Help with IBS?

  In 4/97 began having problems with abdomen becoming enlarged without
  weight gain or any large body fat gain.  Family members noticed enlargement,
  especially those who hadn't seen me in 1 month (appearance of 6 months
  pregnant). Noticed while seeing Dr.
  multiple times weekly for osteoarthritis of cervical/thoracic treatments.
  At time had ultrasound done due to family history of uterine growths.
  Negative.  Told had IBS and to take stool softeners to ease constipation.
  This was a Family Pract. Saw another of same and told basically same.
  Symptoms vary between constipated and loose bowels with mucous / diarreha.
  Also pass something that is larger than a garbanzo bean, yellow in
  color with white interior.  Sample tested and was told no problem.
  Very cautious with diet...no corn, nuts, spicy, etc.  I don't want
  to cause more problems.  Recently got tired of looking 6 months pregnant
  for more than a year.  In addition, whatever gas is trapped is enough
  to cause a feeling of movement within abdomen...such as that of
  movement of baby while pregnant.  Not pregnant!! Also, passing it
  em more frequently...loose stools more frequent...constipation rare now.
  Sought help from Gastro.  He explained items emitted with bowel
  movements as matter that had been stuck in intestines/bowels for
  long period of time that finally were able to move out.  Usually get back pain before passing one...sometimes can
  feel pain move across back. Put on Librax (?) with minimal effect
  .  Now looking at ultrasound and upper GI.
  Over weekend had very busy time with bathroom.  At least 6 times
  (on Saturday alone) of very loose bowels and emitting bean-like item
  again.  
  Am I on the right track?  Any information / advice you can give to
  enlighten me on this problem is so appreciated.  
  Thank you.  From...So tired of all of this!
    
Dear Sally,
Irritable bowel syndrome is a gastrointestinal syndrome characterized by chronic (present for at least 3 months) abdominal pain
and altered bowel habits in the absence of any organic disorder. Approximately 10-20% of the general adult population report
symptoms compatible with irritable bowel syndrome. The abdominal pain is usually described as a crampy sensation with
variable intensity and periodic exacerbations and is generally located in the lower abdomen. Bowel habits in patients with
irritable bowel syndrome can be diarrhea, constipation, diarrhea alternating with constipation or normal bowel movements
alternating with either constipation or diarrhea. Approximately half of all irritable bowel syndrome patients will complain of
mucus discharge with stools.
The definitive cause of irritable bowel syndrome has not been established. Many studies have reported changes in
gastrointestinal motility in patients with irritable bowel syndrome, however, these studies have not been consistently reproduced
nor has a particular pattern been detected. Up to 60% of patients with irritable bowel syndrome have a lower tolerance for
rectal balloon distention than normal controls. This exaggerated response to colonic distention is termed visceral hyperalgesia
and is probably mediated by an as yet undetermined defect in the nerves that control pain sensation. It is not clear whether this
is a problem with the nerves of the gastrointestinal tract or the brain. Although irritable bowel syndrome is not caused by a
psychiatric problem; psychological disorders, stress, emotional difficulties and a history of childhood sexual or physical abuse
are more common in this patient population.
There are however, a number of symptoms that do not suggest the diagnosis of irritable bowel syndrome. These include: large,
volume stools with weight loss, fever, blood in the stool and abdominal pain which awakens one from sleep. If a patient has any
of these symptoms a work-up should be initiated to exclude an organic disease process.
If the patient has the typical symptoms of irritable bowel syndrome an exhaustive work-up is unnecessay. Many
gastroenterologists will perform a complete blood count, sedimentation rate and a chemistry panel. If diarrhea is the
predominant symptom, stool examination for culture, ova & parasites and white blood cells as well as thyroid function tests
should be performed. In patients over 40, a flexible sigmoidoscopy (a test where a tube with a light and video camera is
introduced into the rectum and advanced to about 60 cm-this will allow direct visualization of the left side of the large intestine
and rectum; sometimes a biopsy is performed to exclude a series of intestinal disorders which can cause diarrhea) is usually
performed. In patients with a family history of colon cancer, a colonoscopy is perfomed.
A number of treatments have been suggested to help patients with irritable bowel syndrome. The first step is to have a good
working relationship with your physician. You should review your diet carefully to see if they are playing a role in your
symptoms. Many patients have symptoms with dairy products and other gas producing foods. Exclusion of foods that can
increase flatulence (beans, onions, celery, carrots, raisins, bananas, apricots, prunes, brussel sprouts, wheat germ, pretzels and
bagels) may be helpful. Some patients find that decreasing the intake of caffeinated beverages may help as well. This does not
mean that you have to refrain from all of these foods. What you should do is try these foods and see if they cause a problem. If
they do then you should avoid them. Furthermore, many patients find that increasing the fiber in their diet to obtain 20-30 grams
daily helps regulate their bowel movements. An easy way to do this is to take a high fiber cereal such as FIBER ONE or ALL
BRAN on a daily basis. There are medications to decrease spasm or to relieve diarrhea, but they should be tried only after the
above is accomplished. You should give the fiber at least a month to work. You may get some increased gas and bloating
initially but most patients can eventually tolerate the fiber. I hope you find this information helpful.
This response is being provided for general informational purposes only and should not be considered medical advice or
consultation. Always check with your personal physician when you have a question pertaining to your health.
If you want to be seen at our institution please call 1-800-653-6568, our Referring Physicians