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IBS: When Your Gut Tells You There’s A Problem

September 17, 2009 2:59 PM with Dr. Mitchell Lichtenstein

Irritable bowel syndrome afflicts up to 15% of the U.S. population. Mitchell Lichtenstein, MD, Gastroenterologist, discusses ways to effectively manage and treat IBS.

Moderator (Moderator) - 2:58 PM:
Welcome! Today’s chat: IBS: When Your Gut Tells You There’s A Problem will begin shortly. Please start submitting your questions and Dr. Mitchell Lichtenstein will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the Gastroenterology pages to obtain more information about IBS.

Dr. Mitchell Lichtenstein (NorthShore) - 3:00 PM:
Hello. I am Mitchell Lichtenstein, MD. I am a board certified gastroenterologist with NorthShore University HealthSystem. I've been practicing for 22 years. I look forward to addressing any questions or issues you have regarding IBS.

  Mary Wadleigh (Northfield, IL) - 3:03 PM:
I think I may have undiagnosed IBS. It seems I have more problems now with foods such as onions & garlic, cauliflower, broccolli and the like, and my GI system seems more affected by my emotional well-being. Are these signs indicative of IBS?
Dr. Mitchell Lichtenstein (NorthShore)
IBS can be related to emotional and dietary factors. Any change in the character of symptoms (frequency, severity) needs to be investigated. Your doctor will need to determine if there are any other associated symptoms that are concerning.

  Peyton (Glenview, IL) - 3:08 PM:
What’s the difference between irritable bowel syndrome and irritable bowel disease?
Dr. Mitchell Lichtenstein (NorthShore)
There is no difference between these. Irritable bowel syndrome is usually referred to as IBS. Inflammatory bowel disease (Crohn's, Ulcerative Colitis) is called IBD.

  Jennifer (Evanston, IL) - 3:10 PM:
Is there a way to help prevent IBS?
Dr. Mitchell Lichtenstein (NorthShore)
Unfortunately, since we don't know a specific cause for IBS there is no way to prevent it.

  Mary W (Northfield, IL) - 3:13 PM:
What exactly is going on (mechanically, metabolically)? How does one pinpoint the diagnosis?

Dr. Mitchell Lichtenstein (NorthShore) - 3:18 PM:
Mary,in all likelihood, IBS is a motility disorder. Precipitating factors continue to be investigated (recent interest in intestinal bacteria). The diagnosis is usually made based on historical symptoms and ruling out other GI disorders.

  Ricahrd (Winnetka) - 3:18 PM:
is IBS something you are born with or can it develop over time?
Dr. Mitchell Lichtenstein (NorthShore)
It usually develops over time. There is no known genetic basis for IBS, though it certainly can be more common in some families. More than likely this is environmental, not genetic.

  Jim (Northbrook) - 3:20 PM:
I'm 42 and recently had a colonoscopy because I've been experiencing both extremes - constipation and diarrhea. My screening came back normal but I'm still experiencing the same problems. What other tests might I be able to undergo to determine if IBD is a factor here?
Dr. Mitchell Lichtenstein (NorthShore)
Did you mean IBS? IBD is inflammatory bowel disease (Crohn's, Ulcerative Colitis). An x-ray to visualize the small intestine, a small bowel capsule study or specialized blood tests can help rule out Crohn's Disease. A CAT scan of the abdomen could also be done to rule out other causes for your symptoms. Alternating constipation/diarrhea is usually primarily constipation with eventual passage of substantial amounts of stool from the colon. Treatment directed towards constipation is usually the best approach.

  Joyce (Buffalo Grove,il) - 3:31 PM:
I have IBS and never know what to do about the food. Do you have to experiment and make up your own plan? Is there a nutritionist that specializes in this? I've been to several and they don't seem to know what to do. The doctors I've spoken to focus on the medicine and very little on what and how to eat. i never know what to eat. What can I do?
Dr. Mitchell Lichtenstein (NorthShore)
With IBS symptoms can occur regardless what you're eating. However, if certain foods precipitate symptoms these need to be avoided. We recommend testing all our IBS patients for Celiac disease (gluten sensitivity). We'll sometimes try to alter the bacteria in your intestine with antibiotics or probiotics, which can be helpful at times. Sometimes we try to shift our focus away from IBS as purely related to diet.

  Lilah (Winnetka, IL) - 3:36 PM:
My grandmother was allergic to gluten and had severe IBS when she was living. I have had GI issues at times when I consume too much bread and my 12 year old niece is consistently complaining of stomach pain and cramping after she consumes bread or bread products. Could we be experiencing a genetic issue?
Dr. Mitchell Lichtenstein (NorthShore)
Symptoms related to bread products can be secondary to Celiac Disease. You and your niece should be tested (a blood test). However, sometimes you're unable to tolerate certain foods and have abdominal cramping as a result.

  Jennifer (Evanston, IL) - 3:40 PM:
Does IBS gradually get worse over time?
Dr. Mitchell Lichtenstein (NorthShore)
Not necessarily. IBS symptoms are usually chronic and stable over time. Of course there are cases where IBS can improve or worsen over time.

  Ellen Waxberg (Glenview, Illinois) - 3:42 PM:
What do you think are some of the best medicines/treatments for IBS?
Dr. Mitchell Lichtenstein (NorthShore)
It depends what the predominant symptoms are. We use anti-diarrhea agents (Imodium,Lomotil,Questran). For constipation we use Miralax or Amitiza. For abdominal cramping we've used anti-spasmotics (Bentyl,hyoscyamine,Librax) with limited success. More recently we've had some success using antibiotics and/or probiotics to alter the bacteria in the intestine.

  Lisa Rheinhart (Chicago, IL) - 3:46 PM:
Can IBS result from a lactose intolerant problem, or is being lactose intolerant considered IBS?
Dr. Mitchell Lichtenstein (NorthShore)
Lactose intolerance is a separate problem, although many of my IBS patients are also lactose intolerant. I think that these are just two very common problems so they can occur simultaneously in patients.

  Sharon (Lincolnwood) - 3:48 PM:
There are certain foods that I cannot eat anymore because of the reactions I get (bloating, cramping, etc.). While I don't know if I have IBS, what prompts the body all of a sudden to behave this way? I exercise regularly and am not experiencing any abnormal stress in my life.
Dr. Mitchell Lichtenstein (NorthShore)
Patients can develop sensitivities to specific foods. We have to rule out lactose intolerance and gluten sensitivity (Celiac). Sometimes an infection can result in an alteration in intestinal function which can cause abdominal bloating and cramping. When I rule out the above conditions I'll often try a short course of a non-absorbable antibiotic, then possibly a probiotic to attempt to alter the composition of the bacteria in the intsetine.

Moderator (Moderator) - 3:51 PM:
Thank you everyone for your great participation, the chat will be ending in approximately 10 minutes.

  Shila (Niles, IL) - 3:57 PM:
Sometimes I have an uncontrolled BM. Is this a part of IBS?
Dr. Mitchell Lichtenstein (NorthShore)
This can be related to IBS, but if the episodes are rare it probably is not IBS.

Dr. Mitchell Lichtenstein (NorthShore) - 4:02 PM:
Thank you for sharing this last hour with me. I hope I was able to address some of your issues and concerns. I'm sorry I wasn't able to get to all of your questions. I encourage you to address these issues with your physicians and continue to seek answers/solutions to your problems.

Moderator (Moderator) - 4:04 PM:
Thank you again for participating in our chat today. For more information please visit our Gastroenterology pages .

Also, a transcript of this chat will be available shortly.

This chat has ended.

Thank you very much for your participation.