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Here is Your Prescription for Change!
(There are over 120 illustrations, pictures and
tables in the finished book.)
You always had it.
You always had the power.
- GLINDA, the Good Witch in The Wizard of Oz
If you have Irritable Bowel Syndrome (IBS) or one of the other Functional
Gastrointestinal (GI) disorders, or suspect that you might, then this book
is for you. Many people with ulcerative colitis and Crohn's disease, the
two forms of inflammatory bowel disease (IBD), and many with diverticulosis
also have IBS. If you have one of these conditions, then this book can
help you, too.
IBS is a major public health topic and receives much media attention
in newspapers, magazines, radio and television. Many people recognize the
acronym "IBS" and terms like "spastic colon," "spastic
colitis," "mucus colitis," and "nervous stomach."You
will be hearing more and more about this common and troublesome condition,
as well as about the other functional GI disorders.
WHAT ARE FUNCTIONAL GI DISORDERS?
They are defined as "variable combinations of chronic or recurrent
GI symptoms not explained by structural or biochemical abnormalities."This
means that even after performing blood tests, taking x-rays, and examining
the digestive tract with endoscopes, doctors cannot find a cause. There
are 25 of these disorders, and many people have more than one. Symptoms
can come from nearly all parts of the GI tract.
You will learn to manage your disorder(s) in Step 8 of this book. But
before then, you will understand how much in common all of these disorders
really have in terms of cause and treatment.
SYMPTOMS OF IBS
- Lump in the throat
- Trouble swallowing
- Chest pain
- Abdominal pain, bloating and swelling
- Pain in the pelvis, rectum, or anus
- Bowel incontinence
- Mucus in the stool
WHAT IS IBS?
IBS is the most common functional GI disorder. The symptoms come from
the colon and include abdominal pain and bloating, as well as disturbances
in defecation (the process of having a bowel movement). These symptoms
are diarrhea, constipation, and diarrhea which alternates with constipation.
The stool form (bowel movement) is often altered, being lumpy and hard
or loose and watery. Stool passage can be affected with straining at having
a bowel movement, urgent need to find a bathroom, or a feeling of not having
emptied the rectum. Passage of mucus in the stool is also common. The symptoms
can be continuous or intermittent.
MILLIONS OF PEOPLE ARE AFFECTED
GI disorders are very common and affect approximately 35 millions people
in the United States. They account for 10% of visits to primary care doctors
and at least 50% of visits to gastroenterologists. Each year, 2.6 million
people seek treatment for symptoms related to functional gastrointestinal
disorders, and visits to physicians total 3.5 million. IBS affects nearly
one out of five people in the United States including children, teenagers,
young adults, the middle-aged, and the elderly. The average age of onset
of IBS is between 20 and 29 years of age.
IBS is prevalent throughout the world including China, Canada, the United
Kingdom, Australia, New Zealand, and Scandinavia.
A COST OF BILLIONS OF DOLLARS
Studies now show that these disorders cost billions of dollars in the
United States each year in visits to doctors, diagnostic testing, and treatments.
Furthermore, since IBS is the second leading cause of industrial absenteeism,
loss of work days is costly to companies and employers, as well as to people
with the disorders.
WHAT CAUSES THESE DISORDERS?
We know that these conditions are not caused by infection, inflammation,or
blockage. In fact, evaluation with X-rays, endoscopy, and blood testing
usually fails to show any abnormality. But the symptoms are very real!
What is causing them?
You will learn what you need to know about the causes in Steps 1 through
3, but here is a brief description:
1. Disturbances of the normal activity and function of the digestive
The normal movement of food contents through the digestive tract depends
upon motility, or peristalsis, which is the rhythmic and orderly muscular
contraction of the gut. A disturbance in normal motility and peristalsis
causes symptoms like cramping abdominal pain, diarrhea, constipation, and
relief of pain with the passage of loose bowel movements.
