Alternative therapy
The failure of conventional medicine to help individuals with IBS has led many people to seek alternative care. Acupuncture is widely used as a treatment for IBS. While some claim that it works, clinical evidence is scant and limited trials show that is does very little. There are hundreds of people who have tried acupuncture and found to be junk therapy. Acupuncture is a therapy still looking for a medical disorder it can cure.
Other therapies tried out in IBS include use of peppermint to relax the intestine and Probiotics. The data on both these therapies are mixed. Some say it works and others say it does not. As far as clinical evidence is concerned, there is only one study that shows mild benefit of peppermint. Most of the time the effectiveness of these therapies is only in the minds of people who sell these products.
Wednesday, May 6, 2009
Irritable bowel syndrome 101 part 9
Can IBS be prevented?
One of the ways to avoid symptoms of IBS is to decrease the triggers. To avoid trigger factors and lessen their effects, one may need to undergo some type of counseling, biofeedback, or alternative therapy.
Coping
The best way to cope with IBS is to find a treatment that works for you. Every individual has his or her own remedy and often this regimen does not work for all individuals. The goal is not to find a temporary solution but a long-term solution that is effective
Fiber. Even though fiber is good for patient with IBS, fiber can also be a real hassle. Fiber can help decrease constipation but it can also produce a lot of gas and cause abdominal cramps. Fiber should be gradually introduced in the diet over a period of weeks and not days. Foods, which contain decent amount of fiber, include whole grains, fruits, vegetables, and beans. Most individuals do not need to consult a dietician for a fiber consult. There is enough free literature on cyberspace that can tell you what to eat and how much fiber to eat. When eating a fiber supplement like Metamucil or Citrucel, introduce these supplements slowly and drink lots of water. This will minimize bloating and gas. If a fiber works for you, stick to that brand and use it on a regular basis.
Avoid “problem” foods. Keep a dairy and make a note of foods that make your symptoms worse. Culprit foods that often worsen IBS include:
- Alcohol
- Chocolate
- Caffeinated beverages (coffee and sodas)
- Medications that contain caffeine
- Dairy products
- Sugar-free sweeteners (sorbitol or mannitol)
Other foods that produce gas and make symptoms worse include beans, cabbage, cauliflower, and broccoli. Fatty or oily foods can also be problematic for others.
Individuals who chew gum, drink through a straw and talk while they are eating can swallow more air and this can also lead to more gas
Eat at regular times
To synchronize your bowel movements, eat at regular times. Do not skip meals and do not eat large meals all the time. Many individuals with diarrhea find that eating several small meals can help reduce symptoms. If you are constipated all the time, add fiber to your diet
Dairy products: Individuals who have problems with lactose should avoid dairy products or eat lactose free products. One can even use an enzyme product called lactaid that can break down lactulose. For some individuals, milk or dairy products may have to be completely eliminated from diet to relieve symptoms. In these individual it is essential to eat other food containing calcium and vitamin B
Drink liquids: Drink lots of fluids. While there are hundreds of beverages, there is nothing better than water. Avoid alcohol or caffeine containing beverages as it can make diarrhea worse.
Exercise regularly: Regular exercise will help you maintain a decent weight, relieve stress, and stimulate your bowels to work better. One does not have to join an exercise club, spend a fortune joining a gym- start with walking, or jog regularly. Nothing beats daily walking.
Avoid excessive use of anti-diarrheal medications and laxatives: Individual who have diarrhea should try and avoid use of excessive anti diarrheal medications. Imodium and kaopectate do work, but one should start with the lowest dose. These medications can rapidly resolve diarrhea but can also worsen constipation.
One of the ways to avoid symptoms of IBS is to decrease the triggers. To avoid trigger factors and lessen their effects, one may need to undergo some type of counseling, biofeedback, or alternative therapy.
Coping
The best way to cope with IBS is to find a treatment that works for you. Every individual has his or her own remedy and often this regimen does not work for all individuals. The goal is not to find a temporary solution but a long-term solution that is effective
Fiber. Even though fiber is good for patient with IBS, fiber can also be a real hassle. Fiber can help decrease constipation but it can also produce a lot of gas and cause abdominal cramps. Fiber should be gradually introduced in the diet over a period of weeks and not days. Foods, which contain decent amount of fiber, include whole grains, fruits, vegetables, and beans. Most individuals do not need to consult a dietician for a fiber consult. There is enough free literature on cyberspace that can tell you what to eat and how much fiber to eat. When eating a fiber supplement like Metamucil or Citrucel, introduce these supplements slowly and drink lots of water. This will minimize bloating and gas. If a fiber works for you, stick to that brand and use it on a regular basis.
