His girlfriend, Joan, pointed out that he had the same complaint last week when they went to the salad bar. In fact, James remembered that visit. He later suffered from diarrhea, but he thought it was related to getting an overdose of vegetables instead of his usual burgers and fries.
Maybe this is just gas, James thought. But then he remembered that the cramping, bloating and general bowel problems seemed to occur more frequently. Perhaps it was time to see the doctor, he decided.
James went to his physician that week. He told him of the abdominal pain, general gas problems, alternating diarrhea and constipation. And he noticed that there was some mucus in his stool last time.
After some tests, the doctor gave James the verdict: He likely had irritable bowel syndrome, sometimes referred to just by its initials, IBS.
What is IBS?
For most, IBS is a symptom that comes and goes. At times, it will be terrible but then will disappear for long stretches of time. It’s a disorder of the large intestine (the colon) that can cause cramping, bloating, gas and general discomfort. Unlike its other intestinal cousins, Crohn’s disease and colitis, it is not something that will damage bowel tissue, which can lead to colorectal cancer. But it is a condition that will need to be managed over a lifetime.
About one in five Americans has symptoms of irritable bowel syndrome, but few seek medical help. Because the disease can flare up and then go away for long periods, most dismiss it as a momentary aberration related to something they ate. But it is important to have it diagnosed, particularly if the symptoms worsen to include rectal bleeding, severe abdominal pain and weight loss. IBS is closely related to colitis and Crohn’s disease, which can cause changes in the bowel tissue, and all of them have the potential to develop into cancer.
Causes of IBS
The cause of irritable bowel syndrome is not known. Researchers suspect that signals between the brain and intestines are somehow affected, causing the complicated rhythms of the body to become altered and the intestinal contractions that speed food through the tract to become stronger than normal.
People who fall into one of the following categories are more likely to have irritable bowel syndrome:
1) Young people – Those under age 45 are more susceptible to the onset
2) Female – Women have it at twice the rate of men
3) Relatives with the disease – As with any recurring condition, family history plays a large role in determining who may have it
4) Are in a stressful situation – Whether under pressure at work or undergoing recent trauma, mental health can play a large role
Although the causes aren’t clear, there are certain things that seem to stimulate the condition. It is important to note that not all things stimulate all people -- there are wide variations in triggers.
Factors that Aggravate IBS
Some things to watch for include:
1) Foods that activate problems – Severe symptoms may be triggered by consuming certain foods and can range from milk to spicy foods to chocolate, fruits, nuts, cabbage, carbonated drinks and alcoholic beverages. It’s a good idea to pay close attention to what seems to generate problems and try to cut back on the triggering foods.
2) Stress – Massive deadlines on work or school projects can exacerbate irritable bowel syndrome in some people. This is believed to be an aggravating factor, rather than the cause of problems.
3) Hormones – In women, who suffer from IBS at twice the rate of men, menstruation can exacerbate the condition around or during the cycle.
4) Various illnesses – Gastroenteritis, sometimes referred to as infectious diarrhea, can create too much bacteria in the intestines, sometimes triggering an irritable bowel syndrome attack.
Beyond the symptoms of irritable bowel syndrome and the potential for transformation into colitis, Crohn’s or cancer, the cycle of diarrhea and constipation that’s part of IBS can aggravate hemorrhoids in the tract and may not allow the intake of certain nutritionally dense foods that promote good health.
Doctors will conduct a complete physical exam and do some blood work to make an initial diagnosis. A gastroenterologist referral may be needed for more elaborate testing. It’s a good idea to provide family history and a diary of at least a week’s worth of activities to help the doctor determine triggers. Ultimately, the doctor is most concerned with eliminating the possibility of colorectal cancer. There are two schools of identifying irritable bowel syndrome – the so-called Rome criteria, which looks for certain signs like abdominal pain and altered stool more than three days a month; and the Manning criteria, which looks at mucous in the stool, incomplete defecation and changes in stool consistency. The more symptoms that you have, the more likely it is that you have irritable bowel syndrome. There may be additional testing required to rule out other conditions, including a colonoscopy, a CT scan, a Lower GI series or a flexible sigmoidoscopy. A more complete workup may include a lactose tolerance test, a blood test and a stool sample.
IBS Management Strategies
Irritable bowel syndrome can be managed and controlled. Changes in diet and exercise, stress management, and plenty of the right kinds of fluids will help keep symptoms and pain at bay.
Changes also may include avoiding or cutting way back on foods that produce gas, including broccoli, cabbage, cauliflower and most raw fruits. Doctors may also suggest cutting back on gluten (barley, wheat and rye) and watching FODMAPs, carbohydrates like fructose that ferment in the body.
Depending on the specific condition, your doctor may recommend anti-diarrheal medications, fiber supplements, antidepressants and a short antibiotic regimen.
In many cases, more exercise and diet modification can go a long way toward relieving IBS symptoms and providing long-term help for lessening its impact.