A Debilitating Pain
Coping With Irritable Bowel Syndrome
March 22, 2008
By Megan Willard, MD
Photography ©2008 Jupiterimages Corporation
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Abdominal pain, bloating, diarrhea, constipation … missed days of work, missed social events, missed time — Catherine Moreland knows all about it. For 20 years her stomach hurt every day. On a few occasions the pain was enough to send her to the emergency room. “Chidbirth was not as bad as some of the stomachaches I had,” the Baltimore resident says. “My stomach would swell so badly that I thought my skin would pop.”
It sounds horrible and it is. “It” is Irritable Bowel Syndrome, or IBS. It’s also dismayingly widespread: Nationwide, one in five people has IBS, making it one of the most common disorders diagnosed by doctors. It’s not a lethal disease, but it can wreak havoc in your life. IBS is the second-leading cause of missed time from work after the common cold. Long considered a woman’s problem, IBS is now being recognized in men too. Symptoms usually begin before age 30, though IBS patients can often date the onset of symptoms to their teens.
Says Moreland: “It started when I was 20. I was studying in the library and a pain in my stomach came on like a thunderstorm. That was it — I had one version or another of that pain for two decades.”
Although only 15 percent of IBS sufferers seek medical help, the syndrome accounts for more than 50 percent of referrals to gastroenterologists.
IBS is a broad term defining a multitude of conditions. It involves a change in bowel habits — either diarrhea, constipation or both — accompanied by bloating and abdominal pain. The pain frequently is relieved by bowel movements and exacerbated by stress or certain foods. The pain often can be managed effectively with dietary changes and medications. For some people, however, IBS can be disabling and difficult to treat.
There is no unifying theory about the cause of IBS, but there are several hypotheses. Some propose that IBS involves changes in patients’ gut bacteria, which leads to inflammation. Other hypotheses involve gut interactions with the brain, hormones and our response to stress. Then again, some IBS patients develop symptoms only after a bout of a viral or bacterial gastrointestinal illness.
What are the symptoms of IBS?
IBS patients can have a wide range of symptoms, including gastrointestinal and nongastrointestinal complaints. Chronic abdominal pain accompanied by diarrhea, constipation or both is the primary symptom of IBS. The abdominal pain is described as crampy, with periodic worsenings. The location of the pain is different for everyone.
Moreland reports feeling rotten all over during severe periods of IBS. “I would get cramps up to my shoulders and neck like a claw from the pain,” she says.
Bowel movements can be frequent or infrequent, occuring from a few times a day to a few times a month. With both kinds of IBS there is usually a feeling of incomplete evacuation, leading to straining, the use of enemas and prolonged time on the toilet — all no-nos that cause problems themselves.
Other GI symptoms include reflux, bloating, nausea and gas. Non-GI problems include increased urinary frequency and urgency, painful menstruation and sexual dysfunction.
Not all GI symptoms point to IBS. Some, known as alarm symptoms, should be investigated promptly. These include abdominal pain associated with weight loss, loss of appetite, malnutrition, pain that prevents you from sleeping or awakens you from sleep, onset of symptoms after the age of 50, blood in the stool or on the toilet paper, anemia, a family history of colon cancer or chronic severe diarrhea. These symptoms are not typical of IBS and should be promptly investigated by a specialist.
What is the treatment for IBS?
Treatment depends on the patient’s symptoms. Diarrhea-predominant IBS is usually treated with anti-diarrhea medicines, fiber supplements and dietary changes. Constipation is managed with laxatives, fiber and increased fluid in the diet. Probiotics are increasingly playing a role in treating both types of IBS. Other woes, such as pain and bloating, are frequently more difficult to treat. Tricyclic antidepressants in low doses can help with pain, but their effect is not immediate. Narcotic pain medications have no role in treating IBS, as they can make the symptoms worse in the long run. Psychotherapy, hypnotherapy and biofeedback help reduce the anxiety associated with IBS and can lead to improvement in patients’ overall sense of well-being.
Moreland today is largely free of IBS symptoms. She attributes this to a more relaxed frame of mind, prescription medication to reduce stomach acid and the daily use of probiotics. She cautions IBS patients to not expect immediate or miraculous results from probiotics. “It takes time, but with consistent use they really do help.
“I feel as if I was saved,” she continues. “But I regret all the time that I wasted being in pain.”
DR. MEGAN WILLARD is a specialist in treating gastrointestinal disorders, including IBS. She completed her gastroenterology training at the University of Maryland and is a member of the American Gastroenterology Association. She recently joined Digestive Disease Associates, PA, with offices in Columbia and Ellicott City. To make an appointment, call 410-465-9558 or 410-992-9797.
