Abdominal discomfort and diarrhea or constipation are the hallmarks of this chronic condition. During Irritable Bowel Syndrome Awareness Month, learn the basics about IBS from a Kaiser Permanente gastroenterology chief.
Everyone has the occasional gastrointestinal upset caused by the wrong food or a bug, perhaps. But up to 10-15 percent of North Americans suffer from a chronic condition called irritable bowel syndrome, or IBS. It’s defined as a disorder of the gastrointestinal, or GI, tract.
Pauline Mysliwiec, MD, treats Kaiser Permanente members at the Vallejo Medical Center, where she is the chief of the Gastroenterology Department. Her interest in GI began with clinical nutrition. Today she shares 3 cornerstones to understanding IBS. “I reassure my patients that we understand that it is a painful and challenging condition and that it affects their quality of life. However, it is not life-threating and it is treatable.”
#1 – Symptoms
Characteristics of IBS include abdominal pain and alteration in bowel habits with constipation, diarrhea or both at least once weekly, for at least 3 months. Many can experience painful bloating.
People over 50 may require additional testing to rule out another disease. Additional red flags include symptoms such as blood in stool, escalating abdominal pain, weight loss, and getting up in the middle of the night to have a bowel movement. “These are symptoms that may suggest triggers that it may be more than irritable bowel.”
IBS is exacerbated by stress and other illnesses, from a flu to additional chronic conditions such as diabetes. New medications may affect IBS, too.
#2 – Causes
While clinicians are not certain what causes irritable bowel syndrome, the condition is usually diagnosed in young adulthood, the prevalence is slightly higher in women, and there seems to be a genetic link because it is seen in twins.
Among the several factors that play a role in IBS, abnormalities in the intestinal nerves may cause a person to experience greater than normal discomfort when the abdomen stretches from stool or gas. Some poorly coordinated nerve signals between the brain and gut can cause the body to overreact.
There are a host of other links to IBS, including socioeconomic and cultural influences, environmental factors, and one’s coping skills and cognitive skills, including how people perceive or have issues with pain and the bowel.
“We think of GI issues as disorders of gut and brain interactions because there is a 2-way street between the brain and the intestinal tract. There is a little higher incidence of depression among IBS sufferers, as well as anxiety and chronic pain. But it is not a psychological diagnosis. Patients have a problem at the gut level that feeds back to certain centers in the brain.”
#3 – Treatment
A lot has changed in the treatment of IBS. Over the past decade, there is increased interest in starting IBS treatment with a simple reassessment of diet. Sufferers who are constipated may try a plant-based diet rich in natural roughage, while those with diarrhea may try a gluten-free diet.
Short chain carbohydrates that are poorly absorbed into the small intestine are called FODMAPs, which stands for “Fermentable Oligo-, Di-, Mono-saccharides And Polyols.” Restrictions of these carbs — including fructose, lactose, and sugar alcohols — have been shown to reduce symptoms of bloating, pain, and gas, as do probiotics.
The next step is looking at medications. For those affected by constipation, laxatives can be effective. Neuromodulators and anti-depressants can help with pain. They can target the receptors in the gut and the brain to manage the pain better.
“There are some good studies on mindfulness meditation — not specific to IBS but concerning functional GI overall — that show the practice can be very helpful. There are also cognitive behavioral and other therapies, too. Finally, I encourage my patients to exercise since the elevated endorphins make everyone feel better.”