Sorry, you need to enable JavaScript to visit this website.

A Handle on your Health: Irritable Bowel Syndrome

Article Image Alt Text
Tuesday, November 20, 2018

Lots and lots of bowel problems these days. Too much, too little, crampy, bloated, bloody, irregular, explosive or really inconveniently timed are descriptions I hear from patients about their bowels. What is going on down there in the deep dark depths of our colon and small bowel?  There are over 120 different causes of abdominal pain to give you some perspective.  Today we’re going to focus on just a few of them.

What is IBS or Irritable Bowel Syndrome? Much like the name implies it is a state of irritability in the bowels that results in predominately constipation or diarrhea or a combination of the two alternating back and forth.  It is a common disorder that mostly affects the colon or large bowel. In addition to constipation or diarrhea, most people complain of pain, bloating, gas or mucous in the stool. And most people will only have mild to moderate symptoms.  Women are affected about twice as often as men. IBS seems to run in families and more often affect the young (under age 50). People with depression and anxiety also are affected more often.

We do not know what causes IBS. There are many theories but no one knows for sure. Your DNA seems to be involved as we see a family association but the environment plays a big part too. People experiencing higher levels of stress also experience more IBS. Diet can trigger IBS. Eating dairy or certain fruits, wheat or beans or even sodas can trigger symptoms. As women are affected more often, it would seem hormones are also involved here.

When do you need to worry that something more serious is going on?  If abdominal pain is the predominate symptom and its not relieved by passing gas or having a bowel movement then you need to be further evaluated. IBS does not cause persistent vomiting. Rectal bleeding is not associated with IBS.  You should also not be losing weight uncontrollably.  These symptoms should prompt further evaluations for other conditions like cancer or inflammatory bowel disease (Crohn’s disease and Ulcerative colitis).  Rectal bleeding does not mean you have colon cancer so don’t go running to your doctor declaring you’re dying just yet. More common causes of the bleeding would be hemorrhoids or rectal fistulas, which can be easily detected by physical exam.   Unexplained weight loss is concerning for cancer but may be from malabsorption or endocrine problems like hyperthyroidism or maybe you just returned from an amazing central American vacation and now you have a tapeworm.  

If you go to your doctor what is going to happen to diagnose your IBS? There is no test available to make the diagnosis. We consider IBS to be a "diagnosis of exclusion," which means we look for other causes of your symptoms first and if we don’t find another cause then we fall back to the diagnosis of IBS. You can expect that blood work will likely be ordered to start with. Stool studies are seldom helpful but may be warranted in certain conditions. You may need a colonoscopy or an upper GI endoscopy to look inside your bowels to detect cancer or inflammatory bowel disease. There is a breath test and blood test available to look for H-pylori, which is the most common cause of gastritis – contrary to popular belief stress is not the most common cause of gastritis. 

Celiac disease and food allergies seem to be blamed for a lot of bowel issues, unfairly, these days. There is a simple blood test to look for antibodies to wheat or more specifically gluten. I tell patients if we’re suspicious of a wheat allergy causing their symptoms an easy at home test is to just make a change in your diet. Remove gluten from your diet and see if your symptoms improve then add gluten back and see if the symptoms return.  I wouldn’t put too much emphasis on food allergies being the sole cause of your bowel discomfort, but if making a change in your diet makes you feel better, go for it.

What other treatments are there other than dietary changes? It depends on your predominate symptoms. If you primarily have loose stools or diarrhea then you can try over the counter medications like Imodium.  It will help but you may get bloated from it. There are now some prescription medicines, but they are quite expensive and should be reserved for severe cases.  I think one of the simplest treatments is fiber. You can add fiber to your diet simply and cheaply either through your food choices like having morning oatmeal or using a fiber supplement like Metamucil or Senekot.  It used to be that people complained fiber supplements tasted like a glass full of blended cardboard, but these days the formulations are much more palatable and come in all kinds of forms to suit your preference. Fiber can also help if you have predominately constipation. You need to maintain a healthy hydration though. As long as you are drinking plenty of fluids and using fiber, this will loosen the stool making it transit through your gut easier. If the constipation is severe there are expensive medicines available now to help, but first I would try over the counter medications like milk of magnesia or magnesium citrate as needed. For bloating and gas, simethicone or charcoal tablets are helpful. I would stay away form beans and or dairy too. Bentyl will help with cramping. Some of the antidepressants can help either through their ability to reduce anxiety or direct effects on intestinal receptors.  

Probiotics are being talked about a lot in the news but how effective are they? They may help and they certainly won’t hurt you so give them try. If they work then great and if they don’t then it was a cheap and easy trial. One last helpful tip is to do regular exercise which really does help. If your experiencing symptoms of IBS I hope this was helpful. 

Feel better soon,

--

Dr. John Turner is a family medicine and emergency medicine doctor with 25 years of experience. He is also the owner of My Primary Care Clinic and My Emergency Room 24/7 here in Hays County. Dr. Turner may be reached at 512-667-6087.

San Marcos Record

(512) 392-2458
P.O. Box 1109, San Marcos, TX 78666