The last half century has seen an incredible number of technological advances in medical diagnosis and treatment. It is amazing to think of those that have occurred over the course of my career. When I entered the world of medicine computerized axial tomography (CAT) scans had not been invented. Magnetic resonance images (MRIs) did not exist. Fiberoptic scopes capable of looking directly into the stomach, colon, and bronchial tubes were unknown. Hundreds of chemicals within the body that can now be measured by commercial blood tests had not yet been discovered. Genetic diagnosis was in its infancy; scientists could not even conceive of the possibility of defining the human genome. Lasers were not available. Robotic surgery was science fiction. Organ transplantation was in its infancy. Coronary artery bypass surgery was being performed at a few major medical centers, but no one was thinking of using a balloon to open up closed arteries or the internal placement of metal stents to keep arteries open.

Medical advances over the past few decades are indeed impressive. Ironically, over this same period of time the number of conditions for which modern medicine has little to offer has increased significantly. The incidence of others has increased significantly. It seems that for every person who is helped by a technologically advanced treatment there are dozens of others who wander aimlessly from specialist to specialist seeking relief from conditions for which modern medicine has no answers.

One such condition is officially known as irritable bowel syndrome (IBS). It is defined by the presence of abdominal discomfort that is relieved by having a bowel movement and is accompanied by either a change in stool frequency or stool appearance. The symptoms must have been present for at least twelve weeks during the past year. The most common symptoms reported by those who have a diagnosis of irritable bowel syndrome are abdominal pain or cramping, bloating, gassiness, diarrhea, constipation, and the presence of mucus in the stool. In many instances, episodes of diarrhea (frequent loose stools) alternate with periods of constipation (infrequent hard stools that are difficult to pass).

The condition may have been described by a British physician, Dr. Cumming, in 1849. He wrote in the London Medical Gazette, “The bowels are at one time constipated, at another lax, in the same person. How the disease has two such different symptoms I do not profess to explain. . . .” The condition remained rare for over 100 years. There is little, if any, mention of it in the medical literature until two doctors, Choudhary and Truelove, described what they called irritable colon syndrome in 1962. The term “irritable bowel syndrome” was coined by Dr. C. J. Delor in 1966.

Many names have been used to describe the condition. Mucous colitis, colonic spasm, neurogenic mucous colitis, nervous indigestion, intestinal neurosis, functional colitis, irritable colon, unstable colon, nervous colon, irritable colon, spastic colon, nervous colitis, and spastic colitis have all been used at various times. The number of names which physicians have used to describe the condition is a reflection of their inability to identify the reason for the symptoms or discover an effective treatment. The current criteria used to diagnose IBS were not developed until 1999 and it is only in recent years that Dr. Delor’s term has gained general acceptance in the medical community.

Irritable bowel syndrome has become a very common ailment. It is estimated that as many as 1 in every five people in the United States experiences irritable bowel symptoms. IBS is the most common intestinal diagnosis among gastroenterology (digestive specialists) practices in the United States and it is one of the top ten reasons given for visits to primary care physicians. It is twice as likely to affect women as men.

IBS is considered a functional bowel disorder, meaning that the intestinal tract is not functioning (operating) normally, but no structural or biochemical abnormality can be identified. As terms like nervous colon or intestinal neurosis would suggest, the condition has often been considered psychosomatic (“it’s all in your head”). Treatment has therefore included counseling sessions, anti-anxiety agents, and antidepressants.

The tendency to view IBS as a psychological rather than a physical disorder has caused many physicians to discount its significance. The fact that the condition is not life threatening, nor does it appear to cause damage to the intestinal tract over time has contributed to their lack of concern.

Knowing that the condition is not fatal is of little comfort to those who living with its effects. IBS can cause a great deal of pain and discomfort. Symptoms can come and go for decades and when they are present they can seriously disrupt one’s life. I have known many people with irritable bowel syndrome who felt trapped by the condition. They did not dare go shopping, attend social events, or travel for fear of being hit by an urgent need to have a bowel movement without a restroom being nearby. A 1993 study comparing people with IBS to those without the diagnosis found that IBS patients missed an average of 13 days of work or school annually compared to 5 days for those without the condition.

The good news is that many cases of IBS can be cured by identifying and correcting the underlying cause of the disorder. Most others can be well-controlled, allowing those with the condition to live a normal life.

In my experience the leading cause of what is called irritable bowel syndrome is a disruption of the normal intestinal environment. This referred to as dysbiosis, an improper balance of microorganisms in the intestinal tract.

The body is designed to have symbiotic bacteria growing within the intestines. Some of the more common species include Lactobacillus acidophilus, Lactobacillus casei, Bifidobacterium bifidum, Streptococcus thermophilus and Saccharomyces boulardi. The term symbiotic means that the relationship between the bacteria and the human body is mutually beneficial. The bacteria are able to feed on the food we eat as it passes through our bodies. In return they protect us from disease-causing organisms, aid in the digestive process, and manufacture nutrients including B vitamins.

The type of organisms within the intestinal tract can be altered in many ways. Most antibiotics kill off desirable bacteria but have no effect upon yeasts and some harmful bacteria. Steroid medications such as prednisone lower the effectiveness of the immune system. This allows undesirable organisms to grow out of control. Chlorinated water can adversely affect the beneficial bacteria and allow undesirable germs to overgrow.

