Articles

Irritable Bowel Syndrome

Chia-Hung Tu M.D.
Division of Gastroenterology and Hepatology, Department of Internal Medicine,
Far Eastern MemorialHospital

    Irritable bowel syndrome (IBS) is one of the most common reasons for gastroenterology consultation. The syndrome may include various discomforts; however, they usually encompass three components: 1) abdominal cramping, 2) bloating , 3) diarrhea or constipation. It is characteristic for its chronic and repeated attacks with intervening period of spontaneous recovery, as well as the presence of triggering factors before some of the attacks. Most people with IBS find signs and symptoms improving as they learn to control the condition. Only a small percentage of people have severe signs and symptoms.

    The cause of IBS is not known well, but there are several possible explanations. There may be abnormal peristaltic movement of your bowels or overly sensitive intestines. It often follows the intake of certain foods, emotional stress, and episodes of gastroenteritis. Therefore, we may not see any evidence of inflammation, swelling, obstruction, or bleeding throughout the entire digestive tract. IBS is more common for people with neurosis, anxiety , emotional depression. All people could have a chance to get IBS; however, it is more common for young female people.

    The diagnosis relies on clarification of symptoms, rather than using investigational instruments as for many other disorders. In fact, doctors are asking your detailed symptom atic patterns in order to fit the standard diagnostic criteria, known as “Rome criteria”. In short, you should have a change in stool consistency or frequency, abdominal bloating, abdominal pain, or mucus in the stool, in periods lasting more than 12 weeks. Investigations are indeed necessary in certain conditions, say “red flags”. They are weight loss, blood in feces, vomiting, fever, and an age of onset more than 50 years. Some helpful exams are stool blood test, thyroid function test, erythrocyte sedimentation rate, colonoscopy, and abdominal computed tomography (CT).

    IBS could be severe enough to interfere with your work, personal relationship, and emotional health. It often makes people believe that they might have yet undetected cancer despite investigations with normal results. Fortunately, this disorder is not associated with risk of cancer; it never increases the risk of death, and will eventually cease. In many cases, you can control the symptoms by managing your diet, lifestyle and stress.

    Treatment begins with life style and dietary medications. You should take foods that rich in fiber, drink plenty of water, eat at regular times, exercise regularly, and avoid the food or alcohol that repeatedly trigger your symptoms. Several kinds of medications might be helpful, though not for everyone, such as fiber supplement, anti-diarrheal agents, drugs to slower or calm down peristalsis, probiotics, or anti-depressants. New drugs have been developed specifically for IBS, which exerts their effects by altering bowel secretion, sensitivity to food and feces, and peristaltic function. These medications are prescribed safely only after consultation with a physician. Some researchers report benefit from acupuncture, herbs, and psychotherapy.

    Although never fatal, IBS is a long-lasting, sometimes difficult to treat, and frustrating disorder. We advise a long-term follow up, allowing your physician to observe, to explain, to discuss, and to adjust his therapy specifically for you. Many Taiwanese patients are changing their doctors after every single visit because they believe their doctors are incapable to handle the symptoms or find out cancer. This abnormal culture in seeking doctors is mostly unhelpful, time-consuming, requiring unnecessary examinations, and even harmful. Nevertheless, IBS is always treatable, as long as you learn it well.