Irritable Bowel Syndrome

I’ll never forget when a patient told me that as a child, her doctor had “diagnosed” her with a “nervous stomach”.  She had been struggling with digestive complaints since she was 6 or 7 years old.  The symptoms included abdominal pain, indigestion, bloating, and alternating constipation and diarrhea.  After many years, she decided she wanted a second opinion on what was wrong.  Good for her.  She consulted with another doctor over a decade later and that doctor stated (according to the patient) “you don’t have a nervous stomach, you have an irritable bowel”.  Phew, problem solved.  “Irritable Bowel Syndrome” was the new finding.  OK, now what?  (I honestly don’t know, because she moved out of town very shortly after she came to see me.)  OK, so what does a doctor (and patient) do now that the sun is shining on what the problem “really” is?

My point here is that changing the diagnosis from “nervous stomach” to “irritable bowel syndrome” (IBS) does very little to help.  Please don’t get me wrong, I am not against the use of diagnosing conditions.  It can be (and often is) quite necessary to name a condition.  For example: stroke, appendicitis, aneurysm, myocardial infarction (heart attack), pneumonia, Lyme disease, and many, many others.  That’s because they need emergency medical help or have specific necessary treatments at the onset.  The problem arises when we lump symptoms together and don’t attempt to figure out the process.  Why don’t we diagnose the process and NOT the symptoms.  Even by definition, medical physicians call IBS a “functional digestive disorder”.  So why not thoroughly evaluate their digestive function with what we know (and are even taught in medical textbooks) about digestion.  You’ll soon see that we will be much better off by thinking in those terms.  I’m not a big fan of the approach that says: let’s name it; then we can have a tailored treatment regimen or medication for it.  If you really want to name it, that’s fine, but it’s time to stop treating symptoms (and this goes for much more than IBS).

Before I go further, I’d like to make it cleat that I do NOT diagnose “irritable bowel syndrome”.  For one, I don’t find it of any help, and two, my license does not allow me to.  However, I find I’m better off that way.  Because I’m more concerned with the question of “Why?”, than “What?”.  The symptoms are a good guide, but you can’t stop there by simply throwing a name at them.  Especially in a condition like IBS, where very often the patients have similar symptoms with a different cause.

Again, I do NOT treat IBS, nor do I treat bowels, and I especially don’t treat irritable bowels!  I treat PEOPLE!  And people have debilitating symptoms that can be helped when you start with the questions: “Why are the symptoms there?”, and “How do we get rid of them?”.  That is: “What processes are malfunctioning, and how can we return them to balance in the most efficient way possible?”

Let’s move forward.  I won’t bore with the technical diagnostic criteria.  They are called the Rome III criteria, and can be found on the the foundation’s website by clicking here if you are interested.

OK, let’s talk about some of the symptoms of IBS to start off.  Essentially, they include abdominal pain, bloating and discomfort (not necessarily outright pain).  Additionally, some people have constipation, diarrhea, or alternate between the two.  These symptoms may subside for a few months, or they may worsen over time.

Researcher have not pinned down a specific cause for IBS.  Remember, a syndrome is simply a grouping together of objective signs and subjective symptoms.

Let’s move on to the conventional treatments.  By the way, some of the above information was derived from The National Digestive Disease Information Clearing House (NDDIC).  The NDDIC has this to say about treating IBS: “Medications are an important part of relieving symptoms. Your doctor may suggest fiber supplements or laxatives for constipation or medicines to decrease diarrhea, such as Lomotil or loperamide (Imodium). An antispasmodic is commonly prescribed, which helps to control colon muscle spasms and reduce abdominal pain. Antidepressants may relieve some symptoms. However, both antispasmodics and antidepressants can worsen constipation, so some doctors will also prescribe medications that relax muscles in the bladder and intestines, such as Donnapine and Librax. These medications contain a mild sedative, which can be habit forming, so they need to be used under the guidance of a physician.”

“A medication available specifically to treat IBS is alosetron hydrochloride (Lotronex). Lotronex has been reapproved with significant restrictions by the U.S. Food and Drug Administration (FDA) for women with severe IBS who have not responded to conventional therapy and whose primary symptom is diarrhea. However, even in these patients, Lotronex should be used with great caution because it can have serious side effects such as severe constipation or decreased blood flow to the colon.”

“With any medication, even over-the-counter medications such as laxatives and fiber supplements, it is important to follow your doctor’s instructions. Some people report a worsening in abdominal bloating and gas from increased fiber intake, and laxatives can be habit forming if they are used too frequently.”

“Medications affect people differently, and no one medication or combination of medications will work for everyone with IBS. You will need to work with your doctor to find the best combination of medicine, diet, counseling, and support to control your symptoms.”

They also speak a lot about how changing one’s diet and stress management can have help relieve the symptoms, which I think is of prime importance.  Please see their site by clicking on the link above, if you are interested in more of what they have to say.

OK, here is my approach with patients who complain of symptoms that are similar to IBS. Again, I do NOT treat IBS, I treat people.

First things first! I always start with a thorough history from the patient.  And from there, I will check all of the following.

1 – I’ll check for cervical, thoracic, lumbar, pelvic, extremity, rib, cranial, and TMJ “misalignments”.  Remember, your nervous system function determines your involuntary functions (along with your endocrine/hormonal system).  If we can get the joints functioning and moving properly, we can help get the nervous system to function properly.

2 – Then I look to where digestion begins (in the mouth), by checking the pH (acid or alkalinity) of the saliva.  Digestion really begins when you think about and look at the food you are going to eat – let’s leave that aside.

3- I look to stomach function for an excessive or decreased (most common) amount of “stomach” (or hydrochloric) acid.

4 – Next, we move on to the small and large intestines (I don’t combine them, but for simplicity I will right now).  A problem in these organs typically results from lack of digestive enzymes (could really a pancreas or stomach problem), malabsorption; an overgrowth of yeast, fungus, mold, bacteria, viruses, pollens, parasites, and/or protozoa; chemicals (environmental, food additives, etc.) and toxic metals.  Keep in mind that any of the above can reside anywhere in the digestive tract.

5 – Food intolerances

6 – Eating habits

7 – Stress and/or emotional factors

8 – Additionally the liver, gallbladder, thyroid, adrenal, pancreas, and other organs and glands can play a role – (anything can cause anything).  Typically I will assess these through the correlations between muscles and organs/glands, the acupuncture system, and laboratory analysis – i.e.: blood, urine, saliva, etc..

9 – Also, I’ll look to identify nutritional deficiencies related to the above issues.

I hope this helps to get you thinking!

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology