National Science/HealthThe New York Times on the WebAugust 8, 2000Personal HealthA Common Syndrome Seldom Discussed By JANE E. BRODY Jean's problem started in high school, with repeated bouts of abdominal cramps, a perpetual bloated feeling and the need to visit the bathroom dozens of times a day for long periods at a time but without much relief. Now through college, married and working, Jean has to get up hours ahead to get in enough bathroom time for her chronically constipated bowel before she goes to work. Neither doctors nor dietary changes have provided more than a brief respite from the symptoms, which cause her considerable anxiety and embarrassment and make her unwilling to stay anywhere, including at her in-laws' home, where there is only one bathroom. Jean, who lives in Phoenix, suffers from a condition called irritable bowel syndrome, or I.B.S., a chronic disorder of a seemingly normal gut that national surveys have indicated afflicts as many as one person in five, 70 percent of them women. Lillian, 33, has a different version of the same problem. Instead of the chronic constipation that plagues Jean, Lillian is beset by unpredictable bouts of diarrhea that can occur many times a day. She says: "I.B.S. affects every aspect of my daily life. I can't ride on a city bus or go to the park because there is no bathroom. With the things that I can do, I constantly have to make allowances like leaving extra time in case I experience an episode." Despite the high incidence of the syndrome, it is common for a sufferer to see many doctors over a period of years before getting a proper diagnosis. Many patients endure costly, difficult tests that reveal nothing, although some tests may be needed to rule out more serious conditions. Experts estimate that up to 70 percent of sufferers do not seek medical help. What It Is, and Is Not Let's start with the bad news: irritable bowel syndrome is a poorly understood and has no known cure. Though debilitating, it is not fatal, it does not progress to something more serious and it does not increase the risk of developing colon cancer or other bowel diseases. According to Dr. Michael Camilleri, a gastroenterologist at the Mayo Clinic, "Long-term studies of irritable bowel syndrome show that symptoms may disappear in time and that the survival of these long-suffering patients is unimpaired." Furthermore, several drug companies have promising medicines. A recently approved drug, Lotronex by Glaxo Wellcome, can help women with the syndrome and diarrhea. Another drug, Zelmac by Novartis, is nearing approval, and it has helped those with bouts of bowel syndrome accompanied by constipation. The syndrome has long been misunderstood. Through the years it has been called many things, some of which are inaccurate, including colitis and mucous colitis (unlike real colitis, there is no inflammation in I.B.S.), spastic colon and functional bowel disease. Contrary to widespread belief among the public and in medicine, irritable bowel syndrome is a real condition. It is not a psychosomatic disorder, although its symptoms can be aggravated by stress, anxiety, depression or emotional trauma. Rather, the syndrome is believed to stem from abnormal nerve connections between the brain and gut, resulting in extreme sensitivity to bowel contractions and the passage of gas and fluids. Nerves that control muscles in the gut seem to overreact to gas or to food after a meal, resulting in painful spasms that may either speed or slow the passage of stool and cause diarrhea or constipation. In some sufferers, symptoms alternate between diarrhea and constipation. How People Cope In addition to emotional distress, the symptoms of the syndrome can be made worse by certain habits, like eating big or irregular meals and fatty or spicy foods, as well as by specific foods. Although food sensitivities vary, problems commonly come from chocolate, caffeinated and carbonated beverages, dairy products containing lactose, foods sweetened with sorbitol or mannitol, gas-producing vegetables like cabbage, beans and broccoli and fruits like grapes and raisins, cherries and cantaloupe. Diets rich in fiber help control diarrhea and constipation. But there is a catch: many high-fiber foods increase intestinal gas and can cause more cramping. So go slowly when trying to increase dietary fiber to give your system a chance to adjust. And if high-fiber foods don't do the trick, you might try taking a fiber supplement like psyllium (Metamucil, for example), which may be better tolerated. If diarrhea is a problem, avoid fatty foods; they stimulate the bowel more than any other food. If you are lactose-intolerant, choose lactose-reduced dairy products (there are lactose-free versions of milk, cottage cheese and ice cream), low-fat hard cheeses and yogurt with active cultures. Check the labels on dietetic foods and sugar-free candy and gum. Pass up those with sorbitol or mannitol, which can cause diarrhea. Eat small regular meals and don't rush them. Sit down, relax and enjoy them. Avoid chewing gum, talking while eating and eating too quickly; all cause you to swallow air and increase intestinal gas. Keep a food-and-symptom diary to determine which foods bother you most and try to avoid them. If you think you are sensitive to something, don't eat it for two weeks, then gradually reintroduce it to see if your symptoms get worse. Note, too, that tobacco, alcohol, caffeine and spicy foods are common irritants that may cause a bad reaction. Certain medications, like antacids containing magnesium, may also cause problems for people with diarrhea. Keep track of them as well. As for nonfood remedies, perhaps the most important is regular exercise to help normalize bowel function. Exercise is also a great stress reliever. Other stress-reducing activities include meditation, sports and hobbies. Cognitive behavioral therapy, hypnotherapy or traditional psychotherapy can help people whose symptoms are aggravated by stress. Do not take laxatives for constipation; they can permanently impair gut motility. A fiber supplement, which acts as a bulking agent, is far preferable. Dr. Camilleri of the Mayo Clinic suggests an "osmotic" laxative like milk of magnesia or lactulose or a stool softener. Whichever you use, be sure to drink plenty of water -- more than two quarts a day. If diarrhea proves unresponsive to dietary changes, an antidiarrheal drug like Imodium (loperamide) can be used. Also, low doses of tricyclic antidepressants can relieve both diarrhea and abdominal pain, but these drugs should be avoided by those with constipation. Other medications that may help, depending on the person's illness pattern, include calcium channel blockers, somatostatin analogs and serotonergic antagonists. Copyright 2000 - The New York Times Company[This message has been edited by Jeffrey Roberts (edited 08-08-2000).]
Bud, the NY Times is a good site to bookmark. My husband registered a few years ago. He said it was easy to do. We go there almost every day to check on something. Jeff, thank you for putting the text on the bulletin board.I made a copy. The next time we go to a doctor, we will go armed with this article. Who can argue with Jane Brody?!
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