Millions of Americans Suffer from Abdominal Pain, Bloating

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TAKE THE IBS TEST UNDERSTANDING IRRITABLE BOWEL SYNDROME YES NO A Consumer Education Brochure Do you have recurrent abdominal pain or discomfort?

Do you often feel bloated?

Are you frequently constipated?

Do you have frequent diarrhea?

Have you talked to your doctor?

Abdominal Discomfort or Pain Bloating Constipation Diarrhea Millions If you have one or all of these symptoms, you of Americans may have a real and treatable medical condition called irritable bowel syndrome (IBS). Your doc- suffer from tor now has new information and treatments that abdominal pain, can finally give you the relief you deserve. See bloating, your doctor, talk about your symptoms and ask constipation about new treatments that may be right for you. and diarrhea. Now new American College of Gastroenterology treatments Digestive Disease Specialists Committed to can relieve Quality in Patient Care your pain P.O. Box 3099 and Alexandria, VA 22302 discomfort.

Assistance through an unrestricted educational grant from

For more information call or visit American College of Gastroenterology 1-866-IBS-RELIEF Digestive Disease Specialists Committed to www.ibsrelief.org Quality in Patient Care 3888-IBS Consumer Bro 5/8/03 10:38 AM Page 3

TABLE OF CONTENTS Abdominal Discomfort or Pain, Bloating, Constipation or Diarrhea.

If you have some or all of these symptoms, 1. What Is Irritable Bowel Syndrome (IBS)? ...... 1 you may suffer from a treatable medical 2. How Common is IBS? ...... 2 condition called irritable bowel syndrome or IBS. While not life threatening, this disorder 3. How Does IBS Affect Patients’ Lives? ...... 2 can have significant impact on your life. 4. Are There Different Types of IBS? ...... 3 If you suffer from these symptoms, see your 5. What Causes Bowel Symptoms in Irritable Bowel doctor, talk about your symptoms and ask Syndrome? ...... 3 about treatment that may be right for you. For many sufferers, the abdominal discom- 6. When Should You See the Doctor? ...... 4 fort, bloating, constipation and diarrhea of 7. How is IBS Diagnosed? ...... 4 IBS can be managed effectively. For those patients who will now seek care, physicians 8. What is a Gastroenterologist? ...... 4 have new treatment options that can relieve the abdominal pain, bloating and constipa- 9. What Treatments are Used for Symptoms tion of IBS and improve your quality of life, of IBS with Constipation? ...... 5 giving you the relief you deserve. Tegaserod

Fiber and Laxatives

Antispasmodics and Antidepressants 1. What Is Irritable Bowel Syndrome (IBS)?

10. What are the Treatments for IBS with Diarrhea? . . .6 IBS is a functional gastrointestinal (GI) disorder; it is a real and treatable medical condition. IBS 11. Lifestyle, Diet & Stress ...... 7 is a real medical disorder 12. Is Surgery an Option for Remedying IBS that is characterized by Symptoms? ...... 8 recurring symptoms (that 13. IBS and Quality of Life ...... 8 come and go over time) of abdominal discomfort or pain associated with an altered bowel habit, either constipation, diarrhea or both. IBS is different from routine, infrequent constipation or diarrhea.

