Navigating Irritable Bowel Syndrome: A Comprehensive Guide

In this episode, Ed Delesky, MD, and Nicole Aruffo, RN, discuss Irritable Bowel Syndrome (IBS), covering its symptoms, causes, diagnosis, and various treatment options. They emphasize the importance of understanding IBS as a common condition affecting a significant portion of the population and provide insights into managing symptoms through dietary changes, stress management, and medical treatments. The conversation aims to educate listeners about IBS and encourage proactive health management.

Takeaways

IBS affects 10-20% of the population.
Symptoms include abdominal pain and changes in bowel habits.
Diagnosis is based on symptoms, not a single test.
Treatment requires a personalized approach.
Dietary changes can significantly impact IBS symptoms.
Stress management is crucial for IBS patients.
Medications can help but do not cure IBS.
Probiotics and herbal remedies lack strong evidence for IBS.
Most people with IBS can lead normal lives.
Understanding IBS empowers patients to manage their health.

Keywords

IBS, irritable bowel syndrome, digestive health, symptoms, treatment, management, gut-brain axis, dietary changes, healthcare, patient education

Chapters

• 0:00 Introduction and Updates
• 6:44 Understanding Irritable Bowel Syndrome (IBS)
• 17:50 Symptoms and Diagnosis
• 22:42 Treatment and Management Strategies of IBS
• 36:35 Prognosis and Conclusion

Transcript

Ed Delesky, MD (00:05)
Hi, welcome to your checkup. are the Patient Education Podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky  a family medicine resident in the Philadelphia area.

Nicole Aruffo, RN (00:20)
and I'm Nicole Aruffo. I'm an nurse

Ed Delesky, MD (00:22)
And we are so excited you were able to join us here again today. This has been a sleepy week. Nikki is not aware of any of the topics that we are going to discuss in our preamble. Stick around for about five minutes. That's what we'll keep it to. If you want the actual content in the episode, why don't you go ahead and find that at five minutes. But if you are a loyal listener and want to hear more about what we're up to, stick around. So it's been a sleepy week.

Nicole Aruffo, RN (00:49)
It has been.

Well, yeah, it's been a sleepy week. I'm a little congested and under the weather today, which turns out that's probably why I was sleepy.

Ed Delesky, MD (01:04)
But I take great solace. You know, there was a lot of conversation in my circles this week about being a daylight savings denier and you waking up on Monday morning at 5 a.m. to go exercise. And then around 630 when I stirred and you said, God, he was right. It did feel like 4 a.m. I am holding on to that for a long time.

That damn it. He was right. That's going to keep me going for a long time. So it's been a sleepy week. It's tough to wake up. I'm sure a lot of you people out there feel the same. If you are nodding your head, I hope you are in agreement. Topic number two went to Trader Joe's to get some particulars for this week's meal, which was a cream Mexican corn with contiha cheese. How would you describe it?

Nicole Aruffo, RN (01:59)
out.

It's like a Mexican street corn salad.

Ed Delesky, MD (02:08)
Mexican street corn salad. Turns out that that is difficult to find, the Contija cheese.

Nicole Aruffo, RN (02:14)
It's

not difficult to find. We were just in the store and we didn't know where that section was.

Ed Delesky, MD (02:20)
I know, but it was tucked away. It was in the store and it was tucked away in a different section from the other cheeses. It was separate. But you, you figured it out. You just knew.

Nicole Aruffo, RN (02:29)
We had to find the aisle with all the other Mexican flavorings, which was weird because they had it in a fridge in the aisle.

Ed Delesky, MD (02:39)
Yes, I thought that was.

Nicole Aruffo, RN (02:40)
It wasn't worth all the other refrigerated things.

Ed Delesky, MD (02:44)
And this Mexican street corn cream was paired with a shrimp.

Nicole Aruffo, RN (02:48)
There's no cream in the name. That's gross.

Ed Delesky, MD (02:52)
It was paired with a shrimp taco. The second, third headline is taco dressing from Trader Joe's has been discontinued.

Nicole Aruffo, RN (03:02)
I'm actually very upset about that. It was so good and it was like.

spicy, flavorful. I'm gonna have to write a strongly worded email.

Ed Delesky, MD (03:17)
Yep. So I was looking like up and down scanning. don't know how anyone else does this, but I scan each row of a desired section to try to find the item of interest. If I don't know what it looks like, I actually looked online and saw that these things were going for $30 a pop online. And I was like, that was that's weird. So then I went up to nice employees. They're always so happy there. And they were like, that's discontinued. And they had a big fat smile on their face. And I was like, I got this enchilada sauce and said, I'm sure that will do.

