RON STUBBS 

This article was written by one of my Advanced Clinical Hypnotherapy students.

This article is an introduction to Irritable Bowel Syndrome. This is the first in a series of articles on IBS, and deals with Symptoms, Triggers and Diagnosis.

Irritable Bowel Syndrome - What is it, What causes it?

What would your life be like, if you knew that the next time you climbed on an Airplane, attended an important meeting, or were stuck in traffic, that you would need to find a rest room, RIGHT THEN! How about the worry of ruining another set of clothes was so strong, part of your daily coping mechanism was to carry a spare set everywhere you went. How about living with intense abdominal pain, and you have an inability to get rid of this pain due to constipation? This describes the every day lives and decisions of 20% (Estimates are in the range of 10 – 30%) of people living in the US, and around the world. To put that in perspective, if you are in a room of more than 5 people, someone in your presence could be suffering right now.

IBS or Irritable Bowel Syndrome is a chronic condition which effects over an estimated 58 million people in the US alone. Estimates range because many people suffering with IBS go undiagnosed. IBS is known by many names, such as Spastic Colin, Spastic Bowel, Colitis, Mucous Colitis, Functional Bowel Disease and Nervous Stomach. IBS is characterized by cramps, pain, gassiness, bloating and changes in bowel habits. It is also characterized by abdominal pain, constipation and/or diarrhea. Abdominal pain is relieved by having a bowel movement. Some people report mucus in stool, and alternating patterns of Diarrhea and constipation. The Rome II criterion for diagnosis of IBS is Abdominal Pain, and the pain is associated with altered bowel movement.

In order to understand what happens with IBS, we must first understand the basics of how the digestive system works. The digestive system starts in the mouth, where food is broken down by chewing. Saliva moistens food, and also contains enzymes which start the process of breaking down fats and starches. Swallowing pushes food into the Esophagus, which then continues pushing the food down into the stomach. Once in the stomach, the food is stored, churned and broken down. Pepsin, an enzyme that helps digest protein is released. Hydrochloric acid, kills bacteria in the food, and breaks the food down into a substance called chyme. Mucus is also released by the stomach to protect the lining from acid burns. Once the food has been broken down, the chyme slowly enters the first part of the small intestine, called the duodenum. The small intestine absorbs all of the essential nutrients into the bloodstream. This is where problems with irritable bowel are thought to begin. Fat cells are not easily absorbed, so the liver produces bile, which is stored in the gallbladder. The bile, divides fats into smaller particles which can be suspended in water, so they can be absorbed. In certain susceptible people, this bile enters the digestive track and causes diarrhea. In addition to bile, enzymes are also released into the small intestines by the pancreas. These enzymes break down the chyme into simple sugars, amino acids and fatty acids. All left over material, is passed into the large intestine, or colon. The colons extract water and salt from this material, and compacts it for elimination. The material moves through the colon into the lowest part of the colon, called the sigmoid colon, where pressure is put on the rectum and causes the urge to move your bowels. In healthy people this usually happens 1 – 3 times per day.

It is said that every person has 2 brains, the 1 in their head, and the one in there gut. According to Dr. Michael D. Gershon, author of the Second Brain, and chairman of the Department of Anatomy and Cell Biology at Columbia University College of Physicians and Surgeons, the Enteric Nervous system is similar in structure and neurochemically to the brain. Basically, the ENS system is a brain. This network of neurons allows this system (ENS) to function many of its tasks, even in the absence of the Central Nervous System. When antidepressant therapy was in its early stages, 25% of patients receiving therapy reported diarrhea or nausea. In longer higher dosages, or longer duration, constipation occurs. This is because all neurotransmitters and neuromodulators located in the brain are almost always present in the bowel. This knowledge of these reactions may be utilized in the future to help sufferers of functional bowel disorders.

Doctors and researchers are still unsure as to what causes IBS suffers to have functional difficulty, but the “Brain/Gut” connection is becoming clearer. This connection is demonstrated by one of the main triggers of IBS, stress. While the connection of the mind and gut has been unconfirmed, findings in studies of a drug called Lotronex are substantiating that belief. During a three week study of this drug, patients were given a procedure where the rectum and sigmoid colon are inflated. During this procedure, patients underwent brain scans to assess blood flow to the limbic motor system and pain processing regions of the brain. When compared to a placebo, IBS symptoms were improved, and there was reduced blood flow to the brains limbic motor system. Emeran A. Mayer, MD, professor of medicine and physiology at the UCLA School of Medicine, says that Lotronex may regulate activity in limbic brain regions. This is in addition to the effect it has on the ENS which can be overactive in some IBS patients. In other words, the drug made the regions of the brain that trigger pain responses less sensitive.

Sufferers of IBS, have often been told that the symptoms are all in there heads. There are told to “Get over it”, or “Don’t worry about it.” What most non-sufferers don’t understand is that while IBS can be triggered by stress and anxiety, it is not necessarily a large amount of this anxiety. Small triggers, that everyone experiences, seem to trigger very strong, very real symptoms. There are 2 significant differences between “Healthy People” and people who suffer with IBS. IBS sufferers have abnormal pain perception (Visceral (Gut) Sensitivity) and different motility.

