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It may start with a bang—and a bolt to the restroom. Or, a whimper that lasts for hours—followed by no trips to the restroom for days. The abdominal cramping may grip you after a heavy business meeting. Or after a heavy business lunch.
Most confounding of all, it may happen seemingly for no reason at all. Suddenly, your digestive system has an ax to grind and it is taking it out on you.
Irritable bowel syndrome or IBS is an often painful and sometimes embarrassing condition that accounts for more than one out of every 10 doctor visits. Up to one out of every five Americans (two to three times more women than men) is diagnosed with IBS, making it one of our more common chronic conditions.
Symptoms of IBS can be as long and varied as the gastrointestinal tract itself. Patients may experience
Doctors exclude more serious diseases
such as cancer of the colon, colitis or
Crohn’s disease through
Treatment emphasis is placed on individuality. “Each patient’s symptoms are different and therefore we must treat the condition case by case,” says Deepa A. Vasudevan, MD, assistant professor in family medicine at The University of Texas Medical School at Houston. “Some patients show few to no symptoms, while others find themselves missing several days of work.”
Why our bowels get irritable enough to cause a riot in our bodies is still a mystery. One thing we know though is that it’s a problem of function, not structure. Unlike ulcerative colitis or colon cancer, there is no inflammation of bowel tissue or lesion. The gastrointestinal (GI ) tract just doesn’t perform as it should.
The intestine works to move food down its long tube much like a snake moves fresh-caught prey: through muscle contractions. The intestinal walls are lined with muscle layers that squeeze and relax so that food keeps moving through to its various stations.
Like most of our body functions, there’s a coordinated, intelligent rhythm to these contractions. With IBS, however, the beat is off. The squeezing actions can last too long and contract like a vise. Either food goes flying down the digestive highway, causing painful spasm and diarrhea or it slows to a snail’s pace, clogging the system with hard, scant stools. Either way, pain from gas and cramping can be crippling.
Some research suggests that the blame lies with the nerves that are supposed to inform the muscles when to contract and ease up. These nerves control sensation, movement and sensitivity. Some studies suggest that hormones must play a role since IBS is a predominantly young, female affliction, especially around menstruation. More recent studies are looking into bacterial infection as the culprit. Emotional stress was long held to be the cause of IBS.
What’s so confusing about IBS is that the same symptoms are common in other GI diseases and disorders. To make an IBS diagnosis, physicians first rule out other conditions. IBS becomes a “diagnosis of (or by) exclusion.”
Ruby Reyes, 23, is among the estimated 9 million Americans who suffer from IBS. “I'm the kind of person to shrug off minor stomach aches, constipation for a day or two, the things that seem minor,” says Reyes, who has battled the condition for seven years. “You think maybe you haven't eaten enough fiber and it will pass with time, but the symptoms start disrupting day-to-day activities.”
Her doctor first diagnosed it as a “small gastritis episode, and that I should eat light foods, carry TUMS and drink Mylanta. I convinced myself that this routine was working for me for about two weeks but then the spasms came back full force,” Reyes says.
Reyes saw a family doctor and then a gastroenterologist who made the diagnosis after several rounds of tests. “Finding the right medications wasn’t easy because we couldn’t figure out what triggered the symptoms,” Reyes says.
Emotional stress plays a featured role in triggering IBS episodes, Vasudevan says,“and physicians are beginning to treat the syndrome with antidepressants, such as Zoloft.”
Though research hasn’t pointed to stress as the root cause for IBS, it can start the cascade of symptoms if you’re prone to it by releasing certain stress hormones that over-stimulate the bowel. The chronic, debilitating attacks of IBS also can create a stress feedback loop, becoming an inescapable Catch-22.
Naturally, certain foods can trigger IBS symptoms, but not the same foods for each patient. For example, common irritants such as alcohol, tobacco and fatty foods easily trigger IBS attacks. Dairy products may also be contributors. For others, it could be carbonated beverages, caffeine, gassy vegetables or spices.
“I've had bouts of IBS for years and then years would pass before another round of it. I found that it usually started with a particularly rich meal, during a stressful time in my life,” says Cara Lynch, 48.
“My IBS symptoms involved diarrhea and severe spasms that would last for hours,” says Lynch. “Then, just as suddenly, the spasms would pass. A few days or weeks later, usually after a heavier meal, the symptoms would come on so rapidly that I was doubled over before the end of the meal.”
Vasudevan suggests that patients monitor their eating habits by taking notice of what foods trigger their symptoms. Keep a food/beverage diary until you know what sets off the alarm.
In Lynch’s case, the triggering meals could just as often be one of bland toast as rich sauces. The food source didn’t seem to matter. “What I ate for the next several days, though, made a huge impact on how soon I recovered,” Lynch says. “I learned to keep it bland.”
Experts also suggest identifying your stressors and find ways to manage them through regular exercise, meditation or stress management techniques.
“I advise people to get checked for generalized anxiety disorder or depression, I’ve recently been diagnosed with bipolar disorder along with my IBS,” says Reyes. “Better to be on top of that than to put it on the back burner. Even if there's no known cure for IBS, there's always new information that you need to know.”
Lynch was prescribed antispasmodics to quell the pain and diarrhea. When she finds herself in moderately stressful situations, she chooses her menu carefully and eats lightly.
“Find the emotional triggers and try to work through them,” says Lynch. "When you do start to feel better, continue to take your medications, choose food carefully--in other words, let your GI tract heal," Lynch advises.
For more information on IBS, go to:
Medline Plus - Trusted Health Information for you
National Digestive Diseases Information
International Foundation for Functional Gastrointestinal Disorders
UPDATED: 4-25-2007
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Dr. Deepa A. Vasudevan is an assistant professor in family medicine at the UT Medical School.
See Dr. Vasudevan also at:
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