Irritable Bowel Syndrome (IBS)


What should I know about Irritable Bowel Syndrome?

Are you bothered by nagging abdominal pain, bloating, and loose painful bowel movements alternating with constipation? Do you often find a lot of mucous in your stools? Are you chronically nervous and stressed? If the answer is "Yes," and these problems are not due to some more serious, clearly identifiable bowel disease, you doctor may diagnose you with Irritable Bowel Syndrome.

Also known as "IBS," irritable bowel syndrome is one of the most common gastrointestinal disorders seen in physicians’ offices. IBS is not a life-threatening condition. There is no overt disease or structural defect, in fact, the intestinal tract appears normal for the most part in people with IBS, making the diagnosis harder to pin down. Typical symptoms include distension of the abdomen, pain relieved by bowel movements, constipation alternating with diarrhea, mucous in the stools, and a feeling of incomplete bowel movements. (1) , (2) These problems may be constant or they may come and go. People are generally not diagnosed as having IBS before these complaints have persisted for at least three months.

People with IBS are more likely to have other discomforts such as heartburn, pain when swallowing, fatigue, chest pain (not involving the heart), and urinary-gynecological problems. (3) IBS can mimic more serious diseases such as Crohn’s disease, ulcerative colitis, colon cancer, endometriosis, and psychiatric disorders.

Mental and emotional health seems to play an important role in IBS. While there is no proof that chronic emotional stress is the cause, IBS sufferers often experience flare-ups when angry and upset, especially at mealtime. (4) It is estimated that less than half of people with IBS actually seek medical attention for it, but those that do are often diagnosed with some sort of psychiatric disorder. What’s more, when psychosocial issues are addressed and dealt with, the symptoms often improve. (5) Psychosocial factors do not cause IBS, but they do have a major influence. Diagnosing IBS is largely a matter of ruling out more serious conditions. IBS generally does not cause any abnormalities that a doctor can spot during a physical exam, and routine laboratory tests are typically normal.


International Foundation for Functional Gastrointestinal Disorders, 2002.

  • IBS affects 5 to 25 % of people in countries around the world.

Universiti Putra Malaysia, 2003.

  • Malaysians suffering from IBS with a prevalence rate of 15.8%.

The American Gastroenterological Association, 2002.

    An estimated 10 to 20 percent of people in the general population experience symptoms of IBS, but only about 15 percent of affected people actually seek medical help.

Mayo Foundation for Medical Education and Research, 2000.

    An estimated 35 million Americans have irritable bowel syndrome. IBS accounts for about 3 million physician visits in the United States every year.

Signs and Symptoms

[span class=alert]The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.[/span]

The primary symptoms associated with IBS include abdominal distension, abdominal pain relieved by bowel movements, increased frequency of bowel movements, change in consistency of stools, mucous in stools, and the sensation of incomplete bowel movements.


  • Abdominal bloating and pain
  • Abdominal pain relief following bowel movement
  • Increase number of bowel movements
  • Changes in stool texture and makeup
  • Bowel movement consists of mucus
  • Sensation that bowel is not empty following a bowel movement

Treatment Options


IBS is chronic condition that requires long-term treatment. Teamwork between the patient and the doctor, where the patient can be involved in treatment decisions, is essential. A good doctor/patient relationship that provides an environment of understanding and concern can make a huge difference.

Dietary modifications are generally the first step toward relieving symptoms of IBS. Food such as dairy products and legumes that can cause gas should be avoided. Fiber supplements are also recommended to help regulate bowel function.

A number of medications have been tried in IBS but none have been found effective. (6) Addressing and treating the symptoms present is one approach used in practice. For patients with diarrhea, anti-diarrhea drugs such as loperamide and cholestyramine may be prescribed. Belladonna or dicyclomine are sometimes prescribed for pain, gas, and bloating. Antidepressants may help with chronic pain.

Nutritional Suplementation


People with IBS may be deficient in zinc. Some IBS sufferers have low blood zinc levels while others excrete more zinc in their stool. (7) One study found study reported that individuals with IBS have trouble absorbing zinc. (8) Your doctor can help determine if you are zinc deficient and require zinc supplementation.

