Everything You Ever Wanted to Know About Irritable Bowel Syndrome

Everything You Ever Wanted to Know

An interview with Anthony Weiss, M.D., Clinical Instructor in Medicine, Division of Gastroenterology.
Dr. Weiss is a board certified gastroenterologist, a medical doctor who specializes in diagnosis and treatment of conditions of the gastrointestinal tract.

What exactly is IBS?

Dr. Weiss: Irritable Bowel Syndrome (IBS) is a common disorder of the intestines that leads to both a change in bowel habits accompanied by cramping, and bloating (sense of gassiness). Some people with IBS suffer from constipation while others have frequent loose stools. Often people have a combination of both with alternating frequency. IBS is often referred to as spastic colon or mucous colitis.

What causes IBS? Who is most often affected by it -- any particular group of individuals? Approximately how many people are affected by this condition?

Dr. Weiss: IBS belongs to a group of disorders known as "functional bowel disorders" in that there are no obvious anatomic or biochemical abnormalities associated with the diagnosis. All evidence seems to indicate that IBS is related to altered motility of the colon. Motility refers to the normal muscular contraction of the intestine that pushes food and fluid from one end to the other.

Patients with IBS have a tendency toward increased contraction or cramping of the colon. Some people with IBS complain of a bloating sensation when this occurs. People who have excessive flatulence (passing of gas from the rectum) have another problem in addition, which is excess gas production by bacteria living in the colon.

IBS is most characteristically diagnosed in young, otherwise healthy people. Actually, it is seen almost as frequently in middle aged and older people, as well as children. It affects both sexes. While classically these symptoms are associated with periods of emotional stress, there is no association with any particular type of stress such as occupation.

The incidence of IBS is unknown but has been estimated as high as 15% of the general population. It accounts for up to 50% of referrals to a gastroenterologist.

How is IBS diagnosed? What are some of its main symptoms?

Dr. Weiss: IBS is a diagnosis of exclusion, which means that since there is no precise test to determine if one has IBS, the diagnosis is made after other diseases have been ruled out. In a young, otherwise healthy person with a normal physical exam, no weight loss, fever and blood in the stool, the diagnosis can usually be made on the basis of the patient's symptoms. In a person over 50, a fiberoptic examination of the lower part of the intestine (endoscopy) is usually necessary to exclude other problems such as diverticular disease or colon cancer. Every case is different, however, and the work-up may vary.

The main symptoms are abdominal pain accompanied by diarrhea, constipation or both. There may be varying degrees of bloating and gas production. The passage of large amounts of mucous is very common.

The diagnosis of IBS should not be made if there is weight loss, fever or blood in the stool. Additionally, if the symptoms cause the patient to awaken from sleep, there is usually another problem.

Are there other conditions that could cause the same symptoms? How can doctors be sure it's really IBS and not something else?

Dr. Weiss: There are a variety of other conditions that can cause these symptoms. That's why it is important to be evaluated by a physician. While not necessary in most cases, it is often useful to visualize (or view) the colon, either with endoscopy or barium X-ray.

What can someone diagnosed with IBS expect throughout life? What is the prognosis?

Dr. Weiss: The natural history of IBS is variable. Most commonly, people have "bouts" that come and go with varying degrees of frequency throughout the course of a year. Very often this occurs in times of stress, which seems to "trigger" the colon.

How is IBS treated -- that is, with what medications or diet/lifestyle modifications?

Dr. Weiss: The treatment of IBS generally has three components; stress reduction, diet and medication. If stress is major problem, there are a variety of techniques, such as therapy, biofeedback and stress management counseling, which are very effective in reducing IBS symptoms as part of the treatment plan. The addition of dietary fiber is very effective for several reasons. In diarrhea-prone patients, fiber serves to absorb excess water, while in constipation-prone patients it helps to promote normal contractility of the colon. Occasionally, some people (gas-producers) may experience an increase in symptoms with too much fiber. They do better with non-fermentable sources of fiber such as psyllium. A variety of anti-spasmodic agents are available which can help in cases of severe cramping. These should only be prescribed by a physician.

Again, every patient is different and therapy needs to be individualized. A dietary history should also be performed to elicit any particularly troublesome foods, which varies from individual to individual. Not everybody responds to the same medicine, so some "trial and error" is expected.

What foods/drugs/other factors have been shown to aggravate IBS?

Dr. Weiss: One must always perform a dietary history to rule out other conditions, such as lactose intolerance. Often a patient will find a dietary diary to be very illuminating in illustrating an unusual aggravating cause. For example, some people find that drinking a very cold beverage on a hot day will send them immediately to the bathroom.

How can one live most comfortably with this condition?

Dr. Weiss: The best way to live comfortably with IBS is to learn what works best to control or lessen the symptoms. This may involve lifestyle modification to avoid stress, dietary changes, and the use of medication when appropriate.

What questions should you ask your own doctor if you have it, or suspect you may have it?

Dr. Weiss: Many people have mild episodes of abdominal discomfort and temporary changes in their bowel habits and don't necessarily have to see a doctor. If these symptoms are recurrent, lasting three months or longer, then one should ask his or her physician to evaluate for IBS.

Is there anything people can do to prevent IBS? Is it a matter of heredity, lifestyle, diet...what? What advice can you give people who hope to prevent this troubling condition?

Dr. Weiss: There is no evidence that there is an inherited component to this disease. A high fiber diet, while not guaranteed to prevent IBS, is certainly healthy and can prevent other diseases, such as colon cancer. This should be accomplished by the consumption of 3 to 5 servings a day of fresh fruit or vegetables with whole grains.

Finally, Dr. Weiss, are there any serious misconceptions that the population at large has about IBS? What, in your opinion, is most important for people to realize about this condition?

Dr. Weiss: The most important thing to realize is that while IBS is a serious problem, it is not life threatening or deadly. Often people mistake the diagnosis of IBS for inflammatory colitis or cancer which it is not, nor does it increase one's risk for either. IBS is often difficult to treat but a diligent, cooperative effort between the patient and physician will usually lead to a way to greatly improve an IBS patient's life.

Thank you, Dr. Weiss, for a very interesting and informative interview.

Dr. Weiss: You're welcome

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