Transcription:
Irritable Bowel Syndrome: Symptoms, Triggers and Treatment

Melanie Cole (Host): IBS can be a challenging disorder to treat because symptoms can vary by patient and can change over time. My guest today is Dr. Reggie Thomas. He’s a gastroenterologist at Gastroenterology Specialties. Welcome to the show, Dr. Thomas. What is Irritable Bowel Syndrome, IBS?

Dr. Reggie Thomas (Guest): Hi, there. Thanks for having me. Yes, irritable bowel syndrome is a condition that is a chronic functional disorder of the gastrointestinal tract. Generally it’s characterized by some component of chronic abdominal pain and alterations of bowel habits. So, symptoms really vary between individuals but it’s considered a chronic functional disorder where there’s no anatomic abnormality or structural disease to the lining of the GI tract. It’s just that the gastrointestinal tract isn’t functioning as it should.

Melanie: Who’s typically at risk? Who are you seeing that comes down with IBS?

Dr. Thomas: Irritable bowel syndrome can be seen in anybody, really. It is a condition where men, women, all ethnicities, all ages can be affected but, typically, it is seen more so in younger females. In North America, about ten to fifteen percent of the population has irritable bowel syndrome and we see probably a two to one female predominance. So, generally, our typical patient is a younger female; however, it can be found at any age.

Melanie: Do you have a theory on why that is?

Dr. Thomas: You know, we don’t. It’s a tough condition to diagnose because it’s very multi-factorial and a lot is not known about the condition in terms of why people get it and the factors that make it worse and so, really, we’re not sure why.

Melanie: So, things that might signal it – and you said it’s a little bit difficult to diagnose - what would somebody feel? What are some symptoms that would send them to see a GI specialist in the first place?

Dr. Thomas: Usually, patients come to us with a component of abdominal pain and so they will have some type of cramping sensation in the abdomen. The intensity and severity can vary but this has been associated with a change in bowel habits, whether that is diarrhea, constipation or both. So, some patients might have abdominal pain and diarrhea every day; some people might have some abdominal discomfort and constipation everyday but a large majority of the patients have the alternating mixed type of irritable bowel syndrome where you will have constipation for a few days and then diarrhea for a few days but, generally, to clue us in on the condition, we’re kind of looking for that combination of abdominal pain symptoms combined with an altered bowel habit regimen.

Melanie: So, Dr. Thomas, let’s speak about triggers. Is it stress related? Is there a stress component to it? Is it dietary related? What sort of triggers that bloating or diarrhea or constipation that you’re discussing?

Dr. Thomas: There’s a lot of research going on in this area because we don’t know exactly why people get irritable bowel syndrome. There is a thought that there could be a genetic predominance or genetic factor as well but triggers vary from person to person. What we’re finding is that a lot of people who have irritable bowel syndrome fit into one of three categories. There’s a large category where we don’t know why you have it but the categories where we do know something about is generally related to underlying stress or anxiety and in these situations you really need to address that component for the symptoms to get better. And, the last category is where it could be post-infectious. It’s thought that about thirty percent of patients who have irritable bowel syndrome maybe had an infection at some point in the last few months preceding the symptoms and this has changed the function of their GI tract. We don’t necessarily know why but it can be seen with bacterial infections, parasites and even viral infections. And so, really there are a lot of causes and we tend to hone in on those areas first to try to find a trigger or a cause for the condition.

Melanie: Do you have to use colonoscopy to diagnose it?

Dr. Thomas: No, we don’t, actually, and that is something where a lot of patients think that they immediately need a colonoscopy but a lot of times we can take a good history and do an exam and diagnose the condition without a colonoscopy. Again, it’s a condition where it’s more of a functional change, so a colonoscopy would generally be completely normal in an individual with irritable bowel syndrome. Now with that being said, if somebody were to come into my clinic and tell me that they had certain alarm symptoms, certain things that alarm me in the history such as blood in the stools, nighttime pain, nighttime diarrhea and a variety of other things, then I would often suggest a colonoscopy but I think that’s where it’s important for everyone to talk to their physician and see if that’s something that would be necessary.

Melanie: If you’ve determined that someone does have irritable bowel syndrome, what treatments do you recommended: dietary changes, exercise, lifestyle modifications?

Dr. Thomas: There are a variety of treatments out there for irritable bowel syndrome and because of the multi-factorial nature of the condition, we really have to tailor that to the individual patient. So, it’s not something where we can say, “Oh, you have irritable bowel syndrome. Take this pill and you’ll be just fine.” We have to really get an understanding of when the patients are getting their symptoms and what type of symptoms they have. But, with that being said, there are medications approved for both irritable bowel syndrome that’s diarrhea predominant and irritable bowel syndrome that’s constipation predominant and so sometimes we will recommend a prescription medication to go along with general diet and dietary advice. And, again, there’s not one specific diet that we put people on but, a lot of times, depending on what we find after talking to patients, we might have them avoid certain foods and eat other foods.