Every person’s pain processing varies. In IBS sufferers, it appears that normal contractions in the GI tract can be perceived as painful. Studies have shown that in the prefrontal cortex of the brain, where visceral (gut) stimulus is processed, have distinct differences between normal individuals and individuals with IBS. All pain is caused by electrical activity in the brain, so these scans prove that the pain of IBS is just as real as the pain of hitting your thumb with a hammer. A study was done in 1987, by scientists Cook, van Eeden and Colins, to determine if IBS sufferers were oversensitive to pain in general. The studies showed the opposite, showing that IBS sufferers actually have a higher threshold to pain in other parts of their bodies, than non sufferers.

Motility is the speed of movement of the GI muscles. Difficulties in motility appear to start in the small intestine, and continue through the system. There are 2 types of contractions in the UI system, “Segmental Contractions” which mix and churn intestinal contents and “Propulsive Contractions” which propel the contents forward. If segmental contractions are exaggerated, sufferers experience bloating and cramps, and forward motion is slowed causing hard stools and constipation. Exaggerated propulsive contractions cause material to move forward quickly, before stools can harden causing diarrhea and urgency to find a restroom.

Irritable Bowel Syndrome is a functional bowel disease, which means it is a disorder not caused by structural, inflammatory, infection or other obvious physical problem. What this means is that, at least until recently, diagnosis is made by eliminating other possibilities. There are some disagreements among members of the community how much testing should be done. But generally diagnosis will depend on individual symptoms. Some patient’s symptoms match the Rome II criteria and have obvious triggers, others symptoms and triggers vary. Diagnosis will most likely start with a blood test to look for iron deficiency, and a stool test to check for blood in the stool. Some patients, with upper abdominal pain, may have X-Rays to rule out ulcers. Still other patients may require a colonoscopy to rule out colon cancer, or a Sigmoidoscopy to rule out structural or infectious disease. Patients should pick a physician who they trust, and is thorough in their investigation, both in diagnostic techniques and in case history.

While IBS has different triggers for different people, there do appear to be some consistencies. Mental state, both stress and depression and diet triggers appear to be the most common. There is also an indication that hormones during a woman’s menstrual cycle can be related. In the US, women seek treatment for IBS two to three times as often as men.

Stress causing physical issues, is interesting because physical issues can cause stress. This is true of depression as well. It is common for patients suffering from IBS, also suffer from depression. The difficult question here is which came first, and a cycle can occur, where the physical symptom feeds off the depression and the depression feeds of the physical symptom. Issues of stress and depression definitely need to be addressed in order to live with the symptoms of IBS.

Food can also be a large trigger of IBS symptoms. Different food causes different reactions, but once again, there are some consistencies. One of the largest food triggers is not food, but the way it is eaten. In today’s high paced world, food is often eaten on the run, without time for the body to process the food. Stimulants like caffeine tend to speed up contractions in the colon, and this can contribute to diarrhea. Others depend on this stimulant to help with constipation. Dairy is another regular contributor to IBS symptoms, due to lactose intolerance. Meals high in fat, sugar or with excessive protein can also contribute.

Now that you understand what IBS is, how it is diagnosed, and some of the triggers that cause it, you can begin to have an understanding of what is going on with your body, or the body of someone you know or love. In future articles, we will investigate the triggers in more detail, and some of the ways suffers of Irritable Bowel Syndrome can begin to live a normal life.

*Disclaimer: This article is for informational purposes only. It is not to be used for medical care. If you have a specific concern, please contact your medical professional.

References United States National Institute of Diabetes, Digestive & Kidney Diseases of the National Institutes of Health.. Irritable Bowel Syndrome (chap.) Retrieved February 8, 2003, from http://www.niddk.nih.gov/health/digest/pubs/irrbowel/irrbowel.htm

Bolen, B., Ph.D. (2000). Breaking the Bonds of Irritable Bowel Syndrome: Vol. . A psycological approach to regaining control of your life. 5674 Shattuck Avenue, Oakland, CA 94609: New Harbinger Publications, Inc.

Gershon, M. D. (1999). The Enteric Nervous System: A Second Brain. Hospital Practice. Retrieved February 8, 2003, from http://www.hosppract.com/issues/1999/07/gershon.htm

Guillory, G., MD. (2001). IBS: A Doctor's Plan for Chronic Digestive Troubles: Vol. . IBS: A Doctor's Plan for Chronic Digestive Troubles (3rd. ed.) P.O. Box 147, Point Roberts, Wa.: Hartley & Marks Publishers Inc. (Original work published 1991)

O'Hare, L. (2001). The Irritable Bowel Syndrome Sourcebook. Two Penn Plaza, New York, NY, 10121-2298: McGraw-Hill.

Van Vorous, H. (2001). The First Year - (IBS Irritable Bowel Syndrome): An Essential Guide to the Newly Diagnosed. 161 William St., 16th Floor, New York, NY, 10038: Marlowe & Company.

Willocks, J. (2002). Studies Uncover Mind-Gut Connection in Irritable Bowel Syndrome (IBS), Assess Marijuana_s Possible Effect on Gastroesophageal Reflux Disease (GERD) [News Release]. Gastroenterology. Retrieved from http://www.gastro.org/public/media/newsreleases/ibs-Oct02.html

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