Dear Dr. Garner,

I am 35 and in good condition except for a problem I have been having lately.

Whenever I get upset or worried about something my bowels go haywire. I have pain and diarrhea and I feel a little depressed.

My doctor feels it is due to irritable bowel disease.

Is there a way to know for sure? He has sent me for a zillion tests with everything coming back negative.

My worrying has made the condition worse. I have this fear that it will turn into cancer.

Please help me. It is really getting me down.

Irritable Bowel in Bensonhurst

Dear Irritable Bowel,

Irritable bowel syndrome (IBS) is a common problem that affects the intestines, causing cramping, belly pain, bloating, and change in bowel habit. Despite the severity of the symptoms, irritable bowel syndrome does not cause damage to the bowels.

It does not cause cancer or other diseases such as Crohn’s disease or ulcerative colitis.

Most symptoms will actually improve as the person with the disease gets a better understanding of what causes it for him or her and what treatments are effective.

The diagnosis is difficult to make as there are no specific signs for irritable bowel syndrome. It is diagnosed by a process of elimination. IBS may include other bodily symptoms such as constantly feeling tired and depressed.

To make a diagnosis of irritable bowel syndrome, a person should have belly pain and discomfort, lasting about 12 weeks a year.  In addition, you must have two of the following:
1. A change in the frequency or consistency of your stool.
2. Straining to empty your bowel.
3. Mucous in your stool.
4. Bloating and abdominal distention.

Using these criteria, your doctor can help decide whether or not your symptoms are due to irritable bowel syndrome or something more serious.  The following might be the sign of a more serious condition:
1. Onset of IBS symptoms after age 50
2. Weight loss
3. Rectal bleeding
4. Fever
5. Diarrhea that awakens you from sleep

To evaluate your condition, your doctor may perform the following:
1. Colonoscopy through which your doctor can examine the entire colon.
2. CT scans to help rule out all the causes.
3. Lactose intolerance test as you may not have enough of the enzyme to digest a type of sugar found in dairy products.
4. In addition, your doctor may order blood tests to rule out diseases such as celiac disease.

Simple Lifestyle Changes
Here are some simple lifestyle changes you can make:
1. Increase the fiber in your diet. This can help reduce constipation, however, it can also increase the amount of gas and cramping that you experience. Gradually increase your fiber over a period of weeks.

Avoid problem foods. Chocolate, high-fat foods, milk products, and large amounts of alcohol can trigger symptoms. The best way to understand what your particular problem foods are is to keep a food diary.  When you have bad days, review the diary to see what you ate and avoid those foods in the future.
2. Avoid chewing gum or drinking through a straw which can lead to swallowing air and cause more gas.
3. Eating smaller meals may help to control diarrhea.
4. Substituting yogurt for milk may help reduce symptoms.
5. Drink plenty of liquids.
6. Avoid caffeine.
7. Exercise regularly.

If using products that stop diarrhea or constipation, the medication should be used sparingly with the lowest possible dose. If your symptoms include pain or depression, your doctor may recommend an antidepressant. These medications relieve depression as well as control the spasms. Some doctors may use antibiotics.

Several new medications recently approved for IBS are:
• Lotronex. Doctors who use it must be familiar with its complications. Lotronex works by controlling the nerves that supply the bowels.
• Zelnorm relieves pain, bleeding and constipation but its major side effect is diarrhea.
• Celexa, an anti-depressant, may help those who are anxious.
• Amitiza works by increasing fluids that the body makes in the bowel to help with the passage of food.

Some people have had success with acupuncture, herbal medication, hypnosis and yoga.

In summary, irritable bowel syndrome is common and may occur in up to 20% of adults in the United States. Those most at risk are women younger than 50, and people with a family history of irritable bowel syndrome.

IBS can be successfully managed, but cannot be cured. The symptoms vary in frequency.  Some people can go for weeks or months without symptoms, and others experience symptoms daily. The most important thing to do is rule out the more serious causes of bowel discomfort such as cancer, Crohn’s disease or ulcerative colitis. This can be done by visiting your family physician.  While the cause of IBS remains a mystery, simple treatments can be successful.[hr] Dr. Steven Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on The NET, Tuesdays at 8 p.m. on Channel 97 Time Warner and Channel 30 Cablevision.