A Pain in the Gut

Irritable bowel is no laughing matter when you’re the one running for the john.

by Michele Wojciechowski

November/December 2017

There’s nothing more potentially embarrassing than bowel problems. But what makes irritable bowel syndrome (IBS) frustrating, in addition to embarrassing, is that it’s so hard to pin down.

The term IBS “describes a constellation of persistent and troublesome symptoms related to the gastrointestinal tract and altered bowel habits such as cramping, abdominal pain, bloating, gas, diarrhea and constipation. By definition, IBS describes symptoms and does not identify a cause of the problem,” says Kyrin Dunston, MD, FACOG, of Signature Functional Medicine in Atlanta. She adds that IBS can be set off by anything from insufficient gastric acid or digestive enzymes to inflammation in the intestines from undiagnosed food sensitivities or low-grade infections.

Unlike many other ailments, IBS doesn’t become more prevalent with age. According to one study, 50% of IBS patients experience their first symptoms before age 35.

“The frequency of IBS attacks can vary, and it is widely accepted that excessive stress can trigger flares of IBS,” adds Alyssa Cohen, MS, RD, LDN, of Digestive CARE, a Florida gastroenterology practice. She also notes that IBS can also give people a sense of urgency—when you’ve gotta go, you’ve gotta go.

The symptoms of IBS should send you to a doctor for tests that can rule out other conditions that are more serious, such as inflammatory bowel disease (IBD). “The symptoms of IBD are generally more severe and intractable than with IBS and often carry much greater consequences for overall health,” Dunston explains.

She says testing generally includes a physical exam (and possibly a rectal exam), plus blood tests “to evaluate liver function and to check for anemia.” Holistic practitioners may also do a gastogram to check the ability of stomach acid to properly process food and a functional stool test to check for food sensitivities and pancreatic enzyme activity, and to see if inflammation or infection is present.

If tests show abnormal yeast, bacteria or parasites, botanical therapies and targeted probiotics may be needed. If you have poor gastric acid or pancreatic enzyme deficiency, you may need to take natural supplements. Stress reduction measures, such as yoga or meditation, and acupuncture have also helped some IBS patients.

Dunston says that most people with IBS need to make dietary changes. The most common are removing problematic foods such as gluten or dairy and switching to a whole food, plant-based organic diet with fewer carbohydrates.

Cohen says that more recently, practitioners have recommended what’s called the low-FODMAP diet; the acronym refers to certain carbohydrates that readily ferment within the digestive tract. The idea is to limit your intake of FODMAPs “because the bacteria in our gut ferment these carbs and produce gas as a byproduct, which can exacerbate symptoms of IBS,” she explains.

Cohen strongly encourages people to work with registered dietitians or other knowledgeable healthcare professionals when using an elimination diet—one that eliminates certain foods from a person’s intake and then returns them to the diet in a systematic way—such as FODMAP. You also may need to take a soluble fiber supplement to help with bowel regularity and start exercising, as long as your doctor says it’s okay.

Sage Evans, 25, of Salt Lake City, has been living with IBS for the last couple of years. She started having stomach issues after she graduated from college and was working at her first “real” job, which she describes as “high-stress, busy and non-stop.”

A self-described anxious person, Evans says that she knew something was up after having months and months of diarrhea. After an endoscopy, blood work, a colonoscopy, diet changes, medication and more blood work, her gastroenterologist diagnosed her with IBS.

When Evans found out she had no major health concerns, she was relieved that it was just IBS. “Before I was diagnosed, I was scared I had something seriously wrong with me,” she says.

Today, Evans eats well and takes a fiber supplement. While her condition has affected some of her hobbies, like running, she’s learned to plan ahead and run familiar paths where she knows she can access a bathroom if needed. Evans has told most of her friends she has IBS so if she needs to dash off, they don’t worry.

As Evans notes, an IBS diagnosis isn’t the end of the world. “It’s better to treat your IBS, accept it and move on,” she says. “Don’t let IBS rule your life.”

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