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Irritable Bowel Syndrome: Tips on Controlling Your Symptoms. Kansas City, MO: American Academy of Family Physicians. 2001. 4 p.

This patient education brochure helps readers understand irritable bowel syndrome (IBS) and how they can control the symptoms it may cause. In IBS, the intestines squeeze too hard or not hard enough and cause food to move too fast or too slowly through the gastrointestinal (GI) tract. IBS can cause diarrhea, constipation, or both. The symptoms may get worse when the patient experiences stress, including that associated with travel, social events, menstrual cycles, or a change in daily routine. The brochure outlines diagnostic and treatment options, the role of dietary fiber, the impact of diet on IBS symptoms, the role of milk and milk products and the issue of lactose intolerance, managing stress, and drug therapy. The brochure notes that because IBS is a chronic disease, health care providers are hesitant to prescribe long term drug therapy. However, for acute attacks, antispasmodic drugs, loperamide, sedatives, or antidepressants may be prescribed. The brochure encourages readers to find new freedom from IBS by following a management plan that includes a healthy diet, learning new ways to deal with stress, and avoiding foods that make symptoms worse. 2 tables. (AA-M).

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Irritable Bowel: A Poorly Understood Disorder. FDA Consumer. 35(4): 30-36. July-August 2001.

This article offers an overview of irritable bowel syndrome (IBS), the most common gastrointestinal disorder seen by physicians. IBS presents with abdominal pain, cramps, gas, bloating, diarrhea and constipation as the main symptoms. IBS is a disorder of the intestine that shows no sign of disease (pathology) that can be seen or measured. Second only to the common cold in causing days missed from work, IBS may affect up to 20 percent of Americans. Onset of IBS is usually in late adolescence or early adult life. Although IBS is associated with severe pain and discomfort, the illness does not lead to cancer, life-threatening conditions, or surgery. The author explores how the gastrointestinal system functions independently of the rest of the body (humans can digest their food without thinking), how messages between the brain and gut alert a person to gastrointestinal malfunction, and how conditions such as stress aggravate the IBS symptoms of diarrhea and constipation. The author also discusses a new treatment for IBS, Lotronex (alosetron hydrochloride), which was approved and then subsequently pulled off the market. One sidebar lists resource organizations through which readers can obtain additional information (web sites are also provided). Brief biographies of five patients living with IBS are included. 1 figure.

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Lifestyle Interventions in the Treatment of Urinary Incontinence. In: Corcos, J.; Schick, E., eds. Urinary Sphincter. New York, NY: Marcel Dekker, Inc. 2001. p. 437-442.

The urinary sphincter is the key to understanding both normal and abnormal function of the lower urinary tract. Its relationships with the bladder, the pelvic floor, and the bony structures of the pelvis are complex and incompletely understood. This chapter on lifestyle interventions in the treatment of urinary incontinence (UI) is from a textbook that presents a detailed and systematic account of the current knowledge on the anatomy, physiology, functional relationships, and range of dysfunctions that affect the urinary sphincter. Interventions often recommended by physicians include weight loss, changing activity, smoking cessation, and decreasing or changing fluid intake. In this chapter, the published evidence for recommending these and other lifestyle interventions are addressed. Although the data do strongly suggest that weight loss reduces incontinence in morbidly obese women, no studies have evaluated this intervention in the more commonly seen, moderately obese woman. Given current evidence, maintaining normal weight through adulthood may be an important factor in the prevention of incontinence. There is no strong evidence in the literature that associates smoking and incontinence in humans and no data have been reported concerning the effects of smoking cessation on incontinence. In addition, no randomized trials have assessed the effectiveness of caffeine restriction, fluid management, or dietary changes in the treatment of incontinence. Given that decreasing fluid intake may lead to urinary tract infections, constipation, or dehydration, this intervention should be reserved for patients with abnormally high fluid intakes. The author notes that further research is needed to delineate the role of straining with constipation and the pathogenesis (development) of incontinence. 32 references.

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Management of the Irritable Bowel Syndrome. Gastroenterology. 120(3): 652-668. February 2001.

