My Doctor Online The Permanente Medical Group

Symptoms

The main symptoms of irritable bowel syndrome include stomach pain or discomfort and bloating.

Some people may also experience one or more of the following symptoms:

• Belching
• Heartburn
• Constipation (fewer than 3 bowel movements in a week)
• Diarrhea
• Gas
• Nausea
• Mucus in the stool
• Feeling as if a bowel movement hasn't been completed
• Irregular bowel movements
• Frequent bowel movements (more than 3 a day)
• Emotional stress
• Pain after eating a meal
• Increased pain during a woman's menstrual cycle

Similar symptoms that may not be related to IBS

Other gastrointestinal (GI) conditions, such as inflammatory bowel disease or diverticular disease, have similar symptoms.

Following are symptoms that are not typical of IBS:

• Pain or diarrhea that wakes you up or interferes with sleep
• Blood in your stool
• Weight loss
• Fever

Screening and Diagnosis

Unfortunately, there is no single test to help us diagnose irritable bowel disease. In addition to doing a physical exam, we will ask you a series of questions to better understand the nature of your symptoms and how long you have had them.

There are a standard set of criteria, called the Rome Classification, which can be helpful to support a diagnosis. The criteria include:

• Stomach discomfort or pain that lasts for at least 12 weeks over the last year. This pain does not have to be consecutive – it may be "off" and "on" over different periods of time.
• Abnormal stool frequency. By abnormal, we mean either more than 3 bowel movements per day or fewer than 3 bowel movements per week.
• Abnormal stool form. Abnormal stools are either lumpy and hard or loose and watery.
• Abnormal stool passage. This can mean either straining, experiencing a sudden feeling of urgency, or incomplete evacuation.
• Passage of mucus. You may notice mucus in your stool.
• Feeling bloating, pain, or tightness in your stomach. Your belly may feel sore to the touch or uncomfortably bloated.

We may also request a series of tests (blood and X-ray) to help rule out other disorders. The type of test will depend on your age, symptoms (how often and severe), and response to initial treatment.

If you have a family history of colon cancer or are 40 years old or older, we may order a screening test like a flexible sigmoidoscopy to check your colon health.

Causes

Despite much research, the causes of irritable bowel syndrome remain unclear, but experts have theories about how it develops:

• Abnormal contractions of the colon and intestines can irritate the bowels. This is called "spastic bowel" and may explain why some people experience severe cramps. However, this does not explain symptoms for all patients.
• Severe infection of the intestinal tract (Salmonella, Campylobacter, or Clostridium difficile). It is not clear how these infections trigger IBS, but experts think there is a relationship.
• Food intolerance or food allergy. Some people with IBS have allergies to certain foods or have food intolerance such as lactose (milk sugar) intolerance.
• Heightened nerve sensitivity to normal sensations within the intestines. Some people have an overactive awareness of gas and movement in the intestines.

Treatments

Unfortunately, there is no cure for irritable bowel syndrome. Don't let this discourage you, as many strategies are effective at reducing symptoms, including pain. We will work together to develop a treatment plan to minimize your discomfort.

Your treatment will depend on your symptoms and how severe they are. Depending on your symptoms, we may prescribe a combination of different medications and treatments. 

Sometimes, patients need to try more than one combination of treatments to ease symptoms. Long-term treatment is often necessary to manage symptoms, but this depends on the individual.

Prevention

IBS symptoms can be affected by stress, medications, physical activity levels, certain foods, and other factors. Maintaining a regular exercise routine and managing stress can help prevent and manage your symptoms.

Tracking your symptoms may help you identify patterns or triggers. For each IBS episode, take a moment to write down:

• When your symptoms occur
• What you ate and drank before the episode
• Your mood
• Any medications you took
• Any emotional stress you experienced

After you record each episode, review your notes and look for patterns that might identify triggers. For example, you may notice that spicy foods cause diarrhea. Or you might get constipated when your diet lacks fruits and vegetables. Once you identify triggers, try to avoid them.

