H E A LT H
By Dr. Patricia Knott
T
he best laid plans can go awry for a number of reasons, some catastrophic and some not. I would propose that one system in the body is more to blame, due to noncatastrophic reasons, for ruining a much anticipated event or work goal or social gathering than all the others. That system is the gastrointestinal (GI) tract. How many times have you headed out the door with only minutes to spare and had to make a detour to the bathroom? In addition to bowel and bladder issues, the problems of nausea and vomiting are included in the GI tract concerns One GI complaint seen commonly by physicians is Irritable Bowel Syndrome (IBS). It is a mostly chronic disorder which affects the large intestines but does not cause inflammation and does not increase your risk of colon cancer or cause permanent damage to the colon. It can often be controlled by making a few lifestyle changes. Signs and symptoms of IBS can range from mild to disabling. They may be intermittently worse or better and sometimes disappear altogether. The symptoms which occur with IBS are common symptoms for other disease processes and can vary from person to person, but some of the more common symptoms include: gas, bloating, constipation, diarrhea, cramping and abdominal pain. Picture the intestines as a system of muscular tubing with a coordinated rhythm of contraction/ relaxation which moves the food you eat from the stomach to the rectum. In the person with IBS, the contractions may be stronger and last longer or vice versa. If the contractions are stronger, this may lead to bloating, gas and diarrhea. If the opposite is true (the contractions are weaker), then hard stools and constipation occurs as stool passage slows. The definitive cause of IBS is not known, but the contractions play a part in the symptoms. It is also believed that people with IBS may have abnormal serotonin levels or are missing the right amount of good bacteria in the gut. Certain stimuli seem to trigger reactions in people
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Living with IBS with IBS: • Foods such as carbonated drinks, chocolate, milk and some fruits and vegetables can worsen symptoms. • Stress can increase symptoms. • Women complain of increased symptoms during menstrual periods. • Gas can increase pressure on the intestines. Risk factors for IBS include age (usual onset is before 35 years) and family history (risk increases if you have a close relative who has suffered these symptoms). Women are more likely to have IBS than men. The complications associated with IBS are related to the symptoms, especially diarrhea which can lead to skin irritation, dehydration and electrolyte imbalance. Constipation with straining can lead to hemorrhoid development. As with most chronic conditions, the persons with IBS need monitoring for signs of depression. This condition complicates the person’s social life with friends and family which in itself may lead to symptoms of depression. The diagnosis of IBS is usually made by a process of elimination, but certain diagnostic criteria will be used by your physician to narrow the field of possible disease processes. According to the ROME criteria, a person must have abdominal pain and discomfort lasting a minimum of 12 weeks and must have two other symptoms from the following list: • straining or feeling of not emptying bowel completely • bloating or abdominal distention • mucus in the stool • change in the frequency/consistency of the stool Your doctor will take a thorough history and perform a physical exam. She may wish to rule out some more serious conditions depending on what she learns from the history and physical. If you meet the criteria of IBS without other worrisome symptoms, your doctor will begin a course of treatment. If you do not respond as expected, she will wish to proceed with further testing, which may include a colonoscopy or sigmoidoscopy (use of a tube with a light to look at the lower colon), CT scan of the abdomen and pelvis and blood tests to rule out diseases such as Celiac
disease, which may cause similar symptoms. She may also wish to test you for lactose intolerance. If your symptoms are mild, try making some lifestyle or diet changes such as increasing the fiber in your diet (but do this gradually in order to reduce chances of increasing gas and cramping). Try eating smaller meals to help control diarrhea. Avoid the foods that worsen your symptoms. Drink fluids, especially water. Carbonated drinks can cause increased gas, and drinks with alcohol or caffeine can worsen diarrhea. Use over-the-counter anti-diarrhea medicines or laxatives with caution as these can cause some problems of their own. Discuss these with your doctor before using them. Exercise helps to promote normal contractions of the intestine as well as a general wellbeing of body and mind. Take measures to control stress and seek professional help if needed. If your symptoms are moderate to severe, your doctor may prescribe fiber supplements and anti-diarrhea medicines such as Imodium. He may also prescribe medicines to reduce bowel spasms and to treat any depression. Antibiotics may help in cases of an overabundance of certain bacteria in the intestines. Your doctor may also advise stress counseling. Two drugs are available to be used specifically for treatment of IBS — Lotronex (for severe cases of diarrhea) and Amitiza (for those with constipation). These drugs come with strict guidelines for their use and Lotronex can only be prescribed by doctors who meet strict criteria. Though IBS can wreak havoc with your social plans, the good news is that among the people who suffer, only a small number suffer with disabling symptoms. Most people who make some appropriate changes to their lifestyle and diet have improvement in their symptoms. Patricia Knott is a graduate of LSU Medical School in New Orleans and is board certified in Physical Medicine and Rehabilitation. She serves as the Medical Director for Conway Regional Rehabilitation Hospital.