Mitigating misery

Irritable bowel syndrome is chronic and incurable but treatable.

Story: Chris Gerbasi

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 BandAids 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 selfdiagnosis. 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.”