Spastic Colon (Irritable Bowel Syndrome)

By Roland Larrabee, M.D.

Irritable bowel syndrome (IBS) is a chronic (long-lasting) disorder of the large intestine (colon). It is the most common gastrointestinal disorder. It affects twice as many women as men and usually begins in early adult life. Although IBS can cause much distress, it does not lead to life-threatening disease. Another term for IBS is spastic colon.

The cause of IBS is not fully understood. Most symptoms of IBS probably result from abnormal muscle movement or spasm of the lower part of the colon. Sometimes the spasm delays bowel movements. At other times it may lead to more rapid passage of bowel movements, resulting in diarrhea. In either case the spasm usually causes abdominal cramps. A specific food may trigger attacks. Spasms may also be triggered by stress or depression because muscle movement in the colon is controlled by the nervous system.

The most common symptoms include:

• cramping and pain in the abdomen, which may be severe
• constipation or diarrhea
• lots of gas

• bloating
• a feeling of fullness in the rectum.

There is no specific test for IBS. Depending on your history and exam, your provider may do some tests to look for other possible causes of your symptoms. Your health care provider may also ask you to try a milk-free diet to see if lactose intolerance (trouble digesting milk) may be causing your symptoms.

Doctors have not yet found a cure for IBS. However, controlling the diet and emotional stress usually relieves the symptoms. Some medicines may also help.

• Diet - Increasing the fiber in your diet often helps, although sometimes a decrease in fiber is needed. Try eating smaller meals more often. Avoid gas-producing foods such as cabbage or other cruciferous vegetables.
• Food diary - Your health care provider may ask you to keep a food diary to see if eating a particular food, for example, milk or sausage, worsens your symptoms.
• Stress - Your provider will help you identify things that cause stress in your life and will suggest ways to help you control them. Relaxation or biofeedback techniques may help you manage stress.
• Medicines - Your provider may prescribe a combination of bulk-forming agents (such as bran or methylcellulose), antispasmodic drugs, and tranquilizers or antidepressants.

Because IBS is a chronic disorder, you may have flare-ups of symptoms throughout your life. Although a cure hasn't been found yet, the disorder can usually be controlled. IBS will not progress to something worse. Follow these guidelines to relieve the symptoms of IBS:

• Learn stress-management techniques to reduce stress and anxiety in your life. Professional counseling may be helpful.
• Drink six to eight 8-ounce glasses of water a day.
• Do not drink alcohol, which can make symptoms of IBS worse.
• Select your foods carefully. If a food appears to bring on your symptoms, avoid it. However, don't eliminate a food just because it appears to cause symptoms one time. Be sure that a food produces symptoms several times before you give it up. You should try to keep many different foods in your diet because a varied diet provides better nutrition.
• Ask your health care provider if you should have a high-fiber diet, especially if you tend to be constipated. High-fiber foods may cause gas and bloating, but usually these symptoms lessen as the digestive tract gets used to the increased fiber. Some high-fiber foods include:
  • whole-grain breads and cereals
  • fruits, especially apricots, blackberries, coconut, dates, figs, kiwi, peaches, pears, pineapple, prunes, raspberries, and strawberries
  • nuts, especially almonds, pistachios, and walnuts
    vegetables, particularly Brussels sprouts, corn and popcorn, broccoli, and parsley
  • beans and lentils
• Ask your health care provider about using a nonprescription fiber supplement.
• Eat smaller meals more frequently. Eat smaller portions of foods at a meal.