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!)