IRRITABLE BOWEL SYNDROMESuffering in SilenceIrritable bowel syndrome (IBS), is a common disorder of the intestines that affects nearly one out of five people in the United States. According to the book, Irritable Bowel Syndrome & the Mind-Body-Brain-Gut Connection by William B. Salt II, IBS is the most common functional gastrointestinal disorder. The symptoms include constipation, diarrhea or alternating bouts of both, bloating, abdominal pain and many other problems.
Symptoms of irritable bowel syndrome usually begin during adolescence or early adulthood. Altered bowel movements occur over periods of days to weeks. Occasionally, symptoms may be continuous. In a given individual, both constipation and diarrhea can occur, or either can be the recurring symptom. The course of the disease varies from patient to patient, but individually, it can follow a consistent pattern. The diarrhea of irritable bowel syndrome is usually of small volume, but frequent.
Episodes commonly occur during periods of stress. The initial morning movement may be normal, but followed by successively loose bowel movements throughout the rest of the day. Bowel movements may be associated with extreme urgency. The diarrhea rarely awakens patients from sleep and there is usually no associated fever or rectal bleeding. The abdominal pain of irritable bowel syndrome can vary in severity from mild to severe. It is usually felt in the lower abdomen, especially on the left side.
The pain may be dull, sharp, crampy or continuous. It is commonly relieved by the passage of gas or by defecation *1*. Each year, 2. 6 million people seek treatment for symptoms related to functional gastrointestinal disorders, and visits to physicians total 3. 5 million (Salt xiv). The average age of onset of IBS is between 20 and 29 years of age, and IBS is prevalent throughout the world including China, the United Kingdom, Australia, New Zealand and Scandinavia (Salt xiv, xv).
The public is made aware of cases of HIV, heart disease, various forms of cancer, etc. , on a daily basis, yet IBS is relatively unheard of. Because of this, millions of people who suffer from IBS feel there is a stigma attached to their disease and they must suffer in silence. IBS is not a rare disease.
In fact, it is the second leading cause of absenteeism in the workplace, coming in behind the common cold *2*. Unlike the common cold, however, there is no over-the-counter drug that can be picked up at the local drug store at the first sign of symptoms. Furthermore, there are few prescription drugs that have been used to treat IBS with positive results. The first prescription drug specifically developed for diarrhea-predominant IBS, Lotronex, was released to the market in March of 2000.
Glaxo Wellcome, maker of Lotronex, says the precise mechanism of action of the drug is not fully understood. However, the working hypothesis is that the experimental drug blocks the action of the neurotransmitter serotonin and 5-HT3 receptor sites in the gastrointestinal track. The thinking is that serotonin and 5-HT3 receptors play a role in increasing the sensations of pain and affecting bowel function in IBS patients. In addition, nerves that control the muscles in the gut may overreact to stimuli such as gas and the passage of food after a meal.
This may cause painful spasms and contractions and speed up or slow the passage of stool through the colon, resulting in diarrhea or constipation *3*. Lotronex has only been shown to work in women, and there is presently no medication available for men suffering from Irritable Bowel Syndrome. Lotronex works by blocking the level of serotonin in the intestinal system in order to reduce the cramping abdominal pain and discomfort, urgency and diarrhea. The first step in determining if the bowel problems in question are caused by IBS is to visit a physician for a check up. Chances are, he will refer the patient to a gastrointerologist, who will then order outpatient testing to be done at a hospital. This battery of tests can include an upper and lower GI, a barium enema/X-ray, an EGD?which consists of sticking a scope down the throat to look into the stomach, an ultrasound, and any other deemed necessary by the specialist.
IBS will be diagnosed after it is determined that the patient’s organs are functioning properly and their insides are healthy, leaving no obvious cause for their symptoms. After the initial diagnosis, the doctor will share a variety of treatment options and suggestions with the patient. At this point, it’s important to deal with a physician that is understanding and willing to work with the patient to manage the symptoms. Since there is no one specific cure, the patient is about to begin a long journey to try to find the right balance of medication, therapy, stress relief, relaxation techniques and eating habits. Many top physicians agree that Irritable Bowel Syndrome is not a diagnosis, is a vague term, and carries little significance.
A more correct name for the various GI problems that doctors associate with it should be unknown bowel disorder. IBS is a term that physicians will give to a patient if they have no idea what their problem is from. Its purpose is to give the patient a name for their problem so the doctor can avoid using those words you’ll never hear him or her say, I don’t know. Physicians have a reputation for being more concerned with treating symptoms than finding or treating the cause, bringing suffering patients back into their office again and again *4*. Because of the common occurrence of Irritable Bowel Syndrome, and the inability of the medical profession to find a cause or cure for the disease, there is a pressing need to support more research.
Unfortunately, research remains severely underfunded for functional gastrointestinal disorders. Less than 1% of digestive research funding, through the National Institutes of Health (NIH), is allocated for functional disorders *5*. The worst part for most IBS patients is not knowing why they’re suffering from this syndrome. There are many support groups on the Internet, including www.
ibsgroup. org *6* and www. allhealth. com *7*. In addition, there are various organizations such as the International Foundation for Bowel Dysfunction, which is a nonprofit and informational research program.
According to an article in Johns Hopkins Magazine’s April 1997 issue, there are four major procedures to follow to control IBS: eat more fiber, avoid culprit foods, medication, and reduce stress. First of all, increasing the daily dietary intake of fiber can dramatically improve bowel function. Fiber therapy is effective for both diarrhea and constipation predominant IBS sufferers because it stretches the bowel wall, actually decreasing tension in the bowel. Patients are advised to increase fiber gradually so as not to cause gas or bloating. Doctors further recommend getting enough sleep and physical exercise in order to keep the bowel regular. Secondly, avoiding culprit foods can minimize symptoms.
Fatty, fried or spicy foods are typical culprits for aggravating IBS. Some patients and physicians suggest avoiding traditionally gassy foods such as cabbage, beans, fructose, bran cereals and anything high in gluten. Milk can trigger symptoms in lactose intolerant IBS patients. The only way to pinpoint foods is to keep a daily diary of everything eaten in a two-week time period.
If a certain food seems to elicit a negative reaction in the digestive system, simply eliminate that food from the diet. Third, medication commonly prescribed for patients with IBS includes antispasmodic or anticholinergic medications. These are used to temporarily alleviate abdominal cramps. Over-the-counter antidiarrheal drugs or laxatives should be used as infrequently as possible and in small doses. Some physicians prescribe antidepressants to relieve pain and improve motility of the digestive system.
The final recommendation of this article was to reduce stress. Doctors used to view IBS as a disease that was ?all in the head? of patients. Although many physicians realize the legitimacy of the syndrome, it has been proven that stress can aggravate symptoms by causing an anticipatory response. Many patients complain of anxiety and feeling a lack of control in certain situations, which increases the probability of experiencing problems with IBS symptoms on that particular occasion *8*. Because of the lack of response from medical doctors and failure to be taken seriously, many IBS sufferers have chosen to take a different route to healing?alternative therapy. Various forms of this type of therapy include the use of herbs, vitamins and minerals, yoga, aromatherapy, meditation, massage and acupuncture.
According to the April 2000 issue of GreatLife magazine, Australian researchers treated 116 IBS patients three times a day with the following herbs: Dang Shen, Huo Xiang and Fang Feng. Improvement in these patients was confirmed by gastroenterologists (18). Further herbs used in the management of IBS symptoms include milk thistle, licorice, burdock root, red clover, alfalfa, aloe vera, skullcap, peppermint, valerian root, balm, chamomile, ginger and pau d’arco. Vitamins and minerals can be used to supplement the body to help heal the intestines and lower the stress level in IBS patients. It is important to have extra B vitamins in the body for proper muscle tone in the gastrointestinal tract, proper absorption of foods, protein synthesis, and metabolism of carbohydrates and fats.
Acidophilus is a necessary nutrient to replenish the friendly bacteria and to aid in digestion and the manufacture of B vitamins. Garlic is also used as a digestive aid and destroys toxins in the colon. A major metabolic fuel for the intestinal cells, L-Glutamine maintains the absorption surfaces of the gut. Calcium and magnesium supplements are also needed to help the nervous stomach and the central nervous system. Other than taking nutritional supplements, the use of relaxation techniques such as breathing exercises, yoga, aromatherapy, meditation, massage and acupuncture can be beneficial to the IBS patient.
Because the digestive tract is highly sensitive to emotional stress, anxiety about having an attack can aggravate your symptoms. Stress management can help to alleviate and improve daily anxiety and pressures. Relaxation, 101 Essential Tips details the importance of practicing relaxation techniques. Any physical exercise is helpful?a daily 20-minute walk helps to control stress levels, calms the digestive tract and keeps the IBS from flaring up. Yoga is highly recommended because it not only conditions muscles and connective tissue, but is also thought to improve the functioning of internal organs, including those in the digestive tract. Stretching and yoga are holistic therapies benefiting both the body and mind (20).
Aromatherapy is becoming increasingly popular as a healing art and can be used in an oil form in conjunction with massage. Aromatic essential oils are extracted from flowers, herbs and resins (31). They are commonly found in perfumes, body lotions and candles. Deep, slow, steady breathing relaxes and calms your mind and body. Toxic wastes are expelled and emotional balance is restored (24). Meditation goes hand in hand with breathing exercises.
