A
Typical IBS Story...
...Is it Yours?
I've always been slow going maybe every 3 to 4 days and I use laxatives
to be regular.
All
(IBS) People who use laxatives get an immediate feeling of relief after
a (bowel) movement. That's why I use them and I can get that relief
anonymously, privately and without seeing a doctor. However the downside
of that (using laxatives) is that in a very short time I'm using them
again, then again and again.
Then I'm increasing the dose to get the same effect like I get
immune to it and have to take more and more, and do that more often. I
find that I want to have relief on a daily basis but the medication (bisacodyl)
works less and less effectively as time goes on.
I'll do this for 2 weeks at a time and feel great. I'll get those
quick burst of energy but, if I miss a day I'll drag around feeling
tired, depleted, having no energy, and that gets me down, sometimes real
down and depressed and because I'm dragging I begin to wonder whether
I'm getting enough nutrition especially when I see food pass undigested.
Then there is the bloating, the distention, all of which seems at
times to worsen when I take the little yellow pills (bisacodyl) I start
to feel full and hear gurgling in my upper abdomen the sensation of
water fullness, and I feel gassy. But I dare not pass gas because I may
stain my pants. With the bloating there's the cramping and soreness.
Then I have to go. And I better get there quick or I'll have an
accident.
That's why whenever I go out I have to know where the lavatory is,
just in case.
At times there are little small dry balls then there is the loose
watery stools and if I get too many of those then my hemorrhoids flare
up....so I have to be careful toward the end of my two week run of
laxatives because I'll end up going again and again and again and my bum
gets so sore.
Sometimes, I just think that I don't eat enough so I'll eat and
eat to fill up the gut so I can go. I drink lots of coffee to try in
flush through all the food but that never works though I'll try it every
2-3 months. Sometimes, I think that I'm just too nervous, too anxious
and if I can just relax, then my movements will be regular.
Occasionally, I will blame certain foods, claiming that they are binding
me so I avoid them. It works sometimes but the other times it doesn't.
Then there are those infomercials about the 'toxins in the colon'
that make me wonder whether I should get on one of those cleansing
programs. But who’s got time for that and I'm not so bad that I have to
live for a good movement. But when they tell me that I have coats of
caked up stool lining my colon I almost pick up the phone until I think,
"well my doctor never said that.
Growing Scientific Research
There
is a steadily growing scientific view of IBS and other functional GI
disorders. That view is that the basic abnormality in IBS is a
“neuro-immune” dysfunction within the wall of the GI tract itself
(7-13). It is accepted fact that the GI tract; a) has within its wall
an autonomous (self-governing) nervous system with most of the traffic
being within and unto itself, and only 10-20% of the traffic coming from
outside the GI tract (5); b) serotonin is the main neuro-transmitter
used in the gut to coordinate normal rhythmic contraction of muscles
responsible for regularity (5); c) histio-chemical markers in the bowel
wall itself distinguishes people with IBS and those without it (8,9).
Treatment
No cure has been found for IBS (1), but
several options are available to address the symptoms. Your doctor can
give you the best treatments available for your particular symptoms, and
encourage you to manage your stress and make changes to your diet. For
many people, careful eating reduces IBS symptoms.
Serotonin and Movement of Food in the Gut
Once food has
entered the GI tract, hormonal signals unique and localized to the gut
begin to orchestrate an elaborate physiologic dance known as digestion.
Neuro-transmitters initiate the flow of information used by the GI tract
to churn ingested food selectively mixing in an array of enzymes and
hormones that not only digest food but also signal distal portions of
the gut to prepare for the oncoming bolus of nourishment.
There is the sudden increase in the number of
enteroendocrine cells filled with serotonin initiating signals within
nerve endings that penetrate from the lumen of the gut outward into the
muscular layers so as to initiate contraction in a rhythmic fashion. So
rhythmic are the contractions that food ingested at the beginning of the
GI tract is pushed forward as in an assembly line allowing all sections
of the gut to work on the ingestants according to design.
