| Do you enjoy a good mystery? Even if you do, you wouldn’t
like having the mysterious disorder known as irritable bowel
syndrome (IBS). Aside from simple constipation, it is the
most common problem involving the colon. |
By Dick Broom
People with IBS have abdominal pain and bloating.
Some have diarrhea, and others have constipation.
IBS is mysterious because, as far as doctors can tell,
there is nothing wrong with the bowels. There is no
infection or obstruction or anything else that should
be causing the symptoms.
Some people’s nervous systems just seem to be
super-sensitive to what is going on in the bowel. A
sensation that one person perceives as a comfortable
fullness, someone with IBS might experience as
terrible bloating. Normal bowel activity that most
people don’t even notice causes some to feel pain.
When patients have symptoms of IBS, doctors
always do tests to make sure there isn’t some other
problem. Once all other possibilities have been
eliminated, they focus on relieving the patient’s
symptoms. This typically involves prescription
pain medication and either a laxative or anti-diarrhea
drug. A certain class of anti-depressant is also
helpful in some patients. |
“The anti-depressants turn down the volume
on the nervous system that connects the gut to
the brain,” says Thomas Swantkowski, M.D.,
a gastroenterologist with Pinehurst Medical
Clinic. “If someone has an unusually high perception
of normal stimuli, the antidepressants
modulate that.”
A new prescription drug, just approved a few
months ago, is now being
used to relieve constipation,
bloating and pain.
“It is the first drug that
it scientifically proven to
treat irritable bowel,” Dr.
Swantkowski says.
Plain old constipation
If you eat a lot of fat and not much fiber, and
if you get very little exercise, you’re a perfect
candidate for recurring constipation.
Given the typical American diet and couchpotato
lifestyle, is it any wonder that drugstores
sell truckloads of laxatives?
“Constipation is usually related to not
enough fiber,” says Greg Blakely, M.D., an
internal medicine specialist with Pinehurst
Medical Clinic. “The best treatment is diet
modification—less fat and more fiber. We really
stress drinking a lot of fluids, too.”
Dietary fiber is like a sponge. When it soaks
up liquid, it expands and helps carry stool
through the colon. If you don’t have enough
water in your system, the fiber just clogs up the
colon and makes your constipation worse.
As people age, the muscles in the walls of
their colons can weaken, causing the walls to
bulge out and form pockets called diverticula.
People who have frequent constipation are
more likely to develop diverticula because, as
they strain to have bowel movements, they put
a lot more pressure on the colon walls. At the
same time, lack of fiber in the diet means there
is a lot of stool in the colon that isn’t going
anywhere.
Pat Claudius, M.D.
|
“That makes it easy for the pockets to get
filled with stool,” says Pat Claudius, M.D.,
an internal medicine specialist with the
FirstHealth Montgomery Memorial Hospital
Family & Internal Medicine in Troy. “When
that happens, it can cause inflammation.”
A pocket crammed with stool becomes a
breeding ground for bacteria, which can cause
an infection called diverticulitis.
“The symptoms are often acute pain, fever,
nausea, diarrhea and, sometimes, bleeding,”
Dr. Claudius says. “If someone has a huge infection,
we admit them to the hospital and treat
them with antibiotics.”
Once the infection is gone and the colon
has healed, patients are urged to start eating a
high-fiber diet. Ulcerative colitis is a less common but no less
serious disease of the colon. It is an inflammatory
disorder that is believed to be caused by a mix-up
in the body’s immune system. Common symptoms are diarrhea, weight loss and bleeding.
Akaninyene Okon, M.D.
|
“The main problem we see in patients in
the hospital are GI bleeds, often secondary to
gastritis (inflammation of the stomach) or colitis,”
says Akaninyene Okon, M.D., a hospitalist
physician with FirstHealth Moore Regional
Hospitalist Services.
Several different drugs are used to treat ulcerative
colitis. The most serious cases sometimes
require surgery to remove the inflamed
section of colon.
A preventable killer
The disease of the colon that people worry
about most is cancer. And for good reason. It
is second only to lung cancer as the leading
cancer killer in this country, taking the lives of
more than 55,000 Americans a year.
The standard treatment for cancer of the
colon is surgery.
“We take out just the section of the colon
that is affected, making sure we have all of the
cancer,” says Willy Chu, M.D., a general surgeon
with Moore Surgical Center in Pinehurst.
Willy Chu, M.D.
|
“Then we sew the colon back together so it can
resume functioning normally. Most patients do
very well.”
According to Dr. Chu, very few patients need
to have a colostomy, which involves attaching
the end of the colon to a bag worn outside the
body to collect stool.
If cancer is detected early, before it grows
deep into the colon wall, surgery has a cure
rate of more than 90 percent. But surgery
should rarely be necessary, according to Dr.
Swantkowski.
Colon cancer is second only to lung
cancer as the leading cancer killer in this country. |
“Colon cancer is almost totally preventable,”
he says. “No one should die of colon cancer in
this day and age.”
Regular colonoscopy screenings can detect
polyps growing on the lining of the colon
before they become malignant. When a polyp
is found, it can simply be snipped off.
Thomas Swantkowski, M.D. |
Physicians recommend that people have their first colonoscopy at age 50 or, if a close relative has had colon cancer, at age 40. Medicare and most insurance companies now pay for screening colonoscopies,
and more and more people are getting them. Still, Dr. Swantkowski says, there is a long way to go.
“Of all the people who could and should be screened, probably only about a third take us up on it,” he says. 
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