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For many, IBS may be best defined by surveys have established that IBS is a major reason what it is NOT: for increased absences and reduced productivity. • It is NOT an anatomical or structural problem So, there are compelling reasons for employers to be interested in improving access to treatment for • It is NOT an identifiable physical or chemical patients with IBS. Overall, patients who have disorder untreated IBS report significant reductions in their • It is NOT a cancer and will NOT cause cancer overall quality-of-life. • It will NOT cause other gastrointestinal diseases 4. Are There Different Types of IBS? If you have constipation frequently associated with Generally, doctors classify IBS based on the cluster abdominal discomfort and/or bloating, diarrhea or of symptoms experienced by the patient including alternating symptoms (constipation sometimes, IBS with Constipation (abdominal discomfort or diarrhea at others), you may have irritable bowel pain, bloating and constipation), syndrome, and you should see your doctor or a gas- IBS with Diarrhea (abdominal trointestinal specialist to evaluate your symptoms. discomfort or pain, urgency and diarrhea) or IBS with alternating Remember, IBS is a real medical condition, but it constipation and diarrhea. is not life threatening, and will not lead to other There are approximately an serious diseases. Your GI tract may work different- equal number of patients in each ly, moving more slowly (or more quickly) than the of these classifications. By deter- average. mining the type of IBS that you suffer from, doctors are able to determine the right 2. How Common is IBS? treatment. So it’s important for you to describe all of your symptoms to your doctor including your If you suffer from the symptoms of IBS you are not bowel habits. alone. IBS is one of the most common gastrointestinal disorders in the United States affecting 5. What Causes Bowel Symptoms in Irritable more than 58 million people. IBS affects all races Bowel Syndrome? and both men and women, however approximately 4 out of 5 (or 80 percent) of IBS sufferers are The exact cause of IBS is not clear. However, women. The reason for this is unclear. Women recent medical research has shown that patients may be more conscientious in seeking health care, experiencing abdominal pain or discomfort, bloat- or there may be gender-based biological differences ing and constipation or diarrhea may have a gas- that explain this higher incidence among women. trointestinal (GI) tract that is more sensitive and works more slowly or quickly than it should. 3. How Does IBS Affect Patients’ Lives? Infrequent, occasional constipation or diarrhea is not abnormal. Most people experience these symp- IBS can have a substantial impact on patients’ lives. toms from time to time. Recurrent constipation, or IBS symptoms can disrupt patients’ daily lives caus- constipation that is frequently accompanied by ing them to miss school or work, reduce social abdominal pain or bloating, or constipation alter- activities and interactions, skip meals or make nating with diarrhea or recurrent diarrhea, is a sign other changes to diet and nutrition. Consumer that you may have IBS and need to see the doctor.

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6. When Should You See the Doctor? training as all other physicians, they first com- If you experience recurring diarrhea or constipation plete at least another two years of additional that is frequently associated with abdominal dis- training in order to attain board certification in comfort and/or bloating, or constipation alternat- internal medicine, then study for an additional 2- ing with diarrhea, you may have a real and treatable 3 years to train specifically in conditions of the medical disorder called irritable bowel syndrome, gastrointestinal tract. and you should see your doctor or a gastrointestinal 9. What Treatments are Used for Symptoms of specialist to evaluate your symptoms. IBS with Constipation? 7. How is IBS Diagnosed? Unfortunately, and for too long, IBS has been poorly understood, and there was little in the way The doctor likely will start by asking you about of treatment that could relieve symptoms. The your symptoms. It’s important for the doctor to lack of effective treatments has often been dis- understand the symptoms you couraging to patients. Fortunately, with more are experiencing. So, describe all scientific knowledge and an improved range of of your symptoms to your doc- treatment options, doctors can now provide relief tor. Tell your doctor about your of the symptoms of IBS. abdominal discomfort, bloating and your bowel symptoms. Your TEGASEROD doctor may ask if you strain or have difficulty having a bowel The U.S. Food & Drug Administration (FDA) movement and ask you to has recently approved a prescription treatment describe the appearance of your called tegaserod to treat the bowel movement. Doctors abdominal pain or discom- sometimes request that some medical tests be per- fort, bloating and constipa- formed to assure that you do not have a more tion of IBS. Tegaserod dangerous GI condition. (which is part of a class of drugs know as 5HT receptor Your doctor will rule out other disorders. Your agonists) has been shown in doctor will ask if you have experienced rectal studies to be more effective bleeding, significant weight loss, recurring fever, than placebo (sugar pill) in anemia, and chronic severe diarrhea. Routine use relieving the global spectrum of colon cancer screening tests are recommended of IBS symptoms in female IBS patients: for those with a family history of colon cancer abdominal discomfort or pain, bloating and and for all patients 50 years or older, including constipation. IBS patients. FIBER AND LAXATIVES 8. What is a Gastroenterologist? There are a number of things that you can try to A gastroenterologist is a physician who specializes alleviate occasional infrequent constipation, most- in disorders and conditions of the gastrointestinal ly involving lifestyle modifications or use of over- tract. Most gastroenterologists are board-certified the-counter medications. Increasing intake of in this subspecialty. After completing the same water, fruits, increasing daily exercise, and taking