Besides other things there is a coordinated saturation
and de-saturation of serotonin within the bowel wall. Serotonin is
released, and serotonin is taken up, like the movement of incoming waves
of the ocean against the shore: a wave of serotonin perfuse through the
bowel internal layers, and then is removed through its serotonin
re-uptake system. The center piece of the re-uptake system is the SERT
protein (Serotonin Reuptake Transport Protein). This is a highly
efficient process.
The Medical Cause of IBS
and a Medical Solution that Makes Sense
Following
the review of basic science literature cited here and elsewhere, Dr.
McCullough MD* concludes that IBS irregularity is due to a deficiency of
SERT, serotonin re-uptake transport protein, mainly located in the baso-lateral
walls of enteric epithelium. Though present in other structural elements
in the gut wall, absence of SERT in the side and bottom walls of the
cells lining the gut is striking in those who suffer from IBS. Though
these cells are replaced normally every 7 days, which is sufficient for
most individuals to provide adequate SERT concentration and regularity
of bowel movements. There is a SERT problem in IBS. Whether the
problem is slowed cell turnover, or reduced SERT production or
disrupted SERT production or production of defective SERT, the overall
outcome is deficient concentration of SERT with the result of
uncoordinated uptake of released serotonin, over-stimulation of
serotonin-sensitive nerves responsible for muscular contraction.
Peristalsis, that smooth coordinated rippling rhythm of contraction
within the gut wall, fails to occur resulting in irregularity in the
form of either diarrhea, constipation or both.
REFERENCES
*Dr. McCullough is a board-certified Emergency Medicince physician, a
board-qualified Internal Medicine physician, who holdsa
Master of Science degree in Biology from Brown University,
a Bachelor degree in Chemistry, a Bachelor degree in Biology, and a
Doctorate degree in Medicine.
1) Camilleri M (MD): NIH Publ No. 03-693; 2) Lembo A
(MD): Irritable Bowel Syndrome. HealingWell.com 3)
Arnold W (MD): Patient Information: Irritable bowel syndrome. Univ
Pittsburg Med Ctr. Patients.update.com, Aug, 2005. 4)
Olden KW (MD): Irritable Bowel Syndrome. Am Coll
Gastroenterol, www.acg.gi.org, 5) DePonti F Pharmacology of
serotonin: what a clinician should know. Gut 53: 1520-1535, 2004. 6)
Grundy D. What activates visceral afferents? Gut 53(Suppl2): 5-8, 2004.
7)Gershon MD. Nerves, reflexes, and the enteric nervous system:
pathogenesis of the irritable bowel syndrome. J Clin Gastroenterol
39(4):S184-93. 2005. 8)
Bueno L et
al: Effects of inflammatory mediators on gut sensitivity. Can J
Gastroenterol 13(SupplA): 42A-46A. 1999. 9)
Krisjansson
G et al. Clinical and subclinical intestinal inflammation assessed by
the mucosal patch technique: studies of mucosal neutrophil and
eosinophil activation in inflammatory bowel diseases & irritable bowel
syndrome. Gut 53(1`2): 1806-12, 2004. 10)
Palsson OS et al
: Elevated
vasoactive intestinal peptide concentrations in patients with irritable
bowel syndrome. Dig Dis Sci 49(7-8): 1236-43, 2004. 11)
La JH et al. Visceral hypersensity and altered colonic motility after
subsidence of inflammation in a rat model of colitis. World J
Gastroenetero 9(12): 2791-5, 2003. 12) Bischoff SC:
Mucosal allery: role of mast cells and granulocytes in the gut. BaillieresClin Gastroent 10(3): 443-59, 1996. 13) Costa F et al.
Role of faecal calprotectin as non-invasive marker of intestinal
inflammation. Dig Liver Dis 35(9): 642-7, 2003. 14) Spiller RC
Inflammation as a basis fro functional GI disorders. Best Prac Res Clin
Gastroen 18(4): 641-661, 2004. 15) Morton J Bael Fruit. pg 187-190,
1987 16) Mashhud et al: Efficacy of fruit pul of unripe Bel in the
treatment of IBS: a double-blind randomized controlled trial. 2005