New Insights into IBS

 

Digestique emphasizes a team approach to diagnosing and treating digestive diseases in women. Our staff are experienced gastrointestinal therapists and are willing to accept the challenge your particular problem may pose. Our services range from comprehensive evaluation to a more focused investigation, as dictated by the clinical situation and the client’s needs. Medical and surgical consultation, blood testing, food allergy testing, nutritional assessment, dietary and lifestyle counseling, upper endoscopy, colonoscopy, colonic hydrotherapy, office treatment of hemorrhoids are available in a timely and efficient manner.

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Background

Digestive diseases are remarkably common worldwide. Their severity can range from incidental to life threatening. Many of these conditions respond to dietary or lifestyle modifications. In some instances, however, refractory symptoms may require medication or even surgery. It is estimated that as many as 10-15% of the U.S. population has suffered symptoms of irritable bowel syndrome (IBS), with 80% of these being women. Similarly, gastroesophageal reflux disease (GERD), gallstones, constipation, diarrhea, incontinence, hemorrhoids, and rectal prolapse disproportionately affect women, especially during or following pregnancy. Other intestinal disorders, though no more frequent in women than men, nonetheless are sufficiently common to warrant the attention of this specialty clinic. These include: food allergy, Crohn’s disease, ulcerative colitis, diverticulitis, and others.
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Irritable bowel syndrom

Irritable bowel syndrome (IBS) is a chronic condition characterized by one or more of the following symptoms: abdominal pain, diarrhea, constipation, bloating, increased passage of gas (flatus), or urgency to have a bowel movement. Though not life threatening, these symptoms often lead to a poor quality of life. IBS is often misdiagnosed due to the lack of obvious findings on upper endoscopy, colonoscopy and barium x-rays. For many years, IBS was thought to be a “nervous condition”. New insights have identified specific causes for many individuals suffering IBS symptoms.
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Food allergy or intolerance

Food allergy or intolerance is poorly understood by both those suffering from these conditions and many physicians, as well. The intestinal tract is exposed to innumerable “foreign” substances during the eating process. A large number of potentially injurious substances can be ingested, including chemical preservatives, environmental toxins, and harmful bacteria. In addition, an innocent appearing and otherwise healthy meal may contain nutrients which, in a sensitive individual, can cause a serious allergic reaction or other form of abnormal response. Food allergies or intolerance are difficult to diagnose. Methods used to detect these disorders include elimination diets and blood or skin testing for specific allergic food products. Recently, improvements in testing for food allergy and sensitivity have become much more informative, allowing a customized approach to dietary planning.
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Gastroesophageal reflux disease (GERD)

Gastroesophageal reflux disease (GERD) causes a spectrum of symptoms affecting up to 60, 000,000 Americans at one time or another. The most common symptom is heartburn, resulting from the irritating effects of stomach acid or bile regurgitating into the lower esophagus. If left untreated, chronic reflux of stomach acid can lead to serious intestinal bleeding, narrowing of the esophagus (stricture) or even cancer. The causes of GERD include: decreased pressure in the lower esophageal sphincter, a valve normally preventing backflow; delayed emptying of the stomach: or weakened contractions of the esophagus. Pregnancy exacerbates these factors and is associated with increased symptoms of GERD. Most individuals can be successfully managed with dietary advice, coupled with lifestyle changes.
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Gallstones

Gallstones occur in about 8% of the U.S. population. Between ages 20 and 60, gallstones are twice as common in women as in men. They result from an abnormality in the composition of bile produced by the liver. Bile is necessary for the proper digestion and absorption of dietary fat. When bile contains excessive proportions of cholesterol, it can crystallize to form stones, typically where bile is stored, in the gallbladder. These stones, called gallstones, can be asymptomatic or cause a variety of symptoms. Colicky or crampy pain in the upper abdomen or beneath the right ribs, especially following a fatty meal is typical of gallstone disease. Bloating, excessive burping, or pain radiating around the right flank can also occur. Occasionally, gallstone symptoms first appear during or shortly after pregnancy.
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Crohn’s disease and ulcerative colitis

