stretching exercises for another ten minutes, then performed 15 repetitions on each of a variety of weight machines to exercise upper- and lower-body muscles. Weights were initially set close to each participant's maximum strength, then made progressively lighter to allow them to complete all 15 repetitions.

Add fiber. Dietary fiber also fights constipation, says Dr. Whitehead. The best type is insoluble fiber, which helps form a larger, softer stool that is passed easily and quickly. Bran, whole grains and fruits and vegetables are good sources of insoluble fiber. (For a list of high-fiber foods, see page 122.)

The Food Relationship

Although avoiding stress and constipation will help keep a cranky gut calm, food is the one irritable bowel trigger that's impossible to avoid.

Food normally initiates contractions and stimulates a bowel movement 30 to 60 minutes after a full meal, doctors explain. But with the super-sensitivity of an irritable bowel, instead of contractions and a bowel movement, food can lead to cramps and diarrhea. And it does so in about 75 percent of those with irritable bowel.

The key to preventing an irritable bowel from throwing a tantrum after meals is directly related to what you eat and how many calories you consume at once, doctors agree. Here's what to do.

Think lean. Since any form of fat is the strongest food stimulus of intestinal contractions, keep your diet as lean as possible, doctors suggest. Trim fat from meat, switch to low-fat cheeses and avoid fried foods.

Think small. Large meals have been found to trigger both cramping and diarrhea. So try eating smaller meals, more often.

Block it with medications. If eating lean and small doesn't do the trick, says Dr. Whitehead, ask your doctor to prescribe an antispasmodic drug such as atropine, propantheline (Pro-Banthine) or dicyclomine (Antispas). Taking the drug before you eat will block the nerve signals that trigger bowel spasms.

Be a picky eater. A particular food may irritate some people and not others. So if certain foods or certain ingredients seem to bother you, either decrease the amount you consume or avoid them altogether, doctors say.

Common irritants include dairy products, caffeine, alcohol, the artificial sweetener Sorbitol, beans, spicy foods, concentrated fruit juices and raw fruits or vegetables.

Understand the Problem

Many women have symptoms of irritable bowel syndrome but don't seek health care. Others continually seek a cure that doesn't exist at this time, says Margaret M. Heitkemper, Ph.D., professor of physiological nursing at the University of Washington in Seattle.

This can be particularly frustrating when irritable bowel symptoms are regularly exacerbated by menstruation. "Many women with irritable bowel will very likely have variations in symptom severity based on menstrual cycle phase," says Dr. Heitkemper. For most women, she adds, the symptoms will be worse a day or two before their periods or when they're actually menstruating.

What can you do about it? Here are two things.

Accept your body. Just keep the bowel as calm as you can with diet, exercise and stress reduction and try to understand that menstruation is a natural, common occurrence, says Dr. Heitkemper.

Avoid surgery. Do not try to push your doctor into unnecessary surgery to find a cure for irritable bowel, cautions Dr. Whitehead. "Our data suggest that at least some women seek out hysterectomy or other surgical procedures" in an attempt to find a cure, he says. "Hysterectomy is not a treatment for irritable bowel," he emphasizes. "But if a patient keeps insisting on finding a cause for irritable bowel, the likelihood of a decision being made to do an operation like a hysterectomy--or an appendectomy--is high."

Dr. Whitehead can't explain why. "It isn't rational," he adds. "But if a patient really presses for surgery, she's likely to get it."