Day 1 - Learning

You've just been diagnosed with IBS. Now what?

Day 1 Task List

1. Verify that your IBS diagnosis is accurate
2. Do your symptoms match the criteria?
3. Have you had all the necessary medical tests?
4. Learn the physical pathology behind your symptoms

Well, first of all, take a deep breath and try to relax. IBS is definitely not the end of the world. Make yourself a nice hot cup of peppermint or chamomile tea (both terrific GI muscle relaxants, and mint is packed with a pain-reliever as well), and take a small measure of comfort in finally knowing what's wrong with you. Odds are you've been wondering what the problem was for quite a while.

The (only) great thing about IBS is that it is not associated with, nor does it lead to, any other illness. It will not progress, it does not raise your risk of colon cancer, it never requires surgery, and it is not a genetic disorder you can pass on to your children. Since IBS can be a God-awful problem in its own right, it's nice to know that at least you don't have anything else to worry about in the future. Once you learn how to control your symptoms, you've effectively solved the problem.

Second, take another deep breath, because you might not have been properly diagnosed after all. Unfortunately, there are a great number of much more serious GI tract problems that can mimic IBS, and many patients are given an IBS diagnosis before they have had all (or even any) of the tests required to eliminate other disorders. Before you accept a diagnosis of IBS, make sure that you have had the following problems conclusively ruled out:

Colon and carcinoid cancer
Inflammatory bowel diseases (Crohn's and Ulcerative Colitis)
Celiac (a genetic, autoimmune disorder resulting in gluten intolerance)
Bowel obstructions
Diverticulosis / Diverticulitis
Food allergies, intolerances, and malabsorptions (fructose, lactose, etc.)
Intestinal malrotation
Bacterial infections and small intestine bacterial overgrowth (SIBO)
Intestinal parasites
Ovarian cancer

What diagnostic tests does IBS require?[1] Quite a few, and they're unpleasant but truly necessary. All possible physical, structural, and infectious abnormalities of the GI tract need to be unquestionably ruled out before you agree to an IBS diagnosis. This requires a physical examination, preferably by a board-certified gastroenterologist, and the following studies: complete blood count, sedimentation rate, and chemistries; stool for ova, parasites, and blood; urinalysis; liver function tests; rectal exam; abdominal x-rays; colonoscopy; for women, a gynecological exam including CA-125 blood test for ovarian cancer.

Other diagnostic studies should be minimal and will depend on the symptom subtype. For example, in patients with diarrhea-predominant symptoms, a small bowel radiograph or lactose/dextrose H2 breath test. For patients with pain as the predominant symptom, a plain abdominal radiograph during an acute episode to exclude bowel obstruction and other abdominal pathology. For patients with indigestion, nausea, and bloating, an abdominal ultrasound to rule out gallstones. For patients with any numbness in association with constipation, Multiple Sclerosis should be excluded.

Special Section For Children with IBS

Children with IBS symptoms require fewer diagnostic tests than adults. Colon and ovarian cancers are not typical suspects, diverticulosis and gallstones are quite rare in childhood, and endometriosis does not occur in pre-pubescents. The remaining possible illnesses that can mimic IBS – particularly Crohn's, ulcerative colitis, and celiac - do need to be ruled out. It's worth noting that there is no doubt whatsoever that children can develop IBS, and there is no minimum age requirement for this disorder. I suffered my first attack at age nine; other children have been diagnosed as young as age three.

Click here to continue reading First Year: IBS.

[1] Guidelines of the American Gastroenterological Association.

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