Lifestyle changes
By absorbing water from the intestines, soluble fibre helps keep moisture in the stool, which prevents it from becoming hard and painful to expel. Fibre also bulks up the stool, which in turn fills out the colon and reduces the chances of it going into spasm. Foods that are high in soluble fibre include oatmeal, soy foods, barley, oat bran and beans. You can try a bulking agent, such as psyllium seed (Metamucil, Nucolox), but be sure to take it with plenty of water and other fluids throughout the day to keep things moving.
When your main symptoms is wind, make an effort to eliminate gas-forming foods such as beans, peas, lentils, broccoil, cauli-flower, onions, cucumbers and leafy vegetables. As your symptoms improve, gradually reintroduce these foods and see what happens.
Along with paying more attention to your diet, get more exercise. In studies of women with IBS, those who exercised reported fewer symptoms than those who didn't. Not only does exercise help stimulate digestion, it also firms the abdominal muscles, helping to keep those out-of-control intestines in their place. And working out is also a great way to beat stress. Walk or do some other form of aerobic exercise for at least 30 minutes three times a week.
PROMISING DEVELOPMENTS
If your symptoms don't respond to lifestyle changes, your doctor may suggest adding one or more of the following medicine (be sure to discuss side effects and use the drug only as directed):
>EAT MORE FISH. In a study in the prestigious New England Journal of Medicine, more than half of those who had IBS reduced or eliminated their symptoms when they took daily fish oil supplements, along with their medication. Fish oil may help treat IBS because it contains important fats called omega-3 fatty acids, known to reduce inflammation. Fish oil may also bolster levels of the brain chemical serotonin, normalising the way your brain interprets bowel signals. Try to eat fatty, cold-water fish such as tuna or salmon at twice a week.
TEGASEROD (ZELMAC)
Research has shown that the naturally occuring, neuro-transmitter, serotonin, can have considerable effect on the function of the gastrointestinal tract. While serotonin has more commonly been linked with conditions such as depression, it has been found that when serotonin receptors in the gut are activated the bowel action is sped up, causing diarrhoea and urgency. Conversely when these receptors are blocked the bowel action slows down, causing constipation and bloating.
Zelmac is a partial SHT agonist so it mimics the action of serotonin. It works by acclerating the movement through the gastrointestinal tract and is therefore particularly useful in people whose main symptoms of IBS are constipation, abdominal discomfort and bloating. This theory has been supported by a number of randomised, controlled clinical trials. Because very few men were enrolled in the original clinical trials. Because very few men were enrolled in the original clinical trials, Zelmac is only approved for women with constipation-dominant IBS.
Side effects of Zelmac mainly involve the gastrointestinal tract. The main side effect associated with Zelmac is diarrhoea, which occurs is about 10% of people who take the medication.
Zelmac is taken twice daily just before a meal. The benefits of Zelmac tend to decline with time so you should also only take it for a maximum of 12 weeks. Also, if you haven't shown any improvement after a month you should discontinue taking it. This medication is not addictive.
It is recommended that you don't take Zelmac. If you are pregnant or breast-feeding, or if you have severe liver or kidney disease.
You need a doctor's prescription to obtain Zelmac, and be warned, the drug is not subsidised in Australia or New Zealand and is therefore very pricey.
Procedures
If stress clearly aggravates your IBS, relaxation techniques such as biofeedback and hypnosis may help. Both can be learned from a trained professional and then done at home. In a typical biofeed-back session, you're hooked up to a machine that reads bodily functions such as heart rate, blood pressure and muscle tension. As you try to relax, the machine provides constant feedback, letting you know exactly how relaxed you've become. Eventually you'll be able to generate the same results without the machine. During hypnosis for IBS, you enter a deeply relaxed state as the hyonotherapist talks you though a visualisation that involves relaxing your intestinal muscles. In one study published in the American Journal of Gastroenterology, 250 IBS patients who underwent 12 hypnotheraphy sessions over three months experienced fewer symptoms. After a few training sessions, you'll learn to place yourself in the hypnotic state, implant the positive suggestions you've been taught and then leave the hypnotic state at will.
Natural methods
Many people with IBS find relief by taking peppermint oil supplements, which can act as a natural muscle relaxant. In a recent study of 110 people with IBS, those who took one capsule 15 to 20 minutes before meals had less bloating, diarrhoea and pain within a month. Look for an 'enteric-coated' supplement, which ensures that the peppermint oil gets released in your intenstine, where it's needed. Take one or two capsules (containing 0.2 ml of oil each) two or three times a day before eating. Don't take peppermint oil if you're pregnant (it relaxes the uterus) or if you have a hiatus hernia; and avoid peppermint tea, which may aggravate your symptoms.
By absorbing water from the intestines, soluble fibre helps keep moisture in the stool, which prevents it from becoming hard and painful to expel. Fibre also bulks up the stool, which in turn fills out the colon and reduces the chances of it going into spasm. Foods that are high in soluble fibre include oatmeal, soy foods, barley, oat bran and beans. You can try a bulking agent, such as psyllium seed (Metamucil, Nucolox), but be sure to take it with plenty of water and other fluids throughout the day to keep things moving.
When your main symptoms is wind, make an effort to eliminate gas-forming foods such as beans, peas, lentils, broccoil, cauli-flower, onions, cucumbers and leafy vegetables. As your symptoms improve, gradually reintroduce these foods and see what happens.
Along with paying more attention to your diet, get more exercise. In studies of women with IBS, those who exercised reported fewer symptoms than those who didn't. Not only does exercise help stimulate digestion, it also firms the abdominal muscles, helping to keep those out-of-control intestines in their place. And working out is also a great way to beat stress. Walk or do some other form of aerobic exercise for at least 30 minutes three times a week.
