Irritable bowel syndrome - Diagnosis and treatment - Mayo ...

Advertisement · Onset of signs and symptoms after age 50 · Weight loss · Rectal bleeding · Fever · Nausea or recurrent vomiting · Abdominal pain, ... COVID-19:Advice,updatesandvaccineoptions Weareopenforsafein-personcare. Learnmore: MayoClinicfactsaboutcoronavirusdisease2019(COVID-19) OurCOVID-19patientandvisitorguidelines,plustrustedhealthinformation Lateston COVID-19vaccination bysite: Arizonapatientvaccinationupdates Arizona, Floridapatientvaccinationupdates Florida, Rochesterpatientvaccinationupdates Rochesterand MayoClinicHealthSystempatientvaccinationupdates MCHS Skiptositenavigation SkiptoContent ThiscontentdoesnothaveanEnglishversion.ThiscontentdoesnothaveanArabicversion. SectionsforIrritablebowelsyndromeSymptoms&causesDiagnosis&treatmentDoctors&departmentsCareatMayoClinic Print DiagnosisThere'snotesttodefinitivelydiagnoseIBS.Yourdoctorislikelytostartwithacompletemedicalhistory,physicalexamandteststoruleoutotherconditions,suchasceliacdisease. Afterotherconditionshavebeenruledout,yourdoctorislikelytouseoneofthesesetsofdiagnosticcriteriaforIBS: Romecriteria.Thesecriteriaincludeabdominalpainanddiscomfortlastingonaverageatleastonedayaweekinthelastthreemonths,associatedwithatleasttwoofthesefactors:Painanddiscomfortarerelatedtodefecation,thefrequencyofdefecationisaltered,orstoolconsistencyisaltered. TypeofIBS.Forthepurposeoftreatment,IBScanbedividedintothreetypes,basedonyoursymptoms:constipation-predominant,diarrhea-predominantormixed. Yourdoctorwillalsolikelyassesswhetheryouhaveothersignsorsymptomsthatmightsuggestanother,moreserious,condition.Thesesignsandsymptomsinclude: Onsetofsignsandsymptomsafterage50 Weightloss Rectalbleeding Fever Nauseaorrecurrentvomiting Abdominalpain,especiallyifit'snotrelatedtoabowelmovement,oroccursatnight Diarrheathatispersistentorawakensyoufromsleep Anemiarelatedtolowiron Ifyouhavethesesignsorsymptoms,orifaninitialtreatmentforIBSdoesn'twork,you'lllikelyneedadditionaltests. AdditionaltestsYourdoctormayrecommendseveraltests,includingstoolstudiestocheckforinfectionorproblemswithyourintestine'sabilitytotakeinthenutrientsfromfood(malabsorption).Youmayalsohaveanumberofotherteststoruleoutothercausesforyoursymptoms. Diagnosticprocedurescaninclude: Colonoscopy.Yourdoctorusesasmall,flexibletubetoexaminetheentirelengthofthecolon. X-rayorCTscan.Thesetestsproduceimagesofyourabdomenandpelvisthatmightallowyourdoctortoruleoutothercausesofyoursymptoms,especiallyifyouhaveabdominalpain.Yourdoctormightfillyourlargeintestinewithaliquid(barium)tomakeanyproblemsmorevisibleonX-ray.ThisbariumtestissometimescalledalowerGIseries. Upperendoscopy.Along,flexibletubeisinserteddownyourthroatandintothetubeconnectingyourmouthandstomach(esophagus).Acameraontheendofthetubeallowsthedoctortoinspectyourupperdigestivetractandobtainatissuesample(biopsy)fromyoursmallintestineandfluidtolookforovergrowthofbacteria.Yourdoctormightrecommendendoscopyifceliacdiseaseissuspected. Laboratorytestscaninclude: Lactoseintolerancetests.Lactaseisanenzymeyouneedtodigestthesugarfoundindairyproducts.Ifyoudon'tproducelactose,youmayhaveproblemssimilartothosecausedbyIBS,includingabdominalpain,gasanddiarrhea.Yourdoctormayorderabreathtestoraskyoutoremovemilkandmilkproductsfromyourdietforseveralweeks. Breathtestforbacterialovergrowth.Abreathtestalsocandetermineifyouhavebacterialovergrowthinyoursmallintestine.Bacterialovergrowthismorecommonamongpeoplewhohavehadbowelsurgeryorwhohavediabetesorsomeotherdiseasethatslowsdowndigestion. Stooltests.Yourstoolmightbeexaminedforbacteriaorparasites,oradigestiveliquidproducedinyourliver(bileacid),ifyouhavechronicdiarrhea. CareatMayoClinic OurcaringteamofMayoClinicexpertscanhelpyouwithyourirritablebowelsyndrome-relatedhealthconcerns StartHere MoreInformationIrritablebowelsyndromecareatMayoClinicColonoscopyCTscanFlexiblesigmoidoscopyShowmorerelatedinformation TreatmentTreatmentofIBSfocusesonrelievingsymptomssothatyoucanliveasnormallyaspossible. Mildsignsandsymptomscanoftenbecontrolledbymanagingstressandbymakingchangesinyourdietandlifestyle.Tryto: Avoidfoodsthattriggeryoursymptoms Eathigh-fiberfoods Drinkplentyoffluids Exerciseregularly Getenoughsleep Yourdoctormightsuggestthatyoueliminatefromyourdiet: High-gasfoods.Ifyouexperiencebloatingorgas,youmightavoiditemssuchascarbonatedandalcoholicbeveragesandcertainfoodsthatmayleadtoincreasedgas. Gluten.ResearchshowsthatsomepeoplewithIBSreportimprovementindiarrheasymptomsiftheystopeatinggluten(wheat,barleyandrye)eveniftheydon'thaveceliacdisease. FODMAPs.Somepeoplearesensitivetocertaincarbohydratessuchasfructose,fructans,lactoseandothers,knownasFODMAPs—fermentableoligosaccharides,disaccharides,monosaccharidesandpolyols.FODMAPsarefoundincertaingrains,vegetables,fruitsanddairyproducts. Adietitiancanhelpyouwiththesedietchanges. Ifyourproblemsaremoderateorsevere,yourdoctormightsuggestcounseling—especiallyifyouhavedepressionorifstresstendstoworsenyoursymptoms. Inaddition,basedonyoursymptomsyourdoctormightsuggestmedicationssuchas: Fibersupplements.Takingasupplementsuchaspsyllium(Metamucil)withfluidsmayhelpcontrolconstipation. Laxatives.Iffiberdoesn'thelpconstipation,yourdoctormayrecommendover-the-counterlaxatives,suchasmagnesiumhydroxideoral(Phillips'MilkofMagnesia)orpolyethyleneglycol(Miralax). Anti-diarrhealmedications.Over-the-countermedications,suchasloperamide(ImodiumA-D),canhelpcontroldiarrhea.Yourdoctormightalsoprescribeabileacidbinder,suchascholestyramine(Prevalite),colestipol(Colestid)orcolesevelam(Welchol).Bileacidbinderscancausebloating. Anticholinergicmedications.Medicationssuchasdicyclomine(Bentyl)canhelprelievepainfulbowelspasms.Theyaresometimesprescribedforpeoplewhohaveboutsofdiarrhea.Thesemedicationsaregenerallysafebutcancauseconstipation,drymouthandblurredvision. Tricyclicantidepressants.Thistypeofmedicationcanhelprelievedepressionaswellasinhibittheactivityofneuronsthatcontroltheintestinestohelpreducepain.Ifyouhavediarrheaandabdominalpainwithoutdepression,yourdoctormaysuggestalowerthannormaldoseofimipramine(Tofranil),desipramine(Norpramin)ornortriptyline(Pamelor).Sideeffects—whichmightbereducedifyoutakethemedicationatbedtime—canincludedrowsiness,blurredvision,dizzinessanddrymouth. SSRIantidepressants.Selectiveserotoninreuptakeinhibitor(SSRI)antidepressants,suchasfluoxetine(Prozac,Sarafem)orparoxetine(Paxil),mayhelpifyouaredepressedandhavepainandconstipation. Painmedications.Pregabalin(Lyrica)orgabapentin(Neurontin)mighteaseseverepainorbloating. MedicationsspecificallyforIBSMedicationsapprovedforcertainpeoplewithIBSinclude: Alosetron(Lotronex).Alosetronisdesignedtorelaxthecolonandslowthemovementofwastethroughthelowerbowel.Alosetroncanbeprescribedonlybydoctorsenrolledinaspecialprogram,isintendedforseverecasesofdiarrhea-predominantIBSinwomenwhohaven'trespondedtoothertreatments,andisn'tapprovedforusebymen.Ithasbeenlinkedtorarebutimportantsideeffects,soitshouldonlybeconsideredwhenothertreatmentsaren'tsuccessful. Eluxadoline(Viberzi).Eluxadolinecaneasediarrheabyreducingmusclecontractionsandfluidsecretionintheintestine,andincreasingmuscletoneintherectum.Sideeffectscanincludenausea,abdominalpainandmildconstipation.Eluxadolinehasalsobeenassociatedwithpancreatitis,whichcanbeseriousandmorecommonincertainindividuals. Rifaximin(Xifaxan).Thisantibioticcandecreasebacterialovergrowthanddiarrhea. Lubiprostone(Amitiza).Lubiprostonecanincreasefluidsecretioninyoursmallintestinetohelpwiththepassageofstool.It'sapprovedforwomenwhohaveIBSwithconstipation,andisgenerallyprescribedonlyforwomenwithseveresymptomsthathaven'trespondedtoothertreatments. Linaclotide(Linzess).Linaclotidealsocanincreasefluidsecretioninyoursmallintestinetohelpyoupassstool.Linaclotidecancausediarrhea,buttakingthemedication30to60minutesbeforeeatingmighthelp. PotentialfuturetreatmentsResearchersareinvestigatingnewtreatmentsforIBS,suchasfecalmicrobiotatransplantation(FMT).Consideredinvestigationalatthistime,FMTrestoreshealthyintestinalbacteriabyplacinganotherperson'sprocessedstoolintothecolonofapersonaffectedbyIBS.Clinicaltrialstostudyfecaltransplantsarecurrentlyunderway.   Thereisaproblemwith informationsubmittedforthisrequest.Review/updatethe informationhighlightedbelowandresubmittheform. GetthelatesthealthinformationfromMayoClinicdeliveredtoyourinbox. Subscribeforfreeandreceiveyourin-depthguideto digestivehealth,plusthelatestonhealthinnovationsandnews.Youcanunsubscribeatany time. Emailaddress ErrorEmailfieldisrequired ErrorIncludeavalidemailaddress FirstName(letusknowyourpreferredname) LastName Subscribe LearnmoreaboutMayoClinic’suseofdata. Toprovideyouwiththemostrelevantandhelpfulinformation,andunderstandwhich informationisbeneficial,wemaycombineyouremailandwebsiteusageinformationwith otherinformationwehaveaboutyou.IfyouareaMayoClinicpatient,thiscould includeprotectedhealthinformation.Ifwecombinethisinformationwithyourprotected healthinformation,wewilltreatallofthatinformationasprotectedhealth informationandwillonlyuseordisclosethatinformationassetforthinournoticeof privacypractices.Youmayopt-outofemailcommunicationsatanytimebyclickingon theunsubscribelinkinthee-mail. Thankyouforsubscribing Yourin-depthdigestivehealthguidewillbeinyourinboxshortly.Youwillalsoreceive