Fiber-Type Laxatives Can Ease Symptoms

Q: I was diagnosed with irritable bowel syndrome in 1998. I’m using Imodium occasionally, but it makes me constipated for days. When I have the urge, I need to find a bathroom immediately. These sudden urges to find a restroom make having a normal life nearly impossible. Can you help me? - L.K., Stockton, Calif.

A. You’re not alone in your suffering. Statistically, one in five of you reading my column has irritable bowel syndrome, or IBS. You may not even know you have it, treating the recurrent bouts of diarrhea or constipation with over-the-counter meds like Imodium AD or Metamucil. You may call it a “nervous stomach” or a “spastic colon” without being formally diagnosed with IBS by a doctor.

Irritable bowel syndrome isn’t actually a disease, but rather a “syndrome” - a collection of signs and symptoms. That’s because all blood work, X-rays, stool studies and colonoscopy results are normal - there’s no detectable “disease”. Nonetheless, there’s plenty of lower abdominal pain, gas and bloating. Having a bowel movement relieves symptoms - if only temporarily. There’s a tendency toward alternating between diarrhea and constipation, although some folks may suffer from predominantly diarrhea or constipation.

We’ve known for a long time that our bowels are intimately tied to our emotions.

Stress and anxiety can cause a hyperactivity of the colon, leading to diarrhea, gas and cramping. The colon, a 6-foot long tube, connects the small intestine to the rectum. Its main job is to absorb water and salts from food we eat, and then pass along the waste.

Regulating just how much water to absorb is pretty complex. A slow-moving colon favors constipation; and an overactive colon favors diarrhea. For some folks, dairy products, beans, spicy foods or coffee may provoke IBS symptoms. However, no one food has been universally identified as an IBS offender.

Recently, we’ve learned that IBS may not be quite as simple a problem as “the head controlling the bowels.” You see, the colon of a person with IBS seems to be a lot more sensitive to distention from gas, constipation or a large meal. The nerve fibers supplying the colon seem to have an abnormally low threshold for causing abdominal pain.

So what helps folks with IBS? Fiber-type laxatives like Citrucel, Equalactin or Metamucil work great not only for constipation, but for diarrhea too. If you’re constipated, the fiber pulls in moisture like a sponge to soften the stool. If instead you have diarrhea, the fiber again acts like a sponge to absorb excess liquid to firm up the stool. With fiber, it’s safe to use as much as you need to get improvement. Don’t use laxatives like Milk of Magnesia, Ex-Lax or Magnesium Citrate because they’re not fiber-based. Levsin/Levbid and Bentyl are anti-spasmodic drugs that help with cramping.

We’re just now seeing prescription meds for IBS. The first drug on the block is Lotronex, a drug FDA-approved for women whose main IBS symptom is diarrhea. It’s only intended for diarrhea-predominant IBS. Some serious constipation problems with colon blockage have been reported to the FDA with Lotronex, but they seemed to occur in folks who should not have used it in the first place due to their constipation-predominant IBS. If one develops constipation while using Lotronex, the drug should be promptly stopped. Still, Lotronex does offer modest relief to women whose main IBS problem is diarrhea.

Antidepressants such as Zoloft or Prozac can also help in IBS - even if you’re not depressed. For more info on IBS, contact the IBS Self-Help Group www.ibsgroup.org/ and the International Foundation For Function Gastrointestinal Disorders www.iffgd.org/