Irritable bowel syndrome (IBS) occurs when muscles in your intestines contract faster or slower than normal. This causes pain, cramping, gassiness, sudden bouts of diarrhea, and constipation.

Two types of IBS exist. In spastic colon IBS, you experience constipation, diarrhea, or both, and you often have pain after eating. Painless diarrhea IBS involves the sudden onset of diarrhea during or after meals, or upon waking. Between 10 and 20 percent of the population has IBS at some time. The syndrome often starts in adolescents or young adults. It affects three times as many women as men and is often associated with stress.

• Cramping pain in your lower abdomen
• Bloating and gassiness
• Changes in your bowel habits
• Diarrhea or constipation, or both alternately
• Immediate need to move your bowels when you wake up or during or after meals
• Relief of pain after bowel movements
• Feeling of incomplete emptying after bowel movements
• Mucus in your stool

The underlying cause remains unknown. But the syndrome has no relation to actual disease, and it does not lead to other diseases.

Your health care provider will feel your abdomen to check for signs of pain. He or she will place a gloved finger in your rectum to check its condition. If you're female, you may have a pelvic examination. The provider may use a sigmoidoscope—a flexible instrument inserted into the rectum—to examine your lower colon. You may be asked to provide three days' worth of stool samples. Your provider may also want samples of your blood and urine. The provider may also want an ultrasound or X rays.

Try to avoid stressful situations or foods that have triggered IBS in the past. Monthly hormonal changes and some drugs can affect your condition. Establishing regular bowel habits can be helpful. Your health care provider may prescribe medications to help you with the symptoms.

• Anticholinergic agents—reduce the pain from bowel spasm
• Antiflatulents—reduce gas
• Antidiarrheal medication—such as Loperamide (Imodium)
• Bulk-producing agents—such as psyllium (Metamucil) and other fiber supplements can help with diarrhea or constipation

IBS has many underlying causes that can often be successfully treated with alternative therapies. Stress reduction techniques through biofeedback, hypnosis, or counseling can help you deal with stress.

• Removal of known food allergens or irritants is important. The most common food allergens are dairy products, wheat, corn, peanuts, citrus, soy, eggs, fish, and tomatoes. An elimination/challenge trial may help uncover sensitivities. Eliminate all suspected allergens from the diet for two weeks. Add back one food every three days and wait for reaction to the challenge.
• If you suffer from gassiness, eliminate beans, cabbages, and other "gassy" vegetables from your diet, as well as apple juice, grape juice, bananas, nuts, and raisins.
• Fiber supplementation can help reduce pain, cramping, and gas. Supplements include psyllium, flaxmeal, slippery elm (Ulmus fulva) powder, and marshmallow root (Althaea officinalis) powder.
• Digestive enzymes taken 20 minutes before meals can help enhance digestion and normalize bowel function.
• One teaspoon of raw bran with each meal, supplemented by extra fluids, provides fiber reliably.
• Pro-flora supplements such as acidophilus and lactobacillus species taken two to three times per day can help to rebalance normal bowel bacteria and reduce gas and bloating.
• Magnesium (200 mg two to three times per day) and B-complex (50 to 100 mg per day) with extra B5 (pantothenic acid; 100 mg per day) may help reduce the effects of stress.
• Low-fat diets may relieve abdominal pain following meals.

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

• Enteric-coated peppermint oil: one to two capsules (0.2 ml peppermint oil per capsule) three times a day after meals
• A tea of fennel seed (Foeniculum vulgare) or ginger root (Zingiber officinale) taken after meals promotes good digestion
• A tincture of equal parts of the following before meals (30 drops three times per day): valerian (Valeriana officinalis), passionflower (Passiflora incarnata), anise seed (Pimpinella anisum) extract, meadowsweet (Filipendula ulmaria), wild yam (Dioscorea villosa), and milk thistle (Silybum marianum)

Homeopathy may be useful as a supportive therapy.

• Electric heating pads, hot water bottles, and long hot baths can relieve painful spasms and cramping in the abdomen.
• Regular exercise, such as walking, can reduce stress and encourage bowel movements if you are constipated.
• Castor oil pack. Apply oil directly to skin, cover with a clean soft cloth and plastic wrap. Place a heat source over the pack and let sit for 30 to 60 minutes.
• Abdominal breathing helps to induce the relaxation response and may aid normal physiological functioning (such as digestion).

Several small studies suggest that acupuncture may be of value for IBS. A preliminary study of seven people with IBS, for example, found that acupuncture improved general well-being and symptoms of bloating. No firm conclusions can be drawn about acupuncture's value in treating IBS, however, until larger clinical trials are conducted.

Acupuncturists treat people with IBS based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of IBS, a qi deficiency is usually detected in the spleen and lung meridians. Moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) is frequently used for treatment of IBS because its effect is thought to reach deeper into the body. Because acupuncture is considered safe, and IBS is not easily treated by currently available conventional methods, people with IBS may wish to try acupuncture therapy to improve symptoms.

No well-designed studies have evaluated the effect of chiropractic on individuals with IBS, but chiropractors report that spinal manipulation may improve symptoms of the condition in some individuals. It is speculated that, in these cases, spinal manipulation may have a balancing effect on the nerves that supply impulses to the intestinal tract.

Therapeutic massage may help in reducing the effects of stress.

Be aware that the syndrome itself may cause you stress.

Berkow R, ed. Merck Manual of Diagnosis and Therapy. 16th ed. Rahway, NJ: The Merck Publishing Group; 1992.

Chan J, Carr I, Mayberry JF. The role of acupuncture in the treatment of irritable bowel syndrome: a pilot study. Hepatogastroenterol. 1997;44:1328-1330.

Dambro MR, ed. Griffith's 5 Minute Clinical Consult. New York, NY: Lippincott, Williams and Wilkins; 1998.

Diehl DL. Acupuncture for gastrointestinal and hepatobiliary disorders. J Altern Complement Med. 1999;5(1):27-45.

Koch TR. Peppermint oil and irritable bowel syndrome [In Process Citation]. Am J Gastroenterol. 1998;93:2304-2305.

Li Y, Tougas G, Chiverton SG, Hunt RH. The effect of acpuncture on gastrointestinal function and disorders. Am J Gastroenterol. 1992;87:1372-1381.

Liu JH, Chen GH, Yeh HZ, Huang CK, Poon SK. Enteric-coated peppermint-oil capsules in the treatment of irritable bowel syndrome: a prospective, randomized trial. J Gastroenterol. 1997;32:765-768.

Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed. Rocklin, Calif: Prima Publishing; 1998:396-400.

Pittler MH, Ernst E. Peppermint oil for irritable bowel syndrome: a critical review and metaanalysis. Am J Gastroenterol. 1998;93:1131-1135.