Medications

Several different types of medicines are used to treat IBS symptoms, including:

• Antidiarrheal medications (Imodium or Lomotil). These decrease diarrhea by bulking up your stool.
• Antispasmodics. These help control colon muscle spasms and stomach pain. They are usually prescribed if you have cramps associated with IBS.
• Antidepressants. Most people know of antidepressants as a treatment for depression. However, in low doses, some antidepressants can relieve intestinal spasms and feelings of pain, bloating, and inability to pass a stool. They may be used to treat long-term stomach pain that interferes with day-to-day activities.

It may take a trial period of a few months to determine which medicines work best to address your symptoms.

Home Treatment

Many different home treatments can help decrease irritable bowel syndrome symptoms. We may recommend that you:

Slowly increase your fiber intake. High-fiber foods include fruits, vegetables, whole-grain breads, and cereals. Fiber helps reduce constipation. If you make changes to your diet, try to do it gradually to allow your body some time to adjust.

Take nonprescription fiber supplements. Fiber supplements work by absorbing liquids in the digestive tract. They can help reduce cramping and prevent both diarrhea and constipation. They are available as powders (mix with water and drink) or as pills (chewable or meant to be swallowed whole with water). They are different from laxatives because they are gentle on the lining of the intestine and safe for long-term use.

Drink more water. Water is important because it prevents bloating and constipation. If you use fiber supplements, drink plenty of water because the supplements work by absorbing water to create more bulk in the stools.

Get regular physical activity. Physical activity helps to reduce tension and make your bowels more regular. Exercise, such as walking and yoga, is a great stress reliever that can also help to manage symptoms such as bloating, gas, and constipation.

Get 7 to 9 hours of sleep each night. Lack of sleep leads to fatigue and lowered stress-tolerance levels, which are common triggers for IBS symptoms.

Practice stress management techniques. Stress can stimulate colon spasms, which cause IBS symptoms to flare up. To help reduce stress and anxiety, we may recommend that you try:

• Deep breathing
• Meditation
• Yoga
• Exercise
• Journaling

Avoid dairy products. For some people, milk and other products with lactose may cause symptoms to flare up. If you eliminate milk and milk products from your diet, we can recommend ways to ensure that you get the recommended amounts of calcium and vitamin D.

Avoid or limit foods that cause gas or tend to aggravate IBS symptoms:

• Beans, onions, broccoli, and cabbage. These are gas-producing foods.
• Sugar alcohols (such as sorbitol and mannitol). These can cause gas and diarrhea and are found in chewing gum, candies, and mints.
• Corn, peas, and carrots. These don't digest well.
• Citrus fruits like tomatoes and lemons.
• Caffeine and alcohol.

Avoid chewing gum and eating too quickly. These can cause you to swallow air, which leads to gas.

Avoid carbonated drinks. Soda and fizzy drinks can cause gas and discomfort.

Complementary and Alternative Medicines

Complementary and alternative medicine (CAM) is defined as any treatment that arose outside of conventional Western scientific medicine or is not generally practiced within Western medicine. This may include many different healing approaches and techniques, which come from specific cultures around the world. The Permanente Medical Group's approach to CAM is to evaluate whether it is safe and effective, and to counsel our patients about the relative risks and benefits based on available evidence.

We also recommend that CAM approaches be combined with a healthy diet and a regular exercise routine.

Mind-body approaches

Mind-body approaches to long-term conditions like IBS can help reduce symptoms.

