Irritable Bowel Syndrome
Years ago when I first went to my doctor complaining of stomach pains, I was told that it was probably Irritable Bowel Syndrome (IBS) and I should increase my fiber, limit my dairy, and focus on yoga and maybe therapy to manage my stress level. When I asked about the causes of IBS, the answer was “we don’t know.” I was frustrated because it seemed to me like hand waving and I was not given a clear treatment to relieve my symptoms. For example, they did not recommend that I go to a dietician and did know how much fiber or dairy I was eating to know whether I should change the amount. Additionally, I was diagnosed with “probable” IBS without any tests or attempt to eliminate other possibilities. This conversation was repeated year after year during my annual physical. It was not until I ended up in the emergency room with abdominal pain, cramps, and nausea thinking I had appendicitis that they started testing me to try and reach a definitive diagnosis. About six years after my first complaint, I was diagnosed with Fructose Malabsorption. Digestive issues are hard to diagnose because so many of the symptoms overlap. However, when doctors diagnose patients with IBS based on a quick conversation and without conducting tests to exclude other causes, it does not take the patient’s concerns seriously, potentially makes patients suffer longer than necessary, and diminishes the fact that IBS is a real syndrome. Fortunately, researchers and doctors are starting to better understand and explain IBS to patients as well as to state that it is a real digestive problem and not just in someone’s head. Although there is still a lot of work to do, they are getting closer to finding a cure. Dr. Mark Pimentel heads the Gastrointestinal Motility Program and Laboratory at Cedars-Sinai Medical Center and is in the forefront of IBS research. He recently tweeted, “The last 10 years has seen an incredible increase in our understanding of IBS. The next 10 years will be revolutionary and lead to cures.” Dr. Pimentel is a strong advocate and educator of IBS and also tweeted “Everyone is telling you what to eat. You worry they think it is all in your head. Please understand IBS is real.” In honor of IBS awareness month, I wanted to take time to write about what I learned from two gastrointestinal seminars that I recently attended on what IBS is and current treatments.
IBS is a debilitating, expensive, and global syndrome. It affects 25-45 million Americans (1 in 7) and around 11% of people worldwide. It occurs in both men and women but is more common in women. Only 30% of people who suffer from IBS go to a physician and it takes about 6 years and $20,000 in co-payments before a patient is diagnosed. IBS does not cause permanent damage to the intestines and does not lead to other serious diseases. However, it may affect the person physically, emotionally, socially, as well as affect the person’s ability to attend work, be productive, and be an active participant in life. Below is a history of what doctors thought were the causes of IBS:
- 1950’s: A psychiatric illness
- 1960’s: An intestinal motility disorder
- 1970’s: An increased sensitivity to pain
- 1990’s: The idea that there was a connection between the brain and gut was introduced
- Now: Causes can be genetics, the environment including infections, compromise of the intestinal barrier, and the gut microbiome (the amount of and the type of bacteria in our gut can affect our digestive system).
According to the Rome III Diagnostic Criteria* IBS patients have abdominal pain and discomfort for 3 days per month for at east 6 months, a change in frequency and form of bowel movement [IBS-D (diarrhea), IBS-C (constipation), or IBS-M (both diarrhea and constipation)], and relief after a bowel movement. Other symptoms might include bloating, gas, and the feeling of pressure in the stomach. Patients may have trouble with intestinal motility and may have a higher degree of sensitivity to pain in their digestive system. The causes are still unknown.
*Definition from their website: The Rome criteria is a system developed to classify the functional gastrointestinal disorders (FGIDs), disorders of the digestive system in which symptoms cannot be explained by the presence of structural or tissue abnormality, based on clinical symptoms. Some examples of FGIDs include irritable bowel syndrome, functional dyspepsia, functional constipation, and functional heartburn. Rome IV will be published in May 2016
Although there is currently no cure, there are ways to relieve some or all of the symptoms:
- Eat small portions.
- Increase fiber because it can help with bowel movements, but be careful not to eat too much. That can lead to bloating.
- Avoid milk.
- Decrease fatty foods.
- Work with a dietician to try the low FODMAP diet.
- Take peppermint oil to relax your intestines. Make sure it is enteric coated so it does not get broken down by digestive enzymes in the stomach and is delivered to the intestine.
- Exercise can expel gas out of the intestines. Walk after a meal and do not lie down right after eating to reduce gas.
- Do not use straws, which can cause you to swallow air and cut down on carbonated drinks to reduce bloating
- Take probiotics. It is recommended that if you try them, do so for a while but if they do not seem to work then it may not be worth the money, speak with your doctor or dietician.
- Stress can exacerbate IBS so relaxation and mindfulness exercises can help.
- Talk to your doctor about trying anti-spasmodic drugs or drugs to help with constipation or diarrhea.
If you are having issues with your digestive system, reach out to a gastroenterologist. Be an active partner with your doctor to help find out the right diagnosis and treatment. If your doctor is not helpful, then find another one. There is no reason to suffer.
1. Irritable Bowel Syndrome (IBS): Empowering Yourself and Improving Your Symptoms. Presenter: Dr. Lauren Tormey.
2. Advanced Digestive Health Seminar for Health Professionals: FODMAPS, SIBO, and the Gut Microbiome. Presenters: Kate Scarlata, RDN; Dr. William Chey, and interview with Dr. Mark Pimentel.
Photo taken by Liz Jones on Flickr