Irritable Bowel Syndrome: The Good, The Bad, and Everything In-Between

Summary

IBS, or Irritable Bowel Syndrome, is diagnosed in young adults more than any other age group but people often mistake IBS with other gastro conditions. Dr. Linda Lee discusses these misconceptions and gives us a crash course on all things IBS.

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Transcript

Joey Wahler: Did you know that irritable bowel syndrome known as IBS is diagnosed in young adults more than any other age group? And people often mistake IBS with other gastro conditions like irritable bowel disease, Crohn’s disease and colitis. So we’re discussing IBS, cutting through the confusion.

This is Maimo Med Talk sponsored by Maimonides Health. I’m Joey Wahler. Our guest, Dr. Linda Lee, Director of Gastroenterology at Maimonides Medical Center. Dr. Lee, thanks so much for joining us.

Dr. Linda Lee: Thank you so much for having me.

Joey Wahler: Well, let’s start with a brief primer here, shall we? Explaining the basic differences between each of the aforementioned ailments. Simply put, what are irritable bowel syndrome, Crohn’s and colitis?

Dr. Linda Lee: That is an excellent place to start because often the conditions are very confused. And the reason why they’re confused is because we were not so clear in our terminology years ago, but now we’re very clear. So irritable bowel syndrome or IBS is a condition where individuals might experience abdominal discomfort that is associated with moving the bowels or not moving the bowels in the case of constipation.

Crohn’s disease and colitis are both forms of inflammatory bowel disease or IBD. This is an inflammatory condition of the intestines where when we go in there, we can actually see ulcers and swelling of the colon, which is something you never see with irritable bowel syndrome.

Joey Wahler: And so that would be the difference then, leading into my next question, between irritable bowel syndrome and irritable bowel disease, yeah?

Dr. Linda Lee: That is correct. Irritable bowel syndrome is divided into two categories, Crohn’s disease and ulcerative colitis, depending on what part of the intestine is involved.

Joey Wahler: So how then doctor, do you go about diagnosing patients for those conditions, especially to avoid a misdiagnosis?

Dr. Linda Lee: It all starts with taking a very good history. Patients with irritable bowel syndrome often will report having irritability with their gut. What I mean by that is they report having sensitivity to foods or they notice that when they’re super stressed, their gut kind of acts up like they might get diarrhea or get constipated when they’re under incredible stress. People with inflammatory bowel disease may present with diarrhea, but with bleeding, weight loss or pain that awakens them at night. This does not occur in irritable bowel syndrome. So if you have bleeding, we definitely need to be looking for something else as a potential cause of your symptoms.

Joey Wahler: Gotcha. Now, it would probably surprise people hearing that young adults, as we mentioned at the top, are most affected by IBS. So meaning, what age range roughly? And maybe tell us a little bit more about what some of those symptoms would involve.

Dr. Linda Lee: Yes. Well, both conditions can affect people in young adulthood, meaning in their teens or early 20s. And irritable bowel syndrome typically is going to present like someone, again, as I said before, reporting sensitivity to foods or sensitivity to stress, meaning they’re having GI symptoms when these things occur. But these symptoms are not associated with weight loss, anemia, or bleeding. We become more concerned when somebody presents with sudden loss of weight or a new anemia that’s detected by their doctor, or if they’re passing blood in their stool.

Joey Wahler: And if you have IBS, that can obviously get in the way of everyday life in a variety of ways.

Dr. Linda Lee: Yes, it can. And, you know, I’ve met some people who have had such severe GI symptoms that it makes it difficult for them to schedule their day. Some of them have not wanted to do social events. I’ve even had some patients who are afraid to fly because just the anxiety associated with getting on a plane and being strapped in the seat and not being permitted to go to the bathroom is enough to trigger them to really feel uncomfortable and feel like they have to go to the bathroom and have a lot of abdominal discomfort with that.

Joey Wahler: So doctor, we mentioned that IBS mostly affects young adults. Do we know why that is?

Dr. Linda Lee: It’s really not clear. We know this just from epidemiologic studies, you know, where we look at large populations and we see at what age people are diagnosed. And it’s not really clear why people who are younger will develop irritable bowel syndrome symptoms. Typically, they are under the age of 40, but occasionally we will get individuals who will suddenly present with the symptoms of irritable bowel syndrome, particularly after they’ve had an infection in their gut, like from a bacterial or a viral infection, for example.

Joey Wahler: When you’re shy of that age, younger, should parents be mindful of children getting IBS?

