$Unique_ID{BRK01654}
$Pretitle{Digestive System, Mental and Emotional Conditions}
$Title{Emotional Factors of Irritable Bowel Syndrome}
$Subject{irritable bowel stress}
$Volume{I-23, I-12, E-23, E-12}
$Log{
Steps to control IBS*0008403.scf}

Copyright (c) 1991   Tribune Media Services, Inc.


Emotional Factors of Irritable Bowel Syndrome


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QUESTION:  With a diagnosed case of irritable bowel syndrome, I know I have
many mental hangups.  I would like to know how my doctor figures out my
"mental" symptoms from possible physical problems.

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ANSWER:  Emotional factors seem to play a major role in patients suffering
from the bowel stress of alternating diarrhea and constipation associated with
irritable bowel syndrome.  Therefore, physicians must explore psychological
factors in an attempt to differentiate between patients with organic disease
and those with IBS.  This is not always easy to accomplish because many
symptoms are common to both disorders, but physicians can attempt to rule out
organic problems in a number of ways.
     To begin with, patients with organic diseases are more likely to have
localized tenderness, whereas IBS patients have more generalized pain that
often seems to be out of proportion to more objective findings.  Therefore, in
initial consultations, the physician should ask the patient detailed questions
concerning his discomforts.  Since IBS patients tend to be more vague and
obscure about their symptoms, the more specific the answers, the more likely
the patient is to have an organic disorder.
     Furthermore, IBS patients frequently experience a greater number of
symptoms than organic ones.  Nervousness, indigestion, difficulty in falling
asleep, and a bloated feeling, even after passing stools, are common
complaints.  By comparison, only a small number of patients with organic
disease report such symptoms.
     Once organic disease is ruled out through these measures and through
laboratory tests such as colon x-rays and endoscopy, a positive diagnosis for
IBS can be made and physicians can begin treatment.  Some patients exhibit a
rapid intestinal passage of food, associated with diarrhea, and others exhibit
a slow passage, usually associated with constipation.  Since abnormalities in
passage time may be a symptom of IBS, physicians can investigate this
possibility by giving the patient a whole-kernel corn or a nonabsorbable dye
capsule and note how long it takes to appear in the stool.  Normal transit
time is 48 to 72 hours.  If the corn or dye appear in less than 36 or more
than 72 hours, problems in the function of the neuromuscular system of the GI
tract is the probable cause.
     The first step in treatment is to increase fiber intake with whole cereal
grains and more fruit and vegetables.  IBS patients frequently consume only
half the suggested daily fiber amounts, and when a patient increases fiber
intake, the symptoms often subside.  Fiber dosage should be adjusted to return
bowel function to the patient's normal pattern.
     Low-dose antidepressants are commonly prescribed for IBS patients who are
experiencing depression.  For pain sensitivity, analgesics may offer relief,
though prolonged use will increase spasms and pain.
     If none of these therapies provide sufficient improvement, stress and
psychological factors must be examined.  Most IBS patients are insulted by the
suggestion that they require psychological counseling, (though your attitude
is a good one) but in many cases it proves necessary for helping the patient
understand their problem.  However, periodic examination and testing for
organic disease should still be continued from time to time, since symptoms
patterns can change or new symptoms occur, and there is always the possibility
that some new physical problem has developed.
ÿ
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The material contained here is "FOR INFORMATION ONLY" and should not replace 
the counsel and advice of your personal physician.  Promptly consulting your 
doctor is the best path to a quick and successful resolution of any medical 
problem.
