An invisible illness and a resolving controversy

IBS is an intestinal condition characterized by abdominal discomfort and/or painful defecation as well as abnormal changes in bowel habits.  It may be dominated by constipation, diarrhea or an alternating pattern of both.  It can be chronic and tends to follow a pattern of relapse and remission.  It may coexist with other gastrointestinal conditions.

IBS used to be considered a controversial diagnosis but because there are now specific criteria for diagnosis, IBS is no longer considered a diagnosis of exclusion.  A key criterion is that symptoms must have been present for at least 3 days per month in the past 3 months, and there must be a history of symptoms of at least 6 months prior to diagnosis.  

While IBS is not life-threatening, it does diminish quality of life. About 10 – 15% of the population have IBS and it’s the most common reason for a referral to a gastroenterologist.  Women aged 30 to 50 years are most susceptible but it can be diagnosed in any one, at any age, although it’s much less common in seniors of both genders.

IBS may be more common in people who also have the following:

• depression, anxiety, or panic disorder
• migraines
• chronic pelvic pain
• fibromyalgia
• chronic recurrent indigestion

It’s not known what causes IBS but genetics seems to be part of the picture.  Family clusters are common with this condition.

What It Feels Like

Most of us have occasionally experienced diarrhea and constipation with their accompanying gas, bloating, and flatulence.  Sometimes these conditions are accompanied by cramps as well.  With IBS, there is a lot of cramping.  The cramps can be sharp, stabbing pains, or they might feel more like squeezing.  Some women say they are similar to labour pains.  Some people experience pain when they change position, like when they go from sitting to standing, for example.  Other common experiences include nausea, a feeling like bubbles in the stomach and pain in the area of the ribs.

Diagnosis

Diagnosis is made largely on the basis of clinical presentation and medical history because diagnostic test results are usually normal in patients with IBS.  However, diagnostic testing is still valuable because it rules out other conditions that could resemble IBS, such as colitis, Crohn’s disease and diverticulitis, to name just a few.

Treatment Options

In the conventional system, treatment involves dietary changes, along with medications that modify the motility of the intestinal system.  Sometimes antidepressants are recommended on the basis that changes in the gastrointestinal metabolism of the neurochemical serotonin may be involved.  These antidepressants modify serotonin levels.  Lifestyle changes and Cognitive Behavioural Therapy are also recommended in some cases.

The naturopathic approach is to try to identify all of the controllable factors that may be adversely affecting intestinal function, such as diet, allergies, lifestyle elements, stress and emotional conditions.

Dietary modification may include raising and lowering the level of fiber consumed according to one’s symptoms because we want to reduce the threshold for irritation in the GI tract while promoting healthy elimination.  Certain types of fiber will be better tolerated than others.

Botanicals such as peppermint and anise can help modify GI motility while demulcents like marshmallow and licorice are soothing.  Probiotics are also a very important part of the treatment regimen; this a popular focus for ongoing research.

Outlook

IBS symptoms can vary a great deal over time, in both their nature and their intensity.  A multifocal approach that seeks to modify as many controllable factors as possible tends to bring the best, long term results.  In severe cases, medication may be needed, but most of the time, naturopathic care can bring lasting relief.