Friday, July 21, 2006

Researchers Explore Psychological Link to Bowel Disorder

THURSDAY, June 1 (HealthDay News) -- As many as one in five Americans suffers from the pain, bloating and embarrassment caused by irritable bowel syndrome, one of the most common disorders diagnosed by doctors.
But little is known about the disorder. In fact, doctors have been unable to pinpoint a specific cause, or find any cure.
Increasingly, research is focusing on the effect the mind may have on gut function. Many doctors believe the link between brain and body might prove the key to effective treatment of irritable bowel syndrome (IBS).

"It's really a brain-gut disorder," said Dr. Lin Chang, an associate professor at the University of California, Los Angeles' Division of Digestive Diseases and School of Medicine. "We're gaining more information from many different aspects, but I don't think we have the whole story down yet."

Abdominal pain, bloating, cramping, constipation, and diarrhea are the main symptoms of IBS, according to the National Institutes of Health (NIH).

But specific symptoms vary from person to person. Some have constipation, while others experience diarrhea. Some find their symptoms wax and wane, subsiding for a few months and then returning, while others say their symptoms get worse as time passes.

Awareness of IBS has grown over the past decade, said Chang, who is also director of the Women's Digestive Health Center at UCLA's Digestive Diseases Research Center. "

Most people may not understand what the symptoms are, but they recognize the name."
However, IBS remains a highly embarrassing and taboo disorder. Many people are ashamed of their symptoms, and find it hard to confide even in their family physician. Up to 70 percent of people suffering from IBS are not receiving medical care for their symptoms, according to federal statistics.

"The majority of patients with IBS don't seek medical treatment," Chang said. "I wouldn't say this is an easy topic to talk about at all."

Researchers have not discovered any specific cause for IBS, but several theories have gained some traction.

Chang said it appears that IBS could be initially triggered by some sort of serious physical or psychological problem, such as a runaway infection, a major surgery, or a deep depression.
The sufferer's colon grows particularly sensitive, and reacts violently to certain foods and stress.
Once IBS has been triggered, a number of mental and physical occurrences have been associated with a worsening of symptoms, according to the NIH.

These include:
  • large meals,
  • certain medicines,
  • particular foods, including wheat, rye, barley, chocolate, milk products or alcohol,
  • caffeinated beverages such as coffee, tea or soft drinks,
  • stress, conflict or emotional upsets.

Antidepressants are typically used to treat flare-ups of IBS and provide some relief to patients. Fiber supplements or laxatives for constipation, medicines to decrease diarrhea, or antispasmodics drugs to control colon muscle spasms and reduce abdominal pain also are commonly prescribed.

Interestingly, doctors have found that psychological treatments like hypnosis, relaxation training or psychotherapy provide the same amount of relief -- or even more -- than drug therapy.

"Treating the patient really requires a holistic approach where you treat both the body and the mind," said Dr. Charles Gerson, co-director of the Mind-Body Digestive Center in New York City and an associate clinical professor of gastroenterology at the Mount Sinai School of Medicine. "In the short term, therapy has proven more effective than medicine. Western medicine has forgotten how much the mind and body interact."
A vicious circle can develop with IBS when the patient's body and mind interact in a way to make the disorder grow worse, Gerson said.
For example, the gut can cause discomfort that makes the patient feel depressed or anxious. That depression or anxiety can then turn around and make the discomfort even more severe, he said.

"It just keeps going around and around," Gerson said. "You have to treat both sides of the circle to see positive benefit."

Research has shown that IBS is affected by the immune system, which is affected by stress. Because of that, stress management is an important part of IBS treatment. Patients are urged to deal with stress through counseling, regular exercise and a healthy amount of sleep.

On the physical side, careful eating has been shown to reduce IBS symptoms.
With advice from a doctor or dietitian, IBS patients have been able to reduce their discomfort by removing problem foods from their diet such as dairy products, or by increasing their fiber intake.

Eating smaller meals more often, or eating smaller portions, has also been found to help IBS symptoms in some people. Another effective habit involves eating meals that are low in fat and high in carbohydrates, such as pasta, rice, whole-grain breads and cereals.

More information
To learn more, visit the National Library of Medicine.

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