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A chronic condition with 10 years of annual awareness.
A WARENESS AND DEFINITION:
Since 1997, April has been Irritable Bowel Syndrome (IBS) Awareness Month, urging people involved in healthcare, schools, community outreach and in media to spread awareness of this condition. IBS is actually considered a syndrome, much like chronic fatigue or fibromyalgia, because it is a group of symptoms but without a clear-cut diagnosis or treatment. Symptoms range from mild cases to severe, but include cramping, diarrhea, bloating and constipation. The pain or cramping seems to be relieved by going to the toilet, but there is often a feeling that you still have fullness in the abdomen. Since IBS revolves around a topic people are not comfortable talking about, many suffer symptoms and fail to seek relief. Since IBS affects how a person is able to function in normal activities (because of discomfort, embarrassment from excess intestinal gas, and the need for a restroom nearby), its effects on quality of life is comparable to depression.
Irritable bowel syndrome is a problem suffered by up to 20% of the people in our nation. It is thought that the syndrome stems from a disrupted signal between the brain and nervous system that regulates bowel movements and the large intestines. Nerves and muscles of the large intestine seem to be extrasensitive, causing contractions, cramping and discomfort often shortly after eating a meal. However, clinical tests will not show abnormalities in structure (such as with CT scan methods) nor is there a specific blood test that can detect the problem.
DIAGNOSIS:
Through study of IBS, research has found that IBS takes two forms: either a person has constipation (IBS-C) or diarrhea (IBS-D), yet some may have alternating bouts of both problems. To diagnose the problem, a doctor previously had to perform a process of elimination for more serious problems, including a series of diagnostic tests. Now, after evidence has shown excellent results, physicians typically follow a symptombased diagnosis for IBS. As would be expected, testing choice by the physician depends on the amount of risk a person carries for more serious conditions, such as colon cancer or other significant disease, and the age of the person with symptoms With symptom-based diagnosis, a physician will conduct a thorough physical exam to search for abdominal masses or other palpable abnormalities. Then, a history of medical problems is gathered, focusing on major issues related to abdomi-nal pain or discomfort (weight loss that was not planned or attempted by diet/exercise, symptoms that awaken a person from sleep, blood seen in the toilet or with bowel movements, and a strong family history of bowel disorder/illness).
A blood test is run to check for anemia, abnormal blood chemistries and blood cell counts that could detect cancer or other conditions, such as thyroid problems. If the exam, history, and blood tests are negative, symptoms are determined to likely stem from IBS. A physician may then go on to treat the patient’s main symptoms (diarrhea, constipation) and see how he or she responds in about 4-6 weeks. If no relief is seen, further tests can be ordered, such as CT scans, colonoscopy, endoscopy, flexible sigmoidoscopy, and biopsies of intestinal lining.
From further testing, other chronic illness can be determined – such as inflammatory bowel disorder, including Crohn’s Disease and Ulcerative Colitis. These two conditions can lead to malnutrition, weight loss, and anemia because the intestine is actually damaged from inflammation of its lining or walls. Another condition, called celiac disease, can cause symptoms similar to IBS symptoms. This chronic disorder is a problem of the small intestine to absorb nutrients because of damage done from an abnormal reaction to gluten (a protein found in wheat and other grains).
IBS risk increases in people with family history of the same problem. Women are 2-3 times more likely to have IBS than men. Usually the symptoms develop prior to the age of 35. Stress and other psychological factors are common in people with IBS, and can bring on IBS symptoms, though no scientific studies have shown a concise relationship between IBS and stress. People with depression, anxiety, and other disorders frequently do report that they have frequent bouts of IBS symptoms. More traumatic psychological events have shown direct link to gastrointestinal disorders, and it would not be surprising to find that chronic exposure to stress from various sources may lead to symptoms of IBS as well.
TREATMENT:
Since IBS is a syndrome of gastrointestinal symptoms, and sufferers of the syndrome may fall into categories based on whether they have constipation, diarrhea or both, what is the best treatment?