• Hypnotherapy has been clinically proven to reduce anxiety, stress, and IBS symptoms.
• Mindfulness meditation can improve your overall health, increase well-being, and reduce stress. Tapes and videos are available to guide you in these practices. Call your local Kaiser Permanente Health Education Department for more information.
• Yoga, when practiced regularly, helps keep you strong and flexible and may change your responses to stress, which can trigger IBS symptoms.
• Cognitive restructuring is a practice based on the idea that the way you think about something can affect the way you experience it. In other words, the more you think about IBS in a neutral or positive way, the more likely you are to have a positive experience.
• Humor can reduce stress-related chemicals in the body and boost your immune system's ability to resist disease. Watch a funny movie and let yourself laugh.
• Aromatherapy is the therapeutic use of oils and extracts from plants, like lavender, to promote relaxation.
• Visualization or guided imagery involves focusing on a mental image or imagining you are in a peaceful place. This practice promotes relaxation. Tapes are available to help in visualization and guided imagery.
• Music can influence body, mind, and emotions. Put on your favorite music. Relax and enjoy.
• Massage therapy involves the use of healing touch to relieve pain, stimulate circulation, release tension, and reduce stress.
• Acupressure and acupuncture involve applying pressure to, or inserting very thin needles in, specific points on the body to help restore the balance of energy. Research is inconclusive on the effects of acupuncture on irritable bowel syndrome symptoms. However, some people use acupuncture to help relax muscle spasms and improve bowel function.
• Taking time for yourself and enjoying regular quiet time. Take a walk or a bath, or have a cup of tea.

Herbs and Supplements

Some herbal approaches to chronic conditions like IBS can be effective, while others have not been proven to be effective and may do more harm than good. In addition, we know that some herbs interact or interfere with medications you may be taking. We recommend that you consult with us before taking herbs.

Before using herbs and supplements, consider:

• The Food and Drug Administration (FDA) does not regulate herbs and dietary supplements, so it's hard to tell what you're getting.
• Amounts of active ingredients may differ depending on the products, and some products may contain contaminants from the production process.
• Some herbs do not work well with other herbs, medications, or over-the-counter drugs. We can discuss your options if you are taking medications and wish to start herbs, or vice versa.

Potentially helpful but unproven herbs include:

• Probiotics. Probiotics are the "good" bacteria that live in your intestines. Certain foods, such as yogurt, and dietary supplements, such as acidophilus, contain probiotics. Some studies have shown that probiotics may ease IBS symptoms, but not all studies have had positive results.
• Peppermint is a natural antispasmodic that helps to relax the intestinal muscles. However, research into peppermint's effectiveness for IBS symptoms is inconsistent, and it may aggravate heartburn. If you choose to try peppermint, we recommend that you use enteric-coated capsules.
• Chamomile is well known for its calming and soothing effect. No human studies have been conducted to study chamomile's affect on IBS. Despite this, many people use chamomile (as tea, tincture, or capsules) to soothe muscles in the digestive tract and find relief from IBS symptoms. Because of certain allergic reactions, we recommend that you talk to us before taking chamomile.
• Evening primrose is a supplement containing gamma linolenic acid. In one study, women found relief from IBS symptoms during their menstrual period. More research is needed on this topic.
• Fennel seeds have antispasmodic properties and may stimulate production of gastric juices. However, no human studies have been conducted.

Potentially harmful herbs include:

• Wormwood oil can damage the nervous system.
• Comfrey can cause liver problems.

Lifestyle Changes

Irritable bowel syndrome symptoms can persist for many years, but the condition does not harm the intestines or lead to more serious diseases, like cancer, Crohn's disease, or ulcerative colitis.

If your IBS symptoms flare up, we encourage you to:

• Get plenty of exercise.
• Reduce your stress levels.
• Take medications as instructed.
• Be aware of triggers (stress, certain foods, etc.) and try to reduce those triggers in your life.

We can help you develop a strategy to help manage your symptoms and ensure that you live a healthy, active life.

You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site. You can also book an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you. 

How We Coordinate Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization.  We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures we will schedule an appointment with the radiology department. When the results are ready I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

If you are due for preventive screenings or tests

As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test.  We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.

Convenient Resources for You

My goal is to provide high quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions and schedule appointments.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.