Irritable Bowel Syndrome

IF YOU HAVE A "NERVOUS STOMACH," you aren't suffering alone. As many as 20 million adult Americans have what most doctors call Irritable Bowel Syndrome, or IBS. It's also known as spastic colon or mucus colitis. This common gastrointestinal disorder often begins in the 20s or 30s. It strikes twice as many women as men, and it generally becomes less severe with age. Those who suffer from this disorder become so focused on their gut that, wherever they happen to be, they always make sure they know the location of the nearest toilet.


It's one of the leading causes of absenteeism from work in this country and is responsible for a host of symptoms, most commonly abdominal pain. There are secondary symptoms-chronic indigestion, nausea, vomiting, bloating, gas, constipation and diarrhea, as well as the feeling that there's something left after finishing a bowel movement-but these also may be signs of more serious conditions, so a visit to the doctor is imperative for anyone experiencing such problems.


No one knows what causes a nervous stomach. Victims go from doctor to doctor looking for an answer and a cure and they find neither. Many undergo many tests, all of which are invariably "normal." So they end up being told all the diseases they don't have: no infection, no lactose intolerance and no Crohn's disease or ulcerative colitis. Despite the good news, these people continue to ache, cramp and expect those "unexpected" trips to the toilet.


Although no specific cause has yet been discovered for Irritable Bowel Syndrome, researchers and scientists suspect that erroneous nervous-system signals may be responsible. When communication between the brain and the bowel becomes disjointed, the symptoms of IBS begin, especially the urgent need to use the toilet. But while a disorder of nerve function may explain the reason for the variety of symptoms, it does not answer the question all of these people have: "Why me?" IS IT REALLY IRRITABLE BOWEL SYNDROME?


When a patient describes the classic symptoms of nervous stomach, it must be shown they don't have any of the disorders with similar symptoms:


o Lactose intolerance. Most of us have some deficiency of lactase, the enzyme that digests the lactose in dairy products. Undigested lactose in the gut can cause many of the symptoms of Irritable Bowel Syndrome.


o Medications. Herbs, sedatives, painkillers, tranquilizers and hormones all can cause symptoms of gastrointestinal distress. You should suspect every medication that you're taking and stop using any nonprescription items that aren't absolutely necessary.

o Infection. An irritable bowel often turns out to be caused by an unrecognized bacterial, fungal or parasitic infection of the gastrointestinal tract. The patient and may be surprised (and relieved) to find evidence of infection by Giardia or ameba. When the infection is eradicated, the symptoms disappear.


o Malabsorption. When the pancreas is not making enough of its enzymes, undigested food in the intestinal tract can cause IBS-like symptoms. Fortunately, malabsorption is simple to detect through blood and stool analyses.


o Food allergies account for a surprising number of unpleasant, chronic bowel symptoms.

In a given individual any food can cause an allergy. Bland foods, like potatoes, are just as likely to cause allergic reactions as spicy or exotic foods.


o Inflammatory bowel disease (Crohn's disease or ulcerative colitis) also can mimic IBS, but its treatment and outlook are vastly different. Tests can confirm the diagnosis, and specific therapy can treat this problem.


When all the above and other causes have been excluded and we are left with a diagnosis of IBS, the following treatments and dietary changes are tried:
  • Limit intake of dairy products, and eat foods high in fiber and low in fat. Fiber makes the stool bulkier, wetter and easier to pass. You can get all the fiber you need from wheat bran, oat bran, barley, peas and other vegetables, or you can add fiber supplements to your diet. Your doctor can help you find the right one for you.
  • Avoid "stimulant" laxatives if you're chronically constipated. Prefer osmotic laxatives, which draw water into the bowel and make the stool easier to eliminate. If you have diarrhea, Imodium, Lomotil or Pepto-Bismol may be tried occasionally.
  • Develop a bowel routine. As much as possible, try to "go" at the same time, preferably after a meal. For abdominal cramps or pain, a heating pad or a hot bath may provide relief. Antispasmodic drugs such as Levsin, Librax, or Bentyl also help.
  • Relaxation. Ask your doctor about biofeedback, hypnosis, relaxation therapy and other mind-body techniques. Reducing stress and anxiety may be one of the best measures to help control your symptoms.

Adapted from: PARADE MAGAZINE 8/15/99 “DO YOU HAVE A NERVOUS STOMACH” BY Dr. Isadore Rosenfield