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Chapter 8. Irritable Bowel Syndrome

“One in five Americans has IBS, making it one of the most common disorders diagnosed by doctors. It occurs more often in women than in men, and it usually begins around age 20.”
Irritable Bowel Syndrome; National Institutes of Health[1]

Irritable bowel syndrome (spastic colon) is a chronic condition characterized by bloating, cramping, persistent abdominal pain or discomfort, frequent bowel movements, and bouts of diarrhea alternating with constipation. Inferring from the opening quote, it afflicts over 60 million Americans.

Left unchecked, irritable bowel syndrome gradually progresses to inflammatory bowel disease (IBD), which is one step away from ulcerative colitis (UC) and Crohn’s disease. The fine line that separates IBS from IBD is in the eye of the beholder—if you were to start poking around the bowel of an affected person, you’re bound to find some inflammation of the intestinal mucosa. In general, the causes, treatment, and prevention strategies of IBS and IBD are identical, except that in the case of IBD you suffer more, the treatment and healing takes longer, and the urgency is much higher.

Constipation is one of the most common afflictions associated with IBS. When the constipation is latent, the underlining conditions are hidden from view by the perception of regularity. That’s why ten times as many people complain of having IBS, rather than constipation.

There is an interesting paradox about IBS-related constipation: doctors may not recognize or diagnose IBS because patients may not have constipation at all, or have stools in the prescribed interval of time (at least three times weekly). By “prescribed,” I mean the diagnostic criteria set forth in The Merck Manual of Diagnosis and Therapy[2] (for general doctors), or the more authoritative source, such as Rome II Diagnostic Criteria For Functional Gastrointestinal Disorders[3] (used mainly by the specialists).

The pathologies that cause constipation-related IBS result from an abnormal amount of formed, hardened feces that may accumulate from the rectum all the way back to the cecum. This is a condition typical of latent constipation. The stools correspond to type 1 to 3 on the Bristol Stool Form Scale. The extended contact of the formed fecal mass with the intestinal wall causes irritation and mechanical abrasion of the bowel’s mucosa, especially during the periodic peristaltic contraction of muscles, and the propulsion of stools toward the rectum. In turn, perennial irritation and abrasion of mucosa cause inflammation and low-level discomfort, while peristalsis causes a more acute pain sensation, ranging from mild to sharp, which is referred to as cramps, or cramping.

Defecation is usually distressing, difficult, and requires intense straining. After defecation, some time passes before the residual abdominal pain subsides. This happens because of the transition of the hardened fecal mass from the upper regions of the large intestine into the lower part, which was just voided by defecation.

The initial accumulation of the hardened fecal mass (that causes IBS) inside the large intestine is the hallmark of functional constipation. Fiber by itself doesn’t cause IBS. But it does bulk up and harden fecal mass. Fiber creates even more discomfort and pain from the gases and acidity that result from bacterial fermentation. In time, fiber transforms functional constipation into latent, and, eventually into organic because of the colorectal damage incurred from large stools and straining.

Anorectal disorders that result from constipation, such as hemorrhoids and diverticular disease, are the most challenging aspect of IBS to deal with, because they’re irreversible. Fortunately, the pain, discomfort, and delayed or incomplete emptying of stools can be overcome, but these problems require a proactive approach, described elsewhere in this book.
Besides constipation, other prominent causes of IBS are:

You can’t insure against stress, infections, bad luck, or aging. You can, however, study this book to “insure” against improper nutrition and treatments, that makes an already bad situation even worse.

Hell of a treatment, or the treatment from hell?

Regardless of the cause of IBS, dietary fiber is a common denominator in the majority of cases. The fiber causes bulk, flatulence, and acidity, which deliver a one-two-three punch that only the very lucky can resist or deflect.
According to the International Foundation for Functional Gastrointestinal Disorders, we are in the midst of an IBS epidemic:

Irritable bowel syndrome (IBS) is America’s hidden health problem—a chronic, recurring disease that racks up in excess of $25 billion in direct and indirect costs each year. IBS affects an estimated 30 [to 60—ed.] million men, women, and children—10 to 20 percent of the U.S. population, yet less than one-half of these people seek advice from a healthcare professional. IBS occurs in people of all ages.[4]

The mayhem really starts from getting first-line-of-defense IBS remedies—more fiber, more water, and more exercise. By the time you’re stuffed with fiber up to your nose, water is pouring out of your ears, and you’re straining to the point of tears with your reinvigorated abdominal muscles, you’ve created more problems for yourself than you began with because:

Am I blowing everything out of proportion? Well, let’s again take another look at the prevailing medical view regarding the best treatment for IBS. According to the National Institutes of Health:

Some foods make IBS better.

Fiber reduces IBS symptoms—especially constipation—because it makes stool soft, bulky, and easier to pass. Fiber is found in bran, bread, cereal, beans, fruit, and vegetables.[5]

But the same document also explains the nature of pain related to irritable bowel syndrome:

With IBS, the nerves and muscles in the bowel are extra-sensitive. For example, the muscles may contract too much when you eat. These contractions can cause cramping and diarrhea during or shortly after a meal. Or the nerves can be overly sensitive to the stretching of the bowel (because of gas, for example). Cramping or pain can result.[6]

Doesn’t this depiction of IBS’s action describe exactly what we already know about the damaging properties of fiber and its effect on the large intestine? Yes, it does! The document points out:

So what can you do to prevent, treat, and get rid of IBS? Exactly the opposite of what most medical authorities are telling (or not telling) you to do—cut the fiber to reduce the stools’ volume, consume water in moderation to prevent gastroenteritis, and exclude drugs that may cause gastrointestinal distress. Here are the details:

Ironically, many well-meaning doctors and their families are also victimized by IBS, perhaps even more so than the general population, because they aggressively treat themselves and their families in the way they’d been taught. The scariest claim about IBS, however, is that it’s completely risk and damage-free:

National Institutes of Health: IBS can be painful. But it does not damage the bowel or cause any other diseases.[7]

Well, if you disregard diverticulosis, hemorrhoids, anal fissures, ulcerative colitis, precancerous polyps, and colorectal cancer, then I guess there isn’t any risk. To keep this from happening to you, consider the following key points:



1Irritable Bowel Syndrome; NIH Publication No. 03–693; April 2003; [link]

2Irritable Bowel Syndrome; 3:32; The Merck Manual of Diagnosis and The­rapy; [link]

3Irritable Bowel Syndrome; 7:C1:357; Rome II: The Functional Gastrointestinal Disorders by Douglas A. Drossman (editor);[link]

4Irritable Bowel Syndrome; The Burden of Illness;; [link]

5What I need to know about Irritable Bowel Syndrome. NIH Publication No. 03–4686, April 2003; [link]