Irritable Bowel Syndrome: Aging Begins at 30: Virtual Hospital

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Aging Begins at 30

Irritable Bowel Syndrome

Ian Maclean Smith, M.D.
Emeritus Professor
Department of Internal Medicine
University of Iowa Hospitals and Clinics
Creation Date: August 2001
Last Revision Date: August 2001
Peer Review Status: Internally Peer Reviewed

Irritable bowel syndrome (IBS) is recurrent abdominal discomfort or pain, often with a bloating feeling, relieved by a bowel movement and associated with erratic defecation. There are three loosely defined types with diarrhea predominant, with constipation dominant or a mixed type. Stooling is associated with the passage of mucus and a sense of incomplete evacuation. Patients often have a small volume stool. Bouts usually last one to five days. The pain can be cramping on a background of a constant ache. IBS rarely occurs during sleep. Most new cases present before the age of 45. Women have the disease twice to three times as often as men. The urgency to defecate may lead to the wearing of pads away from home.

Evidence suggests that the disease is caused by changes in the nerves to the gut or an abnormality in the muscle of the gut or both. Maybe patients have a reduced tolerance to gut distention by gas rather than the production of excess gas. Patients often have an abnormal response to stress and have a higher frequency of psychological disturbances perhaps from childhood experiences but a link between IBS and stress is unproved.

The disease doesn't kill you but it makes you sick and very uncomfortable. It can usually be diagnosed in the office without special tests. To make a diagnosis, the symptoms should be present for at least 3 months. Symptoms of other gut diseases such as ulcerative colitis; Crohn's disease, cancer and intestinal parasitism must be excluded. Gut bleeding grossly or microscopically, weight loss or fever should be red flags to look for other diseases. The physical examination will be negative and there are no diagnostic tests. IBS is a diagnosis of exclusion. Barium enemas and colonoscopy are usually reserved for patients presenting over age 40.

Management depends on a proper diagnosis and the treatment of the major symptoms. The establishment of a good non-judgmental doctor-patient relationship is essential. Patient education about the benign nature of the disease and the excellent long-term outlook and realistic expectations of treatment are important. Dietary peculiarities should be sought out and corrected. A trial with an increased fiber diet is a good beginning to treatment. Wheat bran will increase stool weight and hasten its passage through the gut, improving the constipation or the diarrhea. Patients with diarrhea are treated with loperamide (lomotil), patients with bloating get belladonna. Cisapride may help if constipation is the predominant symptom. Tricyclic antidepressants may be helpful. New drugs such as serotonin agonists or two types of serotonin antagonists are showing some promise but their use is limited by toxic side effects so far. Stressful life events can be covered with antianxiety drugs such as Librium, but its use should be limited. Hypnosis or biofeedback can be helpful in some patients.

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See related Patient Topics Digestive System or Irritable Bowel Syndrome.

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