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All (IBS) People who use laxatives get an immediate feeling of relief after a (bowel) movement. That's why I use them and I can get that relief anonymously, privately and without seeing a doctor. However the downside of that (using laxatives) is that in a very short time I'm using them again, then again and again. Then I'm increasing the dose to get the same effect like I get immune to it and have to take more and more, and do that more often. I find that I want to have relief on a daily basis but the medication (bisacodyl) works less and less effectively as time goes on. I'll do this for 2 weeks at a time and feel great. I'll get those quick burst of energy but, if I miss a day I'll drag around feeling tired, depleted, having no energy, and that gets me down, sometimes real down and depressed and because I'm dragging I begin to wonder whether I'm getting enough nutrition especially when I see food pass undigested. Then there is the bloating, the distention, all of which seems at times to worsen when I take the little yellow pills (bisacodyl) I start to feel full and hear gurgling in my upper abdomen the sensation of water fullness, and I feel gassy. But I dare not pass gas because I may stain my pants. With the bloating there's the cramping and soreness. Then I have to go. And I better get there quick or I'll have an accident. That's why whenever I go out I have to know where the lavatory is, just in case. At times there are little small dry balls then there is the loose watery stools and if I get too many of those then my hemorrhoids flare up....so I have to be careful toward the end of my two week run of laxatives because I'll end up going again and again and again and my bum gets so sore. Sometimes, I just think that I don't eat enough so I'll eat and eat to fill up the gut so I can go. I drink lots of coffee to try in flush through all the food but that never works though I'll try it every 2-3 months. Sometimes, I think that I'm just too nervous, too anxious and if I can just relax, then my movements will be regular. Occasionally, I will blame certain foods, claiming that they are binding me so I avoid them. It works sometimes but the other times it doesn't. Then there are those infomercials about the 'toxins in the colon' that make me wonder whether I should get on one of those cleansing programs. But who’s got time for that and I'm not so bad that I have to live for a good movement. But when they tell me that I have coats of caked up stool lining my colon I almost pick up the phone until I think, "well my doctor never said that. Growing Scientific Research There is a steadily growing scientific view of IBS and other functional GI disorders. That view is that the basic abnormality in IBS is a “neuro-immune” dysfunction within the wall of the GI tract itself (7-13). It is accepted fact that the GI tract; a) has within its wall an autonomous (self-governing) nervous system with most of the traffic being within and unto itself, and only 10-20% of the traffic coming from outside the GI tract (5); b) serotonin is the main neuro-transmitter used in the gut to coordinate normal rhythmic contraction of muscles responsible for regularity (5); c) histio-chemical markers in the bowel wall itself distinguishes people with IBS and those without it (8,9). Treatment No cure has been found for IBS (1), but several options are available to address the symptoms. Your doctor can give you the best treatments available for your particular symptoms, and encourage you to manage your stress and make changes to your diet. For many people, careful eating reduces IBS symptoms. Serotonin and Movement of Food in the Gut Once food has entered the GI tract, hormonal signals unique and localized to the gut begin to orchestrate an elaborate physiologic dance known as digestion. Neuro-transmitters initiate the flow of information used by the GI tract to churn ingested food selectively mixing in an array of enzymes and hormones that not only digest food but also signal distal portions of the gut to prepare for the oncoming bolus of nourishment. There is the sudden increase in the number of enteroendocrine cells filled with serotonin initiating signals within nerve endings that penetrate from the lumen of the gut outward into the muscular layers so as to initiate contraction in a rhythmic fashion. So rhythmic are the contractions that food ingested at the beginning of the GI tract is pushed forward as in an assembly line allowing all sections of the gut to work on the ingestants according to design. Besides other things there is a coordinated saturation and de-saturation of serotonin within the bowel wall. Serotonin is released, and serotonin is taken up, like the movement of incoming waves of the ocean against the shore: a wave of serotonin perfuse through the bowel internal layers, and then is removed through its serotonin re-uptake system. The center piece of the re-uptake