Articles written by me on Self-care and Palliative Medicine
On Self-Care & Palliative Medicine

Your Gut Reaction

“To eat is human, to digest divine.” Charles T. Copeland (1860-1952)

It’s been a hectic week. Your boss placed extra assignments on your desk Monday morning and gave you a “no excuses deadline.” You have eaten on the run most of the time–grabbing high-fat, fast food items for expediency. On top of that, you heard today that your uncle and his wife will be passing through town this weekend and would like to stay with you for two nights. And now, you’re miserable! The too familiar bloating and cramping and frequent diarrhea have returned with a vengeance. You’ve resorted to wearing those loose-fitting clothes that you keep at the back of the closet–because by early afternoon every day, you have to loosen your waistband or unzip your slacks or skirt several inches to allow room for an expanding abdominal girth. You’ve got Irritable Bowel Syndrome (IBS), and the above scenario is a typical catalyst for a flair of symptoms.

Irritable Bowel Syndrome is common. In fact, it is second only to the common Cold as a cause of absenteeism from work. Worldwide, it probably affects up to 1 in 7 individuals (1 in 5 in the U.S.), and over 35 million Americans are estimated to suffer from the condition. In fact, each year, around 3 million visits to physicians are generated by IBS–with some estimates stating that almost half of the visits to gastroenterologists are generated by IBS symptoms. It is three times as common in women as in men–in part, perhaps, because hormonal shifts during the menstrual cycle seem to affect IBS symptoms. Other common “triggers” include dairy products, fatty foods, caffeine, chocolate, large meals, and stress. Although the scenario above involves diarrhea as a prime manifestation, many individuals will develop constipation in their IBS flares or will alternate between constipation and diarrhea. Though the actual symptoms may vary from one IBS sufferer to the next, all of them share a sense of general misery that limits daily activities and certainly puts a sense of well-being and happiness on hold.

A.W. Crane is quoted as asking, “What other disease is so well buried under the verbal debris of centuries?” This question is germane to the whole concept of IBS; because it is truly a symptom complex rather than a precisely defined disease entity. Over the years, it has been called Spastic Colon, Mucous Colitis, Spastic Bowel, and Functional Bowel Syndrome. For various reasons, these terms are somewhat inaccurate though they are descriptive of symptoms. Thankfully, as painful and disrupting as IBS symptoms can be, they are not life-threatening and do not lead to more serious illnesses such a colon cancer, ulcerative colitis, or Crohn’s Disease. Bleeding with bowel movements, fever, weight loss, and progressive pain are not symptoms of IBS. In fact, the diagnosis of IBS is based on the pattern and duration of symptoms since no specific diagnostic test is available. It is important to eliminate the presence of other conditions that might share some of the characteristics of IBS. Your physician can perform the appropriate tests to rule out other possible diseases and can then advise you on specific treatment.

What causes Irritable Bowel Syndrome? Generally, the colon in an IBS sufferer seems to be more sensitive and reactive than usual, so it responds strongly to stimuli that would not cause problems in most people. There is a muscular lining in the wall of the colon. In IBS patients, these muscles contract abnormally–too much, not enough, too quickly, or too slowly. As a result, this over reactive colon creates the characteristic bloating, crampy pain, and abnormal bowel movements in a flare. Though psychosocial stressors and dietary changes affect everyone’s bowel function to some degree, these effects are magnified greatly in people with the hypersensitive IBS colons–a true “bummer”!

The treatment of IBS focuses on four main areas: Stress management, Healthy Lifestyle, Fiber Supplementation, and Medical Management. Food diaries can reveal dietary triggers which the patient can subsequently avoid. Sometimes, changing eating patterns from large meals to several small meals throughout the day can be helpful in reducing contractions. Dietary fiber adjustments can promote soft, predictable and painless bowel movements. Regular exercise, relaxation therapy and meditation are useful in stress reduction. Some patients have found benefit from peppermint oil, chamomile, rosemary, and ginger. Prescription drugs–including antispasmodics, antidepressants, anti diarrheal agents, and anti anxiety drugs can all be beneficial in some IBS patients. A new drug was released just this year that seems particularly helpful for female IBS patients who have diarrhea as their predominant symptom. It works to block the effects of serotonin (a neurotransmitter) on the colon and thereby slows intestinal activity–decreasing abdominal cramping and diarrhea as a result.

If you have IBS, know that you have a common medical problem. People are generally reluctant to discuss bowel habits, but I can assure you, you have many co-workers and acquaintances with this same condition. The severity of symptoms can vary from mild annoyance to debilitating, but there are a variety of treatments that can help to reduce the intensity. So, don’t suffer silently. Your gut reaction should be to ask your physician for assistance; the solution is often alimentary.

Stephen L. Hines, M.D.
August 2000

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