By James J. O’Mailia, M.D., Gastroenterologist
I am often asked by my patients about their symptoms of Irritable bowel Syndrome, or IBS. I have known of this affliction for nearly 40 years, since I first entered Medical School, and have seen it used to explain multiple gastrointestinal symptoms – sometimes accurately, many times inaccurately. IBS has had various other names: spastic colon, nervous colon and mucous colitis – in order to describe symptoms of diarrhea, constipation, alternating diarrhea and constipation, abdominal cramps, etc. Once diagnosed accurately, IBS is treatable, but not curable, not at this time. IBS can occur at any age and present itself seemingly without rhyme or reason. It is an all-too-common malady that ranks just below the common cold as a reason for absenteeism at work and school. It is a misery that can lead to a distressed lifestyle.
IBS is not a disease, like Ulcerative Colitis or Crohn’s Disease, nor is it Colon Cancer, and it is not life-threatening. As its name states, IBS is a “syndrome” involving symptoms, not necessarily the structural health of the colon. In fact, many patients with IBS have perfectly normal structural anatomy of their entire gastrointestinal tract. As an analogy, it’s like buying a new Ferrari (structural anatomy), but has no gasoline (functional symptoms). Thus, as disruptive as IBS symptoms may be, they do not evolve into a significant threat or complication.
Although everyone has had a bout with IBS – before a first date, at a job interview, meeting a deadline or onstage at a public performance event – true IBS sufferers endure symptoms on a chronic, almost daily basis, regardless of circumstances. Besides diarrhea and constipation, other symptoms include bloating, excessive gas, increased mucus in stools, abdominal cramps and pain, and the urgent need to have a bowel movement. Although these same symptoms can be brought on by poor diet and bad habits like smoking and excess alcohol, true IBS symptoms usually worsen after eating and are relieved by a bowel movement or passing gas. They generally don’t occur while asleep, but can awaken sufferers in early morning with an urgency to have a bowel movement. At other times, they will have several bowel movements with a sense of incomplete evacuation, sometimes followed by hard, dry stools, like “hard pebbles” or like “pencil-thin”. The symptoms of IBS wax and wane, when under stress, when least expected, and then retreat until the next inevitable bout.
To live with IBS, patients will alter their lifestyles routinely. They will prepare for an important event by not eating for a length of time prior to the event, or they will take anti-diarrhea therapy prophylactically, to ensure confident control. They will study the layout of a restaurant or store to learn the location of the bathroom. They will calculate the distance from a destination back to their home should they need to leave in a hurry if a bout comes on, with the nearly incapacitating cramping, abdominal pain, nausea and sometimes vomiting due to IBS.
Despite extensive research and clinical studies, the full medical understanding of the causes of IBS remains elusive. What we do know is that the core cause of IBS symptoms is what is termed “dysfunctional gut motility”, which is a disorganized squeezing of the gut, and not a more ordered, rhythmic movement – like a farmer milking a cow.
Extensive IBS studies point to hormonal and chemical neurotransmitters as the source of the dysfunction, but much more research is needed. Stress clearly plays a role in IBS, as it can trigger the symptoms. One important distinction: IBS is not “in your head”, but rather “in your gut”. It is real. Although stress relievers (anti-stress medications and quieting techniques) can help alleviate the symptoms of IBS, symptoms many times present themselves absent of stress.
To treat IBS, your doctor must first obtain an accurate diagnosis. Since there is no specific test for this, all other afflictions with similar symptoms must be ruled out. Diagnosing IBS may require a combination of history and physical examination, laboratory tests, x-rays and possibly a flexible sigmoidoscopy/colonoscopy to “see” the lining of the colon. If the diagnosis is IBS, treatment can begin.
There is no specific treatment for all presentations of IBS. However, your doctor can significantly help control your symptoms and therein improve your quality of life. Other than the aforementioned stress relievers, IBS is treated with diet changes and symptom relievers.
A recently developed dietary plan, known as the Low FODMAP diet, restricts certain carbohydrates and can drastically improve symptoms. Yet, in my years of treating IBS, I have found that diet changes are always individualized with basic, common-sense eating rather than purely micromanaging a diet verbatim, as some patients on so-called “healthy diets” can have the worst IBS symptoms. Medications help relieve symptoms, but are constantly changing – and what works for some patients may not work for others.
It generally takes time and effort between the doctor and the patient to reach a good outcome. This includes education, understanding and determination in working together, and staying compliant. As IBS research continues to find an absolute cure, there is the other great hope that better therapies, including diet, natural products and standard medications, will one day lead to maximized control of symptoms and living without IBS.
Be well and stay well.
James J. O’Mailia, M.D., P.A.
1553 Matthew Dr, Fort Myers, FL 33907