Issue link: http://viewer.e-digitaledition.com/i/915948
BS The symptoms of irritable bowel syndrome (IBS) may be uncomfortable to discuss, but for many of the people they affect, living with them in silence can be even more distressing. AVA, A 33-YEAR-OLD ATTORNEY, tells her older sister, Carrie, almost everything, but for the past four months, she has been keeping a secret: All is not right with her health. Ava is living with abdominal cramps and diarrhea that will not go away. Whenever she enjoys a period of relief and thinks the issue has cleared up, it returns with a vengeance. The effects of Ava's symptoms on her life are profound. Before client meetings, she becomes anxious that an emergency might force her to excuse herself and hurry out. Plans with friends are sources of anxiety instead of pleasant anticipation, as she knows she will spend much of the time wondering about the location of the nearest bathroom. Lately, she has avoided social gatherings entirely. Her anxiety creates a self-fulfilling prophecy and makes her symptoms worse. After a visit to her doctor, Ava finally learns what has been turning her life upside down: IBS— which means a change in normal bowel movements in the form of diarrhea, constipation or both, accompanied by abdominal pain. A PROBLEM OF FUNCTION, NOT FORM For many people, IBS is both familiar and mysterious: They have heard the term but know little about the condition itself. One of the most common misconceptions about IBS is that it is a sign of a health-threatening issue involving the digestive system. "IBS is a functional disorder," says Irwin Grosman, M.D., associate chief of gastroenterology (GI) and GI fellowship program director at NewYork-Presbyterian Brooklyn Methodist Hospital. "That means there is a problem with the way in which the digestive tract works as opposed to a problem with its construction, which would be a structural disorder. Two issues define IBS—a change in the way food moves through the stomach and intestines and ends up as waste, and a change in the way the brain perceives that process, which leads to the abdominal discomfort patients feel." Those issues are related to a leading theory about the cause of IBS. Decades ago, the medical community thought the condition was psychosomatic, but a better understanding of the complexity of the digestive system has swept that characterization aside. Many doctors now think dysfunction in the enteric nervous system—a branch of the peripheral nervous system that serves the intestinal tract—plays an important role in IBS. "The brain processes signals from the intestine, which ends up causing symptoms like cramping, abdominal pain and changes in bowel habits," says Vincent Notar- Francesco, M.D., gastroenterologist at NYP Brooklyn Methodist. "Because of the brain's involvement, many patients notice that stress and anxiety—which create hyperactivity in the brain—aggravate their digestive symptoms." SYMPTOMS IN THE SPOTLIGHT For doctors, understanding patients' symptoms is crucial to diagnosing and treating any disease, but that is especially true for IBS. Treatment for IBS depends heavily on a patient's dominant symptom—constipation, diarrhea or a combination of the two. Doctors classify cases of IBS based on their main symptom; IBS-D, for example, is IBS with mainly diarrhea, and IBS-C is IBS with mostly constipation. IBS-M indicates mixed diarrhea and constipation. Patients typically must have symptoms for at least six months for doctors to diagnose IBS. F IN D A D O C T O R 718 . 49 9.C A R E ( 2 27 3 ) 19