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Irritable Bowel Syndrome and how to make it happy
Irritable Bowel Syndrome, or IBS since we like acronyms, is an interesting
condition. It is not a disease, and in fact tests for abnormalities come back
reported as ‘negative’. Does this mean that IBS isn’t really in the bowel, but
all ‘in the brain’? Unfortunately, there is a school of thought in medicine that
says that if all the tests come back negative, the condition is not real, only
imagined. This is, however, totally wrong. There are many conditions for which
we did not know (or had not developed) the right tests. Until the last couple of
decades, we did not have a definitive test for HIV - but the people had the
ailment, even though we couldn’t identify it. We doctors must never forget to
treat the patient, not the test results. (I thank my eldest son, Dr. Jonathan
Corness, for that sage little homily.)
Getting back to IBS, I repeat that it is not a disease. IBS is not the same as
inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative
colitis. In IBS, the structure of the bowel is quite normal. In IBD it is not.
IBS can be a very debilitating condition, characterized by some of the following
(but not necessarily all) symptoms: cramping pain in the stomach area, painful
diarrhea or constipation (now that’s confusing), mucus in the stool, swollen or
bloated belly, increased gas and the feeling that you are unable to totally
empty your bowel.
IBS can occur at any age, but it often begins in the teen years or early
adulthood. It is twice as common in women as in men, and about one in six people
in the U.S. have symptoms of IBS. It is the most common intestinal problem that
causes patients to be referred to a bowel specialist (gastroenterologist).
So, if IBS is not a disease, what is it? It is a functional disorder, which
means that the bowel doesn’t work as it should. What appears to happen is that
the nerves (called Auerbach’s Plexus from memory) and the muscles of the bowel
are extra-sensitive. For example, the muscles may contract too much when you
eat. These contractions can cause cramping and diarrhoea or rapid bowel movement
during, or shortly after, a meal. Or the nerves can be overly sensitive to the
dilating of the bowel (because of gas, for example). Cramping or pain can be the
result.
Any condition that does not have some test result nicely finger-pointing in the
right direction is then too often put into the ‘psychosomatic’ pigeonhole. “It’s
caused by stress,” say the non-medical ‘experts’. In actual fact, emotional
stress will not cause anyone to develop IBS. However, if you already have IBS,
stress can trigger the symptoms, just as it can for a myriad of medical
conditions. Stress does not cause the problem, but it can make it appear worse.
In fact, the bowel can overreact to all sorts of things, including food,
exercise, and hormones (women with IBS get more problems around the time of
their menses).
Food and drinks that tend to cause symptoms include milk products, chocolate,
alcohol, caffeine, carbonated drinks, and fatty items. In some cases, even
eating a large meal will trigger symptoms.
Another complicating factor is that the symptoms of IBS can also mimic other
gastro-intestinal problems, which is why in the ‘work-up’ there may be a barium
enema or lower GI (gastro-intestinal) series. Barium is a thick liquid that
makes the bowel show up on X-ray. Another examination is a colonoscopy. This is
where the doctor inserts the ‘black snake’ into your bowel via the anus and can
look through the small camera on the tip.
Although there is no ‘magic bullet’ to cure someone of IBS, there is treatment
that will help. This includes dietary changes, anti-spasmodic medicine and
stress relief if you are a highly stressed person. As a starter, fiber (found in
bran, bread, cereal, beans, fruit, and vegetables) reduces IBS symptoms -
especially constipation, because it makes stool soft and easier to pass, but you
have to identify the ‘triggers’. (And it ain’t Roy Rogers for those old enough
to remember the celluloid hero!)
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