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Stress and Irritable Bowel Syndrome in the Real World
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Stress and Irritable Bowel Syndrome in the Real World By: Rakesh Gupta, M.D. IRRITABLE BOWEL SYNDROME: I see a lot of patients with this condition. The commonest problem I have seen is that these patients have not been explained what IBS is. Most of them have symptoms for many years, have seen many physicians and even gastroenterologists, but have had no satisfying explanation for their symptoms. No one takes the time to sit down and explain these things. It is too time consuming and often futile as most patients are looking for a quick fix or that magic pill which does not exist. In these Google days, one can type just a few symptoms and come up with a diagnoses which can be soothing or absolutely jarring to your nerves with all the missed diagnosis, wrong diagnosis sites. So before you know, you are thinking that a strange and fatal disease has struck you and the end is near!!! It is for this reason that I am writing about IBS. So here goes...... When you eat food and drink water, the chewed material travels down your throat, food pipe and stomach where it mixes with the acid and churned into gruel like substance. It then passes thru 25 ft of small intestine where all the important nutrients are absorbed and this mixture of gruel, acid and now gas formed by the bacteria breaking down the undigested food; has to move thru this narrow collapsed plumbing inside your body. Imagine your food going through one of those long clown balloons before it is inflated. It moves by peristalsis, that is smooth rhythmic contractions which propel this mixture of food air and water, forward. This happens under stress free situations as if you lived in Utopia! I don't know a single human being living there. We live here in New York or the likes of large and small towns and cities with stresses of daily life. People tell me all the time that they are happy and have no stresses! Do you believe that?! I have yet to meet a person who does not have stresses in life. For a family man stress could be that you have lost your job and have no money for bills to pay or for a teenager to have a pimple on their face on prom nite, stress is same though we just cannot equate these conditions to be equal. We always have 'stress du-jour' and all of them take priority one at a time. It could be just the act of getting up in the morning to get ready for work, school or run your house hold. Catching a bus or train, driving on these highways, getting late for work, meeting deadlines, now throw in some exams for students, shouting of your bosses, friction with your co-workers, girl friends, boy friends, husbands, wives, finances, insecurities of job, bills etc etc. I think you get the point, life is stress. So, under such situations the brain secretes certain hormones, chemicals and neurotransmitters which act on the gut causing it to go into spasms. The intestines are like a long link of sausages or small pouches or sacs. With spasms these sausages or sacs get distended with trapped air and thus the bloated feeling. Water gets absorbed and stool becomes hard and also trapped in these sacs and is unable to move forward. You feel uncomfortable, with belching, burping, feeling full, unable to move your bowels. Eventually the spasm relaxes erratically, some segments become hyperactive and/or some stay contracted. When there is a bowel movement, it is small hard pebble like stool, soft mushy stool or diarrhea, or a combination of all during the same bowel movement, sometimes associated with mucous. There is a sense of incomplete evacuation and you keep running to the bathroom again and again as you need to feel better so that you can get out of the house and go about your day. For people who get diarrhea frequently, the major effect of the brain is to cause hyperactive small contractions which make the bowels run and one has frequent soft or watery bowel movements. Some people experience rectal pain and discomfort because of pressure in the pelvis area with distended intestine and rectum. Another important fact is that people with IBS are hypersensitive to the amount of air in their intestine. It is called visceral hyper-sensitivity. For example if we insuffulate 100 cc of air in normal colon, there is no pain or discomfort, but the same amount of air with the same amount of distension in IBS patient will cause pain and discomfort. The neurons are as if inflamed and raw in these cases and bacteria have been blamed for it and thus the role of probiotics to change the intestinal flora with better bacteria. Of the billions of bacteria in the intestine, majority do not seem to have any role, a small amount of them are beneficial, a vast number of them are a nuisance and only a very minute amount are harmful. The purpose of probiotics is to instill good bacteria which can then multiply and get rid of the nuisance ones. Getting the right type and amount of bacteria is the trick and we are just learning about them. These billions of bacteria have a complex role to play as they live inside us and interact with all our cellular and biological functions. Over the next many years as we put together the DNA structure of this microbiome, we will be able to understand IBS, diabetes, obesity and I believe even heart attacks and cancer, better. Some people will have classic text book symptoms of IBS and some will have only a few of these symptoms. The Rome III criterion of IBS is: Symptoms of recurrent abdominal pain or discomfort and a marked change in bowel habit for at least six months, with symptoms experienced on at least three days of at least three months. Two or more of the following must apply: Pain is relieved by a bowel movement Onset of pain is related to a change in frequency of stool Onset of pain is related to a change in the appearance of stool. Management of IBS: Remember that IBS is a long term condition that can flare up again and again and change over time. It does not shorten your life span or predispose you to cancer or other illnesses. Certain foods can trigger, so keeping a diary or a track of what foods trigger some of these symptoms may be worthwhile Life style habits do not cause IBS, but minimizing excesses and stress, sleeping well, exercising regularly and healthy eating will help. Eat more frequent 5-6 small meals throughout the day, instead of the regular 3 meals. Do not eat on the run and avoid fatty, large meals. Avoid offending foods for about 3 months, cut down on coffee, nuts, chocolate, insoluble fiber like cereal fiber, alcohol, sorbitol containing candies and gum, beans, bagels, raisins, onions, lentils, broccoli, cauliflower, cabbage, brussels sprouts, peas, soybeans etc. The list is long and you cannot avoid all the foods, so you have to be your own detective. Food allergy blood tests are not very helpful as you are not allergic to the foods, just intolerant or sensitive to them. Soluble fiber is better than insoluble as less is available to the bacteria to act on them and thus cause less gas. Soluble fiber is in fuits and vegetables and insoluble fiber is found in whole grains and cereals. SEEK HELP FROM a knowledgeable physician so that appropriate tests and work up can be done to exclude any medical conditions. Rakesh Gupta, M.D. Board Certified Gastroenterology http://www.guptagastro.com
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