Avoid “problem” foods. Keep a dairy and make a note of foods that make your symptoms worse. Culprit foods that often worsen IBS include:
- Alcohol
- Chocolate
- Caffeinated beverages (coffee and sodas)
- Medications that contain caffeine
- Dairy products
- Sugar-free sweeteners (sorbitol or mannitol)
Other foods that produce gas and make symptoms worse include beans, cabbage, cauliflower, and broccoli. Fatty or oily foods can also be problematic for others.
Individuals who chew gum, drink through a straw and talk while they are eating can swallow more air and this can also lead to more gas
Eat at regular times
To synchronize your bowel movements, eat at regular times. Do not skip meals and do not eat large meals all the time. Many individuals with diarrhea find that eating several small meals can help reduce symptoms. If you are constipated all the time, add fiber to your diet
Dairy products: Individuals who have problems with lactose should avoid dairy products or eat lactose free products. One can even use an enzyme product called lactaid that can break down lactulose. For some individuals, milk or dairy products may have to be completely eliminated from diet to relieve symptoms. In these individual it is essential to eat other food containing calcium and vitamin B
Drink liquids: Drink lots of fluids. While there are hundreds of beverages, there is nothing better than water. Avoid alcohol or caffeine containing beverages as it can make diarrhea worse.
Exercise regularly: Regular exercise will help you maintain a decent weight, relieve stress, and stimulate your bowels to work better. One does not have to join an exercise club, spend a fortune joining a gym- start with walking, or jog regularly. Nothing beats daily walking.
Avoid excessive use of anti-diarrheal medications and laxatives: Individual who have diarrhea should try and avoid use of excessive anti diarrheal medications. Imodium and kaopectate do work, but one should start with the lowest dose. These medications can rapidly resolve diarrhea but can also worsen constipation.
Irritable bowel syndrome 101 part 8
The treatment for each patient is individualized and based on type and severity of symptoms.
Constipation-predominant IBS with mild symptoms may benefit from
- Increased fluid intake
- Guar gum
- Exercise
- Fiber
For constipation-predominant IBS with moderate symptoms,
- An antispasmodic (Bentyl)
- Peppermint oil
- Osmotic laxative
In severe cases, the above therapies may be supplemented with
- Tricyclic antidepressants
- Psychotherapy
- Consideration of drug like Paxil/lotronex
For diarrhea-predominant IBS, begin with
- Dietary changes
- Use an antispasmodic (Bentyl)
- Alternatively, peppermint oil if symptoms are moderate.
In severe diarrhea-predominant IBS,
- Consider tricyclic antidepressants
- Add a serotonin 5-HT3 antagonist (lotronex if patient is female).
In pain-predominant IBS
- Use an antispasmodic (Bentyl)
- Tricyclic antidepressant
If severe with diarrhea
- Consider a serotonin 5-HT3 agonist (lotronex).
Constipation-predominant IBS with mild symptoms may benefit from
- Increased fluid intake
- Guar gum
- Exercise
- Fiber
For constipation-predominant IBS with moderate symptoms,
- An antispasmodic (Bentyl)
- Peppermint oil
- Osmotic laxative
In severe cases, the above therapies may be supplemented with
- Tricyclic antidepressants
- Psychotherapy
- Consideration of drug like Paxil/lotronex
For diarrhea-predominant IBS, begin with
- Dietary changes
- Use an antispasmodic (Bentyl)
- Alternatively, peppermint oil if symptoms are moderate.
In severe diarrhea-predominant IBS,
- Consider tricyclic antidepressants
- Add a serotonin 5-HT3 antagonist (lotronex if patient is female).
In pain-predominant IBS
- Use an antispasmodic (Bentyl)
- Tricyclic antidepressant
If severe with diarrhea
- Consider a serotonin 5-HT3 agonist (lotronex).
