Dear Dr. Garner:

I am very embarrassed by a medical problem I have. Every time I eat, I develop the most severe pains in my stomach area. Also, I either have the immediate urge to have a bowel movement or am totally constipated. Sometimes I can have 10 bowel movements in a day, other times I can go a week without one. It really hampers my social life, and I have called in sick to work several times. I am 20 years old, and my mother is insisting I go to a doctor. Which doctor should I go to? A friend of mine said it might be Irritable Bowel Syndrome, could you please tell me a little about this condition?

Irritable Bowel in Irritable Female in Flushing

Dear Irritable Bowel,
I am very sorry for your problem and would guess that many of our readers experience similar problems. Irritable bowel syndrome actually affects about 60 million Americans, of which 80% are women. What is troubling is that only about 30% actually receive medical attention for it. This is because most are too embarrassed to even talk with their doctor, or assume it is because of nerves.
Irritable bowel syndrome or IBS is a problem that affects the bowel (large intestine). The bowel is the part of the digestive system that makes and stores stool.

The symptoms associated with the syndrome are cramping, bloating, gas, diarrhea and constipation. In spite of all these problems, the bowel itself looks entirely normal. It is just that it does not work well. There is some defect in communication between the brain and the bowel, and as a result, one experiences spasms and ineffective digestion.

While stress can aggravate the condition, emotional issues will not cause a person to develop IBS. Other things that can trigger symptoms include food, exercise, and female hormones. In particular, foods that can cause symptoms include milk products, chocolate, alcohol, caffeine, carbonated drinks and fatty foods. In some cases, simply eating a large meal will trigger symptoms. A woman with IBS often has more symptoms during her menstrual period.

The doctor you should see is your family doctor, or a gastroenterologist, a doctor who specializes in diseases of digestion and the intestines.

You will have a physical exam, blood tests and X-rays and possibly a colonoscopy. If all of these are normal, and your symptoms persist for more than 12 weeks a year, then the diagnosis of IBS will be made.

There is no magic cure for IBS, but the following will help lessen the symptoms:

1.  Diet change
2. Medications to control diarrhea and constipation
3. Stress relief such as behavioral therapy or yoga
4. Medications for spasms

There are herbal remedies, such as peppermint oil, which have been shown to be very helpful. There may be adverse side effects, so it is important to discuss with your doctor before starting.

I recommend that my patients keep a diary of their food intake. They record any digestive issues associated with food. It is this way that someone can determine what the offending foods are. It takes painstaking detective work but can be very rewarding.

 Some new treatments have recently been introduced:

• Biofeedback has been shown to be better for relieving constipation than medication.

• While one drug was recently withdrawn by the FDA (Zelnorm) because of increased heart attacks, a new drug, Renzapride will be available shortly. This may give relief to up to 70% of patients.

What is the outlook and prognosis for someone with IBS?

• IBS does not lead to cancer or shorten life.

• It severely affects quality of life with many suffers unable to leave the house.

• There is severe pain associated with it.

• There is also depression, muscle aches and fatigue associated with it.

The cause is unknown, but scientists may be close to an answer. It seems there is a shortage of a chemical that affects the way the brain communicates with the bowels. It is the same chemical (serotonin) that is responsible for depression. This may well explain the link between depression and IBS.

The key is to see your doctor as soon as possible to verify the diagnosis and make sure there are no other serious diseases present. If it is IBS, you can be helped and with proper treatment lead a normal, full, productive life.

I thank you for bringing this issue to the attention of our readers and please stay in touch.

Next week we hear from a reader who wants to know about advances in treatment for diabetes.

Dr. Steven Garner, MD, is affiliated with New York Methodist Hospital in Park Slope. He is a Fidelis Care provider and the host of the popular call-in cable TV show “Ask the Doctor” seen on The Prayer Channel.