Medications have been developed for IBS accompanied by constipation and IBS with diarrhea. The limitation of traditional treatments is that they act on one or the other of the problems (constipation or diarrhea) and, thus, may not help those people who suffer from both sets of symptoms. Therapy aimed at treating diarrhea delay transit of waste through the intestine or may decrease spontaneous activity of the smooth muscle in the intestine. The names of some prescription drugs are Lotronex (for IBS with diarrhea) and Zelnorm (for IBS with constipation). Treatments for constipation or diarrhea may increase fiber intake, as fiber pulls fluid into the stool, where it becomes more gel-like. Other treatments for constipation are aimed at increasing ions or sugars that are not well-absorbed and cause an increase of water and electrolytes into the intestine to aid in easier removal from the body. Antidepressants and antispasmodics may help to reduce some abdominal discomfort.
More recent research has focused on probiotics, either available in prescription form or as a supplement and food additive. Symptoms of abdominal pain, bloating, and gas, have shown some promising results from bifidobacterium infantis strain probiotics. Probiotics are beneficial types of bacteria that can be added to the diet to help achieve or maintain an ideal pH balance within the intestine (think less foul bacteria and more of the good), and thus yield a less upset digestive system. Yogurts contain a variety of probiotics, not all of which have shown improvement in IBS patients such as the bifidobacterium strain, yet have shown beneficial health results in other studies, such as those focused on building a stronger immune system.
Antibiotics, on the other hand, have raised some questionable results. In a large percentage of people with IBS (up to 85% of those followed in a study from Pimental and associates in Los Angeles’ Cedars-Sinai Medical Center and CSMC School of Medicine) have shown that they have higher numbers of bacteria in the small intestine. This overgrowth leads to fermentation of starches that are not easily broken down in the intestine, and leads to excess production of gas. In studies involving the use of neomycin and rifaximin, some patients have shown quite an improvement in symptoms. The problem is that the nature of IBS is a lifelong problem, and taking antibiotics for a long time is certainly not recommended. However, more study may lead to a way in which antibiotics can be prescribed over time.
Sensitivity or intolerance to certain foods has certainly been a topic of study, however, people with allergies to foods must follow the regimen of food exclusion because their life depends on their food choices. Common food triggers for IBS include: alcohol, chocolate, caffeine, high fat foods and milk products. Keeping a diary of foods eaten, symptoms (time of their onset after eating, etc.) and a list of the day’s activities may help to figure out some what triggers are present. Over time, a journal could help determine if there is a pattern. Awareness of what is happening in daily life can help reduce stress as well.
Stress has a negative effect on almost every aspect of health, from raising bad levels of hormones and other substances in the body that can increase chances of heart problems, to many behavioral and psychological problems. Since depression is common in IBS sufferers, managing stress through regular exercise, yoga or other such relaxation exercise, and receiving counseling and psychotherapy as needed, may make a difference in symptoms. Researchers in Great Britain have conducted a large study on IBS patients that showed psychotherapy for changing negative behavior and thoughts was helpful in chronic IBS symptoms. Mind-body awareness is not such an uncommon concept in the US anymore, and more studies are finding that its effects are benefiting many symptoms from a variety of diseases and conditions.
For more information on IBS, treatments and resources for Gastroenterologists, see: www.ibshealth.com/medicalcenters.htm and www.aboutibs.org
Word from the author: I have suffered IBS symptoms for nearly as long as I can remember, throughout my adolescent years and beyond. After becoming a newlywed, I started trying to find answers. I even underwent tests to rule out celiac disease. Limiting alcohol, eating only small amounts of chocolate at a time and, above all, exercising on a regular basis has helped most. Whether it is helpful for physical reasons or for psychological reasons, or both, exercise is a necessary addition to my weekly schedule.
It is not always easy to be around someone with this disorder, as I can confirm. However, it is fantastic that a month has been dedicated to IBS awareness, as maybe getting more public services and researchers involved could help lead to answers, and thus, relief for many.
