By Rebecca Goldstein
Monika Boller can hardly remember a day in 17 years without stomach pain. “Most of the time I just accept that I’ll be in pain,” said the 42-year-old Town of Binghamton resident. “Sometimes it would go away for a few days, and I would be amazed. Not really feeling good becomes the status quo.”
Boller has Irritable Bowel Syndrome. And she is far from alone. As many as 15 million people suffer from IBS, the vast majority of them women. Some suffer in silence, too embarrassed to talk about it. Others go from doctor to doctor seeking a cause and relief, but to no avail.
IBS is a widely misunderstood disease and physicians are the first to admit it. In fact, according to Dr. Marcelo Barreiro, a gastroenterologist at Valley Healthcare in Vestal, New York, that’s why IBS is classified as a functional disorder. Functional disorders are diseases that usually cannot be detected through traditional means, such as a blood test, X-ray or MRI. “IBS is a group of symptoms that have no chemical or physical evidence,” he said.
So what is IBS? It is characterized by symptoms. The IBS Self Help Group www.ibsgroup.org, defines the condition as “abnormal bowel function that results in abdominal pain, cramps, bloating, constipation and/or diarrhea.” According to the International Foundation for Functional Gastrointestinal Disorders, the abdominal pain is accompanied by at least two out of these three symptoms: Pain that is relieved with defecation, a change in frequency of stool, or a change in the appearance of a bowel movement. Symptoms are present for at least 12 weeks (not necessarily consecutive) over a 12-month period.
IBS is diagnosed through a colonoscopy in order to rule out other gastrointestinal diseases. In IBS patients, the test results come back normal. Unlike intestinal diseases such as ulcerative colitis and Crohn’s disease, IBS does not increase your risk of colorectal cancer. But that doesn’t take away the debilitating symptoms. In addition, the private nature of the condition makes many people reluctant to talk about it and reach out for support.
“I feel like there’s this gas-producing machine inside me. I wish it would leave,” Boller said. “The bloating is very noticeable. I tend to wear a lot of sweat pants.”
Treatment, but no cure
There is currently no cure for IBS, and the disorder and treatment is, in large part, trial and error, a combination that leaves many physically and emotionally distraught.
“In 40 percent of these patients, IBS actually overcomes a patient’s life and has a terrible impact on their work and social life,” said Dr. Alan Lerman, of Broome Gastroenterology Associates in Johnson City. “They become prisoners in their own home and are afraid to venture out.”
Anxiety and depression are common among IBS patients, particularly those who are prone to diarrhea. Some live in a hyper-vigilant state of anticipating when their symptoms will strike next; many live in constant fear of having to run to the bathroom during an inopportune moment, or even worse, not making it on time. “They’ll know every bathroom along the highway on the way to a restaurant,” Lerman said.
While anxiety and stress are not at the root of IBS, they are known to aggravate symptoms. Those symptoms of pain and urgency then make patients more anxious and stressed, causing a vicious cycle.
“Reducing my stress levels help,” Boller said. “I have had bouts with diarrhea when I go through extreme stress.”
Treatment options vary widely, depending on the severity of the patient’s IBS. Mild forms of the syndrome can often be improved with dietary and lifestyle changes. A diet rich in fiber is helpful for both diarrhea and constipation. According to Lerman, dairy products, greasy foods or foods high in fat are common trigger foods for IBS patients with diarrhea. People with IBS who are prone to constipation should avoid foods such as cabbage or gas-producing vegetables that can cause bloating.
Over-the-counter anti-diarrheal medicines such as Immodium may be helpful for some. Others turn to prescription drugs, such as anti-spasmodics, to ease abdominal pain. One popular but controversial drug is alosetron, known by the brand name Lotronex. It was pulled from the market in February 2000 after serious complications, even deaths, were attributed to its use. After public demand, it was allowed back on the market, but under strict guidelines for its use.
In your head or your tummy?
In the past, many patients were told IBS was “all in their heads.” While symptoms are very real, there is a psychological component that cannot be dismissed. The IBS Self Help Group reported that studies document improvement in IBS symptoms in patients treated by therapists who are well-informed about IBS.
Barreiro agreed. Through a joint venture with Binghamton University’s Institute for Primary and Preventive Healthcare, he founded the Disorders of Function Clinic to focus on IBS and other functional disorders. Through his research, Barreiro has created a profile of patients who suffer from functional disorders, (ailments that do not appear to have an organic cause), which include IBS, chronic fatigue syndrome, migraines and fibromyalgia: Patients are mostly females, have psychiatric symptoms such as depression, and are affected with three or more of these conditions.
“Eighty-seven percent of patients have three to nine functional disorders. That far exceeds what would occur by chance,” he said. Barreiro’s research has led to evidence of other commonalities among these patients. “Many of them have had peri-natal stress … that is, the mother was stressed while she was pregnant, or the child was stressed. And those people are less able to cope with stress as adults.”
Sensitivity is an issue
Barreiro subscribes to the hypothesis that people with functional disorders are “extra-sensitive.” “Depending on the syndrome the sensitivity can be in your bladder or in your colon or in the muscles,” he said. In IBS, that means the neurons in the gut that communicate with the brain are unusually sensitive. In IBS patients, the brain has problems processing the information the bowel is sending it.
Barreiro has had success treating patients with antidepressants in the selective serotonin reuptake inhibitor category. (Prozac and Paxil are examples of SSRIs). He believes SSRIs modify the communication between the brain and the gut. The drug Effexor, in particular, has had great results for IBS patients. “Patients can continue taking their regular medication while on the SSRI,” Barreiro said, “but many patients find they are able to stop all their other meds.”
Lerman has used other types of antidepressants to alleviate abdominal pain. “We’re not saying your pain is imagined,” he said. “We’re using them as pain relievers. They’re powerful pain relievers and muscle relaxers within the intestinal tract.”
They’re not a perfect answer, he cautioned, because although they relieve pain, some may cause constipation or bloating. Lerman said he urges his patients not to get frustrated because getting IBS symptoms under control can take some time. He said some of his patients have found relief through alternative treatments such as acupuncture and biofeedback.
Society suffers, too
IBS has a profound impact not just on sufferers, but on society. For instance, caring for IBS sufferers costs more than $21.5 billion each year in the United States alone, according to the International Foundation for Functional Gastrointestinal Disorders. Other surveys show that compared with average workers, people with IBS use three times more sick days. There is more absenteeism attributed to IBS than for any other medical problem except the common cold.
Although a cause remains elusive, Barreiro maintains the key to successfully treating IBS is through a comprehensive treatment plan with health-care professionals who have “a solid foundation of psychiatry, solid knowledge of all the anti-depressant drugs, and physicians who can really manage patients as a whole. Otherwise patients see specialists who focus on just one or two sets of symptoms.”
Lerman agreed that the mind-body connection is a complicated concept that warrants further study, and one that doctors will need to continue to address.
Boller simply takes each day in stride. “I believe that each person’s body has a weak point. Some people have headaches. I have IBS.”
Source: © 2005 Binghamton Press & Sun-Bulletin (online at http://www.pressconnects.com/thursday/lifestyle/stories/li050505s164519.shtml)