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Irritable Bowel Syndrome

The symptoms of irritable bowel syndrome – diarrhea, constipation, abdominal pain, bloating and flatulence are very unpleasant.

As one of my patients so eloquently put it, “Irritable bowel syndrome sucks!” And you know, she’s right. The symptoms of irritable bowel syndrome – diarrhea, constipation, abdominal pain, bloating and flatulence are very unpleasant. There’s no question as well that patients are certain something serious must be “going on” if symptoms like this makes them feel so bad.

We don’t fully understand the cause of irritable bowel syndrome. But we do understand that individuals with a history for adverse childhood and adult experiences are more likely to suffer the symptoms of irritable syndrome than those who have not. Experience and research show those who have had emotional, physical, sexual or financial abuse as children and adults are more likely to have irritable bowel syndrome. Doctors also know there’s a connection between anxiety, depression and irritable bowel syndrome. If you have irritable bowel syndrome you are also likely to carry a diagnosis of anxiety and depression.

Food intolerance’s are unique in and of themselves and may cause the symptoms, but there is no clear understanding why some individuals react to certain foods and why certain foods cause irritable bowel symptoms in others.That said, making a diagnosis and ruling out serious disorders is important. Blood tests to look at liver, pancreas and kidney function as well as electrolytes and thyroid functions and blood counts are important. Stool specimens looking for blood in the stool or for certain bacteria and germs which might cause irritable bowel syndrome symptoms are in order as well. And referral to a gastroenterologist for a second opinion is not uncommon.

Gastroenterologist may recommend colonoscopy and upper endoscopy to rule out the more serious causes of the symptoms – cancer or intestinal disorders like Crohn’s disease and ulcerative colitis, peptic ulcer and GERD.

Once serious causes for the symptoms are excluded and confidence in the diagnosis of irritable bowel syndrome is established, it’s time for treatment.

Treatment starts with cognitive behavioral therapy (counseling). Doctors know that what goes on in the brain has a very great effect on our intestines, so much so, counseling is a critical first step in therapy. Because the foods we eat may cause the symptoms, a food diary looking for foods that trigger symptoms is important. Common foods that provoke symptoms include breads and cereals, dairy products for the lactose intolerant and a new category called FODMAPs or fermentable carbohydrates. These are the fruits, vegetables and some grains that go through a fermentation process in the gut and cause the symptoms of irritable bowel syndrome in some people.

Medications may work to relieve symptoms. Bentyl (dicyclomine), an anti-spasmodic that’s been around for years, may effectively relieve bloating and abdominal discomfort. For those individuals with diarrhea associated symptoms, loperamide and a new medication called Viberzi may be effective. For those with constipation predominant irritable bowel syndrome, medications like MiraLAX, Amitizia and Linzess may be just what the doctor ordered.

Some recent studies show probiotics and digestive enzymes may benefit patients with symptoms.

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Reference:

National Institute of Diabetes and Digestive and Kidney Diseases, 2019. Irritable Bowel Syndrome (IBS). Online [available at]: https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome Accessed April 22, 2019.