2. Increased sensitivity to what is happening in the gut and abdomen
Many people with IBS have enhanced sensation and perception of bowel
function. They can feel things in their GI tract, chest, abdomen, and rectum
that people without IBS cannot. Doctors call this "disturbed visceral
nociception." Another way of looking at this is that patients with
IBS and other functional GI disorders have lower internal pain thresholds
for reasons which are not understood.
3. Gut reaction to "triggers"
This sensitive GI tract can have a hyper-reaction to things that activate
or "trigger" pain and symptoms. You will learn how to identify,
control, and eliminate these triggers in Step 5. Stress and psychosocial
problems are not only triggers, but are also integrated into the Mind-Body/Brain-GutConnection.
- Dietary substances
- Inflammation and intection
- Drugs and medications
- Hormones (menstrual cycle)
- Seasonal changes
- Psychological problems
4. Problems related
to the Brain-Gut Connection
The Mind-Body/Brain-Gut Connection is the key to understanding these
disorders and to the healing process, and you will study it throughout
the book. There is a powerful "connection" between the mind and
the body/gut. Gut sensations reach the brain through the circuitry of nerves
in the wall of the intestine, then to the spinal cord, and finally the
brain. Transmission is bidirectional: it is a two-way street. The gut affects
the brain, and the brain affects the gut.
Psychological stress or emotional responses to life stress can influence
GI function in anyone through the Brain-Gut Connection and produce GI symptoms
such as pain and altered bowel function. But people with a functional GI
disorder such as IBS are more likely to experience symptoms which are more
severe and occur more frequently.
show that patients with IBS and other functional GI disorders who see doctors
for the symptoms are more likely to have psychological problems than are
people with the symptoms who do not consult with a doctor about them. This
means that psychological disorders such as anxiety, panic, depression,
somatoform disorders (unexplained bodily symptoms), a history of abuse
(mental, emotional, physical, or sexual), alcohol or substance abuse, or
an eating disorder can lead to increased symptoms and illnessand reduce
the person's ability to cope. Psychological problems are not the cause
of the functional disorders. Instead, such problems increase the need to
consult with doctors, which leads to more testing, procedures,and sometimes
Psychological Consequences of Having a Functional GI Disorder
Any chronic illness, including one of the functional GI disorders, can
have significant psychosocial consequences such as:
- Reduced sense of health and well-being
- Constant concerns related to cause of the symptoms and how to control
- Problems with activities of daily living or Problems with interpersonal
relationships with family, friends, and co-workers.
- Disability with missed work days. Remember, IBS is the second leading
cause of industrial absenteeism in the United States.
IBS and other functional GI disorders cause symptoms and discomfort
ranging from mild and inconvenient to severe, resulting in incapacitation
and disability. Current evidence shows that many people with IBS lead restricted
lives in multiple areas: diet, social activities, and energy level, without
much relief from current health-care practices and medications.
THE MIND-BODY CONNECTION: THE "IRRITABLE
BODY" AND SOMATIZATION
Just as the GI tract is unusually sensitive and irritable, many people
with IBS and other functional GI disorders seem to have a sensitive "irritable
body", or what doctors call "somatization".
As in IBS and other functional GI disorders, these symptoms are associated
with normal test results and cannot be explained by any specific disease
process. Disturbances in the Mind-Body/Brain-Gut Connection account for
much of the trouble.
THE MIND-BODY/BRAIN-GUT CONNECTION: THE VICIOUS
CIRCLE OF STRESS, PSYCHOLOGY, AND SYMPTOMS
The "fight-or-flight" response by the body in response to
perceived stress results in an increase in blood pressure, heart rate,
breathing, and metabolism (Chapter 5). With continued or unrelieved stress,
the body can become unbalanced and unable to recover, leading to the physical
symptoms listed. The emotional responses to these unexplained symptoms
and fear of not knowing when the symptoms will start can actually make
them worse. A vicious circle of stress, psychology, and symptoms can be
established (Chapter 6).