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laxatives or products with increased fiber pill) in relieving the symptoms of IBS in female content can help relieve occasional, infrequent patients with diarrhea. There is an important his- constipation. tory of significant side effects, including colon ischemia (circulatory disorder of the colon) and Fiber supplements may be used for control of constipation, which must be weighed against the occasional diarrhea or constipation, but scientific general good efficacy of that medication. evidence has not demonstrated any benefit in relieving abdominal discomfort or discomfort and 11. Lifestyle, Diet & Stress bloating and in some patients fiber supplements Before some of the newer medications were avail- may worsen bloating. Laxatives may be pre- able, much of the effort to treat IBS symptoms scribed for occasional constipation, although sci- focused on lifestyle, diet and reduction of stress. entific studies have not solidly demonstrated a There are some dietary changes that some benefit. patients have found helpful: ANTISPASMODICS AND ANTIDEPRESSANTS • Avoid or limit the amount of In patients with abdominal pain, some patients gas-producing foods such as have reported relief from antispasmodics, but the beans, onions, broccoli, cab- data remain insufficient to recommend these bage, or any other foods that medications. Antidepressants are sometimes you know will commonly used, and they may improve abdominal pain, but aggravate your IBS symptoms. have not been demonstrated to address the other • Try to slow down how fast you global IBS symptoms. In some patients, antispas- eat and avoid overeating. modics and antidepressants can worsen constipation symptoms. • Avoid drinking carbonated drinks (colas, pop, soda). These can introduce gas into the intes- 10. What are the Treatments for IBS with tines and cause abdominal pain. Chewing Diarrhea? gum also may lead to a significant amount of air being swallowed. If you have diarrhea, your doctor may prescribe drugs • Avoid large quantities of the sugar substitute to decrease the number of sorbitol which can cause excess gas, bloating, bowel movements. cramping and diarrhea. Diphenoxylate with atropine • Intolerance to milk sugar, lactose, is seen in up or loperamide can be used to to 40% of patients with IBS. Avoiding dairy treat occasional diarrhea. products may be helpful in reducing symp- However, scientific evidence toms of IBS. has not demonstrated any benefit from these medica- • The addition of wheat bran or other fiber may tions in relieving abdominal discomfort or pain. be suggested by your doctor in an attempt to Some female patients with IBS and diarrhea may decrease your symptoms. benefit from the use of a medication called alos- etron, which is more effective than placebo (sugar • If you make changes to your diet, do it gradu- ally to give your body time to adjust.

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Overall health can be improved by reducing Some Key Points to Remember about stress, and IBS and its symptoms are no excep- Abdominal Discomfort or Pain, Bloating tion. Some patients have attained some relief and Constipation through relaxation techniques and participation in regular exercise or a hobby. IBS symptoms are In conclusion, here are some important things to not manifestations of psychological disorders. remember about constipation and IBS: Behavioral therapies have been demonstrated to Symptoms of abdominal discomfort, bloating have positive impact on symptoms for some IBS and constipation may be part of a real, patients. treatable medical condition called IBS

12. Is Surgery an Option for Remedying IBS Through no fault of their own, patients have Symptoms? spent a significant amount of time suffering No surgical treatment is indicated or recommend- Symptoms disrupt patients’ everyday lives, ed for patients with constipation and IBS. social interactions and work

13. IBS and Quality of Life Abdominal pain, bloating and constipation characterize a major portion of IBS sufferers Having a long-standing battle with any physical disease or condition is usually debilitating for the Many sufferers do not seek care for IBS patient. IBS is no excep- Today, for many patients, the abdominal dis- tion. It can significantly comfort, bloating and constipation of IBS can detract from social interac- be managed effectively tions and the quality of life. It is important to Physicians now have new therapies that can remember that the condi- more effectively manage and provide relief for tion is real, that it is not the abdominal discomfort, bloating and con- your fault. Patients who stipation of IBS have had IBS for years, New therapies for IBS offer realistic hope to and those who begin to help restore quality of life which these patients experience with some reg- deserve, but which many may have believed ularity symptoms of was out of reach abdominal pain, bloating and/or constipation or diarrhea, should recognize If you experience constipation about one week that seeing the physician and considering some of out of the month, or if your constipation is fre- the newer available treatments could improve quently associated with abdominal discomfort your life. and/or bloating, you may have a real and treatable common medical disorder called irritable bowel syndrome, and you should see your doctor or a gastrointestinal specialist to evaluate your symptoms.