emailsfromMayoCliniconthelatesthealthnews,research,andcare. Ifyoudon’treceiveouremailwithin5minutes,checkyourSPAMfolder,thencontactus [email protected]. Sorrysomethingwentwrongwithyoursubscription Please,tryagaininacoupleofminutes Retry MoreInformationIrritablebowelsyndromecareatMayoClinicAcupunctureHypnosis RequestanAppointmentatMayoClinic Clinicaltrials ExploreMayoClinicstudiestestingnewtreatments,interventionsandtestsasameanstoprevent,detect,treatormanagethiscondition. LifestyleandhomeremediesSimplechangesinyourdietandlifestyleoftenproviderelieffromIBS.Yourbodywillneedtimetorespondtothesechanges.Tryto: Experimentwithfiber.Fiberhelpsreduceconstipationbutalsocanworsengasandcramping.Tryslowlyincreasingtheamountoffiberinyourdietoveraperiodofweekswithfoodssuchaswholegrains,fruits,vegetablesandbeans.Afibersupplementmightcauselessgasandbloatingthanfiber-richfoods. Avoidproblemfoods.Eliminatefoodsthattriggeryoursymptoms. Eatatregulartimes.Don'tskipmeals,andtrytoeatataboutthesametimeeachdaytohelpregulatebowelfunction.Ifyouhavediarrhea,youmayfindthateatingsmall,frequentmealsmakesyoufeelbetter.Butifyou'reconstipated,eatinglargeramountsofhigh-fiberfoodsmayhelpmovefoodthroughyourintestines. Exerciseregularly.Exercisehelpsrelievedepressionandstress,stimulatesnormalcontractionsofyourintestines,andcanhelpyoufeelbetteraboutyourself.Askyourdoctoraboutanexerciseprogram. AlternativemedicineTheroleofalternativetherapiesinrelievingIBSsymptomsisunclear.Askyourdoctorbeforestartinganyofthesetreatments.Alternativetherapiesinclude: Hypnosis.Atrainedprofessionalteachesyouhowtoenterarelaxedstateandthenguidesyouinrelaxingyourabdominalmuscles.Hypnosismayreduceabdominalpainandbloating.Severalstudiessupportthelong-termeffectivenessofhypnosisforIBS. Peppermint.Studiesshowthat,inpeoplewhohaveIBSwithdiarrhea,aspeciallycoatedtabletthatslowlyreleasespeppermintoilinthesmallintestine(enteric-coatedpeppermintoil)easesbloating,urgency,abdominalpainandpainwhilepassingstool. Probiotics.Probioticsare"good"bacteriathatnormallyliveinyourintestinesandarefoundincertainfoods,suchasyogurt,andindietarysupplements.RecentstudiessuggestthatcertainprobioticsmayrelieveIBSsymptoms,suchasabdominalpain,bloatinganddiarrhea. Stressreduction.Yogaormeditationcanhelprelievestress.Youcantakeclassesorpracticeathomeusingbooksorvideos. PreparingforyourappointmentYoumaybereferredtoadoctorwhospecializesinthedigestivesystem(gastroenterologist). Whatyoucando Beawareofanypre-appointmentrestrictions,suchasrestrictingyourdietbeforeyourappointment. Writedownyoursymptoms,includinganythatmayseemunrelatedtothereasonwhyyouscheduledtheappointment. Writedownanytriggerstoyoursymptoms,suchasspecificfoods. Makealistofallyourmedications,vitaminsandsupplements. Writedownyourkeymedicalinformation,includingotherconditions. Writedownkeypersonalinformation,includinganyrecentchangesorstressorsinyourlife. Writedownquestionstoaskyourdoctor. Askarelativeorfriendtoaccompanyyou,tohelpyourememberwhatthedoctorsays. Questionstoaskyourdoctor