I'm not sure why I told them all of that. They didn't need to know, but I definitely was looking for their approval because I don't like seeming so helpless and messaging you at every turn when I'm like someone who's I'm like an online shopper who doesn't know the preference of the person who made the order. Like, is this substitution OK? And there's a functionality in the app. My functionality is texting you. But there's a degree of shame that goes along with that every single time I text thinking, wow, I'm an idiot.

And I can't figure this out.

Nicole Aruffo, RN (04:15)
And I don't blame you for just wanting to text me everything because sometimes it's like something very particular. Sorry, it's something like particular and it needs to be like this certain thing. Yeah. But then sometimes. Which you don't know because you can't read my mind, it's like, my God, just like figure it out and pick something. But you don't know what's a particular thing and what's a figure out thing.

Ed Delesky, MD (04:43)
I don't. And you are a tremendous woman in the way that you recognize that. And in no way, or form have you made me feel this way. It's my own personal thing. Like I had a meltdown. There's a classic Gen Z slash millennial meltdown over like the right tortillas to buy.

Nicole Aruffo, RN (05:03)
my god, the tortilla saga was one of the craziest things I've ever experienced in my whole life.

Ed Delesky, MD (05:08)
and forth three times to ACME on a morning day. Four times over the course of two days. Go ahead. Why is it funny?

Nicole Aruffo, RN (05:11)
Well then it was so funny.

is the nurse practitioner I work with. We were talking about our men and the Y chromosome in general, nothing too inflammatory, general ha-has. And she texted me something funny that her husband did that's along the same lines of this. And I was like, yeah, mine's been texting me pictures of tortillas for two days straight.

Ed Delesky, MD (05:44)
Yeah. I just could. That got to me. That one was a big one. Speaking of Trader Joe's, my dwindling attention span is something I wanted to mention. I make a list for this place. I love the store. It's great, especially this one near where we live. And I make the list, but the list isn't in order of the direction that we take every time we go into the store, which is like in and immediately to the right. Maybe you listening at home have a direction that you take when you walk into a grocery store every time.

but it's the same loop every time and my items are out of order. So I get distracted and then I see those oranges that you like and I get those and then the reason for sure. But then we get further and further down and then I'm like doing those like the suicide running drills. Three episodes in a row with that word. And we're not even talking about mental health today across the store back and forth, back and forth like, no, low fat Greek yogurt on this side.

Nicole Aruffo, RN (06:22)
to get the oranges that I like.

Ed Delesky, MD (06:40)
Go avocado feel on this side. No ripe avocados. Go get avocado mash over there. My attention span is suffering like the rest of society.

And so that, those were all of the points that I had to talk about today. Do you seem satisfied with that? Okay. So what are we going to talk about today, Nick?

Nicole Aruffo, RN (06:55)
I think I am.

Today we're talking about the good old IBS or irritable bowel syndrome.

Ed Delesky, MD (07:05)
Yeah. The point of this episode is to provide an overview of IBS, discuss its symptoms, explore some causes and possible explanations for causes, discuss treatment and management strategies, which will be really helpful all in one episode. And the reason that it's important is because it's bothersome and there are estimations out there that this affects about 10 to 20 % of all people. So if you know 10 people,

One or two of them probably has IBS. Maybe it's you. But only 15 % of people seek medical help. So what an interesting topic to happen for a podcast that someone might listen to to learn more about health for themselves, a loved one, or...

Nicole Aruffo, RN (07:52)
a neighbor with IBS.

Ed Delesky, MD (07:54)
So Nikki, tell us a little bit more if you're up to it. If you're not up to it, then I'll do it. And then you just tell me to tell the audience what to do about IBS.

Nicole Aruffo, RN (08:03)
Irritable bowel syndrome is a common chronic condition of our digestive system. Very common, again, like in the beginning you just said about 10 to 20 % of people have it, which is a lot.

Primary symptoms, which like we'll get more into our change in bowel habits, such as constipation or diarrhea, and then of course, abdominal pain. It can be very frustrating for everyone involved, like the patients and your doctor, because there's not, you know, like a one size fits all treatment and you're in pain and your doctor's trying to help you and you know, you're kind of like trying a lot of things.