BODILY SYMPTOMS: SOMATIZATION AND THE "IRRITABLE
- Painful, tender muscles (fibromyalgia)
- Fatigue and low energy
- TMJ (pain in the jaw)
- Feeling faint
- Difficulty concentrating
- Shortness of breath
- Chest pain
- Abdominal pain
- Back pain
- Pelvic pain
- Painful menstrual periods
- Decreased sex drive
- Bladder problems
THROUGH THE CONNECTION
You will see how to use your mind to take control and reduce or eliminate
the symptoms of IBS or other functional GI disorders. You can learn to
manage the symptoms of the "Irritable Body." You will be able
to recognize and manage stress and psychological problems. You will know
how to live a healthy lifestyle. Finally, you will appreciate how spirituality
can contribute to your healing.
IBS VERSUS COLITIS AND INFLAMMATORY BOWEL DISEASE
The term "colitis" refers to colon inflammation and should
not be used to refer to IBS, because in IBS the colon is not actually inflamed.
However, inflammation is found in several important disorders called inflammatory
bowel diseases (IBD). The two types of IBD are ulcerative colitis, which
affects the rectum and colon, and Crohn's disease, which can involve both
the colon and the intestine. Nearly 1 million Americans suffer from IBD.
Although the treatments for IBS and IBD differ, many people with IBD also
have IBS and can benefit from the treatment advice in this book.
WHAT ABOUT DIVERTICULOSIS?
Diverticulosis is a very common disorder in which pockets develop in
the colon because of increased colon spasm and pressure. Although the cause
of this process is not really known, many people with diverticulosis have
the same symptoms as do those with IBS and can also benefit from this book.
WHY A BOOK ABOUT THESE PROBLEMS?
There have been many new developments in the diagnosis and treatment
of IBS and other functional GI disorders. Furthermore, there is an increasing
awareness of our abilities to heal by leading a healthy lifestyle and utilizing
newer understanding of the Mind-Body/Brain-Gut Connection. As an MD and
board-certified gastroenterologist with more than 20 years of experience
caring for people with IBS and other functional GI disorders, I will provide
you with the information you need.
Trends toward "managed care" will make it harder for your
doctor to spend time with you. In fact, most doctor visits are now limited
to 12 minutes or less! This isn't much time for a patient to understand
diagnosis and treatment. Also, it is becoming more difficult to gain access
to a medical specialist because managed care expects that your primary
care physician (family doctor) will be able to handle most problems. The
model of interaction between the patient and the primary care physician
is shifting so that you, the patient, are given more responsibility in
the management of your health care. You will need accurate and reliable
information in order to fulfill this responsibility and opportunity. That's
where this book will help.
You can learn to be healthy. Accurate information leads to healing and
is often more important than medication. With this book, you can explore
your diagnosis and treatment options in the privacy of your home and on
your own time. Then, armed with information and knowledge about your problem,
you will be better able to partner with your doctor to heal.
The focused information here on IBS and other functional GI disordersis
integrated with holistic Mind -Body concepts and the latest information
on living a healthy lifestyle. The logical 8-step approach can be completed
over a 12-week period.
CHANGE: WHY 12 WEEKS?
It will take you 12 weeks to read this book and walk through the 8 steps
(see Table 4). Change is not easy, but neither is living with IBS and the
other functional GI disorders. Behavioral psychologists have studied people
who have been successful with change. These studies show that it takes
about 12 weeks to make the commitment, begin to change behavior, and establish
AN 8-STEP, 12-WEEK PLAN FOR LIVING A HEALTHY
LIFE WITH A FUNCTIONAL BOWEL DISORDER OR COLITIS
- Understanding the GI tract and "The Connection"
- Reviewing Functional GI Disorders
- Healing with Diagnosis and Education
- Making "The Connection"
- Identifying Gut "Triggers"
- Emphasizing Self-Care and Wellness
- Taking Action If Symptoms Persist
- Managing Your Functional GI Disorder(s)
Use your problem and illness to change your life and health.
Welcome to wellness!
William B. Salt II, MD
International Foundation For Functional
Gastrointestinal Disorders (IFFGD)