Lactobacillus acidophilus

Probiotic supplements are designed to help maintain a healthy population of "friendly" lactic acid producing bacteria, in the intestinal tract. ("Probiotic" means "for life.") Also known as "friendly flora" these bacteria help regulate elimination, support immunity in the gut, and keep "unfriendly" bacteria such as E. coli in check. It is theorized that people with IBS may not have enough of these good bacteria. This possibility was tested in a study of 60 IBS patients who took either a lactobacillus supplement or a placebo daily for four weeks. Compared to those on placebo, subjects taking the probiotic had far less intestinal gas. Twelve months later, overall gastrointestinal function remained better in the people who had received the bacteria supplement. (9)


The gastrointestinal tract is by far the largest user of L-glutamine in the body. Though research indicates that glutamine may be useful for irritable bowel syndrome in animal models. (10) There is some concern regarding its use in another disease of the intestinal tract, Crohn's disease. In several clinical trials, patients with Crohn’s disease who took 7 grams of glutamine three times daily did not perform any better than the patients who took placebo. (11) , (12) , (13) Though several case reports have indicated a benefit to using glutamine for irritable bowel syndrome, glutamine’s use in Crohn’s disease and irritable bowel syndrome requires more study.

Herbal Suplementation

Psyllium Seed

Increasing dietary fiber is an important strategy for relieving constipation and improving intestinal function. Psyllium seed husk powder is rich in fiber. It absorbs water and provides bulk in the gut that helps promote healthy elimination by increasing the mass and water content of stool. Psyllium is very "mucilaginous," giving it a soothing effect on walls of the intestinal tract. (14) Psyllium has traditionally been used as a bulk-forming laxative; however, recent research suggests that it may help treat IBS and ulcerative colitis. (15) , (16) Several studies have found psyllium effective for increasing bowel movements in constipated IBS sufferers. (17) , (18) , (19)


Peppermint is a favorite herb for relief of digestive problems such as upset stomach, gas, and colic in children. In Europe, peppermint oil is given routinely to people with IBS for its relaxing, soothing effect. Peppermint oil helps relieve intestinal spasms. Its antispasmodic action has been demonstrated in laboratory animals. Peppermint oil relaxes the smooth muscle in the intestinal tract by acting as a mild "calcium channel blocker" to reduce muscle contractions. (20) , (21)

Many clinical trials have shown that enteric coated peppermint oil relaxes the intestine and relieves pain in people with IBS. (22) , (23) , (24) These results are somewhat tempered by one study that showed no effect in relieving symptoms of IBS. (25)

Cat's Claw

Cat’s claw is a vine that grows in the rain forests of South America. In the villages of Peru, local medicine people have used cat’s claw for hundreds of years to treat a wide variety of ailments, including stomach pain, ulcers, and other gastrointestinal complaints. Modern research has found active ingredients in cat’s claw that stimulate the immune system with a possible anti-viral effect. (26) , (27) , (28)

Cat’s claw also neutralizes free radicals, cell-damaging by-products of oxygen metabolism that contribute to inflammation. (29) Cat’s claw soothes irritated and inflamed tissues and helps eliminate harmful organisms from the GI tract, making the herb potentially beneficial in IBS. (30)

Olive Leaf

Olive trees are widely cultivated throughout Mediterranean countries for their universally popular fruit. But olive trees have more to offer that just the olive and its delicious, healthful oil. The olive leaf has been used as a traditional medicine in health conditions including malaria, infections, cardiovascular diseases, and for improving general well being. Oleuropein, an active ingredient in olive leaf, shows promising antiviral properties. (31) , (32) Lab studies have found that oleuropein stimulates activity of immune cells called "macrophages" which serve as the body’s garbage collectors to remove toxins and destroy foreign organisms. (33)

Evening Primrose

Evening primrose oil (EPO) is rich in GLA, an essential fatty acid that keeps inflammation under control, supports immunity, and plays many other important roles. Fatty acids are an important part of normal homeostasis. The human body can produce all but two fatty acids: omega-3 and omega-6 fatty acids. Both must be obtained through the diet or by the use of supplements. Obtaining a balance of these two fatty acids is essential. Essential fatty acids are needed for building cell membranes and are precursors for production of hormones and prostaglandins. Modern diets tend to be lacking in quality sources of fatty acids.

