Stomach Pain: Is it Irritable Bowel or Something More Serious?

By:  Corey Howard, MD, FACP

Gas, bloating, constipation, diarrhea and cramping are common symptoms of a condition called irritable bowel syndrome (IBS).  These symptoms affect millions of people every day.  The question is:  “ Is this something I should be worried about?”  Here is the typical person who gets IBS:  women more than men over 45 years old.  That accounts for many people.   To make it worse you can also have heartburn, sexual dysfunction, urinary issues and nausea or even vomiting.  The problem is that most of these symptoms can also be related to colon cancer, inflammatory bowel disease or even celiac (a gluten sensitivity issue) disease.  Therefore, IBS really becomes a diagnosis of exclusion.  That means that you MUST determine if this is just IBS or another problem.  The best way to do that is to see your physician and a gastroenterologist (a doctor who specializes in the intestinal tract).

I want to discuss colon cancer because it is the second most common cancer and because IBS can mimic many of the symptoms.  First, realize that colon cancer may present with no symptoms at all until late in the illness.  That is the reason why anyone over 50 should have a colonoscopy and if you have a family history you may need one sooner.  Colon cancer risk increases with a diet high in meats and processed foods and one that is rather low in fiber.  It is avoidable in many cases by having a screening colonoscopy.

Here are some additional criteria that can help determine if this is IBS (called the Rome III criteria):
• Symptoms relieved by a bowel movement
• Onset associated with change in stool frequency
• Change in stool form
• Change in frequency
• Mucus in your stool

These symptoms must be recurrent and present for at least 3 days per month for the last 3 months.  However, since this is a diagnosis of exclusion you must make sure it is not something more serious.

What are other reasons to have these symptoms?  Stress.  This is a problem for many diseases and not just irritable bowel.  Stress can lead to high blood pressure, obesity, stroke and so much more.  Altered bacteria in your gut.  I discussed this last month.  The type of bacteria in your intestines can lead to many of the symptoms listed.  Additional  problems include: food allergies, infection, diverticular disease as well as hormonal imbalances.

The diagnosis is made through a good history and physical exam, followed by x-rays, colonoscopy, stool culture and testing for bacteria, and blood examination.

The treatments are related to diet and lifestyle primarily.  Medications can be used for symptomatic relief if necessary.  I prefer a more holistic approach first, second, third… You get the picture.  Once the more serious causes are “ruled out” then treatment can proceed.

Common treatments:
• Increase fiber in diet.  Just eat more foods that contain fiber such as whole grains (not processed grains), vegetables and fruits with pulp (as long as you are not diabetic)
• Improve your lifestyle.  Decrease stress, eat better, drink enough water daily (most people do not drink enough) and exercise regularly.
• Probiotics.  Probiotics may be an excellent choice for many people with IBS.  I suggest checking the stool and finding out the bacterial make up first.
• Avoid certain foods.  If you have identified a particular food or food group, you might want to try avoiding it and see if that makes a difference.  Often times the culprit is lactose intolerance or sometimes (becoming more frequent in the US) gluten sensitivity.
• Medications. Avoid taking anti-diarrheal agents unless you have discussed it with your doctor as they can mask and even cause other issues.  That is also true of constipation predominant IBS.  Do not start taking laxatives unless you have ruled out the other conditions and it is under your doctor’s advice.  The reason is that too many laxatives and damage your intestine’s nervous system and cause long-term problems.  Other categories of drugs typically used include: antidepressants, antianxiety drugs, or sometimes antibiotics.

Irritable bowel syndrome and its symptoms can be related to conditions that are more serious.  See your physician and determine what the best course of action for you.

Corey Howard, MD, FACP
Dr. Corey Howard, is a fellowship-trained gastroenterologist, board certified in internal medicine, Anti-aging, and Regenerative Medicine.  He has done additional training and obtained professional certification in Plant Based cooking.  His Lifestyle Medicine practice is in Naples.  He has regular seminars on the importance of lifestyle in improving you health as well as cooking demonstrations.
Go to: or to learn more.

1048 Goodlette Road, Suite 101, Naples, FL 34012  .  239-325-6504  .

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