February 5, 2001
A disorder comes out of the closet

Millions suffer privately from irritable bowel syndrome


As a child, Margaret (not her real name) remembers experiencing cramps and searing abdominal pains that "no one else seemed to have." As she grew up, the problem persisted, bringing bouts of pain early in the day. "For years, I had problems with absenteeism and being late for work," says the 50-year-old mother of three, who lives outside Vancouver. Her doctor sent her for a battery of tests, which showed there was nothing physically wrong. Then in 1997, she switched doctors -- and her life was transformed. After reading Margaret's medical records, the physician told her she might have a disorder called irritable bowel syndrome (IBS). After that, Margaret began taking medication that eased her cramps, and made contact with thousands of fellow IBS sufferers on the Internet. "At last," says Margaret, "there are people I can talk to and learn from. My life is more normal now than it has ever been."

Margaret has a relatively mild form of the condition that afflicts at least two million Canadians -- two-thirds or more of them women -- with symptoms that include abdominal cramps and pain, constipation and diarrhea. Because there is no known cause -- or cure -- IBS for years has remained in medical limbo, with patients going from one physician to another in an often fruitless search for help. "Sometimes," says Dr. Geoffrey Turnbull, a Halifax gastroenterologist, "IBS patients get the message from family physicians that 'your condition isn't serious.' " Now, with increased research and clearer guidelines for family physicians, that may be changing. "This disorder," says Toronto psychologist Brenda Toner, "is coming out of the closet."

Still, IBS victims are often understandably embarrassed by their affliction. Some with severe forms of the disorder, notes Toner, "are so afraid of having an 'accident' in public, they won't leave their homes." Working with researchers in North Carolina, Toner has developed a "cognitive-behavioural" approach to the disorder based on evidence of an interplay between the gastrointestinal system and the brain. "Stress does not cause IBS," says Toner. "But IBS symptoms may be aggravated by stress of various kinds -- physical, hormonal, dietary or psychological."

On a physical level, physicians know that some dietary items -- including coffee, fatty foods, green peppers, onions and raw vegetables -- can trigger IBS symptoms. And a wide range of remedies, including antidepressant drugs and fibre supplements, can help alleviate symptoms. But the key, according to Turnbull, lies in patients learning to identify and control factors that can trigger symptoms. Turnbull encourages patients with IBS to devise stress-management practices, such as relaxation exercises and avoidance of stressful situations.

Though scientists have yet to pin down the details, Toner and other researchers believe IBS is associated with a malfunction in the neural circuits linking the bowel and brain. It could turn out to have other origins. In December, researchers at Cedars-Sinai Medical Center in Los Angeles reported that treatment with antibiotics left 50 per cent of the IBS patients tested temporarily free of symptoms. A team led by gastroenterologist Dr. Mark Pimentel, a Thunder Bay, Ont., native, administered antibiotics to 47 IBS patients who had bacteria in their small intestines, organs that are usually free of microbes. "The important thing about this," said Pimentel, "is that it gives us a direction that could point to a cause of IBS" -- and eventually lead to more effective treatment for an affliction that brings misery to millions.

Related Links:

Irritable Bowel Syndrome Self Help Group
Aimed at educating those who suffer from irritable bowel syndrome and increasing awareness about it and other functional gastrointestinal disorders.

MedicineNet forum
Includes doctors' responses to questions about irritable bowel syndrome.

Nursing library
Behavioural and dietary tips for living with irritable bowel syndrome.

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