FREE ESSAY ON IRRITABLE BOWEL SYNDROME

IRRITABLE BOWEL SYNDROME

IRRITABLE BOWEL SYNDROME
Suffering in Silence
Irritable bowel syndrome (IBS), is a common disorder of the intestines that affects
nearly one out of five people in the United States. According to the book, Irritable
Bowel Syndrome & the Mind-Body-Brain-Gut Connection by William B. Salt II, IBS is the
most common functional gastrointestinal disorder. The symptoms include constipation,
diarrhea or alternating bouts of both, bloating, abdominal pain and many other problems.

Symptoms of irritable bowel syndrome usually begin during adolescence or early adulthood.
Altered bowel movements occur over periods of days to weeks. Occasionally, symptoms may
be continuous. In a given individual, both constipation and diarrhea can occur, or either
can be the recurring symptom. The course of the disease varies from patient to patient,
but individually, it can follow a consistent pattern.
The diarrhea of irritable bowel syndrome is usually of small volume, but frequent.
Episodes commonly occur during periods of stress. The initial morning movement may be
normal, but followed by successively loose bowel movements throughout the rest of the
day. Bowel movements may be associated with extreme urgency. The diarrhea rarely awakens
patients from sleep and there is usually no associated fever or rectal bleeding. 
The abdominal pain of irritable bowel syndrome can vary in severity from mild to severe.
It is usually felt in the lower abdomen, especially on the left side. The pain may be
dull, sharp, crampy or continuous. It is commonly relieved by the passage of gas or by
defecation *1*.
Each year, 2.6 million people seek treatment for symptoms related to functional
gastrointestinal disorders, and visits to physicians total 3.5 million (Salt xiv). The
average age of onset of IBS is between 20 and 29 years of age, and IBS is prevalent
throughout the world including China, the United Kingdom, Australia, New Zealand and
Scandinavia (Salt xiv, xv). The public is made aware of cases of HIV, heart disease,
various forms of cancer, etc., on a daily basis, yet IBS is relatively unheard of.
Because of this, millions of people who suffer from IBS feel there is a stigma attached
to their disease and they must suffer in silence.
IBS is not a rare disease. In fact, it is the second leading cause of absenteeism in the
workplace, coming in behind the common cold *2*. Unlike the common cold, however, there
is no over-the-counter drug that can be picked up at the local drug store at the first
sign of symptoms. Furthermore, there are few prescription drugs that have been used to
treat IBS with positive results. The first prescription drug specifically developed for
diarrhea-predominant IBS, Lotronex, was released to the market in March of 2000. Glaxo
Wellcome, maker of Lotronex, says the precise mechanism of action of the drug is not
fully understood. However, the working hypothesis is that the experimental drug blocks
the action of the neurotransmitter serotonin and 5-HT3 receptor sites in the
gastrointestinal track. 
The thinking is that serotonin and 5-HT3 receptors play a role in increasing the
sensations of pain and affecting bowel function in IBS patients. In addition, nerves that
control the muscles in the gut may overreact to stimuli such as gas and the passage of
food after a meal. This may cause painful spasms and contractions and speed up or slow
the passage of stool through the colon, resulting in diarrhea or constipation *3*.
Lotronex has only been shown to work in women, and there is presently no medication
available for men suffering from Irritable Bowel Syndrome. Lotronex works by blocking the
level of serotonin in the intestinal system in order to reduce the cramping abdominal
pain and discomfort, urgency and diarrhea. 
The first step in determining if the bowel problems in question are caused by IBS is to
visit a physician for a check up. Chances are, he will refer the patient to a
gastrointerologist, who will then order outpatient testing to be done at a hospital. This
battery of tests can include an upper and lower GI, a barium enema/X-ray, an EGD-which
consists of sticking a scope down the throat to look into the stomach, an ultrasound, and
any other deemed necessary by the specialist. IBS will be diagnosed after it is
determined that the patient's organs are functioning properly and their insides are
healthy, leaving no obvious cause for their symptoms. 
