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Rajni’s Story
Rajni* is a 35-year-old first-generation immigrant to the United States who lives in the San Francisco Bay Area and works in the IT sector. She is single. For the past three months, she has been having pain in her abdomen with cramping and bloating, especially aggravated while defecating. She has noticed changes in her bowel movements and feels a sensation of incomplete evacuation after passing stools. She has written that she has both lumpy and hard bowel movements as well as watery and loose movements. She is anxious and depressed and has contacted us with a need for guidance.
Q: Why does my stomach ache so much?
Dr. Sharma: Rajni, from what you are describing, it seems to be a condition called Irritable bowel syndrome (IBS). You will, of course, need to consult your primary care provider (PCP), who may refer you to a gastroenterologist (an expert in digestive disorders) for an accurate diagnosis.
IBS is a common, chronic, functional gastrointestinal disorder (FGID), which is characterized by persistent pain related to defecation and alteration in gastrointestinal (GI) motility. IBS is often associated with depression and anxiety, as you are describing, which lowers the quality of life.
This disease affects between 4% to 10% of individuals, depending on the criteria for diagnosis used, with a predominance seen in women and the third and fourth decades of life. Most people with IBS have some normal days and some abnormal days of bowel movement, and it is characterized by three types: (a) with constipation, (b) with diarrhea, and (c) with both hard and loose stools.
Q: What are the causes of IBS?
Dr. Sharma: The exact mechanism behind this disorder is not known but here are some possible causes:
- Increased contractions in the large intestine cause cramps and abdominal pain.
- A leak in the intestinal lining may cause bacteria and toxins to enter the bloodstream, causing infection.
- Increased levels of bile acids may be produced by the liver for food digestion.
- IBS is also thought to be an autoimmune disease, with the body’s overactive immune system being the cause of it.
- An imbalance in the gut microbes, or the bacteria that reside in the intestines.
- The fermentation of non-digestible foods in the system.
- Genetics and stress may also be causes.
Q: I have noticed that when I am stressed, it triggers my symptoms. Is that true?
Dr. Sharma: Yes, as I mentioned, stress does play a role in IBS flare-ups. There is evidence that an irritable bowel is a result of an irritable brain. Therefore, the treatment of IBS requires managing stress and learning ways to relax.
Besides stress, certain foods like dairy products, gluten (e.g., wheat), and sodas can also trigger IBS. The other triggers for women are menstrual cycles.
Q: How is IBS diagnosed?
Dr. Sharma: Your health care provider will first ask you about your symptoms in detail. Then they will order a blood test, a stool test, a hydrogen breath test to check if you have overgrowth of bacteria in your intestines, and sometimes imaging studies if needed (e.g., colonoscopy, flexible sigmoidoscopy, and endoscopy) to rule out other conditions.
Q: What is the treatment for IBS?
Dr. Sharma: A five-pronged approach can often help manage IBS by combining stress management, dietary changes, activity adjustments, psychotherapy, and medications.
For stress management, you can practice relaxation techniques such as progressive muscle relaxation, visual imagery, or autogenic training. When it comes to dietary changes, increase your fiber intake with foods like fruits, vegetables, and nuts. It’s also helpful to limit or eliminate dairy products, reduce gas-producing foods like beans, cabbage, and carbonated sodas, and avoid gluten. Always remember to drink plenty of water.
To get more active, aim for 150 minutes of moderate-intensity physical activity each week and make sure you get a consistent eight hours of sleep every night. Psychotherapy, specifically cognitive behavioral therapy (CBT), can help you develop awareness of your thinking patterns to better cope with challenges. Finally, medications should only be prescribed and used under the direct supervision of a healthcare provider.
Q: Can Indian philosophy and holistic techniques help with this condition?
Dr. Sharma: Yes, Yoga can help treat this complex condition by reducing stress, improving digestion, reducing pain, anxiety, and improving quality of life. However, you must start slowly with the practice of yoga.
Q: Can you suggest some additional resources on IBS?
Dr. Sharma: Here are some additional resources:
- Cleveland Clinic’s website on irritable bowel syndrome (IBS) with a video
- Mayo Clinic’s website on irritable bowel syndrome (IBS) with a video
- Cleveland Clinic’s website on cognitive behavioral therapy
- Five yoga poses for IBS
If you have questions, reach out to Dr. Sharma at editor@indiacurrents.com
*Names changed upon request
