Mitigating misery

Written by Chris Gerbasi

Irritable bowel syndrome is chronic and incurable but treatable.

In addition to its obviously unsettling name, irritable bowel syndrome also is an unsettling disorder: it’s common yet not always correctly diagnosed, it has no known cause yet has some telltale traits, and, most troubling, it’s incurable.

IBS, as it’s known, is one of the most common diagnoses made in primary care and probably the most common for gastroenterologists, says Dr. Trini Vaidya, of Gastroenterology Associates in The Villages. He says the syndrome affects more women than men by a 2-1 ratio, and one in five women have IBS. Worldwide, IBS affects 10 percent to 15 percent of the population, and people of all ages, according to aboutibs.org.

Just as the name suggests, a person with IBS has a bowel that acts in an irritable manner and causes changes in bowel habits: either frequent trips to the bathroom for diarrhea, few trips to the bathroom because of constipation, or what doctors call “rapid cyclers,” patients who vacillate between diarrhea and constipation literally within a day with no rhyme or reason. It’s a chronic, though treatable, condition that can range from mild to severe. Along with it comes abdominal pain or discomfort and spasms, however, IBS does not involve rectal bleeding, weight loss, or other serious conditions such as jaundice or ulcers.

In fact, the doctor says IBS has no known effects on the human body other than distress and discomfort. IBS doesn’t lead to any other medical problems, such as cancer, strokes, heart attacks, or high blood pressure, doesn’t necessarily lead to surgery, and doesn’t shorten the patient’s lifespan.

“What it does do is it makes people miserable,” Dr. Vaidya says. “People are unhappy, and it causes a lot of psychological stress for people, and it’s a vicious loop.”

The doctor explains that often an IBS patient may be under stress and their symptoms act up. Then they start to worry about their IBS, which makes them more stressed out, which, in turn, makes their symptoms act up even more.

IBS is a diagnosis of exclusion—doctors pin it down by eliminating other possibilities, namely cancer, ulcerative colitis, Crohn’s disease, and celiac disease, which is a gluten sensitivity. It’s easy for patients, and even for primary care doctors, to mix up diagnoses because IBS and these other conditions have overlapping symptoms, Dr. Vaidya says.

IBS also is not to be confused with IBD, or inflammatory bowel disease, which Dr. Vaidya says leaves the colon inflamed, red, bloody, and full of ulcers. IBD often leads to ostomies, which are openings created from the inside of the body to the outside to pass waste. The IBS colon, on the other hand, is normal in appearance. At one time, IBS mistakenly was called spastic colon disorder and also colitis, which is an inflammation of the colon. But there’s no colon inflammation associated with IBS, the doctor says.

Many conditions can be gleaned from a careful patient history, says Dr. Vaidya, who graduated from the University of Miami School of Medicine and completed his internship, residency, and fellowship at the University of California Davis Medical Center in Sacramento.

If symptoms arise, people should see a doctor, preferably a specialist, especially if they are over the age of 50, he says. People should get a colonoscopy at 50 for cancer colon screening anyway, and a colonoscopy also can help doctors eliminate conditions in the diagnosis of IBS.

While the cause is unknown, doctors do have some insights into IBS.

“We think that it might be hormonally based because women do report increased symptoms related to their menstrual cycles,” Dr. Vaidya says.

In women and men patients, doctors see a particular personality type—Type A—perfectionists with high-powered occupations, such as lawyers, accountants, college professors, and, yes, doctors. They are people who live stern, regimented lives.

“I’ve never met a surfer who has irritable bowel syndrome,” Dr. Vaidya says. “I’ve met plenty of accountants and bankers that have IBS.”

The doctor says IBS also may have a neuropsychiatric component, which means the hormones that play a role in the brain also play a role in the nervous system. There is a “brain-gut axis,” as he describes it, which all of us have experienced. For example, nervousness before a public speaking engagement may cause someone to need to go to the bathroom.

“The nervousness really is only a perception by the brain yet there are bodily manifestations of it—your pulse will go up, your blood pressure might climb, your mouth might get dry, your pupils may dilate,” Dr. Vaidya says. “The brain does have all kinds of effects on the body.”

So when the brain receives a new piece of information, it starts affecting the entire body, including the bowels, he says.

Irritable bowel syndrome is not believed to be genetic.