Crohn’s disease and ulcerative colitis are collectively known as inflammatory bowel diseases (IBD). The cause is still incompletely understood, but seems to require a genetically susceptible individual being exposed to an intestinal irritant (dietary, infectious, chemical, etc.), which results in an abnormal and excessive inflammatory response within the wall of the intestine. The immune system plays a major role in this response by not reverting to normal at the appropriate time. Crohn’s disease can involve any portion of the intestinal tract, while ulcerative colitis only affects the colon and rectum. Symptoms can include: crampy lower abdominal pain, fever, diarrhea, bloody diarrhea, and fecal urgency. IBD is often misdiagnosed since its symptoms can mimic other more frequently seen digestive diseases.
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Functional constipation

Functional constipation is a common condition defined as less than three bowel movements per week, especially if straining is required to evacuate. It occurs more often in women, worsens during pregnancy or with advanced age, and can be a prominent symptom of irritable bowel syndrome (IBS). When simple measures fail to help relieve the symptoms, a thorough evaluation should be conducted to identify potential hormonal, metabolic or mechanical causes of constipation, as these could lead to serious consequences.
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Diverticular disease

Diverticular disease is common in western civilizations and is increasing in frequency within the U.S. A diet low in roughage and high in fat content seems to predispose to the formation of tiny outpouchings or sacs within the colon. These outpouchings are called diverticula. Symptomatic diverticulosis is characterized by vague lower abdominal pain, bloating, constipation, diarrhea, or passage of mucus. These symptoms are similar to IBS and some physicians, in fact, suggest that diverticulosis is an end result of untreated IBS. In some circumstances, these diverticula can become infected, leading to diverticulitis. Once thought to be a disease of the elderly, attacks of diverticulitis are increasingly seen in younger individuals. Diverticulitis results in fever and moderate to severe lower abdominal pain (especially left-sided). Diverticulitis requires prompt medical attention to prevent serious complications. While antibiotics and dietary restrictions usually resolve a bout of diverticulitis, occasionally perforation of the colon or abscess formation warrant urgent surgical intervention.
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Hemorrhoids

Hemorrhoids occur in two forms, internal and external. Internal hemorrhoids occur about one-half to one inch inside the anal opening while external hemorrhoids occur at or just outside the anal opening. Hemorrhoids form as a result of chronic straining, typically from constipation, diarrhea, or poor bowel habits. Increased abdominal or pelvic pressure from pregnancy or repeated heavy lifting can also produce hemorrhoids. Hemorrhoids are abnormally dilated blood vessels covered by an otherwise normal overlying membrane. Internal hemorrhoids are covered by a delicate intestinal lining and can bleed or protrude (prolapse) with straining or irritation. Internal hemorrhoids typically do not cause pain. To the contrary, external hemorrhoids are covered by thick but very sensitive skin and can become swollen and quite painful at times (thrombosis). External hemorrhoids can also result in excessive anal skin tags which are not only unsightly, but can cause difficulties with hygiene, leading to irritation and burning.
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Incontinence

Incontinence is defined as the uncontrolled passage of bodily excretions. Fecal incontinence is a surprisingly common condition in women, occurring in middle aged women as well as the elderly. Its causes can be multifactorial and include: chronic diarrheal conditions; inflammation of the colon and rectum; injuries to the anal sphincter from accident, surgical procedures or obstetrical deliveries; and neurologic conditions such as strokes, spinal injuries or pinched nerves in the lower back. Fecal incontinence is embarrassing and, if left untreated, can lead to social isolation and extremely poor quality of life. Successful management depends upon accurate determination of the specific cause of the incontinence.
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Rectal prolapse

Rectal prolapse is an uncommon condition which occurs almost exclusively in women. Although typically occurring later in life, occasionally it can be seen in younger women. Rectal prolapse results from excessive and inappropriate straining to defecate over a period of months to years. The straining results in stretching of the normal attachments of the rectum to boney structures within the pelvis. If sufficient damage occurs to these attachments, the rectum can begin to drop in the pelvis, eventually turning inside out as it protrudes through the anal opening. This protrusion or prolapse of the rectum initially occurs following defecation, but if left untreated, can occur with relatively minor physical activity, such as standing or walking. Oftentimes, the prolapsed rectum requires manually pushing it back inside the pelvic cavity. If allowed to progress, rectal prolapse can be complicated by fecal incontinence.
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