The most common form of dysbiosis I see is an overgrowth of the yeast, candida. If you have ever had a heat rash or observed a bad diaper rash you know that yeast infections can be very irritating to the skin. They can be just as irritating to the lining of the intestines. It is therefore not surprising that the bowel becomes irritable when an overgrowth of candida occurs. Since yeast thrive on simple sugars it is not surprising that a diet in which refined sugars and starches are restricted often brings improvement in irritable bowel symptoms.

Probiotic supplements, which contain desirable bacteria, will improve dysbiosis to some degree, but are rarely effective in restoring a normal balance of organisms within the intestinal tract unless the growth of candida is suppressed. I have found that combining pau d’arco (taheebo), an extract from a South American tree bark, with extracts from castor bean (undecylnic acid) and grapefruit seed works well for this purpose.

Potentially harmful bacteria can also be the cause of the dysbiosis. Some include Group B streptococcus, enterobacter, klebsiella, and pathogenic E. coli. This is the reason that some people report the clearing of IBS symptoms when given an antibiotic called rifaximin (Xifaxan) is taken for two weeks. Rifaximin is not absorbed into the body, but remains in the intestine where it affects bacterial growth. I have not chosen to prescribe rifaximin since the cost of a two week course is nearly $600. I have seen good response when a combination of garlic and olive leaf extract is taken over the course of a month.

Probiotic support must be included no matter which type of dysbiosis is present. Unless beneficial bacteria are reintroduced into the bowel undesirable organisms will inevitably return and cause symptoms to reappear. In most cases I use a product called Health Flora for several reasons. First, it contains lactobacilli in a form that is capable of surviving stomach acid. Secondly, it does not require refrigeration; the organisms remain viable for long periods when stored at room temperature. Finally, Healthy Flora contains fructooligopolysaccharides (FOS), substances which act as fertilizer for the friendly bacteria. Studies have shown that IBS symptoms improve in individuals who take FOS supplements, and it is likely that including them in a regimen directed at reestablishing a normal growth of intestinal bacteria will enhance the chance of success.

Food intolerances can cause IBS symptoms. The most common conditions are lactose intolerance and gluten sensitivity. Lactose is a complex sugar found in milk and other dairy products. Individuals who lack adequate amounts of lactase, the enzyme needed to digest lactose, will often experience cramping, gassiness, bloating, and diarrhea after consuming dairy products. Hard cheeses, such as cheddar or Swiss, are an exception as lactose is predigested in the manufacturing process. Those who wish to continue using dairy products can use lactase supplements to aid the body in digesting them.

Gluten sensitivity, which is also known as celiac disease, is a condition in which the body is unable to digest gluten, a protein found in certain grains including wheat, barley, and rye. Unlike IBS, which is annoying but does not cause damage to the intestines, celiac disease can significantly damage the lining of the small intestine leading to malnutrition and cancer. Celiac disease is managed by avoiding dietary sources of gluten.

An often overlooked cause of IBS is a condition called sibling rivalry in which the various segments of the small and large intestine are not working together to smoothly move stool through the body. Sibling rivalry can be corrected by practitioners trained in resetting the body’s computer system.

Regardless of the cause of IBS, dietary changes and supplementation can result in a marked improvement in symptoms. As mentioned above, restricting refined foods is helpful in easing gassiness and bloating. This is also true of eliminating carbonated beverages. Fiber is the most beneficial substance in dealing with IBS. Dietary sources of fiber include legumes, whole grains, fruits and vegetables with skin, crucifers (broccoli, cabbage, cauliflower, and Brussels sprouts), nuts, and berries. Supplemental fiber is often required to bring relief, however. The most commonly used fiber supplement is psyllium husk. Because it is able to absorb many times its weight in water, psyllium is helpful in producing formed stools and easing diarrhea. By adding bulk to the stool it encourages movement through the colon to reduce constipation.

When using fiber it is best to start with a small serving and gradually increase the amount to the point that stools are moving through smoothly and effortlessly. Adding too much fiber too soon can aggravate IBS symptoms. This does not generally occur if the body is given an opportunity to acclimate to fiber gradually. If using a psyllium supplement begin with half the recommended serving once daily and increase to a full serving several days later. Multiple daily servings may be required to achieve optimum results.

Magnesium is another supplement that is beneficial in easing IBS symptoms. Magnesium tends to ease intestinal muscle spasms while improving peristalsis, which is the series of contractions that move stool smoothly through the bowel.

Individuals with irritable bowel syndrome should be wary of abdominal surgery and request a second or even a third opinion if an operation is recommended. This is because people with IBS are up to three times more likely than others to undergo unnecessary surgery. I have seen IBS symptoms attributed to, and surgery recommended for, a non-functioning gallbladder, chronic appendicitis, uterine fibroids, or a twisted colon. Unfortunately, IBS symptoms rarely improve after surgical procedures.

Peppermint oil has been shown to relax intestinal muscles and prevent abdominal cramping. Products that contain sedative herbs such as valerian, skullcap, and hops can be helpful in reducing symptoms that are aggravated by stressful situations.

Irritable bowel syndrome need not interfere with a person’s activities nor should it continue for decades. By searching diligently for and correcting the factors that are irritating the bowel, normal function can be restored and IBS symptoms eliminated or controlled.