Irritable bowel syndrome 101 part 7
Other treatments
Clonidine, which is an anti hypertensive drug, has been shown to relieve symptoms of IBS in a few patients. So far, studies are few and benefits are not seen in all individual with IBS.
Complementary therapies
Because of lack of satisfaction with conventional medicine, many individuals with IBS now seek treatment from alternative care. The complementary treatments for IBS include peppermint that can reduce muscle spasms and improves digestive function. Individuals who take peppermint claim that the supplement does wonders, cures cramps, and improves life style. Recent trials indicate that peppermint does work in about 10-30 percent of individuals with IBS. It decreases stool frequency and also helps ease up on gas and bloating.
Other supplements that may be beneficial in individuals with IBS is ginger, fennel seeds and Aloe Vera. Anecdotal reports by individuals with IBS claim that these herbs can help relieve bloating. Unlike peppermint, there are no clinical studies that actually prove efficacy of these herbs. There are also lots of testimonials that these herbs do not work in IBS. Less than 5% of individuals with IBS show improvement with herbal therapy
Approach to the Patient
There is a tremendous variation in response of IBS patients to treatment. There is no one treatment that works for everyone. The treatment is generally focused on methods to improve dysfunction of bowels. However, it is vital that the individual understand and know about the disorder. Education is a vital part of treatment. Other aspects of treatment include reassurance that nothing life threatening will occur, methods to ease stress and learn how to relax
Clonidine, which is an anti hypertensive drug, has been shown to relieve symptoms of IBS in a few patients. So far, studies are few and benefits are not seen in all individual with IBS.
Complementary therapies
Because of lack of satisfaction with conventional medicine, many individuals with IBS now seek treatment from alternative care. The complementary treatments for IBS include peppermint that can reduce muscle spasms and improves digestive function. Individuals who take peppermint claim that the supplement does wonders, cures cramps, and improves life style. Recent trials indicate that peppermint does work in about 10-30 percent of individuals with IBS. It decreases stool frequency and also helps ease up on gas and bloating.
Other supplements that may be beneficial in individuals with IBS is ginger, fennel seeds and Aloe Vera. Anecdotal reports by individuals with IBS claim that these herbs can help relieve bloating. Unlike peppermint, there are no clinical studies that actually prove efficacy of these herbs. There are also lots of testimonials that these herbs do not work in IBS. Less than 5% of individuals with IBS show improvement with herbal therapy
Approach to the Patient
There is a tremendous variation in response of IBS patients to treatment. There is no one treatment that works for everyone. The treatment is generally focused on methods to improve dysfunction of bowels. However, it is vital that the individual understand and know about the disorder. Education is a vital part of treatment. Other aspects of treatment include reassurance that nothing life threatening will occur, methods to ease stress and learn how to relax
Irritable bowel syndrome 101 part 6
Psychotherapy
Many individuals with IBS tend to be under stress and undue tension. This often aggravates the condition and symptoms. To relieve tension, a variety of psychotherapy techniques have been utilized to reduce stress; this includes cognitive behavior therapy, hypnosis, stress management, yoga, acupuncture and relaxation. Psychotherapy does benefit some patients. The problem with these techniques is that it requires a long-term commitment and results are not immediate. In addition, these treatments are quite expensive and not usually covered by medical insurance plans. When treatments are stopped, relapses are common. Overall, about 10-20 percent of patients with mild IBS show benefit with psychotherapy.
Serotonin Receptor antagonists
A new class of drugs like Alosetron (lotronex) has been approved for use in decreasing symptoms of IBS. Lotronex has been shown to increase colonic compliance, and decreases gastrocolonic reflexes. So far, a few studies indicate that this drug can lead to modest benefit over a sugar pill, reduce bloating, and pain. When the drug was first released, it was linked to a few deaths. However, it is now again available with strict prescribing regulations. Alosetron is currently indicated only for women with severe diarrhea-predominant symptoms in whom conventional treatment has failed. Constipation is a common complaint with use of this drug.
Another drug released for IBS is Tegaserod (zelnorm). It has been found to be of mild benefit in individuals with constipation-predominant IBS. Tegaserod is approved for up to 12 weeks for treatment of constipation-predominant IBS in women. At present there is still some concern regarding long-term safety of the drug. Individuals with generalized symptoms of IBS do improve but the benefits are mild. More studies are needed before the drug can be used in all patients with IBS.
