EASING IRRITABLE BOWEL SYNDROME
An aspiring young pop singer was telling me about a health problem that threatened her career, forcing her to miss rehearsals and even cancel a few performances.
Ever since she had returned from a gig aboard a Caribbean cruise ship six months before, she had been plagued by alternating bouts of diarrhea and constipation. She experienced abdominal pains before bowel movements, often felt bloated, and was embarrassed by gas. She thought she might have picked up some intestinal infection in the tropics.
But my patient also confided that she had had bowel problems before, especially at stressful times, such as during school exams or before an audition. A doctor once told her she had a “nervous stomach.” She was afraid that I would label her a hypochondriac if I found nothing wrong with her physically.
I assured her that emotional factors could not be causing her symptoms, although stress or worrying about the problem could be making them worse. Pd check for parasites and other possible causes. But it sounded as if she had irritable bowel syndrome, a common disorder that afflicts as many as one in five adults in the United States.
Diagnosing the syndrome
Doctors used to attribute irritable bowel syndrome to anxiety or depression. That was partly because people with that condition have no evidence of physical disease other than their intestinal symptoms and partly because anxious or depressed people are more likely to seek medical attention for those symptoms. Overall, however, there’s no evidence that people with irritable bowel syndrome have more psychological problems than the average person. What actually causes the syndrome in the first place remains unknown.
Before I could diagnose irritable bowel syndrome in my patient, I first had to check for various underlying disorders involving the lower intestinal tract that can cause similar symptoms. Blood and stool tests ruled out any parasites or bacteria that she might have brought back from the tropics. A short trial on a restricted diet ruled out intolerance to lactose (the sugar in dairy products), which stems from a deficiency of lactase (the intestinal enzyme that breaks down the sugar). Careful questioning excluded a possible intestinal reaction to
excessive amounts of sorbitol or fructose, often used as sweeteners in low-calorie products.
The other main possibilities were more serious: gynecological disorders, such as endometriosis; inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease; and even colon cancer. But her overall good health and normal blood tests suggested that she didn’t have any of those disorders, so expensive testing was not warranted at that point.
I diagnosed her problem as irritable bowel syndrome and started treatment to relieve her symptoms.
Self-help for symptoms
Irritable bowel syndrome can cause three different types of problems: constipation, diarrhea, and a combination of abdominal pain, gas, and bloating. Some people with the syndrome experience only one symptom; others go back and forth from one to another. Still others have the pain-gas-bloating complex plus either diarrhea or constipation at different times. Fortunately, most people diagnosed with irritable bowel syndrome can treat themselves, depending on their symptoms:
• Constipation is the most common symptom of irritable bowel syndrome. Note that a daily bowel movement is not necessary for good health. If you aren’t bloated and you move your bowels without discomfort, you’re not constipated, no matter how infrequently you defecate.
When constipation is a problem, extra fiber in the diet usually helps. That’s because fiber absorbs water and swells in the bowel, creating bulkier stools that stimulate bowel contractions. People who are constipated should gradually add fiber to their diet over several weeks until they’re consuming about 20 to 30 grams a day. (If you’re eating more fiber, you should drink more fluids, too.)
Good sources of fiber include wheat bran, whole grains, whole-grain breads, and certain fruits and vegetables, notably raspberries, pears, peas, and brussels sprouts. Prunes are especially effective bowel cleansers, since they’re not only high in fiber but they also contain an irritant that rouses the bowel muscles.
If dietary measures alone aren’t sufficient, a bulk laxative containing psyllium (Metamucil, Mylanta Natural Fiber) can sometimes help. But avoid regular use of other types of laxatives, such as saline products (Phillips’ Milk of Magnesia) or stool softeners (Colace, Surfak). Over time, those laxatives can weaken bowel function. As a result, many people with chronic constipation become dependent on the drugs, which can have significant side effects ranging from potassium depletion to liver damage.
• Diarrhea, often containing mucus, is probably the easiest symptom to treat. Again, dietary modifications can help bring relief. In this case, however, you should cut back on fresh fruits and vegetables that contain lots of fiber and eat more complex carbohydrates, such as potatoes, pasta, and white rice. If dietary measures fail, a few doses of over-the-counter loperamide (Imodium A-D, Pepto Diarrhea Control) will usually do the trick. Again, don’t rely on medication any longer than you have to. (See your physician if you notice blood in the stool; that can signal a more serious disorder.)
• The pain-gas-bloating complex is the most distressing manifestation of irritable bowel syndrome and the most difficult to treat. A bowel movement usually relieves the pain, but cramps often return soon after. People who suffer from this set of symptoms apparently have increased sensitivity to normal amounts of intestinal gas. Even small amounts of food produce abdominal distention, or bloating.
The first step in treating this complex is to try to identify and cut out any foods that might be causing gas. The most common offenders include beans, brussels sprouts, cabbage, and onions. But the culprits vary from person to person, and you might have to do some detective work yourself. Some physicians recommend simethicone (Gas-X, Mylanta Gas Relief) or charcoal tablets, but I’ve found that those drugs usually don’t help.
If dietary measures and judicious use of nonprescription drugs don’t bring relief, your physician can prescribe stronger drugs. For example, an antispasmodic medication may help people whose pain stems from intestinal spasms. But all you may really need from your doctor is reassurance that nothing is seriously wrong with you physiologically or psychologically. Irritable bowel syndrome waxes and wanes and often remains quiescent for long stretches.
When I last saw my patient a few months ago, she had made several dietary changes and was coping with her problem successfully. She was less concerned about the symptoms that remained, and she had returned to the stage.
Health handbook introducing you to read the article: OFFICE VISIT: WHEN YOUR BELLY HURTS
Copyright ownership rights: The Best of Health – Consumer Reports