After the initial diagnosis, the doctor will share a variety of treatment options and
suggestions with the patient. At this point, it's important to deal with a physician that
is understanding and willing to work with the patient to manage the symptoms. Since there
is no one specific cure, the patient is about to begin a long journey to try to find the
right balance of medication, therapy, stress relief, relaxation techniques and eating
habits. 
Many top physicians agree that Irritable Bowel Syndrome is not a diagnosis, is a vague
term, and carries little significance. A more correct name for the various GI problems
that doctors associate with it should be unknown bowel disorder. IBS is a term that
physicians will give to a patient if they have no idea what their problem is from. Its
purpose is to give the patient a name for their problem so the doctor can avoid using
those words you'll never hear him or her say, I don't know. Physicians have a reputation
for being more concerned with treating symptoms than finding or treating the cause,
bringing suffering patients back into their office again and again *4*. 
Because of the common occurrence of Irritable Bowel Syndrome, and the inability of the
medical profession to find a cause or cure for the disease, there is a pressing need to
support more research. Unfortunately, research remains severely underfunded for
functional gastrointestinal disorders. Less than 1% of digestive research funding,
through the National Institutes of Health (NIH), is allocated for functional disorders
*5*. The worst part for most IBS patients is not knowing why they're suffering from this
syndrome. There are many support groups on the Internet, including www.ibsgroup.org *6*
and www.allhealth.com *7*. In addition, there are various organizations such as the
International Foundation for Bowel Dysfunction, which is a nonprofit and informational
research program.
According to an article in Johns Hopkins Magazine's April 1997 issue, there are four
major procedures to follow to control IBS: eat more fiber, avoid culprit foods,
medication, and reduce stress.
First of all, increasing the daily dietary intake of fiber can dramatically improve bowel
function. Fiber therapy is effective for both diarrhea and constipation predominant IBS
sufferers because it stretches the bowel wall, actually decreasing tension in the bowel.
Patients are advised to increase fiber gradually so as not to cause gas or bloating.
Doctors further recommend getting enough sleep and physical exercise in order to keep the
bowel regular.
Secondly, avoiding culprit foods can minimize symptoms. Fatty, fried or spicy foods are
typical culprits for aggravating IBS. Some patients and physicians suggest avoiding
traditionally gassy foods such as cabbage, beans, fructose, bran cereals and anything
high in gluten. Milk can trigger symptoms in lactose intolerant IBS patients. The only
way to pinpoint foods is to keep a daily diary of everything eaten in a two-week time
period. If a certain food seems to elicit a negative reaction in the digestive system,
simply eliminate that food from the diet. 
Third, medication commonly prescribed for patients with IBS includes antispasmodic or
anticholinergic medications. These are used to temporarily alleviate abdominal cramps.
Over-the-counter antidiarrheal drugs or laxatives should be used as infrequently as
possible and in small doses. Some physicians prescribe antidepressants to relieve pain
and improve motility of the digestive system.
The final recommendation of this article was to reduce stress. Doctors used to view IBS
as a disease that was "all in the head" of patients. Although many physicians realize the
legitimacy of the syndrome, it has been proven that stress can aggravate symptoms by
causing an anticipatory response. Many patients complain of anxiety and feeling a lack of
control in certain situations, which increases the probability of experiencing problems
with IBS symptoms on that particular occasion *8*.
Because of the lack of response from medical doctors and failure to be taken seriously,
many IBS sufferers have chosen to take a different route to healing-alternative therapy.
Various forms of this type of therapy include the use of herbs, vitamins and minerals,
yoga, aromatherapy, meditation, massage and acupuncture.
According to the April 2000 issue of GreatLife magazine, Australian researchers treated
116 IBS patients three times a day with the following herbs: Dang Shen, Huo Xiang and
Fang Feng. Improvement in these patients was confirmed by gastroenterologists (18).