Ed Delesky, MD (08:51)
Yeah, that can be tough. I remember one young woman specifically who told me that she had been through it was like the first time I was meeting her and she had been through three or four other doctors and she's had this chronic abdominal pain. A reasonable evaluation was done to make sure that it wasn't anything dangerous. And she was frustrated. And you can just tell like the temperature in the room was rising and rising. And I went to go speak to one of my more senior colleagues and they

basically took the time and they told me like the best way to go about this is to make an alliance with the patient against this thing and that you're all on the same team working together to try to make this better. And so it is a frustrating diagnosis. And one of the most frustrating things about it is that despite a lot of intense research, there is not a great explanation about what the cause of irritable bowel syndrome is, especially because as you heard Nick say right there,

Like there's a irritable bowel syndrome, diarrhea component, irritable bowel syndrome, constipation. So it can lead to different things all yielding around abdominal pain.

Nicole Aruffo, RN (10:02)
And to put it on top of all of that, GI in general, abdominal pain, constipation, and or constipate, or did I say constipation first? I can't even think. I'm not feeling well. Abdominal pain, constipation, and or diarrhea can all mean a thousand different things. So to even tease that out can probably be frustrating.

Ed Delesky, MD (10:31)
requiring probably a pretty large, possibly invasive evaluation culminating in a colonoscopy or an endoscopy. So here are some of the proposed theories about what irritable bowel syndrome comes from. One proposed theory is that there are abnormal contractions of the colon and intestines. And this is described as a spastic bowel. It's thought that maybe

These contractions themselves cause cramps and it is the reason that people think that anti-spasmodic medications and fiber may help. So by getting to this treatment and seeing that these things may do the trick for some people, there is a thought out there, maybe that's why this is the way it is. But it's not clear if these abnormal contractions are a cause or a symptom of irritable bowel syndrome.

So I had a dear friend who had this next one and he was texting me a whole lot and maybe he's listening to this episode. You know him very well and I'll just not say his first name because borderline health information.

He had a severe gastrointestinal infection, whatever it was, puke, diarrhea, diarrhea, diarrhea, puke, diarrhea, puke. And then he was having abdominal pain. He was having IBS, like point blank. He was having IBS after it. And so there is a community out there. There is a thought process, a theory that says maybe the IBS

can develop after severe gastrointestinal infection. Maybe it wipes out the flora and wipes out the cellular milieu, if you will, of the gastrointestinal system and makes it difficult to process food and all that jazz. But most people who have irritable bowel syndrome don't have this history of infection. And so there's a subcategory of IBS called post-infectious IBS.

Nicole Aruffo, RN (12:41)
Feels like regular, standard IBS, guess. That's not... I don't know if we'll talk about this down. So sorry if we are like, there's no inflammation. Right. With that, it's more of like the... I don't know what word, like functional piece, I guess.

Ed Delesky, MD (13:01)
Yes.

this is a perfect lead in.

what it is next. So then there's a broader community and a thought process that IBS itself is a part of an umbrella term of gastrointestinal disorders called functional gastrointestinal disorders, where something is going on that a patient is feeling, but there is no anatomical explanation. There is nothing that with the tests that we have today that can detect.

what the patient is feeling. And so that's just because our science hasn't caught up to it yet. And so the step beyond that is that could you look at irritable bowel syndrome as a disorder of the gut brain axis? What the heck is that? The gut brain axis is based on the idea that your entire gut has its own nervous system.

all the nerves that are in your brain that we've talked about in the past that communicate to each other, giving flights of information to and from. And it's different from all of the nerves in your fingers and your arms that make you feel and move. Quietly, there is a nervous system that lives in your gastrointestinal system, and it is as innately related to your central nervous system as anything.

but it's also separate. And so you may be fine working upstairs. You have no issues whatsoever. Or you're not. And your stomach hurts, which is another cause. So.

Nicole Aruffo, RN (14:40)
or not? And your stomach hurts?

Ed Delesky, MD (14:47)
To get to the point, a disorder of the gut-brain axis could be related to how people are

perceiving normal bowel functions. People can have heightened sensitivity of intestines or it's called visceral hyperalgesia, which may result that normal sensations that Nikki or I feel may be perceived as painful. And that's why certain medications like antidepressants may help blunt the pain. That's one thought about what irritable bowel syndrome can be from. But then you mentioned what if someone's not doing quite well enough upstairs, right?

that perhaps stress and anxiety is related to this and they worsen symptoms, but they aren't quite related to the underlying cause. Could that live under the umbrella of the gut brain axis disorder?

