“Indigestion, that conscience of every bad stomach,
Shall relentlessly gnaw and pursue him with some ache.”

-- E.R. Bulwer-Lytton
(1831–91), English poet
“The Dinner Hour”

"Irritable -- capable of being irritated: as a: easily exasperated or excited b: responsive to stimuli” (in Merriam-Webster’s Collegiate Dictionary). We’d rather not say it but most of us steer clear from irritable people. It’s the natural thing to do. Like “loud and aggressive persons,” irritable people are “vexations to the spirit.” The Desiderata tells us to avoid them. But what if our own gut is irritable? How do we deal with that?

Irritable bowel syndrome. This complex disorder of the lower intestinal tract, also known as IBS was recognized as long ago as 1943. It makes sense, doesn’t it, that bloating, abdominal cramping, constipation, and diarrhea worsened by emotional stress was discovered in the middle of a World War. Well, it’s still around but few people want to discuss it openly like a cough or a cold or a sprain.

But if we are assaulted by TV ads on “menstrual odor” heck, we can talk about this too.

Causes. Normally, the efficient transit of ingested food from stomach to rectum in our intestines will put any factory conveyor to shame. A coordinated rhythm of intestinal muscular contraction and relaxation moves material south. In IBS, these contractions are stronger and longer for some reason.

Food passes through in fast-forward causing gas and bloating, diarrhea and mucus in the stool.

Sometimes, food passage is slower than normal and fecal matter becomes hard and dry, resulting in constipation. Women are two to three times more affected than men, and they complain around the time of menstruation. So some investigators believe a hormonal factor is involved in IBS. Others think that there are abnormal changes in the nerves controlling intestinal muscle contractions. IBS can also be caused by abuse of laxatives, anti-diarrheal drugs, and antibiotics that alter the normal flora of the gut.

Signs and Symptoms. Irritable bowel syndrome usually presents as

• bloating

• gas (frequent passage of)

• abdominal cramping or pain – after meals and relieved by bowel movement

• diarrhea or constipation

• mucus in the stool

• emotional distress

• depression

Diagnosis. The difficulty of IBS lies in interpreting beyond normal tests. A good doctor will base his diagnosis of IBS on, fittingly, gut feel after a complete history and physical examination. Remember that at the back of the doctor’s mind, he or she may be thinking of the worst: colorectal cancer, inflammatory and infectious diseases of the gut. That is why the doctor may want a colonoscopy done. In this exam, a flexible, fiberoptic tube is inserted retrograde (from your butt, dude) to look for abnormalities.

Treatment and prevention. In many cases, patients respond to symptomatic treatment. Psyllium or methylcellulose supplements add fiber to the diet and works in constipation. Anti-diarrheal drugs like loperamide can be bought over-the-counter for watery stools. For painful bowel spasms, the doctor can prescribe anti-cholinergic drugs.

Since IBS is associated with emotional distress, patients cope by meditation, regular exercise, massage, and counseling. The goal is to reduce stress and save the gut from further aggravation. Let’s put it this way – we react to stress in many ways. Some get headaches, some spasms of the neck and shoulders. Some deal with stress by overeating and God forbid, overshopping. IBS patients face stress by getting diarrhea and cramping.

Some say that if you can’t keep away from irritable people, try to understand them and find out why they are the way they are. It’s just as true with IBS. In fact, learning as much as you can about IBS - what triggers the symptoms for example — is a way of taking charge. “Befriending” the irritable gut may be the only true solution just as making the irritable an ally the only lasting strategy.

Dr Pujalte is an orthopedic surgeon. e-mail jspujalte@yahoo.com
webpage http://www.orthopedicspujalte.com