Grapefruit Seed

Grapefruit seed extract is another herb that may benefit IBS sufferers by keeping harmful organisms out of the intestinal tract. Clinical and experimental studies indicate grapefruit seed extract has broad spectrum antimicrobial properties. (34) Grapefruit seed extract also inhibits the growth of two ulcer-causing bacteria: H. pylori and C. jejuni. (35) In one human study, grapefruit seed extract relieved constipation, gas, and abdominal distress after four weeks. (36)


Artichoke leaf extract (ALE) may have potential for treating irritable bowel syndrome (IBS). In a study evaluating the use of ALE in patients with dyspepsia or indigestion, a small group was identified as having IBS. This group of IBS patients had the severity of their symptoms reduced and provided an overall favorable evaluation of the extract. As many as 96% of them claimed that the artichoke leaf extract was well tolerated and that it worked at least as well as other therapies used for their symptoms. (37)

Diet & Lifestyle

  • Identify and eliminate allergic foods.
  • Eliminate sugar, refined carbohydrates, and caffeine.
  • Avoid milk and dairy products.
  • Increase dietary fiber.
  • Reduce stress: Take time to relax, spend more time on fun, stress-reducing activities!
  • Seek out counseling to deal with emotional issues.


  1. View Abstract: Manning AP, et al. Towards positive diagnosis of the irritable bowel. BMJ. 1978;2:653.
  2. View Abstract: Borum ML. Irritable bowel syndrome. Prim Care. Sep2001;28(3):523-38,vi.
  3. Lynn RB, Friedman LS. In: Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. Harrison’s Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998: 1646-8.
  4. View Abstract: Gaynes BN, Drossman DA. The role of psychosocial factors in irritable bowel syndrome. Baillieres Best Pract Res Clin Gastroenterol. 1999;13(3):437-52.
  5. View Abstract: Gaynes BN, Drossman DA. The role of psychosocial factors in irritable bowel syndrome. Baillieres Best Pract Res Clin Gastroenterol. 1999;13(3):437-52.
  6. View Abstract: Klein KB. Controlled treatment trials in the irritable bowel syndrome: A critique. Gastroenterology. 1988;95:232.
  7. View Abstract: Cavallo G, et al. Changes in the blood zinc in the irritable bowel syndrome: a preliminary study. Minerva Dietol Gastroenterol. Apr1990;36(2):77-81.
  8. View Abstract: Valberg LS, et al. Zinc absorption in inflammatory bowel disease. Dig Dis Sci. Jul1986;31(7):724-31.
  9. View Abstract: Nobaek S, et al. Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. Am J Gastroenterol. May2000;95(5):1231-8.
  10. View Abstract: Fujita T, Sakurai K. Efficacy of glutamine-enriched enteral nutrition in an experimental model of mucosal ulcerative colitis. Br J Surg. 1995;82:749-751.
  11. View Abstract: Akobeng AK, Miller V, Stanton J, et al. Double-blind randomized controlled trial of glutamine-enriched polymeric diet in the treatment of active Crohn's disease. J Pediatr Gastroenterol Nutr. Jan2000;30(1):78-84.
  12. View Abstract: Den Hond E, Hiele M, Peeters M, et al. Effect of long-term oral glutamine supplements on small intestinal permeability in patients with Crohn's disease. JPEN J Parenter Enteral Nutr. Jan1999;23(1):7-11.
  13. View Abstract: Hond ED, et al. Effect of glutamine on the intestinal permeability changes induced by indomethacin in humans. Aliment Pharmacol Ther. May1999;13(5):679-85.
  14. View Abstract: Wong PW, et al. How to deal with chronic constipation. A stepwise method of establishing and treating the source of the problem. Postgrad Med. Nov1999;106(6):199-200, 203-4, 207-10.