Dr. Linda Lee: Well, I think that parents should probably be mindful. But often teenagers, they’re not very comfortable talking about their bowel movement to their parents. So sometimes, parents have to really be on the lookout to make sure they know what’s going on with their kid. Obviously, if the child is reporting diarrhea, you’re noticing frequent trips to the bathroom or in the bathroom for prolonged periods of time, that can be a hint that there’s something going on. And some children will report having food intolerances when actually it may not be the specific food that’s triggering it, but just eating in itself because eating can sometimes precipitate some of the abdominal cramping or bloating or other symptoms that people with IBS report.

Joey Wahler: Now, having said all of the above, IBS does affect some older people too. So how does treatment differ for those younger versus older?

Dr. Linda Lee: Actually, treatment is similar in terms of the general approach. I think it’s really important for any healthcare provider to spend time with the patient, understand the scenarios in which the symptoms are occurring, because one of the best things we can do to help patients is help them identify what the triggers are for their symptoms.

We know that patients with irritable bowel syndrome, the nerves in their gut are really hypersensitive. And sometimes, there are things in the diet or things that they do or emotional stress that will make those nerves kind of go crazy and trigger the symptoms that we associate with IBS. So if we can help patients understand what some of those triggers are, we can then begin to come up with a strategy of how we’re going to prevent or even manage those symptoms using different modalities. Sometimes we use medication. Sometimes we use diet. Sometimes we use behavioral therapies, especially if stress is a trigger. And many times, it’s a combination of all those three. So finding the right combination is really important regardless of the age of the patient.

Joey Wahler: And so you alluded to the fact that teens, for instance, and I think this would probably apply to almost any age actually, people are often reluctant to discuss some of these issues that they may be having with probably just about anybody else. How do you, as a doctor in this field, battle that, the fact that this is something that is perhaps more unpleasant to discuss than some other ailments?

Dr. Linda Lee: Yeah. You know, I think anybody of all ages is not comfortable really talking about their bowel symptoms. So what I try to do is to create a very private, relaxing environment in which the patient can answer some questions. Sometimes I will use visual aids. But generally, I just ask a series of questions and really try to normalize the act of moving one’s bowels because, after all, we all do it and there is no reason why anybody should be suffering or uncomfortable when they do. And so I really just try to get people sometimes to keep a diary. We call it a stool diary and there they can record the symptoms they’re having on a daily basis. And that can be sometimes very helpful for me as a practitioner to get an idea about the frequency and the severity, especially if the patient isn’t comfortable talking to me about it verbally.

Joey Wahler: Gotcha. So at any age, what would you say is the most common misconception out there about IBS?

Dr. Linda Lee: Well, I think you hit on one of them. One misconception is that IBS is the same as IBD. IBS is not an inflammatory condition and it does not increase anyone’s risk for colon cancer. I think that there is a misperception that IBS, “Oh, it’s just a diagnosis when your doctor doesn’t know what’s wrong with you,” and that is absolutely a huge misconception. We have learned so much about IBS and we now know it does have something to do with the interaction between the nerves in your gut, as well as the nerves in your brain.

Joey Wahler: But whether we’re talking about IBS or any of the other common illnesses involved in the gastro field that we’ve touched on earlier, talk a little bit about before we go how important it is to, A, get this diagnosed if you think it might be an issue and, B, to continue staying on top of it, if it is an issue, because this is not something to avoid, right?

Dr. Linda Lee: I think if you’re having symptoms that interfere with your ability to lead the life that you want, then you need to get help. If you are finding that you’re avoiding social situations, if you are having issues at work or even at home, you should go and seek help. If you’re having abdominal pain that is so disruptive to you during the day, or even in the middle of the night, you should definitely seek help. And obviously, as I talked about bleeding or unexplained weight loss, these are other reasons to go and see your doctor and start talking about you symptom.

Joey Wahler: And finally, in summation here. What would you say compared to other facilities is special about Maimonides’ approach to IBS?

Dr. Linda Lee: As I was mentioning before, I think the key to managing IBS is being open to creating an individualized treatment plan that really engages the patient as a partner with the healthcare provider. And that’s what we emphasize here at Maimonides. I would like to say that we do it well. So, if you are somebody who wants to learn how to get control of your gut symptoms rather than having your gut symptoms control your life, we are definitely the place for you.

Joey Wahler: Sounds like a great slogan to live by, especially if you’re affected by these issues. Well, we certainly hope we’ve cleared up some of the confusion and misconceptions about IBS for people of all ages really. Dr. Linda Lee, thanks so much again.

Dr. Linda Lee: Thank you.

Joey Wahler: And to learn more about Maimonides Health, we ask that you visit maimo.org. And thanks for listening to Maimo Med Talk. Hoping your health is good health. I’m Joey Wahler.

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