system is the SERT protein (Serotonin Reuptake Transport Protein). This is a highly efficient process. The Medical Cause of IBS and a Medical Solution that Makes Sense Following the review of basic science literature cited here and elsewhere, Dr. McCullough MD* concludes that IBS irregularity is due to a deficiency of SERT, serotonin re-uptake transport protein, mainly located in the baso-lateral walls of enteric epithelium. Though present in other structural elements in the gut wall, absence of SERT in the side and bottom walls of the cells lining the gut is striking in those who suffer from IBS. Though these cells are replaced normally every 7 days, which is sufficient for most individuals to provide adequate SERT concentration and regularity of bowel movements. There is a SERT problem in IBS. Whether the problem is slowed cell turnover, or reduced SERT production or disrupted SERT production or production of defective SERT, the overall outcome is deficient concentration of SERT with the result of uncoordinated uptake of released serotonin, over-stimulation of serotonin-sensitive nerves responsible for muscular contraction. Peristalsis, that smooth coordinated rippling rhythm of contraction within the gut wall, fails to occur resulting in irregularity in the form of either diarrhea, constipation or both. REFERENCES *Dr. McCullough is a board-certified Emergency Medicince physician, a board-qualified Internal Medicine physician, who holdsa Master of Science degree in Biology from Brown University, a Bachelor degree in Chemistry, a Bachelor degree in Biology, and a Doctorate degree in Medicine. 1) Camilleri M (MD): NIH Publ No. 03-693; 2) Lembo A (MD): Irritable Bowel Syndrome. HealingWell.com 3) Arnold W (MD): Patient Information: Irritable bowel syndrome. Univ Pittsburg Med Ctr. Patients.update.com, Aug, 2005. 4) Olden KW (MD): Irritable Bowel Syndrome. Am Coll Gastroenterol, www.acg.gi.org, 5) DePonti F Pharmacology of serotonin: what a clinician should know. Gut 53: 1520-1535, 2004. 6) Grundy D. What activates visceral afferents? Gut 53(Suppl2): 5-8, 2004. 7)Gershon MD. Nerves, reflexes, and the enteric nervous system: pathogenesis of the irritable bowel syndrome. J Clin Gastroenterol 39(4):S184-93. 2005. 8) Bueno L et al: Effects of inflammatory mediators on gut sensitivity. Can J Gastroenterol 13(SupplA): 42A-46A. 1999. 9) Krisjansson G et al. Clinical and subclinical intestinal inflammation assessed by the mucosal patch technique: studies of mucosal neutrophil and eosinophil activation in inflammatory bowel diseases & irritable bowel syndrome. Gut 53(1`2): 1806-12, 2004. 10) Palsson OS et al : Elevated vasoactive intestinal peptide concentrations in patients with irritable bowel syndrome. Dig Dis Sci 49(7-8): 1236-43, 2004. 11) La JH et al. Visceral hypersensity and altered colonic motility after subsidence of inflammation in a rat model of colitis. World J Gastroenetero 9(12): 2791-5, 2003. 12) Bischoff SC: Mucosal allery: role of mast cells and granulocytes in the gut. BaillieresClin Gastroent 10(3): 443-59, 1996. 13) Costa F et al. Role of faecal calprotectin as non-invasive marker of intestinal inflammation. Dig Liver Dis 35(9): 642-7, 2003. 14) Spiller RC Inflammation as a basis fro functional GI disorders. Best Prac Res Clin Gastroen 18(4): 641-661, 2004. 15) Morton J Bael Fruit. pg 187-190, 1987 16) Mashhud et al: Efficacy of fruit pul of unripe Bel in the treatment of IBS: a double-blind randomized controlled trial. 2005 IBS Irregularity The primary function of the colon is to absorb nutrients and water while expelling waste. It also is responsible to identify and eliminate toxins, irritants, viruses, and bad bacteria. All of this work is done on the surface of the lining. In IBS, hypersensitivity of the surface lining falsely triggers natural defense mechanisms in the colon, leading to pain, bloating, distention, diarrhea, urgency, and constipation known as IBS irregularity. Why IBS\Regulan Works In IBS, the hypersensitized lining attempts unsuccessfully to calm itself by secreting natural factors into its mucus. IBS\Regulan provides dietary supplements that assist these naturally existing factors to do their job, which is to reverse the “irritability” & “hypersensitivity” of irritable bowel. It’s mechanism is unique, patented, and is clinically proven to work in all 3 forms of IBS: constipative, diarrhea, and mixed constipative and diarrhea. Direction of Use For mild-moderate IBS Irregularity: Take 2 capsules nightly for 2 days then 1 capsule every 2-3 days (approx. 20 caps/month). For moderate-severe IBS irregularity: Take 2 capsules nightly for 3 days, then 1-2 capsules every other day (aprrox. 45 caps/month). More Info IBS/Regulan is designed according to pre-ripened Bael-fruit wood apple, which grows in India & Bangladesh. IBS is an immuno-neuronal hypersensitivity syndrome of the mucosal lining for which there is no cure. IBS\Regulan however restores regularity for those with IBS.