Helen Dandurand (Host): Welcome back to the Well Within Reach podcast. I'm your host, Helen Dandrand, and today I'm going to be joined by Miranda Cervinskis, nurse practitioner at Riverside Medical Group's Internal Medicine Bourbonnet Office, to discuss all that you need to know about a very fun topic, IBS. Health care can be confusing, but thanks to your My Riverside MyChart, you can easily manage not only your care, but your family's as well. With a single click, your My Riverside MyChart lets you stay well connected to the same information your provider sees. You can view your health history, get test results, request prescription refills, pay your bill, or make an appointment. Manage your care from anywhere, your laptop, phone, or tablet. Learn more and enroll today at riversidemychart.org.

 And we're back. Thank you so much for joining me today. You're welcome. We're glad to have you. let's get started. You've never been on the podcast before. Could you just tell us a little bit about yourself and your background?

Miranda Sirvinskas, FNP-C: Of course. so I've been in healthcare for about 9 years now. I started at Christ Hospital in Oakland as a med surg nurse.

I was doing that for 3 years and then I was an ICU nurse for 4 years. I worked in urgent care as a nurse practitioner for 1 year before starting at Riverside with internal medicine in January.

Helen Dandurand (Host): Awesome. Awesome. So we're going to jump right into the topic. can you provide like a quick overview of what IBS is or irritable bowel syndrome?

Miranda Sirvinskas, FNP-C: So IBS is a functional disorder of the gastrointestinal tract that is characterized by pain and altered bowel habits such as diarrhea, alternating diarrhea and constipation or normal bowel habits alternating with either diarrhea and or constipation.

Helen Dandurand (Host): Okay, so that kind of answers the question a little bit, the next one, but what are like the common symptoms typically associated with IBS and how can they vary maybe from person to person?

Miranda Sirvinskas, FNP-C: Yeah, so every person will kind of vary and not each patient will have the same symptoms. different, symptoms would be the abdominal pain that varies in intensity, altered bowel habits with diarrhea and or constipation. one person might have the diarrhea while the other person might deal with more constipation and the next person might, alternate between the two.

Helen Dandurand (Host): Got it. And how is it diagnosed? Like, are there some key criteria or tests used to diagnose it?

Miranda Sirvinskas, FNP-C: So not really. We go based off of symptoms. there's no specific diagnostic laboratory test, but we can do lab testing to exclude alternate diagnoses, and all patients with suspected IBS will collect a complete blood count.

and in those who have diarrhea, we might perform various stool tests, testing for celiac disease, and C reactive protein levels to check for infections.

Helen Dandurand (Host): So is it kind of like I guess what you said, ruling other things out and then it's kind of diagnosed based off of that?

Exactly.

Miranda Sirvinskas, FNP-C: Yeah. We want to make sure there's no other underlying cause first before we diagnose the IBS. Gotcha. And I've also heard there are like different subtypes of IBS. Can you tell us more about that? Of course. so the different subtypes with IBS, include IBS with predominant constipation, where the patient will report abnormal bowel movements with constipation.

IBS with predominant diarrhea is when the patient reports mostly diarrheal bowel movements as their abnormal bowel movement. IBS with mixed bowel habits, of course, with both constipation or diarrhea. And IBS unclassified is when the patients meet the criteria for IBS, but they can't go in one or the other.

Got it.

Helen Dandurand (Host): We are going to take a quick break to talk about finding a primary care provider. Riverside knows that health is your greatest asset and that your primary care provider is your partner in health. Find a primary care provider that fits your needs at riversidehealthcare. org slash primary care. All right, jumping right back into the topic at hand, what are some potential triggers or factors that can bring out IBS symptoms in individuals?

Miranda Sirvinskas, FNP-C: some potential factors that contribute to IBS would include decreased gastrointestinal motility, meaning that the time it takes for substances to move through the GI tract is decreased, which can cause constipation. visceral hypersensitivity or increased, sensitivity in response to stimuli may cause distention or bloating.

Inflammation of the intestines and bacterial overgrowth may also cause IBS with diarrhea. Food sensitivities and food allergies These may also trigger IBS symptoms. And lastly, anxiety, sleep problems, depression, and somatic disorders can also trigger IBS symptoms.

Helen Dandurand (Host): And you just touched on this a little bit just now, but how does stress and mental health impact IBS symptoms?

 And are there strategies potentially for people to use to manage stress in relation to that condition?

Miranda Sirvinskas, FNP-C: Yeah, so as I mentioned previously, anxiety and depression, among other mental health issues, can trigger the IBS symptoms, but it can also be reversed and the IBS may cause a person to feel anxious.

Depressed, stressed when dealing with illness, having to plan your day around using the bathroom can be embarrassing, could be exhausting for some people, and sometimes they may choose, you know, not to participate in an event altogether depending on how they feel that day.

Helen Dandurand (Host): Got it. what would you say, then, are some treatment options available to manage the IBS symptoms?

Miranda Sirvinskas, FNP-C: so when a person is first diagnosed with IBS, we can try lifestyle changes and dietary changes first to see if we can identify triggers and then eliminate them. Physical activity is another great option for reducing the severity of the IBS symptoms. furthermore, in patients with IBS with constipation, fiber supplement is recommended as the first line treatment.

If it fails, laxatives are the next option, such as Miralax, Mocha Magnesia, and there are also some prescribed medication options such as Lubaprostone, as well as Linactalide and Planactalide.

those with IBS with diarrhea may be offered an antidiarrheal such as loperamide or bioacid sequestrants such as cholestyramine. there also is another option, tricyclic antidepressants may be used, because they slow the transit time in the intestines as well. there are also medications that can be given for abdominal cramping such as dicyclamine.

and lastly, antibiotics and probiotics, they're not routinely used but might be used in certain scenarios.

Helen Dandurand (Host): Got it. So it sounds like there's a lot of different things you could do and probably the place to start is maybe going to a primary care so they can help. figure that out for you? Absolutely.

Miranda Sirvinskas, FNP-C: This isn't something that you have to go to a gastrointestinal doctor for digestive diseases. we can diagnose and treat within the primary care office. Awesome. Is there anything else you'd like to add? if you feel like you're dealing with some IBS, just reach out to your primary care provider.

Helen Dandurand (Host): Awesome. Well, so much for being here today, Miranda. Thank you for having me. And thank you listeners for tuning in to the Well Within Reach podcast brought to you by Riverside Healthcare. For more information, visit Riverside Healthcare.