APRIL 1, 2016
April is Irritable Bowel Syndrome (IBS) Awareness Month, a good time to focus on this common digestive disorder, as well as other conditions affecting the gastrointestinal (GI) tract.
IBS affects 10 to 15 percent of American adults, according to the American College of Gastroenterology. It is the most common condition treated by gastroenterologists and one of the more common illnesses that primary care physicians see. However, many people who suffer from IBS do not seek medical attention and have not been diagnosed with the condition.
IBS is defined as a “functional gastrointestinal disorder,” which essentially means the digestive system is not working correctly. When someone has IBS, the muscle contractions of their colon are either occurring too frequently or not often enough. Importantly, IBS is not a result or a symptom of a structural problem with the GI tract, such as cancer or any other GI disorders.
IBS symptoms are not present all the time, but they are recurring. The most common symptoms of IBS include excessive pain in the gut, gas, bloating and mucus in the stool. Constipation, diarrhea or a combination of both are also symptomatic of IBS. These symptoms can be severe and frequent enough to disrupt someone’s work schedule, limit activity and impact social interactions.
The exact causes of IBS are difficult to pinpoint, but the disorder is generally believed to be caused by a GI tract that has unusual sensitivities and/or a digestive system that is working faster than it should (causing diarrhea) or slower than it should (causing constipation).
“Everyone experiences virtually all of the major symptoms associated with IBS occasionally, which is perfectly normal and does not mean they have IBS,” says Dr. Pavani Muddasani, a Gastroenterologist. “But if you experience these symptoms frequently, you should definitely see your doctor about it.”
Diagnosing IBS often involves ruling out other conditions first, which may be done through blood and other lab tests, as well as imaging. Occasionally, a colonoscopy may be ordered to rule out cancer, especially in patients over the age of 50. For the physician to make a diagnosis, it is especially important that the patient fully describe all of their symptoms in detail to the doctor.
Treatments for IBS vary widely and can include medication, as well as individualized food restrictions. A physician will often work with the patient to make modifications to diet in an effort to identify and avoid foods that trigger an onset of IBS symptoms.
Different people have different triggers. There are no foods which are universally known to cause IBS, but some of the most commonly identified triggers include:
- Fruits, vegetables, and legumes which cause gas, such as cauliflower and cabbage, beans and broccoli
- The sugar substitute sorbitol
- Carbonated beverages
- Dairy products – many people with IBS are found to be lactose intolerant
Keeping a food journal and correlating it to when symptoms occur will help narrow down and identify potential triggers.
“Sometimes we will recommend increasing dietary fiber in an effort to aid the digestive process and ease constipation,” notes Dr. Paul Senter, who specializes in colon and rectal surgery. “However, it’s very important that this be done gradually, as a sudden jump in fiber consumption can cause additional gas and bloating.”
In addition to dietary changes, your physician may prescribe medication to treat IBS. It’s important that a person with IBS not habitually rely on over-the-counter laxatives to relieve constipation or on anti-diarrheal medications. While it is OK to use these on a limited basis for occasional symptoms, they should not be used regularly and are not an effective treatment for IBS.
Other GI Issues
Inflammatory Bowel Disease
There are two main types of Inflammatory Bowel Disease (IBD): Chron’s disease and Ulcerative Colitis. With Ulcerative Colitis, the inner lining of the large intestine becomes inflamed, while Chron’s disease is characterized by inflammation that extends deep into the intestine wall and possibly into the small intestine and other parts of the digestive system. Both types of IBD cause severe symptoms, including rectal bleeding, fever, fatigue, loss of appetite, diarrhea, weight loss and cramping pain in the gut.
“While IBS causes pain and discomfort, Inflammatory Bowel Disease can be quite dangerous if not treated properly,” warns Dr. Glen Hooker, a colon and rectal surgeon. “Anyone experiencing a combination of these symptoms should see a doctor immediately.”
There is no identified cause of IBD, but research suggests that the introduction of certain bacteria or viruses into the digestive system may play a role, as could food allergies or genetics. The immune system mistakes food or other substances, such as bacteria, for a threat and begins to attack, causing fever and white blood cell counts to rise.
IBD can be treated with a variety of medications, including anti-inflammatories, immune system suppressors and antibiotics. While there is no cure for IBD, medications can sometimes prevent symptoms from recurring and push the disease into remission. In some cases, surgery is also required to treat both Chron’s disease and ulcerative colitis.
A common GI issue in adults over the age of 50 is diverticular disease, which occurs when a weakening of the wall of the colon allows small pouches to push through these weak areas. For many people, this never causes any symptoms, but sometimes the pouches can become infected or inflamed, bringing about an onset of diverticulitis.
Diverticulitis can come on suddenly and causes nausea, fever, pain and changes in bowel movements. You should see a physician immediately if these symptoms occur. In milder cases, diverticulitis can be treated with antibiotics, rest and a restricted diet for a few days. In more severe cases, hospitalization may be required. Surgery may be necessary if the diverticulitis symptoms recur frequently or a complication, such as a bowel obstruction, develops.
A gallstone is a hard object that develops in the gallbladder. It can range from a small speck to the size of a golf ball. Most gallstones are made up of hardened cholesterol and usually produce no symptoms or problems. However, if a gallstone obstructs the ducts in the gallbladder, this interferes with the normal digestive process and can cause intense pain in the upper right abdomen, nausea, and vomiting.
A gastroenterologist can diagnose the presence of gallstones through a CT scan or ultrasound. The most common treatment is surgery to remove the gallbladder, which is a non-essential organ.
“Gallbladder surgery is one of the more common surgical procedures performed, and it can often be done laparoscopically, requiring only a few small incisions,” says Dr. Paul E. Gray, a surgeon. “Most of the time, this is an out-patient surgery and someone can be back to their regular routine in just a few days.”
Most people experience acid reflux and heartburn occasionally, which occur when stomach acid travels up the esophagus. This is a common condition and can usually be managed with dietary adjustments (different foods can trigger heartburn for different people) and a variety of over-the-counter medicines.
However, if someone experiences acid reflux on a frequent and regular basis, that could indicate a more serious condition, known as Gastroesophageal Reflux Disease (GERD). GERD is a chronic condition characterized by frequent and severe episodes of acid reflux. GERD is a serious disease, as it can cause damage to the esophagus if left untreated. In addition to dietary changes, your doctor may prescribe medication to treat GERD and in some cases, surgery is an option.
“Occasional heartburn is normal and can usually be managed by avoiding certain foods. This varies person to person; for some people, it could be spicy foods, for others it could be fried foods, etc.” says general surgeon Dr. Travis Crudup. “But if you frequently experience heartburn or acid reflux, this could be a sign of a more serious GI issue that needs to be addressed. Further treatment options can include medications. In cases where there is poor response to medications, or if there is a significant hiatal hernia, surgery can provide good relief.”
“Whether it’s heartburn or Irritable Bowel Syndrome, it’s normal to experience GI symptoms from time to time,” adds Dr. Muddasani, the Gastroenterologist. “But if you have these symptoms on a frequent basis and you’re finding that they are interfering with your lifestyle, you should definitely visit your physician.”
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