Have you sat in the bathroom countless times wondering, "Why me?"
Know that there are 58 million Americans who feel the same way.
Irritable bowel syndrome isn't a simple illness because everyone's IBS is different.
Also, some people might have IBS without even realize what they are going through is more than just a pain in the butt.
Dr. Christina Pieper-Bigelow will help us get to the bottom of it.
Selected Podcast
The Ins-and-Outs of IBS
Featured Speaker:
Christina Pieper-Bigelow, MD – Gastroenterology and - Internal Medicine
Dr. Pieper-Bigelow loves working on cars, riding horses, spending time outdoors and travelling in her spare time. Her favorite 'gut healthy' tip is to eat a high fiber, low fat diet. She sees patients at the Allina Health Hastings First Street Clinic. Transcription:
The Ins-and-Outs of IBS
Melanie Cole (Host): Have you sat in the bathroom countless times wondering why me? Well, know that there are 58 million Americans who feel the same way. Irritable bowel syndrome isn’t a simple illness because everybody’s IBS is just a little bit different. My guest today is Dr. Christina Pieper-Bigelow. She’s a gastroenterologist and she sees patients at the Allina Health Hastings 1st Street Clinic. Welcome to the show, Dr. Pieper-Bigelow. Tell me a little bit about IBS. What is it and what are the risk factors for it?
Dr. Christina Pieper-Bigelow (Guest): IBS is irritable bowel syndrome. What I think it is to be known right away is that it’s not a disease. It’s a constellation of symptoms and I often say it’s like a diagnosis of exclusion. In other words, we make sure there is nothing organically wrong with the colon. IBS is a constellation of symptoms like diarrhea, constipation (sometimes alternating between the two), abdominal bloating, gas, mucus in the stool, and intestinal cramping. The risk factors we know that it tends to be more common in women more than men. It tends to be a disorder of young people. Typically, before the age of 45, a person will start to have symptoms of IBS. There are also some risk factors associated with psychological issues. People who tend to have more anxiety, depression, and this surprises a lot of patients that I see, but people that have had some type of abuse in their past. They’ve been sexually abused or perhaps they’re in a situation of domestic abuse. Sometimes when I ask really personal questions like that, a person will look at me like, “Why are you asking me that when I’m here because of my diarrhea.” The fact is it is a risk factor.
Melanie: People who have bloating, women especially, we get upset stomachs. Whether it’s from stress or just that time of the month, so how do you know the difference? What would be some red flags that would send you to the doctor to get this checked out?
Dr. Pieper-Bigelow: That’s what’s really difficult. I know that. Because we do have bloating around the menses and sometimes even normally the bowels may change around menses. Women are forever going, “What do I do? Do I even talk to anybody about this?” There are red flags. The red flags would be bleeding. If one has seen blood in the stool, black tarry stools, blood mixed into the stools, unexplained weight loss or trouble with your appetite and then some other things like fatigue, just unexplained fatigue, if the doctor says, “Gee, you’re a little anemic,” or you go to donate blood and they say, “We can’t take blood. You’re anemic. You seem to be low on iron.” Those are the things that you would say, “Gee, I better go in and just get this checked out.”
Melanie: How do you diagnose it, Dr. Pieper-Bigelow? As someone who had it when I was in my 20s and now don’t have it anymore, they did a colonoscopy on me at the time, just to check because Crohn’s runs in my family. How would you normally diagnose somebody? Do you always do a colonoscopy to check and make sure it’s not something else or are there just history and things you can do?
Dr. Pieper-Bigelow: Yeah. There are certain criteria. There’s one called the Rome, R-O-M-E, Rome criteria that people can satisfy. Just with those criteria, if they meet that and the symptoms are very compatible with IBS, we can sort of put it to rest because there aren’t alarm symptoms, the ones that I told you about that were the red flags. Not everybody gets a colonoscopy. That would be an overuse of healthcare dollars, quite honestly, because there are millions and millions of people with IBS that do not have to go through colonoscopy. Now, if somebody comes in with just daytime symptoms, they know, “Gee, if I eat, I get all this bloating, I might have some diarrhea. Now I’m better.” They can sleep through the night. They’re not having weight loss. It’s a pretty typical symptom complex and it’s fairly safe to just try some lifestyle changes first. But clearly if there is some family history like you described, or perhaps a really strong family history of colon cancer, stomach cancer, then someone may be put through the ringer a little bit more as we say. Oftentimes, just some very simple blood tests can be done. We look for anemia. We look for signs of inflammation. If the symptoms are stable and not progressive, not associated with the Lime symptoms, we often just treat it with lifestyle changes. Clearly, if things change or those other things start to crop up, or if someone’s older, if someone’s over 45 and starts having these symptoms out of the blue, those people typically go through the whole workup. They have perhaps a colonoscopy, an upper endoscopy. We look for everything that could cause it. When it’s all negative, then we say, “Okay, this is IBS.” I think the other thing that I would be remiss if I didn’t mention, a lot of times I will order a pelvic ultrasound in a woman with kind of a lower abdominal pain and bloating to make sure there’s nothing going on with the ovaries because that can kind of overlap. It can be really tough to tell them apart.
