by Dr. Mark J Pellegrino, MD
November 20, 2009
Q: I have fibromyalgia, but now I’m wondering what the heck is wrong with my stomach… I have constant bloating/gas, pain in my stomach off and on… and I suffer from constipation most of the time. I know everything else has to be ruled out, but could these be symptoms of IBS?
A: Our autonomics have gone astray in fibromyalgia. In addition to causing pain and fatigue, the dysfunctional and hypersensitive autonomic nerves can cause a number of distinct conditions – including IBS - which are part of fibromyalgia but may require separate treatment approaches to try and calm them down.* [The autonomic nervous system maintains the “automatic” bodily functions performed by many organs, muscles and glands, and drives responses to physical or emotional stress – “fight or flight.”]
IBS is seen in the majority of patients with fibromyalgia syndrome and can cause cramping, bloating, gas pains, diarrhea and constipation due to dysfunctional autonomic nerves.
Shortly after a meal, cramping and diarrhea may result. If the bowel is stretched from gas or constipation, there can be increased pain. There is no actual damage to the bowel, but the syndrome produces distressing symptoms. In addition to the cramping pain and diarrhea alternating with constipation, other symptoms can include swollen or bloated abdomen, mucus in the stool, or a feeling that you have not emptied your bowels completely after a bowel movement.
Some Triggers
Certain foods can trigger IBS symptoms, including nut products, chocolate, caffeine, carbonated drinks, fatty foods and alcohol. Women with IBS will tend to have more symptoms during their menstrual period. And intestinal Candidiasis [yeast overgrowth] can aggravate IBS.
Different Tests May be Ordered to Investigate IBS
Tests that can be done include:
• Lab tests to evaluate liver and pancreas;
• Abdominal ultrasound to evaluate gallbladder and liver; and
• Barium enema to lower gastrointestinal tract; or
• Endoscopy to look inside the bowel and check for problems.
Usually these tests are normal with IBS, as the problem with IBS is not a structural problem but more of a functional problem with the autonomic nerves. There is no cure for IBS, but if it becomes a problem of its own, different things can be done to relieve symptoms. Treatments include the following.
Avoid Foods That Make IBS Worse
Specific foods may be identified as causing IBS flare-ups. French fries, ice cream, chocolate, alcohol, soda and caffeine are examples of foods that can make IBS worse.
Some foods tend to make IBS better, such as foods that contain fiber. Fiber is found in whole grain breads, cereal, fruits, beans, vegetables and bran. If you are adding fiber to your diet, add a little at a time to let your body get used to it. Too much fiber all at once may aggravate IBS symptoms.
Alter Your Eating Style
Large meals can trigger IBS symptoms. Try eating four or five small meals a day or if you have your usual three meals, eat less at each meal.
Medications
The following medicines can be prescribed to help IBS symptoms.
• Fiber supplements: examples include Metamucil, Citrucel, Flax Seed
• Laxatives: these can help treat constipation. Examples include Senokot and Ex-Lax
• Antispasmodics: this type of medicine helps slow contractions of the bowel and can help decrease cramping, pain and diarrhea. Examples include Bentyl, Levbid, and Levsin.
• Antidepressants: this class of medicine including tricyclics and serotonin reuptake inhibitors can help reduce pain and cramping.
Reduce Stress
Stress doesn’t cause IBS but once one has it, stress can aggravate the symptoms. Whatever the techniques you are using for your fibromyalgia, you can use these stress relieving techniques for IBS as well.
- Dr. Mark J Pellegrino, MD
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* For information on other conditions often associated with dysfunctional autonomics – interstitial cystitis, depression, anxiety, migraine, and orthostatic intolerance, see Dr. Pellegrino’s article “Those Dysfunctional Autonomics.” This information is excerpted with kind permission from his highly recommended book, Fibromyalgia: Up Close and Personal.
Note: This information has not been evaluated by the FDA. It is generic and is not intended to prevent, diagnose, treat or cure any condition, illness, or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.
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