Irritable bowel syndrome (IBS) is the most common disorder diagnosed by gastroenterologists and one of the more common ones encountered in general practice. This article reviews the management of IBS, focusing on the definitions, epidemiology, and pathophysiology as a means of understanding strategies for optimal management; the natural history and 'safety' of the disorder that justifies a conservation and reassuring approach to patients; and consideration of conventional and newer treatments of IBS. The overall prevalence rate is similar (approximately 10 percent) in most industrialized countries; the illness has a large economic impact on health care use and indirect costs, chiefly through absenteeism. IBS is a biopsychosocial disorder in which 3 major mechanisms interact: psychosocial factors, altered motility, and heightened sensory function of the intestine. Subtle inflammatory changes suggest a role for inflammation, especially after infectious enteritis, but this has not yet resulted in changes in the approach to patient treatment. Treatment of patients is based on positive diagnosis of the symptom complex, limited exclusion of underlying organic disease, and institution of a therapeutic trial. If patient symptoms are intractable, further investigations are needed to exclude specific motility (movement) or other disorders. Symptoms tend to fluctuate over time; treatment is often restricted to times when patients experience symptoms. Symptomatic treatment includes supplementing fiber to achieve a total intake of up to 30 grams in those with constipation, those taking loperamide or other opioids for diarrhea, and those taking low dose antidepressants or infrequently using antispasmodics for pain. Older conventional therapies do not address pain in IBS. Behavioral psychotherapy and hynotherapy are also being evaluated. Novel approaches include alosetron; a 5 HT3 antagonist, tegaserod, a partial 5 HT4 agonist, K opioid agonists, and neurokinin antagonists to address the remaining challenging symptoms of pain, constipation, and bloating. The author concludes that understanding the brain gut connection is the key to the eventual development of effective therapies for IBS. 7 figures. 7 tables. 176 references.

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Motility Disorders. In: Farthing, M.J.G.; Ballinger, A.B., eds. Drug Therapy for Gastrointestinal and Liver Diseases. Florence, KY: Martin Dunitz. 2001. p. 143-162.

The motility disorders of the gut represent a heterogeneous group of conditions associated with different parts of the gastrointestinal tract. Although investigative techniques are becoming more sophisticated, the exact relationship between gut dysmotility and gut symptoms is far from clear. In addition, there is a marked overlap, not only between apparently discrete motility conditions but also between these conditions and the normal population. This chapter on motility disorders is from a textbook that reviews the drug therapy for gastrointestinal and liver diseases. Disorders covered include achalasia (swallowing dysfunction), Chagas' disease, diffuse esophageal spasm, gastroparesis, chronic idiopathic (of unknown cause) intestinal pseudo obstruction, systemic sclerosis, functional constipation, megacolon, postoperative ileus, and sphincter of Oddi dysfunction. The chapter provides a brief summary of the pathophysiology of each disease, the rationale for drug intervention, and appropriate treatment regimens as indicated by current knowledge. The chapter concludes with a drug list that summarizes mode of action, and other aspects of clinical pharmacology where appropriate, drug doses, common adverse affects, and drug interactions. 4 tables. 124 references.

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Rectocele: Symptoms Include Vaginal Pain or Constipation. Participate. 10(3): 5. Fall 2001.

A rectocele is a bulge from the rectum into the vagina and may be present without any other abnormalities. This brief article on rectocele is from a newsletter from the International Foundation for Functional Gastrointestinal Disorders. The author describes the causes of rectocele, the typical symptoms, how rectocele is diagnosed, when treatment for rectocele should be considered, and treatment options. Treatment should be considered for rectocele when it causes significant symptoms. Rectoceles that are not causing symptoms do not need to be treated, as advised by the patient's physician. In general, one should avoid constipation by eating a high fiber diet and drinking plenty of fluids. Patients should also avoid prolonged straining at defecation. If symptoms persist with medical therapy, then surgical repair may be indicated. Both colorectal surgeons and gynecologists are trained to deal with these problems.

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Manometric Assessment of Anorectal Function. Gastroenterology Clinics of North America. 30(1): 15-32. March 2001.

The anorectum plays an important role in the regulation of defecation (having a bowel movement) and in the maintenance of fecal continence. This article reviews some of the tests that commonly are used for assessing anorectal and pelvic floor function, assesses the significance of these tests, and provides an approach for the manometric assessment of anorectal function. Tests discussed include anorectal manometry, anal endosonography, sphincter electromyography, object expulsion test, defecography, saline continence tests, and pudendal nerve terminal motor latency. In addition, tests that may be performed in research laboratories are discussed: rectal barostat, anal vectorgraphy, rectoanal scintigraphy, ambulatory anorectal manometry, MR (magnetic resonance) imaging, and videofluorodefecometry. The purpose of anorectal manometry is to evaluate the integrated function of the defecation unit, including its motor and sensory function. From these measurements, it is possible to assess the expulsion forces, the resistance to bowel evacuation, the anorectal sensory responses, and the neuronal innervation (the nerve supply to the area). The information obtained from these studies influences the management and outcome of patients with defecation disorders. These findings are confirmed further by another study that showed colorectal physiologic tests provided a definitive diagnosis in 75 percent of patients with constipation, 66 percent of patients with incontinence, and 42 percent of patients with intractable anorectal pain. The authors call for a more uniform method of performing these tests and interpreting the results in order to facilitate a wider use of this technology for the assessment and subsequent treatment of patients with anorectal disorders. 5 figures. 1 table. 52 references.

