Hi, and welcome to this BB. You will, or have already, found out how friendly and helpful these BB buddies can be!Yes, the term is "incomplete evacuation," but gastro professionals have come to understand that, most of the time, the bowels are completely evacuated. In IBS, it appears that the nervous systems "signals" in the bowel are all screwed up. You bowels are probably actually empty, but you are receiving messages that you have to go again.Here are the John's Hopkins Hospital's questions in evaluating IBS:"During the past three months have you experienced continuous or recurrent symptoms of:1. Abdominal pain or discomfort which is: relieved by defecation? and/or associated with a change in frequency of stool? and/or associated with a change of consistency of stool? and2. Two of the following at least 25 percent of occasions or days?- altered stool frequency (more than three bowel movements/day or fewer than three bms/week)- altered stool form (lumpy/hard or loose/watery stools)- altered stool passage (straining, urgency, or feeling of incomplete evacuation) passage of mucus- bloating or feeling of abdominal distension?"Here's more relating to some of your questions:"In IBS, the factory is out of sync.Schuster and his colleagues conducted a series of studies in which volunteers wore tiny pressure transducers that recorded the pressure of the muscles lining their colon and rectum. Recordings were made over a 24-hour period, while volunteers went about their normal daily routines.The researchers found that many IBS patients have disorganized and significantly more vigorous contractions.The muscles tend to spasm. "There's a more prolonged contraction, over a larger area," says Schuster. "It's like having a Charlie horse in the gut."The Hopkins team found that while healthy volunteers hadbetween six to eight peristaltic contractions in their colon within a 24-hour period, IBS volunteers who tended to be constipated had almost none, and volunteers who frequently had diarrhea had as many as 25 peristaltic contractions per day.There's no magic bullet for IBS.Treatment for IBS often comes "as a package," says Schuster. Patients may need to try a combination of the following measures:Get diagnosed, says Nancy Norton, "just for peace of mind. Getting a diagnosis validates that there is a physiological basis to the problem. Then you're in a position to get control."Establish a good relationship with an empathetic physician, advises Schuster. "It's important for physicians to educate patients that IBS is a chronic disease--like high blood pressure, arthritis, or diabetes--and that there are ways to manage it." Physicians should also make clear that "there is no single magical cure for IBS," he says. "If patients are looking for a cure, they'll be disappointed." Many physicians now use a biopsychosocial model in treating IBS patients. "This model recognizes that biological, psychological, and social factors work together to trigger or perpetuate the symptoms of IBS," says Schuster.Bayless always describes the physiology of the illness to his IBS patients, drawing many diagrams of the digestive system to illustrate his points. Patients benefit a great deal by visualizing what is happening inside of them, he says.Eat more fiber. This idea may seem counterintuitive. But according to a rule of physics called LaPlace's Law, the tension in the wall of a cylinder is inversely proportional to the cylinder's diameter. Thus, fiber, which gently stretches the bowel wall, actually decreases the tension in the bowel, says Schuster.A high-fiber diet will probably produce gas at first, but that usually lasts for only about three weeks, says Schuster. He advises patients to increase their fiber gradually, since adding too much fiber too rapidly will cause persistent gas pains. (About 15 percent of patients cannot tolerate a high-fiber diet.) Although bran products may help some patients, others cannot tolerate them. Some physicians recommend bulking agents made from psyllium seeds. Schuster also advises against laxatives. Getting enough sleep and physical exercise also helps keep the bowels regular.Avoid culprit foods. Fatty foods aggravate symptoms in many people with IBS, says Schuster. Fats slow down the digestive tract, gumming up the works in an already irregular system. But with the exception of fats, it is unclear whether particular foods exacerbate symptoms. Some patients and physicians suggest avoiding the traditional gassy foods (cabbage, coleslaw, beans), fructose (found in figs and dates), sorbitol-containing gums and candies, bran cereals, and anything high in gluten (even apple juice has it.). Milk can trigger symptoms in people with IBS who are lactose intolerant. Some patients appear to have their own idiosyncratic problem foods. Nancy Norton says carbonated beveragesand caffeine are her culprits. Medication. Drugs prescribed for patients with IBS include antispasmodic medications (also called anticholinergics), which temporarily relieve abdominal cramps. In severe cases, patients can benefit from antidiarrheal drugs or laxatives, but in small doses and for the shortest time possible, says Schuster. Certain antidepressants relieve pain and improve the motility of the digestive system.A handful of experimental drugs are currently being tested for IBS. At Hopkins, Crowell is studying a new drug that blocks receptors for one form of serotonin, a neurotransmitter involved in the pain pathway. The drug may dull the perception of intestinal pain, and thus could benefit those IBS patients who appear to perceive sensations in the gut more acutely. Another medication called fedotozine acts to numb sensory nerves, and is in clinical trials.Reduce stress. "In the treatment of IBS, emotional catharsis is often more beneficial than physical catharsis," says Schuster.Although IBS is not "all in the head," stress can aggravate symptoms, and often in a complicated way. "There is an anticipatory response," says Norton. "You feel a lack of control--you don't know what your body is going to do. I remember thinking, 'Is today going to be a problem day?' The anxiety, in and of itself, increases your stress level." Many IBS patients have benefited from relaxation techniques, breathing exercises, or meditation. Others have tried hypnotherapy, and there is some evidence demonstrating its effectiveness, according to Schuster. Finally, reducing stress may warrant psychotherapy or another form of counseling.What IBS isn't.IBS is not colitis or cancer, and IBS patients do not have a greater risk of developing those illnesses. However, Schuster cautions that patients should be alert to any changes in their symptoms, which could indicate a new illness."Hope this helps.Oh, I wouldn't start taking stuff for the constipation. You will set up a viscous cycle with that. Get some Perdiem, or other fiber supplement and start to take it gradually. That will help you with both your C and D. Good luck! ------------------"To dare is to lose one's footing momentarily. Not to dare is to lose oneself." (Soren Kierkegaard)