Probiotics & Antibiotics
The role of antibiotics in IBS is not common. Antibiotics are only used when an infection is suspected. Prolonged use of antibiotics can lead to severe diarrhea due to overgrowth of bowel bacteria.
The health food industry is heavily marketing Probiotics for treatment of IBS. Probiotics consist of mixtures of live organisms that are presumed to restore normal bowel flora. To date, most reports of efficiency of Probiotics are made by vendors of these products. Scientific studies are lacking. In addition, not everyone sees benefits from Probiotics
Many individuals with IBS tend to be under stress and undue tension. This often aggravates the condition and symptoms. To relieve tension, a variety of psychotherapy techniques have been utilized to reduce stress; this includes cognitive behavior therapy, hypnosis, stress management, yoga, acupuncture and relaxation. Psychotherapy does benefit some patients. The problem with these techniques is that it requires a long-term commitment and results are not immediate. In addition, these treatments are quite expensive and not usually covered by medical insurance plans. When treatments are stopped, relapses are common. Overall, about 10-20 percent of patients with mild IBS show benefit with psychotherapy.
Serotonin Receptor antagonists
A new class of drugs like Alosetron (lotronex) has been approved for use in decreasing symptoms of IBS. Lotronex has been shown to increase colonic compliance, and decreases gastrocolonic reflexes. So far, a few studies indicate that this drug can lead to modest benefit over a sugar pill, reduce bloating, and pain. When the drug was first released, it was linked to a few deaths. However, it is now again available with strict prescribing regulations. Alosetron is currently indicated only for women with severe diarrhea-predominant symptoms in whom conventional treatment has failed. Constipation is a common complaint with use of this drug.
Another drug released for IBS is Tegaserod (zelnorm). It has been found to be of mild benefit in individuals with constipation-predominant IBS. Tegaserod is approved for up to 12 weeks for treatment of constipation-predominant IBS in women. At present there is still some concern regarding long-term safety of the drug. Individuals with generalized symptoms of IBS do improve but the benefits are mild. More studies are needed before the drug can be used in all patients with IBS.
Probiotics & Antibiotics
The role of antibiotics in IBS is not common. Antibiotics are only used when an infection is suspected. Prolonged use of antibiotics can lead to severe diarrhea due to overgrowth of bowel bacteria.
The health food industry is heavily marketing Probiotics for treatment of IBS. Probiotics consist of mixtures of live organisms that are presumed to restore normal bowel flora. To date, most reports of efficiency of Probiotics are made by vendors of these products. Scientific studies are lacking. In addition, not everyone sees benefits from Probiotics
Irritable bowel syndrome 101 part 5
Antispasmodic agents
There are many patients with IBS who get frequent abdominal cramps. These individuals may benefit from anti spasmodic agents. These drugs can help relax the intestine and reduce intensity of contractions. Some of the common anti spasmodic used to treat IBS include dicyclomine (Bentyl) and hyoscyamine (levsin). A number of studies have shown that these agents are significantly better than sugar pills at reducing abdominal distension and cramps but do not alter constipation. To date, these agents have only been evaluated for short-term efficacy and long-term results remain unknown.
Antidiarrheal agents
Both Imodium and pepto bismol can decrease diarrhea and do work well in individuals with diarrhea type IBS. However, both these drugs have side effects and can immediately turn the diarrheal IBS type into the constipation variety. Use of these drugs should be used with caution and one should start at very low doses.
Antidepressant and antianxiety medications
Of all the medications for IBS, anti depressants have had great success. Many anti depressants have been shown to relieve pain with very low doses. How anti depressants relieve pain is not well understood but is believed to be to due to an action in the brain. These drugs also help reduce diarrhea and improve mental status. Many studies have been conducted on antidepressants and their role in IBS. Overall about 30% of patients show improvement. Among patients who do respond, many stop using the drug because of side effects.
Among the anti depressant shown to be beneficial include amitriptyline, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), and trimipramine (Surmontil).