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Meta-Analysis of Smooth Muscle Relaxants in the Treatment of Irritable Bowel Syndrome. Alimentary Pharmacology and Therapeutics. 15(3): 355-361. March 2001.

This review article updates previous overviews of placebo controlled double blind trials assessing the efficacy and tolerance of smooth muscle relaxants used to treat irritable bowel syndrome (IBS). A total of 23 randomized clinical trials were selected for meta analyses of their efficacy and tolerance. Six drugs were analyzed: cimetropium bromide (five trials), hyoscine butyl bromide (three trials), mebeverine (five trials), otilium bromide (four trials), pinaverium bromide (two trials), and trimebutine (four trials). The total number of patients included was 1,888, of which 945 received an active drug and 943 a placebo. The mean percentage of patients with global improvement was 38 percent in the placebo group (n = 925) and 56 percent in the myorelaxant group (n = 927). The percentage of patients with pain improvement was 41 percent in the placebo group (n = 568) and 53 percent in the myorelaxant group (n = 567). There was no significant difference for adverse events. The authors conclude that myorelaxants are superior to placebo in the management of IBS. These drugs showed significant efficacy on the global assessment despite a high placebo effect (38 percent global improvement), with a range of difference from 31 percent for cimetropium to 11 percent for hyoscin. The efficacy was also significant and in the same range for pain relief, as well as for abdominal distension relief, although lower. There was no significant difference for transit abnormalities, diarrhea, or constipation. 4 figures. 1 table. 37 references.

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Oral Hypoglycaemic Drugs and Gastrointestinal Symptoms in Diabetes Mellitus. Alimentary Pharmacology and Therapeutics. 15(1): 137-142. January 2001.

This article describes a study that explored the association between gastrointestinal symptoms and treatment with oral hypoglycemic drugs in a large cohort of subjects with type 2 diabetes. A total of 956 subjects with type 2 diabetes participated in the study. All subjects completed a validated, self-administered questionnaire on gastrointestinal symptoms, diabetes, drug use, and various potential risk factors for gastrointestinal symptoms. The association between oral hypoglycemics and the gastrointestinal symptom groups of frequent abdominal pain, gastroesophageal reflux symptoms, dysmotility like dyspepsia, ulcer like dyspepsia, bowel related abdominal pain, constipation, diarrhea, steatorrhea like stools, and fecal incontinence was assessed based on logistic regression. The study found that any oral hypoglycemic drug use was significantly associated with diarrhea. This association was confined to the metformin users. Metformin use was also significantly associated with fecal incontinence. Use of sulfonylureas was associated with less abdominal pain, but not with any other gastrointestinal symptom. The article concludes that troublesome gastrointestinal symptoms are common in patients with type 2 diabetes. These symptoms do not appear to be caused by oral hypoglycemics, except for diarrhea and fecal incontinence, which are strongly and independently associated with metformin use. 3 tables. 20 references. (AA-M).

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Breaking the Bonds of Irritable Bowel Syndrome: A Psychological Approach to Regaining Control of Your Life. Oakland, CA: New Harbinger Publications, Inc. 2000. 177 p.

Irritable bowel syndrome (IBS) consists of recurrent episodes of abdominal pain related to altered bowel habit, which may consist of predominantly constipation or diarrhea, or an alternation between the two. In this book, the author encourages an open discussion of the symptoms and feelings that accompany irritable bowel syndrome (IBS). Charts and worksheets help readers track the relationship between unpleasant symptoms and external triggers such as foods, stressful events, emotional states, and certain thoughts. By using these tools and improving their emotional awareness, readers will benefit their overall mental health, gain a tremendous sense of accomplishment, and regain a feeling of being in charge of their life. Coping skills, such as relaxation exercises and assertiveness techniques, teach readers how to manage their stress more effectively and help them break free of the restrictions placed upon them by the disruptiveness of this digestive disorder. The book includes ten chapters, a section of references, and a brief list of resources for additional information.

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