Melanie: Now, tell us about some of those things we can do to manage those symptoms. It can be very uncomfortable. What things can we do in our diet? Also, speak about some of the alternative things like probiotics that are cropping up all over the media.
Dr. Pieper-Bigelow: Sure. Some people respond to some probiotics. I’m not pushing any particular brand, but the one called Culturelle has the probiotic that actually has gone through some testing to show that in some people, it is beneficial. The thing is, it’s not everybody. There is not a dietary prescription that you can receive from the doctor and that’s going to take care of all of your symptoms because everybody is so different. I would say one of the most common food intolerance is actually milk, or lactose intolerance. Quite honestly, once you’re over the age of two or three, the enzyme which digests milk, that level starts decreasing in our intestines over time. As we get older, we actually have less and less of that enzyme available. Undigested milk or partially digested milk causes more bloating and can cause diarrhea and gas. Other things, high gas foods, so carbonated beverages like pop, things like cabbage or broccoli, cauliflower, raw fruits. A lot of these are really good for you, maybe not the pop, okay? The other things are really good for you so I don’t think you should just like eliminate everything at once. Now, there is this big fad on the Internet right now where everybody is getting rid of gluten and studies are showing that it actually is not getting rid of gluten that’s making them feel better, but in fact, something called FODMAP and that’s an acronym and I’m not going to list it out, it’s a big long name. Anyway, it includes things like high fructose corn syrup, wheat, onions, garlic, lactose, mannitol, sorbitol, like all those artificial sweeteners that people have in their chewing gum and their soda pops and things like that. Those are things that one can kind of work at eliminating. Not from a dietary standpoint but from just an overall health standpoint is just relaxation, dealing with stress, and if there are some underlying psychological issues, dealing with that with perhaps some counseling.
Melanie: Now, what about things that they might try that are over-the-counter? If they’ve got diarrhea from this, trying some of those antidiarrheal medications or fiber supplements. You see Metamucil and all these things on the market. Do we try any of those to regulate your bowels?
Dr. Pieper-Bigelow: Yeah, I think that a lot of people who tend to have more of a constipation-predominant irritable bowel syndrome do better when they take like psyllium husk, which has been –yes, the name brand is Metamucil, but there are lots of generics out there. There’s also something called methyl cellulose, which is Citrucel, and then of course, there is Benefibre. There are a lot of fiber supplements. I usually tell people, “Get the generic, it’s cheaper. Just see if it even works for you.” Sometimes people complain that it makes them gassier, but honestly those fiber supplements tend to be less gassy and bloaty than the food that have more fibers such as beans and things. The antidiarrheal medications—that’s like Imodium or loperamide is the generic for that—that can be really helpful and it’s not unsafe to use it. You don’t want to use more than six to eight tablets a day, but it’s not unsafe if a person has a lot of diarrhea. Then, there are of course prescribed medications, but that’s not exactly what you asked me.
Melanie: That’s okay. In just the last couple of minutes, Dr. Pieper-Bigelow, please give us your best advice about IBS and what to do really to keep those symptoms at bay and still be able to eat healthy and get the best quality of life.
Dr. Pieper-Bigelow: I think it really is important to eat regular meals, smaller meals, low fat, high fiber, and just learn to look at it and go, “Okay, this is my idea. This isn’t terrible. I can deal with this and relax through it.” I see people who just get incapacitated because they’re so afraid of the symptoms because they’re worrying that it’s something more than it is. This is very important to eat a healthy diet and avoid the junk food, the fatty foods, going through fast food, drinking pop and things like that. It’s important to avoid some of these alternative things that are out there. There are people recommending cleanses and herbal teas and colonic enemas. A lot of the products that are sold from alternative practitioners have laxatives in them that can be detrimental. I think a lot of patients don’t even realize that.