Further herbs used in the management of IBS symptoms include milk thistle, licorice,
burdock root, red clover, alfalfa, aloe vera, skullcap, peppermint, valerian root, balm,
chamomile, ginger and pau d'arco.
Vitamins and minerals can be used to supplement the body to help heal the intestines and
lower the stress level in IBS patients. It is important to have extra B vitamins in the
body for proper muscle tone in the gastrointestinal tract, proper absorption of foods,
protein synthesis, and metabolism of carbohydrates and fats. Acidophilus is a necessary
nutrient to replenish the friendly bacteria and to aid in digestion and the manufacture
of B vitamins. Garlic is also used as a digestive aid and destroys toxins in the colon. A
major metabolic fuel for the intestinal cells, L-Glutamine maintains the absorption
surfaces of the gut. Calcium and magnesium supplements are also needed to help the
nervous stomach and the central nervous system.
Other than taking nutritional supplements, the use of relaxation techniques such as
breathing exercises, yoga, aromatherapy, meditation, massage and acupuncture can be
beneficial to the IBS patient. Because the digestive tract is highly sensitive to
emotional stress, anxiety about having an attack can aggravate your symptoms. Stress
management can help to alleviate and improve daily anxiety and pressures. Relaxation, 101
Essential Tips details the importance of practicing relaxation techniques.
Any physical exercise is helpful-a daily 20-minute walk helps to control stress levels,
calms the digestive tract and keeps the IBS from flaring up. Yoga is highly recommended
because it not only conditions muscles and connective tissue, but is also thought to
improve the functioning of internal organs, including those in the digestive tract.
Stretching and yoga are holistic therapies benefiting both the body and mind (20). 
Aromatherapy is becoming increasingly popular as a healing art and can be used in an oil
form in conjunction with massage. Aromatic essential oils are extracted from flowers,
herbs and resins (31). They are commonly found in perfumes, body lotions and candles.
Deep, slow, steady breathing relaxes and calms your mind and body. Toxic wastes are
expelled and emotional balance is restored (24). Meditation goes hand in hand with
breathing exercises. It enhances the clarity of consciousness by stilling the mind (25).
Some people choose to repeat a specific word or phrase as they meditate, for example,
"inner" as they inhale and "peace" as they exhale. Massage is one of the most beneficial
therapies for relaxation because it eases the pain and tension, bringing vitality to a
sluggish system and soothing and calming the overactive nervous system (28). 
Acupuncture is an ancient technique in which a skilled practitioner inserts hair-
thin needles into specific points on the body to prevent or treat illness. Practiced for
over 
2,500 years in China, where it originated, acupuncture is part of the holistic system of

traditional Chinese medicine (TCM), which views health as a constantly changing flow 
of energy, or qi (pronounced chee). Acupuncture helps regulate imbalances in this 
natural flow of energy, which result in disease *9*.
Anxiety plays a major role in Irritable Bowel Syndrome by exaggerating the symptoms and,
in some cases, actually causing the individual to trigger a reaction simply by
anticipating it. Lucinda Bassett, former IBS sufferer, wrote a book called From Panic to
Power and details the role anxiety played in her life. "I began avoiding situations where
I couldn't come and go as I pleased, situations where I couldn't be in control . . . it
was difficult for me to sit in class. I felt anxious, panicky, and trapped. I made all
kinds of excuses for my lack of social activity and my inability to travel with friends .
. . my world became smaller and smaller (Bassett xv)." She also states that IBS is an
anxiety-related problem common to many people with anxiety disorder and that by age
fourteen, everything in her life revolved around her fear of diarrhea. She was constantly
in a state of worry and felt uncomfortable in any situation where she couldn't run if
need be (Bassett 5). 
