Irritable Bowel Syndrome: A Misunderstood Condition

Irritable bowel syndrome (IBS) is the most common gastrointestinal condition in the United States, but all too often people are too embarrassed or reluctant to discuss or seek treatment. Not surprising since this condition involves chronic abdominal pain, diarrhea or constipation or both—and is exacerbated by stress.

Another hurdle people with IBS face is actually getting a diagnosis. IBS is often diagnosed and treated according to the symptoms alone since there aren't medical tests that confirm the condition. While a great deal is still not well understood about IBS, experts have made major advances and encourage people to have an open dialogue with their doctors about their IBS symptoms.

What is irritable bowel syndrome (IBS)?
IBS is a chronic disorder that affects the nervous system and the digestive system. For an IBS diagnosis to be made, patients need to have abdominal pain about 25 percent of the time. Other primary symptoms include constipation or significant diarrhea or, in some patients, alternating constipation and diarrhea.

Secondary symptoms include bloating, abdominal distention, feelings of incomplete evacuation. Sometimes patients experience urgency; they feel like they have to go to the bathroom right away. Finally, about 20 percent of patients with IBS have fecal incontinence and lose control of their bowels.

What causes IBS?
Some research has pointed to people with IBS having a genetic predisposition. Other possible causes could be environment factors that trigger the condition, or medications, viral infections, bacterial infections. Experts have yet to pinpoint the exact cause.

What is wrong with the digestive systems in people with IBS?
Experts used to attribute IBS only to abnormal gut motility – abnormal muscle or nerve movement in the gastrointestinal tract. However, over the last 20 to 30 years, experts have learned that patients with IBS sense things in their gut differently. Their body may interpret normal gut function as abnormal. During the day the gut is in motion – the stomach is growling, mixing, churning and emptying of food in the small intestine and colon. Most people are not affected by those signals, but many patients with IBS seem to feel those signals and find them painful. Also, through studies using MRI and CAT scans of the brain, patients with IBS seem to sense pain in the brains differently.

What are the main types of treatment for IBS?
The doctor must identify the predominant complaint, and then treatment can begin. For pain, a variety of drugs called antispasmodics might be used. They help prevent muscle spasms in the gut. Another option for pain is a class of drugs called tricyclic antidepressants, which at very low doses, they can ease abdominal pain and discomfort. For patients with diarrhea Imodium or Lomotil may be used. For constipation, over-the-counter fiber therapies, such as Milk of Magnesia or the laxative MiraLax are used. There are also prescription medicines available that can treat either the constipation or the diarrhea that the person is experiencing.

Why is IBS a syndrome and not a disease?
It is called "irritable bowel syndrome" because there is no precise, objective disorder that doctors can identify, but rather a group of symptoms or complaints. IBS really affects the entire gut: the colon, the small intestine and the esophagus, and unlike like other conditions, there is no specific abnormality like an lesion or a polyp.

Do women and men have an equal chance of having this condition?
Studies have shown that women are more likely than men to report symptoms consistent with IBS. However, experts do not understand why women seem to be more affected by it. One possible answer is that hormones play a role in this disorder. Also it may reflect the fact that men are less likely to see a physician on a routine basis or for these problems.

What are neurotransmitters and what role do they play in IBS?
Neurotransmitters are substances that transmit nerve impulses. Serotonin is a major neurotransmitter throughout the nervous system in the gut. It has been shown to be very important in the movement of food from the mouth through the stomach, through the small intestine and colon.

Serotonin also seems to be important in gut sensation and many experts believe it plays a major role in IBS. It may be the unifying link in these patients who have disordered gut motility and disordered sensation.

Is there a psychological component in IBS?
For many years, patients were told that anxiety or depression caused IBS, but that's a misconception. When patients see a physician for this chronic disorder, especially after having it for many years, they are more likely to have some co-existing anxiety or depression. So the goal of therapy is to treat the entire body, especially any coexisting psychological problems, if they exist. Many patients find that their IBS improve when their anxiety or depression is treated.

Are people with IBS are getting the help they need?
About 20 percent of adult Americans meet the criteria for having the syndrome, but only about 25 percent of those with symptoms actually see a doctor to be diagnosed or treated for the problem. Many patients are scared that their symptoms mean that something is seriously wrong. Or they may have heard that nothing can be done about their symptoms. But there are many good and effective treatments available and people with IBS should not suffer in silence.

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