Melanie: Thank you for such great information. It’s very important information. You are listening to the WELLcast with Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks for listening.
The Ins-and-Outs of IBS
Melanie Cole (Host): Have you sat in the bathroom countless times wondering why me? Well, know that there are 58 million Americans who feel the same way. Irritable bowel syndrome isn’t a simple illness because everybody’s IBS is just a little bit different. My guest today is Dr. Christina Pieper-Bigelow. She’s a gastroenterologist and she sees patients at the Allina Health Hastings 1st Street Clinic. Welcome to the show, Dr. Pieper-Bigelow. Tell me a little bit about IBS. What is it and what are the risk factors for it?
Dr. Christina Pieper-Bigelow (Guest): IBS is irritable bowel syndrome. What I think it is to be known right away is that it’s not a disease. It’s a constellation of symptoms and I often say it’s like a diagnosis of exclusion. In other words, we make sure there is nothing organically wrong with the colon. IBS is a constellation of symptoms like diarrhea, constipation (sometimes alternating between the two), abdominal bloating, gas, mucus in the stool, and intestinal cramping. The risk factors we know that it tends to be more common in women more than men. It tends to be a disorder of young people. Typically, before the age of 45, a person will start to have symptoms of IBS. There are also some risk factors associated with psychological issues. People who tend to have more anxiety, depression, and this surprises a lot of patients that I see, but people that have had some type of abuse in their past. They’ve been sexually abused or perhaps they’re in a situation of domestic abuse. Sometimes when I ask really personal questions like that, a person will look at me like, “Why are you asking me that when I’m here because of my diarrhea.” The fact is it is a risk factor.
Melanie: People who have bloating, women especially, we get upset stomachs. Whether it’s from stress or just that time of the month, so how do you know the difference? What would be some red flags that would send you to the doctor to get this checked out?
Dr. Pieper-Bigelow: That’s what’s really difficult. I know that. Because we do have bloating around the menses and sometimes even normally the bowels may change around menses. Women are forever going, “What do I do? Do I even talk to anybody about this?” There are red flags. The red flags would be bleeding. If one has seen blood in the stool, black tarry stools, blood mixed into the stools, unexplained weight loss or trouble with your appetite and then some other things like fatigue, just unexplained fatigue, if the doctor says, “Gee, you’re a little anemic,” or you go to donate blood and they say, “We can’t take blood. You’re anemic. You seem to be low on iron.” Those are the things that you would say, “Gee, I better go in and just get this checked out.”
Melanie: How do you diagnose it, Dr. Pieper-Bigelow? As someone who had it when I was in my 20s and now don’t have it anymore, they did a colonoscopy on me at the time, just to check because Crohn’s runs in my family. How would you normally diagnose somebody? Do you always do a colonoscopy to check and make sure it’s not something else or are there just history and things you can do?
Dr. Pieper-Bigelow: Yeah. There are certain criteria. There’s one called the Rome, R-O-M-E, Rome criteria that people can satisfy. Just with those criteria, if they meet that and the symptoms are very compatible with IBS, we can sort of put it to rest because there aren’t alarm symptoms, the ones that I told you about that were the red flags. Not everybody gets a colonoscopy. That would be an overuse of healthcare dollars, quite honestly, because there are millions and millions of people with IBS that do not have to go through colonoscopy. Now, if somebody comes in with just daytime symptoms, they know, “Gee, if I eat, I get all this bloating, I might have some diarrhea. Now I’m better.” They can sleep through the night. They’re not having weight loss. It’s a pretty typical symptom complex and it’s fairly safe to just try some lifestyle changes first. But clearly if there is some family history like you described, or perhaps a really strong family history of colon cancer, stomach cancer, then someone may be put through the ringer a little bit more as we say. Oftentimes, just some very simple blood tests can be done. We look for anemia. We look for signs of inflammation. If the symptoms are stable and not progressive, not associated with the Lime symptoms, we often just treat it with lifestyle changes. Clearly, if things change or those other things start to crop up, or if someone’s older, if someone’s over 45 and starts having these symptoms out of the blue, those people typically go through the whole workup. They have perhaps a colonoscopy, an upper endoscopy. We look for everything that could cause it. When it’s all negative, then we say, “Okay, this is IBS.” I think the other thing that I would be remiss if I didn’t mention, a lot of times I will order a pelvic ultrasound in a woman with kind of a lower abdominal pain and bloating to make sure there’s nothing going on with the ovaries because that can kind of overlap. It can be really tough to tell them apart.