It enhances the clarity of consciousness by stilling the mind (25). Some people choose to repeat a specific word or phrase as they meditate, for example, ?inner? as they inhale and ?peace? as they exhale. Massage is one of the most beneficial therapies for relaxation because it eases the pain and tension, bringing vitality to a sluggish system and soothing and calming the overactive nervous system (28). Acupuncture is an ancient technique in which a skilled practitioner inserts hair-thin needles into specific points on the body to prevent or treat illness. Practiced for over 2,500 years in China, where it originated, acupuncture is part of the holistic system of traditional Chinese medicine (TCM), which views health as a constantly changing flow of energy, or qi (pronounced chee).
Acupuncture helps regulate imbalances in this natural flow of energy, which result in disease *9*. Anxiety plays a major role in Irritable Bowel Syndrome by exaggerating the symptoms and, in some cases, actually causing the individual to trigger a reaction simply by anticipating it. Lucinda Bassett, former IBS sufferer, wrote a book called From Panic to Power and details the role anxiety played in her life. ?I began avoiding situations where I couldn’t come and go as I pleased, situations where I couldn’t be in control .
. . it was difficult for me to sit in class. I felt anxious, panicky, and trapped. I made all kinds of excuses for my lack of social activity and my inability to travel with friends .
. . my world became smaller and smaller (Bassett xv). ? She also states that IBS is an anxiety-related problem common to many people with anxiety disorder and that by age fourteen, everything in her life revolved around her fear of diarrhea. She was constantly in a state of worry and felt uncomfortable in any situation where she couldn’t run if need be (Bassett 5).
A recent guest of the Montel Williams show, Bassett is now cured of both her anxiety disorder and her Irritable Bowel Syndrome. Her public appearance was one of the few times the subject of IBS has been aired on national television. However, the month of April was designated in the year 2000 as the first National IBS Awareness Month *8*. A celebrity IBS sufferer, Camille Grammer?wife of ?Frasier? star, Kelsey Grammer?came forth recently to speak about the disease on NBC’s Today Show. According to Kelsey Grammer, ?You don’t hear much about IBS because some of the symptoms involved relate to subjects traditionally considered taboo by the public and the press .
. . ? The Grammers are working with the International Foundation for Functional Gastrointestinal Disorders (IFFGD) to raise awareness and educate the public about this condition and its effects. Camille Grammer found out she has IBS nearly four years ago, but says, ?As long as I can remember, I’ve always had stomach and bowel problems and have never really known what to do about it. I have been amazed to learn how so many women have been suffering in the same way. I hope that my efforts to speak openly about my condition will encourage others to do the same and get the help that they need.
?The Grammers have been working with IFFGD to create and broadcast television and radio public service announcements to educate the public through the media. Nancy J. Norton, President and Founder of IFFGD, hopes this will inspire a national openness about IBS to make it easier for patients to discuss the issue *10*. It’s time for people with IBS to realize that there’s light at the end of the tunnel. They’re not crazy.
The symptoms aren’t ?all in their head?. There may not medically be a cause or a cure, but now there can be an understanding. Why some people feel the burden of stress in their gut?and not, for instance, in their heart?can also be explained by the close communication between the brain and the gut. When the big brain consciously perceives a stressful situation, it calls on its fraternal twin through specialized mast cells, embedded in the gut’s lining.
These mast cells secrete a chemical called histamine, which activates the nerves controlling the gut, telling the muscles to contract. Hence, the cramps and bathroom trips so often associated with bouts of stress *11*. Now that there’s an understanding, hopefully physicians will open their eyes to potential triggers and/or causes of Irritable Bowel Syndrome, such as gluten or wheat irritability, lactose intolerance, candida albicans and intestinal fungus. Wheat or gluten allergies are inherited from previous generations. These products can cause serious gastrointestinal upset in a wheat or gluten sensitive individual *12*. When the person eats milk products, symptoms such as gas, bloating and abdominal pain may occur *13*.
Candida albicans can cause a variety of complications including digestive problems *14*. These items are just a few examples of possible causes of Irritable Bowel Syndrome and should researched in depth in order to be ruled out. In conclusion, IBS is a legitimate and serious condition that deserves a lot more attention than it has gotten in the past. Advances are being made in the pharmaceutical area and patients are opening their eyes to the idea of alternative medicine.
Many IBS sufferers are choosing to take control of their health and learn as much as possible about the disease. Where the medical profession lacks knowledge, perhaps the patient can provide the breakthrough information needed to find a cause, and ultimately a cure, for this debilitating disease. Most of all, having a celebrity spokesperson such as Camille Grammer, will hopefully do for Irritable Bowel Syndrome what Montel Williams has done for Multiple Sclerosis and Michael J. Fox has done for Parkinson’s Disease?awareness is the key to overcoming this major medical obstacle.Health Care