Your diagnosis is “irritable bowel.” You have been having recurring attacks of abdominal pain, diarrhea and constipation. After a series of tests, your doctor diagnoses your ailments as irritable bowel syndrome. Also known as spastic colon, mucus colitis and a variety of other names, this condition consists of a functional disorder of the large intestine or colon.
“Functional” disorder – what is it?
An abnormality in the behavior or function of an organ or part of the body in the absence of a specific organic disease. The colon – also called the large intestine or large bowel – consists of the last five feet of the digestive tract, and its main function is to conduct indigestible portions of the food, or waste material, out of the body. Any disruption of this function can lead to a change in bowel activity – to diarrhea or constipation – and abdominal pain.
However, this does not mean that your colon is damaged or diseased. The irritable bowel is just unstable, a little out of kilter.
Does that mean it is not a serious condition?
It can be uncomfortable, but it is definitely not serious. Try not to worry about that or you will make it even worse. It never leads to cancer and very rarely to serious complications. But the symptoms – abdominal pain with diarrhea or constipation – can be distressing and these should be alleviated by medical treatment when they persist.
Is it common?
Extremely common. So common, in fact, that it can be accepted by the patient as a way of life. It is estimated that from a third to a half of all patients with abdominal disorders have irritable bowel syndrome.
What is the cause or causes of this syndrome?
Our knowledge of why the colon malfunctions when there is no organic disease is incomplete, but certain causative factors are well established.
In many patients, the symptoms stem chiefly from emotional stress. Virtually everybody responds to the stresses of life – anxiety, anger, frustration, depression – with some form of physical reaction, and no part of the body is more vulnerable to these psychological disturbances than the gastrointestinal tract or gut. The brain is “connected” to the muscles of the gut by a network of nerves. When we get emotionally upset, we may actually feel intestinal muscles tighten and contract in spasms. Some people get headaches when under stress; others get vomiting spells, diarrhea, duodenal ulcers, etc.
All age groups are affected. Students and athletes often have nausea or diarrhea before an exam or sports event.
In addition to psychic factors, many agents can irritate the colon and trigger symptoms. In some patients, coffee, alcohol, spices, salads and other foods can provoke attacks of diarrhea. Some people are allergic or highly sensitive to certain foods. Milk sugar intolerance, for example, is a very common problem – but one that can easily be treated by the avoidance of milk and certain milk products.
Infections, acute illness, environmental factors – even a change in the weather – can bring on symptoms. Metabolic and endocrine disorders – such as carbohydrate intolerance and diabetes – may also be responsible. There is some evidence that colonic instability is hereditary or, at least, “runs in families.”
Women with the syndrome may have more symptoms in the week before menstruation or during menopause.
How is it diagnosed?
All other diseases that may reasonably cause the same symptoms must be excluded. Then, and only then, is it reasonable to suggest a diagnosis of irritable bowel. In patients with symptoms that are clearly due to emotional stress, all that may be required is a careful history and physical examination of the patient. In other patients, more thorough checkups are needed, including X-ray and instrument examination of the colon. Analysis of the stool should be made for the presence of blood and possibly for infections or parasitic agents that might cause diarrhea.
How is the irritable bowel treated?
When the condition is acute or transient or there is only occasional appearance of symptoms, no treatment may be needed – other than an explanation of the causes of the symptoms. It is important that the patient be fully satisfied that he or she does not have a serious disease and that he or she be properly instructed as to the role of life stresses on intestinal function.
When the symptoms are chronic and keep recurring, then a variety of treatments may be tried by your physician. Diet is the factor that is most easily controlled. If your symptoms are traced to a certain food, that should be eliminated from or curtailed in your diet. If your problem is constipation and you aren’t getting enough roughage in your diet – as is the case with millions of Americans who eat highly refined, over-processed carbohydrates – then a high-fiber supplement, such as 100% bran, should be added to your diet. These measures, simple but effective, may be all that is necessary. Medications to relax the muscle spasm on the colon may also be used.
What about psychotherapy for emotional tension?
Generally, psychotherapy is not needed. If you realize that an emotional matter can easily upset your digestive system, you will not worry that you have a serious condition and this, in itself, will reduce nervous tension. You should, of course, try as far as possible to avoid situations that cause tension and to seek adjustments and modifications in your work, in your family relations and in your lifestyle, in order to reduce stress.
What about drugs?
A number of drugs have been tried to reduce tension and relieve symptoms. Sometimes, the use of a smooth muscle relaxant is helpful. In contrast to skeletal muscle, which is uneven, intestinal muscle is smooth and certain drugs have been shown to alter the abnormal motor patterns in the irritable bowel syndrome. Sometimes a combination of a sedative and a smooth muscle relaxant is helpful.
Can surgery cure it?
No. There is no surgical treatment called for.
What may I expect over the years to come?
Depending upon your own attitudes and personality and upon your ability to deal intelligently with this problem, a normal life is expected. At this time, your best hope will come from a self-examination of the way you live, the problems and situations that cause stress and emotional upset, the way you eat and what you eat, perhaps even a closer look at the foods and substances that you may be allergic to. If you will work to find your own best balance using trial and error to learn about reactions to food, emotional stress and allergies, you may be able to control the problem.
With self-knowledge and awareness, you can make adjustments to create a place in your life for this medical situation that will help you minimize the inconvenience, the upset and disruption that an irritable bowel can cause.