Q: My doctor thinks I may have a mild case of irritable bowel syndrome. I will be fine for days at a time and then suddenly need to run to the bathroom because I know I’m going to have a bowel movement. I can’t tell what foods trigger this. I’ve stopped eating one hot pocket type microwaveable item which definitely seems to trigger the IBS. I generally consume a healthy diet, eat a lot of fruit, and try to go to the gym three times a week.
Earlier this year I was diagnosed through blood work with H. pylori. It is gone now and I’m scheduled for blood work again soon. My reflux doesn’t bother me as long as I stay away from caffeine. What can you tell me about IBS and the symptoms I’ve mentioned?
A: Irritable bowel syndrome is a common disorder of the gastrointestinal tract that affects up to 55 million Americans, most of which are women under the age of 35, and have a family history. This intestinal disorder can cause cramping, constipation, diarrhea, bloating and abdominal pain. It is not clear why IBS exists, however specific foods including alcohol, milk, chocolate, some fruits and vegetables and carbonated beverages can trigger an attack, resulting in either constipation or diarrhea. It may be that individuals who suffer from IBS simply don’t have the proper balance of bacteria in their intestines, causing an abnormality in digestive system functioning. The walls of the intestines are lined with muscle layers that contract and relax as they move food from the stomach through the intestines and into the rectum in preparation for evacuation. When IBS is present, those contractions may be stronger and last longer than they do in the healthy individual. This may cause food to pass through too quickly, resulting in diarrhea and bloating. Then there are instances when the opposite occurs – food passes too slowly and stool becomes dry and harder to pass, resulting in constipation.
As you might expect, signs and symptoms vary from patient to patient and they often mimic other disorders that may have to be ruled out before a diagnosis is made. This chronic condition can improve at some times and even disappear altogether for a period of time.
Diagnosis may come about through the process of elimination; however, there are a few different criteria, including one known as Rome criteria for this, as well as other GI disorders. The most important consideration is that the pain and discomfort last at least 12 weeks, although they do not have to occur 12 weeks in a row. This is followed by at least two events – mucus in your stool, a feeling of straining and urgency with a feeling the person cannot empty his or her bowels completely, or abdominal distension. Other testing including a flexible sigmoidoscopy, colonoscopy, laboratory testing, and lactose intolerance testing might be ordered.
Treatment is geared toward decreasing symptoms, making dietary changes and learning to manage stressful situations better. Over-the-counter remedies are available to help control constipation, and diarrhea. Depression and painful abdominal spasms may require prescription drugs. There are a number of medications approved for the treatment of severe IBS, including Lotronex and Amitiza, yet long-term experience is limited. Lotronex was quickly removed from the market following its original approval because of complications; however the FDA now approves it with specific restrictions. It is not approved for use by men and it can only be prescribed for women who have diarrhea-predominant IBS and who have failed to respond to other treatments. Further, it can only be prescribed by physicians enrolled in a special program. Amitiza is approved for both genders for those who suffer from IBS with constipation and who have failed to receive satisfaction from other products. It is designed to increase fluid secretion in the small intestine that helps pass stool.
On the home front, be sure to avoid foods that trigger symptoms. Eat smaller meals more frequently. If you are lactose intolerant, substitute yogurt. Drink plenty of water and exercise regularly through yoga, tai chi, massage and meditation.
Readers who would like related information can order Dr. Gott’s Health Report “Irritable Bowel Syndrome by sending a self-addressed, stamped #10 envelope and a $2 US check or money order payable to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.