PROMISING DEVELOPMENTS
- Besides Lotronex, more drugs specifically designed for IBS symptoms are on the way. One, Cilansetron, another 5-HT3 receptor antagonist now in clinical trials, may complete with Lotronex, helping to ease sever diahorrea.
- Alosetron (Letronex), another 5-HT3 antagonist, is back on the market in the US after being withdrawn by the manufacturer following serious health concerns. Now under considerable restriction, the drug is very effectivee for diarrhoea in IBS.
If your symptoms don't respond to lifestyle changes, your doctor may suggest adding one or more of the following medicine (be sure to discuss side effects and use the drug only as directed):
- Antidiarrhoeal agents, such as loperamide (Imodium) and diphenoxylate hydrochloride/atropine sulfate (Lomotil), help stop the contractions that lead to diarrhoea. While not for daily use, these work particularly well in preventing diarrhoea at inconvienient times (such as during a social engagement) and at predictable ones (while exercising on a hot day).
- Hyperosmotic laxatives, such as magnesium hdyroxide (Milk of Magnesia) and lactulose (Duphalac), sold over the counter, may help constipation. As with antidiarrhoeal agents, don't make them a regular habit, because long-term use can worsen constipation. You may want to try a psyllium product first.
- Antispasmodics, such as Donnatab, hyoscine butylbromide (Buscopan) or meberverine (Colofac), also help. They relax the intestinal muscles and are useful if you suffer from acute abdominal pain. Take the medication 30 to 60 minutes before you eat a meal.
- Tricyclic antidepressants, such as imipramine (Tofranil) and amitriptyline (Endep, Tryptanol), counteract the brain neurones responsible for telling your intestines to spasm. Prescribed at much lower does than for depression, these drugs also stop the pain receptors in your gut from relaying their signals to your brain.
- 5-HT receptors are worked on by Tegaserod (Zelmac). It stimulates the movement through the gastrointestinal tract so it is most useful for women whose irritable bowel symptoms are abdominal pain/discomfort and constipation (see box below).
>EAT MORE FISH. In a study in the prestigious New England Journal of Medicine, more than half of those who had IBS reduced or eliminated their symptoms when they took daily fish oil supplements, along with their medication. Fish oil may help treat IBS because it contains important fats called omega-3 fatty acids, known to reduce inflammation. Fish oil may also bolster levels of the brain chemical serotonin, normalising the way your brain interprets bowel signals. Try to eat fatty, cold-water fish such as tuna or salmon at twice a week.
TEGASEROD (ZELMAC)
Research has shown that the naturally occuring, neuro-transmitter, serotonin, can have considerable effect on the function of the gastrointestinal tract. While serotonin has more commonly been linked with conditions such as depression, it has been found that when serotonin receptors in the gut are activated the bowel action is sped up, causing diarrhoea and urgency. Conversely when these receptors are blocked the bowel action slows down, causing constipation and bloating.
Zelmac is a partial SHT agonist so it mimics the action of serotonin. It works by acclerating the movement through the gastrointestinal tract and is therefore particularly useful in people whose main symptoms of IBS are constipation, abdominal discomfort and bloating. This theory has been supported by a number of randomised, controlled clinical trials. Because very few men were enrolled in the original clinical trials. Because very few men were enrolled in the original clinical trials, Zelmac is only approved for women with constipation-dominant IBS.
Side effects of Zelmac mainly involve the gastrointestinal tract. The main side effect associated with Zelmac is diarrhoea, which occurs is about 10% of people who take the medication.
Zelmac is taken twice daily just before a meal. The benefits of Zelmac tend to decline with time so you should also only take it for a maximum of 12 weeks. Also, if you haven't shown any improvement after a month you should discontinue taking it. This medication is not addictive.
It is recommended that you don't take Zelmac. If you are pregnant or breast-feeding, or if you have severe liver or kidney disease.
You need a doctor's prescription to obtain Zelmac, and be warned, the drug is not subsidised in Australia or New Zealand and is therefore very pricey.
Procedures
If stress clearly aggravates your IBS, relaxation techniques such as biofeedback and hypnosis may help. Both can be learned from a trained professional and then done at home. In a typical biofeed-back session, you're hooked up to a machine that reads bodily functions such as heart rate, blood pressure and muscle tension. As you try to relax, the machine provides constant feedback, letting you know exactly how relaxed you've become. Eventually you'll be able to generate the same results without the machine. During hypnosis for IBS, you enter a deeply relaxed state as the hyonotherapist talks you though a visualisation that involves relaxing your intestinal muscles. In one study published in the American Journal of Gastroenterology, 250 IBS patients who underwent 12 hypnotheraphy sessions over three months experienced fewer symptoms. After a few training sessions, you'll learn to place yourself in the hypnotic state, implant the positive suggestions you've been taught and then leave the hypnotic state at will.
Natural methods
Many people with IBS find relief by taking peppermint oil supplements, which can act as a natural muscle relaxant. In a recent study of 110 people with IBS, those who took one capsule 15 to 20 minutes before meals had less bloating, diarrhoea and pain within a month. Look for an 'enteric-coated' supplement, which ensures that the peppermint oil gets released in your intenstine, where it's needed. Take one or two capsules (containing 0.2 ml of oil each) two or three times a day before eating. Don't take peppermint oil if you're pregnant (it relaxes the uterus) or if you have a hiatus hernia; and avoid peppermint tea, which may aggravate your symptoms.
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