A recent guest of the Montel Williams show, Bassett is now cured of both her anxiety
disorder and her Irritable Bowel Syndrome. Her public appearance was one of the few times
the subject of IBS has been aired on national television. However, the month of April was
designated in the year 2000 as the first National IBS Awareness Month *8*. 
A celebrity IBS sufferer, Camille Grammer-wife of "Frasier" star, Kelsey Grammer-came
forth recently to speak about the disease on NBC's Today Show. According to Kelsey
Grammer, "You don't hear much about IBS because some of the symptoms involved relate to
subjects traditionally considered taboo by the public and the press . . ." The Grammers
are working with the International Foundation for Functional Gastrointestinal Disorders
(IFFGD) to raise awareness and educate the public about this condition and its effects.
Camille Grammer found out she has IBS nearly four years ago, but says, "As long as I can
remember, I've always had stomach and bowel problems and have never really known what to
do about it. I have been amazed to learn how so many women have been suffering in the
same way. I hope that my efforts to speak openly about my condition will encourage others
to do the same and get the help that they need."
The Grammers have been working with IFFGD to create and broadcast television and radio
public service announcements to educate the public through the media. Nancy J. Norton,
President and Founder of IFFGD, hopes this will inspire a national openness about IBS to
make it easier for patients to discuss the issue *10*. 
It's time for people with IBS to realize that there's light at the end of the tunnel.
They're not crazy. The symptoms aren't "all in their head". There may not medically be a
cause or a cure, but now there can be an understanding. Why some people feel the burden
of stress in their gut-and not, for instance, in their heart-can also be explained by the
close communication between the brain and the gut. When the big brain consciously
perceives a stressful situation, it calls on its fraternal twin through specialized mast
cells, embedded in the gut's lining. These mast cells secrete a chemical called
histamine, which activates the nerves controlling the gut, telling the muscles to
contract. Hence, the cramps and bathroom trips so often associated with bouts of stress
*11*.
Now that there's an understanding, hopefully physicians will open their eyes to potential
triggers and/or causes of Irritable Bowel Syndrome, such as gluten or wheat irritability,
lactose intolerance, candida albicans and intestinal fungus. Wheat or gluten allergies
are inherited from previous generations. These products can cause serious
gastrointestinal upset in a wheat or gluten sensitive individual *12*. When the person
eats milk products, symptoms such as gas, bloating and abdominal pain may occur *13*. 
Candida albicans can cause a variety of complications including digestive problems *14*.
These items are just a few examples of possible causes of Irritable Bowel Syndrome and
should researched in depth in order to be ruled out.
In conclusion, IBS is a legitimate and serious condition that deserves a lot more
attention than it has gotten in the past. Advances are being made in the pharmaceutical
area and patients are opening their eyes to the idea of alternative medicine. Many IBS
sufferers are choosing to take control of their health and learn as much as possible
about the disease. Where the medical profession lacks knowledge, perhaps the patient can
provide the breakthrough information needed to find a cause, and ultimately a cure, for
this debilitating disease. Most of all, having a celebrity spokesperson such as Camille
Grammer, will hopefully do for Irritable Bowel Syndrome what Montel Williams has done for
Multiple Sclerosis and Michael J. Fox has done for Parkinson's Disease-awareness is the
key to overcoming this major medical obstacle.
Bibliography
APPENDIX
Bassett, Lucinda. From Panic to Power. New York: Harper Collins Publishers, Inc., 
1995.
Chinese Herbs For IBS. Great Life Magazine. April 2000, 18. 
Lacroix, Nitya. Relaxation, 101 Essential Tips. London: Dorling Kindersley Limited, 
1998.
Salt, William B. Irritable Bowel Syndrome & the Mind-Body-Brain-Gut Connection. 
Columbus: Parkview Publishing, 1997.
Scanlon, Deralee. The Wellness Book of IBS. New York: St. Martin's Press, 1989.
Shimberg, Elaine F. Relief From IBS. New York: M. Evans and Company, Inc., 1988.
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