Tue, 08/02/2011

When the Belly Rebels

For patients with an irritable bowel life can turn into torture. To stress their digestion reacts with pain.

You feel bloated or think lightning is rushing through your belly? For most patients with an irritable bowel everyday life becomes torture: bloating, diarrhea, occlusion, painful cramps and a burning feeling in the belly. That are typical disorders of people with irritable bowel syndrome (IBS). Its appearance alternates over months and years and it can stay forever. Some people suffer from occlusion, others from diarrhea. Some suffer from both.

The digestive system of those people does not work as it should. But its causes are not fully clear. In routine examinations no organic reasons can be found. “Affected are people of every age. A bigger group is between 30 and 40 years of age”, says Professor Hubert Mönnikes, Neurogastroenterologist at Martin Luther Hospital in Berlin.

Finding the reasons for IBS is tedious. Sabine S.'s problems started six years ago. Sometimes it was bloating, sometimes diarrhea: “It just wasn't as it used to be”. The 66-year-old does not want to reveal her full name. Nobody likes to talk about digestive problems. Her troubles did not vanish. Even today on some days she lays in agony. Then her belly feels rock hard. At night she awakes from violent cramps, walking up and down her apartment, massaging her belly and putting on a warm wet-pack. Between those attacks she often is without pain for days. Only when Sabine S. decided she could not ease the pain on her own she went to see a doctor. But he did not find anything that could be a reason for the pain.

“That is the problem. The irritable bowel syndrome is not an illness, which causes could be detected with a routine examination”, Mönnikes describes the situation. “The cause for IBS is a dysfunction of the bowel or the connection of the bowel with the nervous system.” Therefore the search for the reason should be conducted by excluding causes. That means that illnesses which can cause similar symptoms must be excluded for good. This can be done with examinations as gastroscopy and proctoscopy, ultrasound, diagnostic investigations of blood and stool as well as biopsies to detect tumors and infections. Additionally one has to find out whether the patient has a lactose or fructose intolerance. Even an intolerance against gluten – a protein, that is part of certain crops and can be found in most groceries – can be the cause. And chronic stress can change the bowel cells.

Sabine S. visited a lot of doctors. Some of them did not take her serious she accounts. Maybe because the illness is neither malignant nor a threat to life. Nevertheless the caused pains are so severe that they restrict her daily life. “I do not meet people spontaneously anymore”, Sabine S. says. One never knows whether there is a bathroom nearby. So Sabine S. secludes herself more and more. “The troubles IBS cause are for real”, Mönnikes points out. The expert assumes that five to ten percent of the population of western countries are affected by this chronic illness. Women are three times more affected by IBS as men. The reason for that can be that women are more likely to visit a doctor when they do not feel well. Female hormones play a part in it as well. And people with mental problems are part of the risk group too.

Latest scientific research concludes that in most of the IBS-cases the sensitivity of the patients bowel is disturbed. “The digestive tract has more than 100 million nerve cells”, Mönnikes explains. Between those nerves and the brain exists a connection which is used by the belly-brain to send information about the digestive process to the brain. While the healthy are not aware of most of those signals IBS-patients feel them undamped because their threshold of awareness is lower. Every digestive gurgle, every fear and every indisposition, which the brain does not even notice, IBS-patients feel in their belly. These findings should help to develop methods to fight IBS. “According to today’s level of knowledge IBS is not curable”, Mönnikes says. But individual therapy can abate the pain if it is adjusted to the main symptoms. To achieve that the patient should write a 'pain-diary' so that the correlations can be detected. “But the concerned must be willing to try something new”, Mönnikes explains.

Sabine S. has found a way to deal with her illness. She resigned from eating certain food and she quit drinking coffee and alcohol. And she finds strength from her volunteer work for the Verein Deutsche Reizdarmselbsthilfe (Self-help Association for IBS). “In talks with others I can always take something out for myself”, she says. Even hope to be without pain one day.