Dr. Patricia Yarberry Allen is a collaborative physician. This week, she asks gastroenterologist Brian Landzberg to advise a patient with irritable bowel syndrome, a functional bowel disorder that requires thoughtful management.

 

irritable-bowel-syndrome

IBS, with its debilitating symptoms, including bloating and gas pains, can dramatically reduce a patient’s quality of life. (Image via)

Dear Dr. Pat:

I am 47 years old and have had colon problems for most of my life. I was given castor oil as a child for constipation. I take a laxative almost every week; if I didn’t, I might not have a bowel movement for days (unless I count the days when I have what the doctor referred to as “rabbit pellets”). I have bloating and gas pains as the days pass without a bowel movement. Then I have problems after I take a laxative, because it causes severe cramping and then diarrhea. I feel wiped out for most of a day. Then I have diarrhea for another day. 

Stress and travel make the constipation worse. I actually miss work sometimes because of either the abdominal cramping pain or the symptoms from the treatment. I saw a GI doctor and she insisted that I have a colonoscopy, then told me that I had irritable bowel syndrome and nothing could be done about it. She did not suggest a change in diet, supplements, or medicines. I am healthy otherwise, but this gastrointestinal disorder has taken over my life.

Donna

 

Dr. Pat Responds:

Dear Donna:

Thank you for writing to us about a topic that is difficult to discuss. I have been saving your question for April because this is Irritable Bowel Syndrome Awareness Month.

Irritable bowel syndrome (IBS) is a gastrointestinal syndrome characterized by chronic abdominal pain and altered bowel habits in the absence of any other cause such as inflammatory bowel disease, diverticulitis, or anatomic deformities of the colon. It is the most commonly diagnosed gastrointestinal condition. More women than men have this condition, and it has been estimated that almost 15 percent of the population will have some form of this disorder. In addition, the health care costs for this disorder are staggering, some estimate the costs at $30 billion a year. 

All primary care doctors should be familiar with the symptoms and the general management of this disorder, since we are the doctors who most often see patients with these symptoms. We need either to help patients manage the symptoms or know when to refer them to a specialist who actually has an interest in functional bowel disease instead of just doing colonoscopies.

I have asked Dr. Brian Landzberg, Assistant Attending Physician at New York-Presbyterian Hospital, to discuss the treatment options available. Dr. Landzberg is the gastroenterology specialist on the Women’s Voices for Change Medical Advisory Board.

Dr. Pat

 

Dr. Landzberg Responds:

Dear Donna:

I can’t tell you how often I hear the story you relate. Many of my fellow gastroenterologists have become very good at performing colonoscopies and are losing their skills of consultation and therapy, especially for functional disorders, like IBS.

The fact is that the colonoscopy, while important in ruling out cancer, Crohn’s disease, etc., is the easy part. The challenge, requiring time and thought, is the management once the physician has ruled out those structural diseases. Establishing a therapeutic rapport, doing detective work to find triggers and subtle diagnoses, reviewing diets, laying out a tolerable bowel regimen, and creatively using medications, all take more time than most gastroenterologists are willing to spend. A helpful start for you may be avoidance of caffeine, lactose-containing milk products, cruciferous vegetables, artificial sweeteners, and chewing gum, and taking a regimen of Citrucel fiber powder with Culturelle probiotic twice daily.

Functional bowel disorders like yours do not shorten life, but can dramatically reduce the quality of life, and they deserve thoughtful management. You need to find a gastroenterologist who will spend time with you and work through these issues. Unfortunately, you may need to come in to a large city or academic center. Local community gastroenterologists  will likely accept all major insurances, but are not likely to spend much time in the office with the patient. There are some gastroenterologists in the academic centers and large cities who will spend an hour exploring these issues with a new patient in the office, but they may not accept insurance plans.

Brian Landzberg, M.D.

 

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  • Patricia Yarberry Allen, M.D. April 8, 2013 at 10:12 pm

    Dr.Landzberg will be answering a question about diverticulitis next month, Ruth. So watch your diet until then….

    Dr. Pat

    Reply
  • Ruth Woodie April 8, 2013 at 6:37 pm

    Thank you so much for sharing this information. I have been diagnosed with diverticulitis & thought it was a part of IBS. Fiber, fiber, fiber…is what I need. So true that we need to do our own detective work!!

    Reply