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Women's Health

My Aching Tummy The pain, the cramps, the bloating. By Dr. Lisa Karamardian Published: January, 2003

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Frequently, visits to my gynecologist office involve complaints of crampy, lower abdominal (stomach) pain. Women generally assume that lower abdominal pain is a sign of some pelvic problem, but often further questioning and a negative gynecologic exam leads to the diagnosis of a common digestive problem - irritable bowel syndrome (IBS). Through the years, IBS has been called by many names - colitis, spastic colon and functional bowel disease. Whatever the name, IBS is a common disorder of the intestines that leads to crampy pain, gassiness, bloating and changes in bowel habits. IBS is a chronic disease whose course is extremely variable in the general population. Some people with IBS suffer from constipation, some suffer from diarrhea, and others experience both symptoms. It is estimated that only 10 percent of people with IBS seek medical care for evaluation or treatment of their symptoms. Nevertheless, IBS accounts for 3.5 million doctor visits in the United States annually, and it is the most common diagnosis for gastroenterologists, accounting for about 25 percent of all patient visits. Interestingly, women with IBS are four times as likely to present to their doctors than men are with the same problem. IBS is a significant problem because patients with IBS have increased absenteeism from work, more doctor visits for both IBS-related and unrelated complaints, and they unfortunately report a reduced quality of life. How do you know if you have this common disorder? First of all, it is important to realize that normal bowel function varies from person to person with regard to frequency. A normal movement, however, is one that is formed but not hard, contains no blood and is passed without cramps or pain. When a person has IBS, ordinary events such as eating or a mild buildup of gas can cause the colon to overreact and have spasms. Sometimes the spasms delay the passage of stool, leading to constipation; in other cases, they cause diarrhea. In some people the symptoms can alternate. Additional effects of these spasms can include cramping, bloating and excessive gas. IBS is a disease that can be diagnosed positively on the basis of identifying an established series of criteria and then excluding any organic disease. Your doctor needs to take a complete medical history that includes a careful description of symptoms. Stool samples and laboratory tests help to make the diagnosis. Rectal bleeding, anemia and a high erythyrocyte sedimentation rate are significant "red flags" that you are suffering from a problem other than IBS. Fever, weight loss and persistent pain also may indicate other more serious problems for which you need to consult your physician. What causes IBS? Doctors are not sure. In regular fashion, the colon contracts between the small intestine and the rectum to control bowel movements. These contractions of the colon are controlled by several factors, which include nerves, hormones and electrical activity in the colon muscle. Whatever the cause, people with IBS seem to have a colon that is more sensitive and reactive than usual, so it responds excessively to stimuli that may not bother another person. IBS is sometimes called a functional disorder because there is no sign of disease when the colon is examined. Diet and emotional stress are triggers to cause IBS symptoms. Certain medicines and foods may trigger spasms in some people. Caffeine, chocolate, milk products and alcohol are frequent offenders. Research also shows that women with IBS have more symptoms during their menstrual cycles, suggesting that hormones can increase IBS symptoms. The colon is controlled partly by the nervous system, therefore stress can affect colon function. Stress reduction can improve IBS symptoms, but this does not mean that IBS is the result of a psychological disorder. It is a disorder of colon motility. Just as the symptoms of IBS can vary from patient to patient, the treatment for IBS also varies. Symptomatic treatment includes fiber for constipation, loperamide for diarrhea and low-dose antidepressants or infrequent use of antispasmodics for pain. Eating a high-fiber diet often helps to decrease IBS symptoms. Many people who have IBS find that high-fat meals cause more symptoms than do low-fat ones. This is because fat of any kind causes colonic contractions. If you have IBS, it would be wise to limit red meats, poultry skin, whole milk, cream cheese, butter, oils, fried foods, avocados and whipped toppings. Exciting news is out there for women suffering from IBS with constipation as their main bowel problem. Novartis has come out with a new drug called Zelnorm. Zelnorm is a short-term treatment specifically for women (it has not been shown to work in men with IBS). Zelnorm increases the movement of stools through the bowels. Just like all IBS therapies, it does not cure IBS, but for those who are helped, Zelnorm reduces pain and discomfort in the abdominal area, bloating and constipation. Contact your doctor. If the description in this article fits you, do not be distressed about this chronic intestinal problem. Most people with IBS are able to control their symptoms through medications prescribed by their physicians, diet, and stress management. Dr. Lisa M. Karamardian is a board-certified OB/GYN and Fellow of the American College of Obstetricians and Gynecologists. She can be reached at 949.644.2722.

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