  15. View Abstract: Tomas-Ridocci M, et al. The efficacy of Plantago ovata as a regulator of intestinal transit. A double-blind study compared to placebo. Rev Esp Enferm Dig. Jul1992;82(1):17-22.
  16. View Abstract: Mac Mahon M, et al. Ispaghula husk in the treatment of hypercholesterolaemia: a double-blind controlled study. J Cardiovasc Risk. Jun1998;5(3):167-72.
  17. View Abstract: Hotz J, et al. Effectiveness of plantago seed husks in comparison with wheat brain on stool frequency and manifestations of irritable colon syndrome with constipation. Med Klin. Dec1994;89(12):645-51.
  18. View Abstract: Chapman ND, et al. A comparison of mebeverine with high-fibre dietary advice and mebeverine plus ispaghula in the treatment of irritable bowel syndrome: an open, prospectively randomised, parallel group study. Br J Clin Pract. Nov1990;44(11):461-6.
  19. View Abstract: Fernandez-Banares F, et al. Randomized clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Spanish Group for the Study of Crohn's Disease and Ulcerative Colitis (GETECCU). Am J Gastroenterol. Feb1999;94(2):427-33.
  20. Shulz V, et al. Rational Phythotherapy: A Physician's Guide to Herbal Medicine. New York: Springer-Verlag; 1996:187-190.
  21. View Abstract: Beesley A, et al. Influence of Peppermint Oil on Absorptive and Secretory Processes in Rat Small Intestine. Gut. Aug1996;39(2):214-219.
  22. Rees WD. Treating Irritable Bowel Syndrome With Peppermint Oil. Br Med J. Oct1979;2(6194):835-836.
  23. View Abstract: Pittler MH. Peppermint Oil for Irritable Bowel Syndrome: A Critical Review and Metaanalysis. Am J Gastroenterol. Jul1998;93(7):1131-1135.
  24. View Abstract: Liu JH, et al. Enteric-coated Peppermint-oil Capsules in the Treatment of Irritable Bowel Syndrome: A Prospective, Randomized Trial. J Gastroenterol. Dec1997;32(6):765-768.
  25. Nash P, et al. Peppermint Oil Does Not Relieve the Pain of Irritable Bowel Syndrome. Br J Clin Pract. Jul1986;40(7):292-293.
  26. View Abstract: Aquino R, et al. Plant Metabolites. Structure and in Vitro Antiviral Activity of Quinovic Acid Glycosides from Uncaria tomentosa and Guettarda platypoda. J Nat Prod. 1989;52(4):679-85.
  27. Jones K. Cat’s Claw: Healing Vine of Peru. Seattle: Sylvan Press; 1995:48-49.
  28. View Abstract: Aquino R, et al. New Polyhydroxylated Triterpenes from Uncaria tomentosa. J Nat Prod. 1990;53(3):559-64.
  29. View Abstract: Aquino R, et al. Plant Metabolites. New Compounds and Anti-inflammatory Activity of Uncaria tomentosa. J Nat Prod. 1981;54(2):453-59.
  30. View Abstract: Sandoval-Chacon M. Antiinflammatory actions of cat's claw: the role of NF-kappaB. Aliment Pharmacol Ther. Dec1998;12(12):1279-89.
  31. View Abstract: Tassou CC. Effect of phenolic compounds and oleuropein on the germination of Bacillus cereus T spores. Biotechnol Appl Biochem. Apr1991;13(2):231-7.
  32. View Abstract: Aziz NH. Comparative antibacterial and antifungal effects of some phenolic compounds. Microbios. Jan1998;93(374):43-54.
  33. View Abstract: Visioli F, et al. Oleuropein, the bitter principle of olives, enhances nitric oxide production by mouse macrophages. Life Sci. 1998;62(6):541-6.
  34. Ionescu G, et al. Oral Citrus seed extract. J Orthomolecula Med. 1990;5(3):72-74.
  35. View Abstract: Arimi SM. Campylobacter infection in humans. East Afr Med J. Dec1989;66(12):851-5.
  36. Ionescu G, et al. Oral Citrus seed extract. J Orthomolecula Med. 1990;5(3):72-74.
  37. View Abstract: Walker AF, Middleton RW, Petrowicz O. Artichoke leaf extract reduces symptoms of irritable bowel syndrome in a post-marketing surveillance study. Phytother Res. Feb2001;15(1):58-61.