| Text Copyright 2007 by Nancy Sculerati MD - all rights reserved | ||
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Irritable bowel syndrome is not a disease - but a set of symptoms. Those symptoms are related to the large bowel, and to defecation - that is, to things that most people find embarrassing to at least some extent. Most of them have to do with feelings of excess gas or a very rapid transit time through the large bowel.
This syndrome is a clinical picture, that is: it's a set of symptoms and complaints - it's a recognizeable illness but the actual cause of this recognizeable set of symptoms and complaints is not defined. That means that many causes exist, and all patients who have the syndrome do not actually have the "same thing", but can suffer from widely different underlying problems that have similar mainifestations. That also means that there is not going to be one remedy that works in everybody who has this diagnosis. Further- it's a functional disorder. There is no abnormality on physical exams or laboratory tests that explain the symptoms. Many gastroenterologists and other physicians believe that functional disorders of the gut are not true abnormalities of the gut, but are due to abnormal responses by the patient.
It's classed as a "functional" bowel disorder. What doctors mean by that is that there is no physical correlate that goes along with the patient's symptoms and complaints. X-rays and bowel series done with radiologic dyes are normal, colonoscopy is normal - or shows the sorts of incidental findings expected in a percentage of people that do not explain the symptoms. At one time, all these tests needed to be done before the diagnosis was given. In other words, irritable bowel syndrome was a diagosis of exclusion, that was not properly given to any patient unless a full work-up including blood tests, x-rays and physical examination was done and every other possible cause of the set of symptoms was ruled- out. These kinds of so-called functional disorders are considered to be psychosomatic by many physicians. |
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| "Symptoms of irritable bowel syndrome (IBS), include constipation, diarrhea, or alternation between the two. Many practitioners use the “Rome II” criteria shown in the box, “Diagnostic Criteria for Irritable Bowel Syndrome,” to make the diagnosis of IBS. Irritable bowel syndrome is common and affects women twice as often as men.1 It is difficult to determine the true prevalence because many women with symptoms of IBS do not seek medical attention. An estimated 10–15% of adults in the United States have IBS; 12% of visits to primary care physicians and 28% of referrals to a gastroenterologist are for IBS.2 Irritable bowel syndrome is estimated to be responsible for the second highest degree of absenteeism from work (after the common cold)."[Aaronson MJ. Saltzman JR. Nygaard I. Abdominal pain, bloating, and urgency. Obstetrics & Gynecology. 105(4):889-92, 2005 Apr.] | ||
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Rome II Criteria for Diagnosis of IBS
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| A Holistic View by Dr. Sculerati | ||
| It's no wonder that people with irritable bowel syndrome are not prone to seek help for this disorder from their doctors. The whole area of "functional disorders" in medicine is a treachorous one, doctors have been traditionally educated to see these as having no firm basis in reality, and depending on individual practitioners, either dismiss the complaints as politely as possible as being delusional or hysterical, offer referral for psychiatric care, do intensive and aggresive work-ups to make sure that some "real" problem (like cancer) has not been over-looked, or offer sympathy without effective therapy.
And so, it's easy to understand why a given patient is not likely to pursue the problem once it's met with that kind of reaction. Interestingly, surveys have shown that -as compared to adults who do not have symptoms of IBS, those with such symptoms are generally more likely to seek medical care and to vist doctors, nurses, and health providers. The truth is that the symptoms of IBS have everything to do with transit time in the large colon, and how quickly food is propelled through the colon once it leaves the small intestine has everything to do with a complicated network of nervous impulses and hormonal influences that is regulated in ways we do not yet have down. It's also true that animal care experts are well aware that overcrowding and other stress conditions cause all kinds of large bowel problems in animals that are dramatic and not related to specific tumors, or infections - that are also "functional", and yet presumeably, as they affect rats, chinchillas and horses among other species, do not depend on a complicated psyche. Instead, the motility of the gut is set in a general way by the aitonomic nervous system which is quite sensitive to stress, and severe stress reactions include such things as |
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