Dealing With Irritable Bowel Syndrome

Irritable bowel syndrome brings its own special challenges

Most of us prefer to keep our bowel habits to ourselves, thank you very much, and even if we’re not feeling 100 percent in that regard, we don’t typically announce the fact to acquaintances or co-workers. You understand: what happens (or not) in the bathroom stays in the bathroom.

But irritable bowel syndrome, or “IBS,” is a chronic condition that can interfere with daily life to the point where maintaining privacy becomes difficult. Its embarrassing nature creates an additional burden for IBS sufferers who already have to live with the anxiety caused by IBS’s unpredictability and related pain along with the stigma of having a disorder that many mistakenly believe to be solely a psychological issue. “Irritable bowel is thought to be a fairly benign problem — and it is — but it creates symptoms for people that are just very upsetting and it really bothers them a lot,” says Myles D. Keroack, MD, a gastroenterologist at Elliot Gastroenterology and Elliot Hospital in Manchester.

IBS affects an estimated 10 to 15 percent of the American population, literally and figuratively cramping the lifestyle of twice as many women as men. The disorder appears more commonly in individuals who are less than 45 years old, although why that is, like much about IBS, is not well understood. Causes of IBS can range from food to medications and hormones, “so it can be hard to say exactly what the predominant contribution is,” says Michael J. Gilbert, MD, a gastroenterologist at GI Associates in Concord and at Dartmouth-Hitchcock Concord, Concord Hospital and Monadnock Community Hospital.

Compounding the complexity of IBS is the fact that there are many different kinds of IBS. Some people who have IBS experience diarrhea while others become constipated, for example, and some alternate back and forth between diarrhea and constipation. “There’s also a subset of irritable bowel that’s called dyspepsia, where people get upper abdominal symptoms with nausea and abdominal pain,” Keroack says.

Symptoms of IBS run the gamut from annoying to debilitating. And because the symptoms can accompany ailments other than IBS, much of IBS diagnosis centers on excluding other conditions. “You have to rule out other conditions that can mimic irritable bowel — things like celiac disease, Crohn’s disease, and forms of colitis,” says Keroack. “You have to go through a series of studies to make sure people don’t have something more serious going on.”

With the many variations of IBS, treatment differs from patient to patient; doctors tailor therapy to alleviate whatever symptoms the patient has. Certain medications might be added to or eliminated from the patient’s regimen, and typically the doctor reviews the patient’s diet for possible IBS triggers. Some patients learn that they’re lactose-intolerant, for example, or that fatty foods pose a problem. Pinning down dietary provocateurs can be difficult, however, Keroack says.

Long-term IBS patients, in particular, often pursue non-traditional forms of therapy. Alternatives such as acupuncture can be “extremely helpful” for treating IBS, Keroack says, and stress busters like yoga and massage can also help ease symptoms.

Other treatments for IBS that are of particular interest lately are probiotics, which are intended to boost the good bacteria that live inside each of us, and gluten-free diets, Keroack says. Also, many patients find that symptoms improve when they avoid what are known as FODMAP foods such as wheat and certain fruits and dairy products (“FODMAP” being an acronym for a handful of scientific terms). A low-FODMAP diet, in essence, means limiting intake of complex sugars and carbohydrates that are difficult to digest.

But in addition to physical symptoms, IBS sufferers do have to deal with the psychological aspects of the disorder — including the misconceptions that surround it. “All too often, [IBS] patients have been told, ‘Oh, it’s just in your head,’” Keroack says. “There are clearly multiple factors playing a role in [IBS] and certainly psychological issues are there, but unfortunately because of the stigma that it has in our society, too many patients think, ‘Well, I guess it’s all related to that.’”

Although it’s true that there is interplay between IBS symptoms and psychological factors such as stress, a person’s emotional state is not always to blame for IBS. In fact, Gilbert says, it’s unclear in at least some cases whether emotions caused a reaction in the gastrointestinal system or whether upsetting GI symptoms triggered an emotional response.

This much is clear: “Depending on the severity of [IBS] and how much it bothers the patient, it can consume far too much of their life. It’ll make them miss work, it’ll make them go to the doctor’s a lot, it makes them end up being on medications they don’t really want to be on, and it can set them up for problems with anxiety, depression, and all these other things that sort of spin off it,” Keroack says.

Practice website awareness

In this age of easy access to free, online medical information, patients often turn to websites in an attempt to gain a better understanding of ailments. Patients of all stripes would be wise to peruse online information with a cautious and skeptical eye, but doctors warn that web surfing for IBS information calls for a particularly vigilant approach. In general, patients should stay away from corporate-sponsored websites, which tend to be more about exposing consumers to advertising than providing sound medical data, says Michael J. Gilbert, MD, a gastroenterologist at GI Associates in Concord and at Dartmouth-Hitchcock Concord, Concord Hospital, and Monadnock Community Hospital.

Indeed, “there are so many people that pirate on [IBS] patients,” says Myles D. Keroack, MD, a gastroenterologist at Elliot Gastroenterology and Elliot Hospital in Manchester. “They’re basically taking advantage of people who are worried and anxious” about their condition. Steer clear of such sites and aim your mouse instead at high-quality, reputable medical websites, such as the one provided by the Mayo Clinic, he says.