$Unique_ID{BRK01654} $Pretitle{} $Title{Emotional Factors of Irritable Bowel Syndrome} $Subject{irritable bowel syndrome stress Digestive System Mental Emotional Conditions diarrhea constipation psychological IBS Nervousness indigestion falling asleep bloated colon x-rays endoscopy intestinal stool neuromuscular fiber antidepressants depression analgesics bowels stresses Digestion Condition constipated sleep sleeping x-ray endoscopies endoscope intestine intestines stools endoscopes IBD} $Volume{I-23, E-12} $Log{ Causes of Irritable Bowel Syndrome*0008401.scf Diagnosis of Irritable Bowel Syndrome*0008402.scf Controlling Irritable Bowel Syndrome*0008403.scf} Copyright (c) 1991-92,1993 Tribune Media Services, Inc. Emotional Factors of Irritable Bowel Syndrome ------------------------------------------------------------------------------ QUESTION: With a diagnosed case of irritable bowel syndrome, I know I have many mental hang ups. I would like to know how my doctor figures out my "mental" symptoms from possible physical problems. ------------------------------------------------------------------------------ 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 symptom patterns can change or new symptoms occur, and there is always the possibility that some new physical problem has developed. ---------------- 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.