Melanie: So, would a high-fiber diet be something that helps or hurts and what do you think about probiotics?

Dr. Thomas: Probiotics are a real hot issue right now. There’s a lot of research going into that. I’ll address your fiber question first. I think that fiber can be really tricky. With some people, they don’t tolerate it very well. It causes a lot of gas and bloating. So, the way you introduce fiber into the diet has to be very gradual and you have to be very cautious with it. We often will provide patients with lists of foods that can be slowly introduced. Sometimes, I’ll even have patients just start a fiber supplement in their diet. With that being said, it’s not a cure for IBS but it does help some of the patients mainly with constipation but we will use it in a variety of situations. Probiotics are really being researched right now in terms of, does the bacterial flora of the gastrointestinal tract predispose an individual to getting irritable bowel syndrome? With irritable bowel syndrome essentially you have a visceral hypersensitivity or your GI tract is just hypersensitive to distention that an individual without IBS would not be sensitive to. So, we haven’t quite figured that out yet, how bacteria play a role in this. A lot of patients will try probiotics and are coming to us and a lot of physicians will recommend probiotics. They tend to take that on an individual basis. I’ve found in my practice, it helps more so with diarrhea predominant irritable bowel syndrome, so I might use it in that situation. But, a lot of patients do tend to feel a little better and we’re slowly understanding why that is in terms of just bacteria playing a role in the condition.

Melanie: What about managing stress? Do you think that that’s helpful in managing IBS triggers?

Dr. Thomas: Absolutely. The psycho-social component and the link to anxiety, depression and stress is very clear in irritable bowel syndrome. It tends to work such that if we have an individual that has uncontrolled anxiety, stress, depression, we’re not going to get their abdominal pain and their GI tract functioning as it should. So, that is something that we tend to address almost immediately in our visits when irritable bowel syndrome comes up. We discuss the use of medications for that, lifestyle modifications, sometimes visits with a psychologist or psychiatrist as well.

Melanie: Dr. Thomas, are there certain foods that can contribute to IBS symptoms, some gassy foods that you want people to know about and maybe stay away from?

Dr. Thomas: Yes, a lot of patients do have a component of gas and bloating when it comes to irritable bowel syndrome. Some people will have gas and bloating without having irritable bowel syndrome. And, again, this is an area that’s kind of difficult to treat. We don’t have great medications that can take this away. Almost always it is related to dietary intake, so we’ll often provide you with a list of foods to try to avoid initially when it comes to increased gas and bloating. With specifics regarding irritable bowel syndrome, I’ve found that dietary therapy is actually very beneficial. I’ve had some patients resolve all of their symptoms just by changing what they’re eating. The diets do get kind of detailed and specific. One in particular that I like to use is a low FODMAP diet, stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides Polyols. You don’t have to remember those details but you can ask your physician about it and, hopefully, they can refer you to someone who knows a little more about that diet because it does tend to help patients with irritable bowel syndrome.

Melanie: So, in just the last few minutes, give your best advice for people who suffer from irritable bowel syndrome, what you tell them every day about managing this.

Dr. Thomas: I think my best advice would be for them to make sure they talk to their physician about this condition. A lot of patients with irritable bowel syndrome tend to feel that it’s not something that they should talk about, in terms of their bowels, diarrhea and constipation are not topics that most people are willing to talk about every day. So, make sure you address it because there are some good treatments available and suggestions we can make to regular lifestyle modifications in terms of your diet that will often help people get through their symptoms to a point where they don’t even realize that they really have irritable bowel syndrome. Some people might have a milder form and they have these bowel habit changes and they’re able to get along just fine throughout their day but for others, it’s quite disabling. They can have quite a bit of abdominal pain, maybe they’re going to the bathroom every couple of hours and it can really start to affect their lifestyle and, therefore, worsen any underlying anxiety and depression. So, it is something that’s very treatable and manageable. It’s not something that has a one-stop cure but it is something that’s worth talking about to get you feeling better.

Melanie: Thank you so much, Dr. Thomas, for being with us today. If you have any IBS symptoms, talk to your doctor or if you want to learn more about common GI conditions, you can go to BryanHealth.org. That’s BryanHealth.org. You’re listening to Bryan Health Podcasts. This is Melanie Cole. Thanks so much for listening.