Irritable Bowel Syndrome
Guest: Dr. Christopher Lawrence – Gastroenterology-Hepatology
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I am Dr. Linda Austin. I am talking with Dr. Chris Lawrence of the Digestive Disease Center. Welcome, Dr. Lawrence.
Dr. Chris Lawrence: Good morning. Thank you.
Dr. Linda Austin: Let’s talk about irritable bowel syndrome. What are some of the most common symptoms of that disorder?
Dr. Chris Lawrence: Irritable bowel syndrome involves some degree of abdominal discomfort. People describe it in various ways: my tummy hurts, I have pain. It can be described as bloating or abdominal cramps. It can really present in a number of different ways.
Dr. Linda Austin: So, when you say, my tummy hurts, for example, a low-level stomach ache or feelings of nausea, could those be symptoms of irritable bowel?
Dr. Chris Lawrence: Those certainly could be symptoms, yes.
Dr. Linda Austin: Cramping pain, what does that feel like?
Dr. Chris Lawrence: Cramping pain, people sometimes describe it as labor pains.
Dr. Linda Austin: Ouch.
Dr. Chris Lawrence: Not being a female, it would be hard for me to really describe that, but people sometimes relate it as a less intense labor-type pain. Frequently it is in combination with bloating where people actually feel that their abdomen distends or enlarges at various portions of the day.
Dr. Linda Austin: What are some other signs or symptoms of irritable bowel?
Dr. Chris Lawrence: The definition of irritable bowel syndrome also generally involves some alteration of bowel habits. What that means is people in essence are not pleased with their bowel movements. Maybe their bowel movements are too loose; maybe they have diarrhea, maybe they have constipation. Frequently people alternate between one and the other.
Dr. Linda Austin: Any other signs or symptoms of irritable bowel? How severe does it have to be to really get that diagnosis?
Dr. Chris Lawrence: It frequently has intermittent symptoms so people should not have symptoms nonstop or continuously. I think it is also important to realize what it is not. We look for warning signs, or warning symptoms, that people have. Irritable bowel syndrome should not have blood in the stools. People should not have weight loss. People should not have fevers and chills. Also, it is uncommon for irritable bowel to develop in an older person, out of the blue, so you need to think about other diagnoses, such as colon cancer, colitis, things like that, if you have some of these warning signs or symptoms.
Dr. Linda Austin: The warning signs like blood in the stool, for example. That points to it not being irritable bowel syndrome? Is that right?
Dr. Chris Lawrence: Correct, and perhaps a more dangerous diagnosis.
Dr. Linda Austin: So, blood in the stools really means you should go and give your doctor a call pretty quickly?
Dr. Chris Lawrence: Correct.
Dr. Linda Austin: Now, how long would you recommend to somebody who has some of the more simple symptoms, let’s say, cramping pains, or whatever, to tolerate that before they get that worked up? I mean, those are common things that people have from time to time in their life. Is there a threshold for when you should call your doctor?
Dr. Chris Lawrence: Again, let’s exclude the warning signs or symptoms. In essence, it really depends on how much it affects your daily life. People are affected to varying degrees. If it really is not limiting you in your enjoyment of your pastimes, your family, your work, there really is no urgency to the diagnosis because there really are not any long term health consequences. I frequently tell my patients that have a family member there with them that this is a diagnosis that you may struggle with. It may come and go but it is not going to affect your mortality. It is not going to cause your death any sooner than who is here with you, assuming that you are in an equal state of health.
Dr. Linda Austin: Is it difficult to treat?
Dr. Chris Lawrence: It can be. There is a lot of research in this area of new medications. There are a lot of old medications that we use. Frequently it comes down to a trial-and-error of let’s try a medicine for two weeks. If it works, great, we will leave you on it. If it does not, then we move on to something else.
Dr. Linda Austin: It sounds, though, as if it is one of the most common illnesses that you treat as a gastroenterologist. Is that right?
Dr. Chris Lawrence: Absolutely. No matter your practice setting, it probably will take up about half of the patients of any GI doctor’s clinic on any given day.
Dr. Linda Austin: Am I right in hearing that this is an illness that is a nuisance? It is really a pain in the neck for the people who have it, but it is not worrisome or life threatening at that level?
Dr. Chris Lawrence: Right. Not to down play someone’s symptoms, frequently people look at it as they should, from a selfish perspective. It can be a very painful and, in some way, life altering process for some patients, particularly on the days that they have symptoms. But, looking at it from a more detached, medical, perspective, there is not any real danger in the disease. It is not going to affect their mortality.
Dr. Linda Austin: Are there any dietary measures one can take?
Chris Lawrence: That is debatable. Very frequently these patients will describe some food product that seems to cause their symptoms to be more severe. Frequently it is high fat foods. Occasionally it is salad. It really runs the gamut. I caution people that fatty food intolerance, I get bloated, I feel full when I eat a lot of fat, because there is a fairly physiologic thing that happens with the stomach. So, that is to be expected and may not necessarily indicate irritable bowel syndrome.
Dr. Linda Austin: And I guess your sound medical advice, then, would be, well, then, don’t eat so much fat?
Dr. Chris Lawrence: Exactly. What is good for your heart is probably also good for you GI tract, and your IBS, correct.
Dr. Linda Austin: Dr. Chris Lawrence, thanks so much for talking with us today.
Dr. Chris Lawrence: Thanks for having me.
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