Paxil has also been demonstrated to work well in some patients with IBS. However, experience with these drugs is limited and is not recommended as first line therapy. Other drugs that have shown to be beneficial in some patients with IBS include the benzodiazepines. However, these drugs are expensive, have side effects including dependence, and can interact with alcohol. Currently these drugs are only recommended for short-term use in acute situations
There are many patients with IBS who get frequent abdominal cramps. These individuals may benefit from anti spasmodic agents. These drugs can help relax the intestine and reduce intensity of contractions. Some of the common anti spasmodic used to treat IBS include dicyclomine (Bentyl) and hyoscyamine (levsin). A number of studies have shown that these agents are significantly better than sugar pills at reducing abdominal distension and cramps but do not alter constipation. To date, these agents have only been evaluated for short-term efficacy and long-term results remain unknown.
Antidiarrheal agents
Both Imodium and pepto bismol can decrease diarrhea and do work well in individuals with diarrhea type IBS. However, both these drugs have side effects and can immediately turn the diarrheal IBS type into the constipation variety. Use of these drugs should be used with caution and one should start at very low doses.
Antidepressant and antianxiety medications
Of all the medications for IBS, anti depressants have had great success. Many anti depressants have been shown to relieve pain with very low doses. How anti depressants relieve pain is not well understood but is believed to be to due to an action in the brain. These drugs also help reduce diarrhea and improve mental status. Many studies have been conducted on antidepressants and their role in IBS. Overall about 30% of patients show improvement. Among patients who do respond, many stop using the drug because of side effects.
Among the anti depressant shown to be beneficial include amitriptyline, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), and trimipramine (Surmontil).
Paxil has also been demonstrated to work well in some patients with IBS. However, experience with these drugs is limited and is not recommended as first line therapy. Other drugs that have shown to be beneficial in some patients with IBS include the benzodiazepines. However, these drugs are expensive, have side effects including dependence, and can interact with alcohol. Currently these drugs are only recommended for short-term use in acute situations
Irritable bowel syndrome 101 part 4
Treatment
The treatment of IBS is difficult and no one treatment is adequate for all patients. The major emphasis of therapy focuses on changes in diet, drugs, behavior, and alternative therapies
Dietary therapy
It has been known that certain foods can trigger IBS symptoms. These foods include caffeine, citrus, corn, dairy lactose, wheat, and wheat gluten. The two most common foods that can worsen IBS include Lactose and caffeine. It is highly recommended that individuals who have IBS keep a diary to identify and avoid trigger foods. Based on elimination of certain foods, at least 50 percent of individuals can have a dramatic reduction in their condition.
The role of Probiotics and other dietary changes have not been effective in treatment of IBS. However, some patients develop symptoms that occur with all types of foods. These individuals are the most difficult to treat.
There are some experts who recommend dietary fiber for treating IBS. It is believe that fiber can hold more water, increases lubrication, and bulk of stools. The evidence for dietary fiber in treating IBS is not very strong. Some studies do show improvement, whereas others show no difference in symptoms.
However, individuals with IBS who have constipation should try out dietary fiber. Dietary fiber is cheap, readily available and very safe. Synthetic fibers can improve symptoms but produce more gas. Other fiber containing foods include psyllium and linseed, both of which are natural and provide good lubrication to stools. Wheat bran is good but should not be consumed by individuals who have gluten sensitivity.
Those individuals with IBS with slow transit time may show improvement with use of osmotic laxatives like magnesium salts, phosphate salts and polyethylene glycol. Other fiber substances that have been used include hydrolyzed guar gum. A number of studies have shown that guar gum is especially useful for individuals who cannot tolerate other fibers.
The treatment of IBS is difficult and no one treatment is adequate for all patients. The major emphasis of therapy focuses on changes in diet, drugs, behavior, and alternative therapies
Dietary therapy
It has been known that certain foods can trigger IBS symptoms. These foods include caffeine, citrus, corn, dairy lactose, wheat, and wheat gluten. The two most common foods that can worsen IBS include Lactose and caffeine. It is highly recommended that individuals who have IBS keep a diary to identify and avoid trigger foods. Based on elimination of certain foods, at least 50 percent of individuals can have a dramatic reduction in their condition.
The role of Probiotics and other dietary changes have not been effective in treatment of IBS. However, some patients develop symptoms that occur with all types of foods. These individuals are the most difficult to treat.
There are some experts who recommend dietary fiber for treating IBS. It is believe that fiber can hold more water, increases lubrication, and bulk of stools. The evidence for dietary fiber in treating IBS is not very strong. Some studies do show improvement, whereas others show no difference in symptoms.
