Irritable bowel syndrome

Doctor : Good morning. Well, following the symptoms that you described during our previous meeting, namely abdominal pain and altered bowel habits, and according to lab results and in the absence of a specific and unique organic pathology, you seem to suffer from a functional gastrointestinal disorder.

Patient : Sorry, I don’t understand what it is exactly. Can you be more specific ?

Doctor : It’s what we call the irritable bowel syndrome (IBS). It is characterized by alternation of constipation and urgent diarrhea, as well as frequent and diffuse abdominal pain which can be sometimes sharp and often superimposed by more constant, dull ache.

Patient : Oh, and furthermore, I sometimes seem to undergo episodes of dyspepsia, heart burn, nausea, vomiting… I constantly feel stressed.

Doctor : This, unfortunately, goes along the IBS symptoms, together with weight loss and rectal bleeding.

Patient : But can anything be done about that ?

Doctor : We first and foremost think of dietary measures that may include fiber supplementation to improve the symptoms of constipation and diarrhea and flatulence; judicious water intake if you predominantly experience constipation; caffeine avoidance to limit anxiety and symptom exacerbation; legume avoidance to decrease abdominal bloating; lactose and fructose limitation to avoid diarrhea; and the intake of probiotics to favor the intestinal flora.

Patient : And therefore this should relieve the symptoms all together !

Doctor : Yes, but you should also avoid spicy and fried food. And in all cases food should be well chewed to decrease stress on the intestines.

Patient : Apart from diet therapy, can anything be done to heal this illness ?

Doctor : Unfortunately, the IBS cannot be healed, but symptoms can be relieved. In this sense, we might also think of cognitive-behavioral therapy, but also drugs for the management of symptoms, which may include anticholinergics, antidiarrheals, tricyclic antidepressants, serotonin receptor antagonists and antispasmodics. However, we may also recommend some iron supplement to compensate for the associated anemia.

Patient : What’s the cognitive-behavioral therapy ?

Doctor : It’s a psychological therapy that aims at improving daily life quality. Evidence also supports the improvement in gastrointestinal symptoms in either relaxation or hypnotherapy, or even the use of antidepressants, in small doses, to increase the level of serotonin in some cases. And in patients who were recently diagnosed with IBS, frequent visits with the clinician enhance the patient-provider relationship for the understanding and management of this condition. The visits can become less frequent as patients are educated and reassured.

Patient : Thank you for all these explanations. But I still feel a bit lost…

Doctor : Don’t worry. Bit by bit you’ll learn to manage your symptoms and get round them.