It’s an annoying problem with an annoying name: irritable bowel syndrome, sometimes abbreviated (and given a kind of nominal anonymity) IBS. And it affects more people than you might think–about 10% of the US population, 25 million people, two-thirds of them female.
According to Dr. Douglas Drossman, codirector of the Functional GI Disorders Center at the University of North Carolina, Chapel Hill, irritable bowel syndrome is what we call a change in bowel pattern and one or more of the following: abdominal pain, poor regulation of bowel function, diarrhea, constipation. We think that about two-thirds of people with IBS don’t visit a physician because the discomfort is mild, occasional, and tolerable. The other third of IBS, however, suffer severe symptoms. About 5% of people with severe IBS require treatment from a gastroenterologist.
It is one of those medical problems called a “disorder of dysfunction.” Unlike cancer and ulcers, for instance, Drossman says irritable bowel syndrome isn’t obvious when the patient is tested. “These patients have symptoms of pain and bowel dysfunction. But when you look, you don’t see anything. That’s led to a negative attribution, because when the doctor doesn’t find anything, he or she may say, ‘Well, there’s nothing wrong.’ But the symptoms are still very real to the patient.”
Just like migraines and sprains, IBS is not verifiable by test, but it can be quite severe. In fact, some experts believe it is second only to the common cold in causing work absenteeism in the United States. Drossman says that in irritable bowel syndrome we are really seeing a malfunction in how the brain and gut work together. What might normally affect the bowel in a healthy individual can become exaggerated when this syndrome is present. This appears to happen because the brain makes pain receptors in the bowel too sensitive. The syndrome predisposes the bowel to have a greater response, or an overreaction, to various stresses: a large meal with too much fat, excessive exercise, change in lifestyle, menstruation, and, of course, stress.
Although gastroenterologists usually see IBS complaints among patients in their 20s through 40s, the disease is typically a lifelong syndrome that starts in childhood. Interestingly, it seems to become less common in the older population. However, Drossman says other ailments in an increasingly ill population may result in irritable bowel syndrome receiving less attention. The problem crosses all socioeconomic, religious, racial, ethnic, rural, and urban groups and is seen in all parts of the world.
Although irritable bowel syndrome is extremely common, many general practitioners and even gastroenterologists know little about it. Therefore, Drossman says the diagnosis is largely a process of elimination. Blood tests, stool samples (to test for parasites or infection), and sigmoidoscopies are often performed to eliminate the possibility of other serious conditions such as cancer, colitis, and ulcer. If all results are negative, then the physician can diagnose IBS, create a treatment plan, and monitor the patient for improvement.
Treatment for IBS
Irritable bowel syndrome can reveal itself through discomfort, cramps, pain, bloating, diarrhea, constipation, or any combination of these symptoms. Here is a simple breakdown of treatment for the three most common symptoms:
- Pain: If discomfort is meal related, antispasmodics (otherwise known as anticholinergics) are often prescribed. If pain is severe, antidepressants in small doses (about one-third the dosage prescribed to treat depression) are used. “They act on the brain to modulate, or turn down, the pain volume,” explains Drossman.
- Diarrhea: Antidiarrheal remedies such as loperamide (Imodium) calm the gastrointestinal system and help to treat this limiting symptom.
- Constipation: Treatment aims at increasing the frequency and functionality of the system by introducing more dietary fiber or other over-the-counter fiber preparations.
New drugs that treat IBS are currently in clinical trials and are expected to receive FDA approval within the next couple of years. These pharmaceuticals are in the same class as serotonin. They focus on the pain receptors in the bowel and spinal chord that are involved with IBS. Unlike colitis, which is exclusive to the bowel, or depression, which is special to the brain, IBS reveals a unique brain-gut interaction. Drossman says that these new agents act to turn down an oversensitive gut that is the hallmark of IBS: “If these prove effective, and I think they will, then you’re going to have a whole new class of drugs to use to turn down the volume.”
If you think you have IBS, contact your physician to further discuss your treatment options.
Article By: Liz Gordon, Medical Writer