Melanie: Now, tell us about some of those things we can do to manage those symptoms. It can be very uncomfortable. What things can we do in our diet? Also, speak about some of the alternative things like probiotics that are cropping up all over the media.
Dr. Pieper-Bigelow: Sure. Some people respond to some probiotics. I’m not pushing any particular brand, but the one called Culturelle has the probiotic that actually has gone through some testing to show that in some people, it is beneficial. The thing is, it’s not everybody. There is not a dietary prescription that you can receive from the doctor and that’s going to take care of all of your symptoms because everybody is so different. I would say one of the most common food intolerance is actually milk, or lactose intolerance. Quite honestly, once you’re over the age of two or three, the enzyme which digests milk, that level starts decreasing in our intestines over time. As we get older, we actually have less and less of that enzyme available. Undigested milk or partially digested milk causes more bloating and can cause diarrhea and gas. Other things, high gas foods, so carbonated beverages like pop, things like cabbage or broccoli, cauliflower, raw fruits. A lot of these are really good for you, maybe not the pop, okay? The other things are really good for you so I don’t think you should just like eliminate everything at once. Now, there is this big fad on the Internet right now where everybody is getting rid of gluten and studies are showing that it actually is not getting rid of gluten that’s making them feel better, but in fact, something called FODMAP and that’s an acronym and I’m not going to list it out, it’s a big long name. Anyway, it includes things like high fructose corn syrup, wheat, onions, garlic, lactose, mannitol, sorbitol, like all those artificial sweeteners that people have in their chewing gum and their soda pops and things like that. Those are things that one can kind of work at eliminating. Not from a dietary standpoint but from just an overall health standpoint is just relaxation, dealing with stress, and if there are some underlying psychological issues, dealing with that with perhaps some counseling.
Melanie: Now, what about things that they might try that are over-the-counter? If they’ve got diarrhea from this, trying some of those antidiarrheal medications or fiber supplements. You see Metamucil and all these things on the market. Do we try any of those to regulate your bowels?
Dr. Pieper-Bigelow: Yeah, I think that a lot of people who tend to have more of a constipation-predominant irritable bowel syndrome do better when they take like psyllium husk, which has been –yes, the name brand is Metamucil, but there are lots of generics out there. There’s also something called methyl cellulose, which is Citrucel, and then of course, there is Benefibre. There are a lot of fiber supplements. I usually tell people, “Get the generic, it’s cheaper. Just see if it even works for you.” Sometimes people complain that it makes them gassier, but honestly those fiber supplements tend to be less gassy and bloaty than the food that have more fibers such as beans and things. The antidiarrheal medications—that’s like Imodium or loperamide is the generic for that—that can be really helpful and it’s not unsafe to use it. You don’t want to use more than six to eight tablets a day, but it’s not unsafe if a person has a lot of diarrhea. Then, there are of course prescribed medications, but that’s not exactly what you asked me.
Melanie: That’s okay. In just the last couple of minutes, Dr. Pieper-Bigelow, please give us your best advice about IBS and what to do really to keep those symptoms at bay and still be able to eat healthy and get the best quality of life.
Dr. Pieper-Bigelow: I think it really is important to eat regular meals, smaller meals, low fat, high fiber, and just learn to look at it and go, “Okay, this is my idea. This isn’t terrible. I can deal with this and relax through it.” I see people who just get incapacitated because they’re so afraid of the symptoms because they’re worrying that it’s something more than it is. This is very important to eat a healthy diet and avoid the junk food, the fatty foods, going through fast food, drinking pop and things like that. It’s important to avoid some of these alternative things that are out there. There are people recommending cleanses and herbal teas and colonic enemas. A lot of the products that are sold from alternative practitioners have laxatives in them that can be detrimental. I think a lot of patients don’t even realize that.
Melanie: Thank you for such great information. It’s very important information. You are listening to the WELLcast with Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks for listening.