FWD: Article on Irritable Bowel Syndrome

Pain Question & Answer

Irritable Bowel Syndrome
by Scott M. Fishman, MD

Question: My doctor just told me that I have irritable bowel syndrome. Can I do anything to prevent the pain of IBS and are there any medications I can take that will decrease this pain?

Answer: Irritable bowel syndrome, otherwise known as IBS, is a problem of the intestines where patients have irregular bowel motility or movement of the bowels (either constipation or diarrhea). These patients often suffer from ongoing discomfort, if not frank pain. It is usually a difficult problem to manage and it is typically treated by gastroenterologists, or bowel specialists.

The exact mechanism of IBS is not well understood. One key feature seems to be relief of pain after bowel movements. Pain seems to arise if bowel movements are too frequent or not frequent enough. With too much motility, one might take medications that would reduce it slightly. On the contrary, with too little motility, one might take medications to stimulate the intestinal motility.

Patients with IBS may need medications to decrease pain. These medications can include anti-inflammatory agents or opioids. However, there are often problems with anti-inflammatory drugs that, for many, tend to be hard on the stomach and the bowels. Opioid medications tend to cause constipation by turning off or slowing down the motility of the bowels. Thus, patients who have too much intestinal motility and pain may find that opioids help with pain and problems resulting from increased bowel motility. However, these opioids run the risk of slowing the bowels too much.

The exact cause of IBS is unknown, and thus the treatments can't be really targeted to the underlying cause. Pain specialists may be involved in treating IBS; however, such patients are primarily treated by physicians in the specialty area of gastroenterology.

November, 2006