However, individuals with IBS who have constipation should try out dietary fiber. Dietary fiber is cheap, readily available and very safe. Synthetic fibers can improve symptoms but produce more gas. Other fiber containing foods include psyllium and linseed, both of which are natural and provide good lubrication to stools. Wheat bran is good but should not be consumed by individuals who have gluten sensitivity.
Those individuals with IBS with slow transit time may show improvement with use of osmotic laxatives like magnesium salts, phosphate salts and polyethylene glycol. Other fiber substances that have been used include hydrolyzed guar gum. A number of studies have shown that guar gum is especially useful for individuals who cannot tolerate other fibers.
Irritable bowel syndrome 101 part 3
Tests for IBS
Common tests which are performed in patients suspected of IBS include:
Sigmoidoscopy- a test which uses a flexible scope passed through the rectum and examines lower colon
Colonoscopy uses a flexible scope with a camera but can examine the entire colon.
CT scan is used to examine the entire abdomen and pelvis. It does use radiation and a dye
Because symptoms of IBS are often similar to lactose intolerance, many individuals undergo a breath test to rule out it out.
The other disorder that is very similar in presentation to IBS is celiac disease. Thus, one may need to undergo some types of blood tests to determine presence of celiac disease
Affect on lifestyle
IBS is not life threatening but can interfere with personal life, relationships and friends. One becomes preoccupied with food and develops certain degree of paranoia. This often leads to a disturbed personality, anger, and isolation. One can even develop malnourishment if proper nutrients are not consumed.
Most patients seek help when symptoms affect quality of life. Because of the vague symptoms, the diagnosis of IBS is always delayed. However, even when the diagnosis is made, treatment is not always effective.
Pathophysiology
Why IBS occurs is a mystery. There are countless theories and speculations but the real reason for IBS is not known. The most likely factors that lead to development of IBS include disordered gut motility, increase sensitivity of intestines to food or chemicals, and increased contractions of gut. When these factors are combined, they can lead to constipation, diarrhea, abdominal bloating, nausea, and abnormal gas expulsion. Most individuals who have IBS are very sensitive to wheat and dairy products leading to rapid diarrhea, abdominal cramps, and gas production.
In each and every case, the symptoms can be very confusing and doctors generally try to rule out the most common abdominal disorders with radiological tests.
In all cases, IBS is a diagnosis of exclusion and often it takes several months to a year to make the diagnosis
Common tests which are performed in patients suspected of IBS include:
Sigmoidoscopy- a test which uses a flexible scope passed through the rectum and examines lower colon
Colonoscopy uses a flexible scope with a camera but can examine the entire colon.
CT scan is used to examine the entire abdomen and pelvis. It does use radiation and a dye
Because symptoms of IBS are often similar to lactose intolerance, many individuals undergo a breath test to rule out it out.
The other disorder that is very similar in presentation to IBS is celiac disease. Thus, one may need to undergo some types of blood tests to determine presence of celiac disease
Affect on lifestyle
IBS is not life threatening but can interfere with personal life, relationships and friends. One becomes preoccupied with food and develops certain degree of paranoia. This often leads to a disturbed personality, anger, and isolation. One can even develop malnourishment if proper nutrients are not consumed.
Most patients seek help when symptoms affect quality of life. Because of the vague symptoms, the diagnosis of IBS is always delayed. However, even when the diagnosis is made, treatment is not always effective.
Pathophysiology
Why IBS occurs is a mystery. There are countless theories and speculations but the real reason for IBS is not known. The most likely factors that lead to development of IBS include disordered gut motility, increase sensitivity of intestines to food or chemicals, and increased contractions of gut. When these factors are combined, they can lead to constipation, diarrhea, abdominal bloating, nausea, and abnormal gas expulsion. Most individuals who have IBS are very sensitive to wheat and dairy products leading to rapid diarrhea, abdominal cramps, and gas production.
In each and every case, the symptoms can be very confusing and doctors generally try to rule out the most common abdominal disorders with radiological tests.
In all cases, IBS is a diagnosis of exclusion and often it takes several months to a year to make the diagnosis
Subscribe to:
Posts (Atom)
Posts
