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  I'm a 23 year old student who was diagnosed with IBS almost 5 years
  ago.  I've had it pretty much under control since '96, but a few
  months ago I started having new pains in my lower abdomen.  At
  first it was just mild cramps, and I thought that it was just the
  same old thing starting again.  But, then my diet, fiber supplements,
  or medicines were not helping me.  Now, the only way I know if I have
  to have a BM is if my lower stomach has sharp pains that make it
  difficult to walk at times.  When I'm on my period it is difficult
  for me to have a BM and I was in the ER for bowel inpactation once
  during this time.  I was told then the pain was from my reproductive
  tract but, they could not find anything.  I can not get a straingt
  answer from anyone where I live.  Could this be my IBS getting
  worse?  Also, if anyone has a list of good doctors west of Atlanta
  that might be able to help me.
Dear Tara,
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
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