“However, there have been observational trends in families,” he says. “It’s unclear whether it’s based on genes or whether it’s based on personalities and learned behavior.”

For example, if three generations of men in a family all go into similar professions, live similar lifestyles, and suffer IBS, there may be a personality trait inherent in the men that’s related to their symptoms.

People who have anxiety or depression have high rates of irritable bowel syndrome compared to the general population, Dr. Vaidya says. Because of that relationship, doctors often prescribe antidepressants as an adjunct therapy for IBS, and they largely help with the symptoms, he says.

Treatments vary depending on the individual: imodium for diarrhea, high fiber and laxatives for constipation, and anti-spasmatic medications for spasms.

“So we are basically putting Band-Aids on the symptoms as they arise,” Dr. Vaidya says. “And we tell people to use these [medications] as needed, judiciously. Some people have a very high tolerance for discomfort or pain, and others [do not].”

In other words, some people may head to the emergency room when symptoms flare up, while others never see a doctor and simply try to “deal with it.”

Dr. Vaidya advises against that latter strategy. People should seek medical advice and not try to make a self-diagnosis. Knowing their condition also is beneficial to a patient’s family, because some conditions have a genetic basis.

As for solving irritable bowel syndrome, Dr. Vaidya says there is slow progress at best and no cure in sight, most likely because the causes are not understood. For now, sufferers can only treat their condition and learn more from their doctors.

“They will get all their options and they will understand more about their condition, and really, that is empowering,” he says. “Knowing is half the battle.”

An IBS patient’s view: ‘It doesn’t control my life’

When Stacy was diagnosed about seven years ago with irritable bowel syndrome, some frightening thoughts came to mind.

“My first thought was, ‘Does it lead to Crohn’s disease or something worse?’ That was my first concern,” says Stacy, who lives in The Villages and prefers not to use her real name.

Her former doctor assured her that IBS doesn’t lead to any other disorders or diseases. He had recommended a colonoscopy, which found nothing else wrong with Stacy, and gave the verdict of irritable bowel syndrome—of course, her bowel was irritated, she thought, a little dubious of the diagnosis.

Though she can’t be sure, Stacy believes an antibiotic she was taking ignited her IBS symptoms, which she never had experienced before. Her symptoms, which strike most often in the morning, include frequent cramps, diarrhea, and similar ailments.

She believes in a holistic approach and uses probiotics and digestive enzyme supplements, which she thinks works well against IBS. She also watches what she eats, avoiding spicy foods, though that doesn’t always help. She makes sure to get colonoscopies every five years.

“There’s nothing else I can do,” says Stacy, now a patient of Dr. Trini Vaidya at Gastroenterology Associates in The Villages.

Stacy realizes other women have much worse IBS symptoms, and she has empathy for them.

“It’s not overwhelming [for me]. It doesn’t control my life per se,” she says. “It’s just uncomfortable many times. What I’ve got is not as extreme as what other people might have, but it’s enough to be uncomfortable.”

Stacy prefers to take a low-key approach to IBS—she doesn’t feel the need for a support group or a lot of dialogue with friends.

But that’s one reason sufferers may have trouble finding support. Irritable bowel syndrome isn’t a topic that comes up in casual conversation.

While many IBS support groups exist online, they’re difficult to find locally on the ground.

Linda Manson, president of the Ostomy Support Group in The Villages, believes quite a few Villagers suffer from IBS. She feels that few people are aware of ostomy support groups—Leesburg and Ocala also host groups—and that IBS sufferers could use one, too.

“There’s a need for one for IBS if someone wants to set one up; somebody who would like to give back,” Linda says.

Dr. Vaidya, who emphasizes there’s no correlation between IBS and ostomies, agrees the general public probably has little understanding of IBS. So half of a doctor’s job is educating patients or guiding them to reputable websites like WebMD and the Mayo Clinic, he says.

Women, who are more likely than men to seek medical care for IBS, often are relieved to know they’re not alone—one in five women have the syndrome, Dr. Vaidya says. In a way, educating the patient and allaying their concerns is one form of treatment.

“When people know that they’re not going to die from this, that they’re not going to get cancer or other things from this, that in itself brings a huge relief,” he says.

–Chris Gerbasi

About the author


Chris Gerbasi

Chris Gerbasi has been a journalist for more than 30 years, writing and copy editing for newspapers and magazines throughout Michigan and Florida, and covering everything from city hall to spring training.

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