What'sthemostlikelycauseofmysymptoms? WhattestsdoIneed?Isthereanyspecialpreparationforthem? Whattreatmentapproachdoyourecommend?Arethereanysideeffectsassociatedwiththesetreatments? ShouldIchangemydiet? Arethereotherlifestylechangesthatyourecommend? DoyourecommendthatItalkwithacounselor? Ihaveotherhealthproblems.HowcanIbestmanagetheseconditionstogether? IfIhaveIBS,howlongwillittakeformetoseeimprovementfromthetherapyyouhaveprescribed? Inadditiontothequestionsthatyou'vepreparedtoaskyourdoctor,don'thesitatetoaskquestionsduringyourappointmentanytimeyoudon'tunderstandsomething. WhattoexpectfromyourdoctorYourdoctorislikelytoaskyouanumberofquestions.Beingreadytoanswerthemmayleavetimetogooverpointsyouwanttospendmoretimeon.Youmaybeasked: Whatareyoursymptoms,andwhendidtheybegin? Howsevereareyoursymptoms?Aretheycontinuousoroccasional? Doesanythingseemtotriggeryoursymptoms,suchasfoods,stressor—inwomen—yourmenstrualperiod? Haveyoulostweightwithouttrying? Haveyouhadfever,vomitingorbloodinyourstools? Haveyourecentlyexperiencedsignificantstress,emotionaldifficultyorloss? Whatisyourtypicaldailydiet? Haveyoueverbeendiagnosedwithafoodallergyorwithlactoseintolerance? Doyouhaveanyfamilyhistoryofboweldisordersorcoloncancer? Howmuchwouldyousayyoursymptomsareaffectingyourqualityoflife,includingyourpersonalrelationshipsandyourabilitytofunctionatschoolorwork? WhatyoucandointhemeantimeWhileyouwaitforyourappointment: Askfamilymembersifanyrelativeshavebeendiagnosedwithinflammatoryboweldiseaseorcoloncancer. Startnotinghowoftenyoursymptomsoccurandanyfactorsthatseemtotriggerthem. ByMayoClinicStaff IrritablebowelsyndromecareatMayoClinic RequestanAppointmentatMayoClinic Symptoms&causesDoctors&departments Oct.15,2020 Print Shareon:FacebookTwitter Showreferences HadjivasilisA,etal.Newinsightsintoirritablebowelsyndrome:Frompathophysiologytotreatment.AnnalsofGastroenterology.2019;doi:10.20524/aog.2019.0428. Irritablebowelsyndrome.NationalInstituteofDiabetesandDigestiveandKidneyDiseases.https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/all-content.AccessedAug.28,2020. KellermanRD,etal.Irritablebowelsyndrome.In:Conn'sCurrentTherapy2020.Elsevier;2020.https://www.clinicalkey.com.AccessedAug.28,2020. FeldmanM,etal.Irritablebowelsyndrome.In:SleisengerandFordtran'sGastrointestinalandLiverDisease:Pathophysiology,Diagnosis,Management.11thed.Elsevier;2021.https://www.clinicalkey.com.AccessedAug.28,2020. Irritablebowelsyndrome.AmericanCollegeofGastroenterology.https://gi.org/topics/irritable-bowel-syndrome/.AccessedAug.28,2020. 6tips:IBSandcomplementaryhealthpractices.NationalCenterforComplementaryandIntegrativeHealth.https://www.nccih.nih.gov/health/tips/tips-ibs-and-complementary-health-practices.AccessedAug.28,2020. Irritablebowelsyndrome.CanadianSocietyofIntestinalResearch.https://badgut.org/information-centre/a-z-digestive-topics/ibs/.AccessedAug.28,2020. BrownAY.AllscriptsEPSi.MayoClinic.June24,2020. KashyapPC(expertopinion).MayoClinic.Sept.21,2020. Related Howirritablebowelsyndromeaffectsyou Spasticcolon:Whatdoesitmean? 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