Paging Dr. Frischer: IBS

Do you suffer from abdominal pain, bloating, cramping, or gas; along with diarrhea and/or constipation? Has this been going on for some time? Have you had relatives who experienced these issues? 

If the answer is yes to some of these questions, you may suffer from an extremely common disease known as Irritable Bowel Syndrome (IBS). IBS affects the large intestine (colon), and is a chronic condition that has no cure. The treatment is to prevent and manage the symptoms.
Those at highest risk for IBS are under the age of 45, and women are twice as likely as men. Also increasing the risk is a family history of IBS; suffering from anxiety or depression; exposure to childhood emotional traumas (such as sexual abuse or domestic violence); and even geography. 

In Mexico, for example, it impacts as much as 26% of the population, while in Canada it’s closer to 6%. Here in the United States, it affects about 15% of the population. 

Even though the signs and symptoms of IBS can be extremely uncomfortable, IBS does not lead to changes in bowel tissue and it does not increase the risk for colorectal cancer (as do ulcerative colitis and Crohn’s disease). 

In fact, only a small number of people with irritable bowel disease have severe symptoms. Many manage their disease through diet, lifestyle and stress management. Others need medication. For most, IBS symptoms come and go, and can be mild, severe, or even absent for a time.

The cause of IBS is unknown, but a variety of factors may play a role. The body appears to overreact to the digestive process, perhaps due to poorly coordinated signals between the brain and the intestines. The walls of the intestines are lined with layers of muscle that contract and relax in a coordinated rhythm as they move food from the stomach, through the intestinal tract, and to the rectum. 

With irritable bowel syndrome, the contractions may be stronger and last longer than normal, causing gas, bloating and diarrhea. Or, the opposite may occur, with weak intestinal contractions slowing food passage and leading to hard, dry stools and constipation.

There are common triggers that stimulate IBS symptoms. Food triggers include chocolate, spices, fats, beans, cabbage, cauliflower, broccoli, milk, carbonated beverages and alcohol. 
Stress is a common trigger. IBS patients tend to experience high levels of anxiety, and often also suffer from fibromyalgia and chronic fatigue syndrome, leading some to speculate that IBS involves a malfunction in the way stress is managed. 

Hormones play a role, which may explain why women are twice as likely as men to have IBS. Many women find that symptoms are worse during or near their menstrual period. Gastrointestinal infections can also trigger IBS.

IBS complications result from its symptoms. Constipation or diarrhea can aggravate hemorrhoids. Avoiding certain foods can lead to being malnourished. 

Probably the most significant effect is on quality of life. Uncontrolled diarrhea, painful constipation, or abdominal cramping can pose substantial obstacles to living life to the fullest.

To diagnose IBS, your doctor will take a complete medical history and conduct a physical exam. There are no conclusive lab tests, x-rays, or biopsies - it is actually a process of ruling out other conditions. The bowel appears normal, but doesn’t function properly. Even with classic IBS symptoms, your doctor must still rule out other causes by ordering a colonoscopy and an ultrasound or CT scan of the abdomen. You will likely be asked to avoid dairy products and gluten (in order to rule out lactose and gluten intolerance), have a breath test (to rule out bacteria overgrowth syndrome), have blood tests (to rule out celiac disease), and give stool samples (to rule out bacterial or parasitic infections).

Treatment for IBS focuses on the relief of symptoms. Learning to manage stress and making changes in diet and other lifestyle measures will usually control mild symptoms:

*For gas, avoid chewing gum, drinking through a straw, carbonated beverages, and foods like beans, cabbage, cauliflower and broccoli.

*Limit dairy products if you are lactose intolerant. Substitute yogurt and aged cheeses for milk. Avoid chocolate.

*Try eliminating gluten in the diet to reduce diarrhea.

*Dine at consistent times to help regulate bowel movements.

*Drink plenty of fluids every day; water is the best. Alcohol and caffeinated beverages stimulate the intestines and make diarrhea worse.

*Avoid sugar-free sweeteners such as sorbitol and mannitol.

*Avoid medications that contain caffeine

*Exercise regularly to help with anxiety and depression, and get enough sleep.

Other approaches can be helpful. These may include probiotics, acupuncture, hypnosis, yoga, massage, meditation, biofeedback, progressive relaxation, deep breathing, mindfulness…and peppermint.

Moderate to severe IBS symptoms often require medication. Most of these are available over-the-counter. Constipation is usually treated with fiber such as psyllium (Metamucil), or methylcellulose (Citrucel). Be cautious with anti-diarrheal medications and laxatives. If they are necessary, try the very lowest doses. There are a growing number of newer prescription medications that can be quite effective. Speak with your doctor to find a medication or course of action that works best for you. 

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.