I mean, I've been talking for two or three minutes right now. And if it isn't evident, there's so many disparate ideas about why this can be, why this is such an issue and so common and so tough to deal with. And the last one I'll talk about while I'm waxing poetic over here is possible food intolerances or sensitivities, not inflammation, but intolerances. So maybe there's a thought that certain foods are bothering you, which can lead to

This symptom pattern of abdominal pain, constipation, or diarrhea.

What do you think about all that?

I mean, one one one thought I'm having is like, how are you supposed to like, this is a lot of research and evidence that goes into like, what, five different possibilities of what this could be from.

So we really don't know.

Nicole Aruffo, RN (16:45)
Yeah. there, like, really there is so much research on it. And then all of that to say,

We don't exactly know, which is like really frustrating. Right. Right. Like you go to the doctor, have all these things. And then even if, you know, whenever they make a diagnosis, like which we'll talk about, but then treating that. You know, like your doctor is going to take you and your symptoms and everything and kind of make like the best plan. But that's still kind of could be like a shot in the dark and like that might not work.

Ed Delesky, MD (17:19)
Yeah. This gets at one of our earlier episodes, with the what taste being a patient, what your doctor wishes you knew. Yeah.

Nicole Aruffo, RN (17:28)
I mean, and even the people like when I worked on like a peds like GI primarily floor like we got all those GI kids and all like short, well, the IBS, Crohn's, blah, blah, blah. And like even these people who like the GI attendings who like did fellowships and specialized training and all of the things and like are the experts in it are still kind of like, there's no straight answer. Yeah.

Ed Delesky, MD (17:57)
So what that really does breed is there's certainly an opportunity for frustration on the parts of multiple parties that are involved. Frustration from a patient like you were mentioning earlier, a clinician's frustration. And so it's a tough thing. So maybe you'll learn something today that you can be proactive. And we're going to talk about a whole different array of treatment options, which kind of gets it.

like how you get down to the solution. You have to try a couple different things based on your symptom pattern and what it most likely might be from.

So I just went on that diatribe about how we, know, there are like five different theories about where IBS comes from. Probably the disorder of the gut brain axis is where I fall on the whole arc of things. I don't know, what do you think?

Nicole Aruffo, RN (18:50)
What did you just say?

Ed Delesky, MD (18:52)
I said, think like I fall on the disorder of the gut brain axis as being the most likely cause of this.

Nicole Aruffo, RN (18:58)
Yeah. But especially, you know, it's like you can't like see it, you know, it's not like you can like, let's do this X-ray and see if there's something going on here, you know? Yeah, even, yeah.

Ed Delesky, MD (19:06)
Right.

Let's do this colonoscopy.

Yeah. But so let's get back to practicality a little bit. What we were theorizing. You told us about what it is, but why don't you tell us a little bit more in more detail about common things that people experience when they have IBS.

Nicole Aruffo, RN (19:32)
So we first talked about abdominal pain and the abdominal pain with IBS is typically crampy and then can vary in intensity. It might get worse if you're having any kind of like emotional stress. Some people will notice that it's worse around their period. And then also will typically improve after you've had a bowel movement, which you'll probably notice your doctor ask you.

When is your pain? When does it get better? Does it get better after you've had a bowel movement? Because that's pretty common. And then changes in your bowel habits, whether that's diarrhea, constipation, or both of them. With diarrhea, you're having frequent loose stools. Usually in the daytime, nighttime diarrhea is rare in IBS. And then you have like that urgency.

And also the feeling of like incomplete emptying. like, like a normal person without IBS, you have a bowel movement that you feel like you feel like a skinny legend. You're empty for the day, but you don't really have that feeling with having diarrhea and IBS. And then with constipation that can be intermittent and can last for a couple of days. And then you're having hard, you know, just like a constipated.

Ed Delesky, MD (20:37)
Thank

Nicole Aruffo, RN (20:56)
stool, like hard pellet-shaped stools. And again, with the feeling of incomplete emptying, even after you've had a bowel movement. That has to be an awful feeling. There's honestly like, I mean, in our doctor nurse household, a lot of our days are surrounded around, my gosh, I cannot talk today. Surrounded around the bowel movements of the family.

Ed Delesky, MD (21:07)
Yeah, damn, that's rough.

Nicole Aruffo, RN (21:25)
including Oli. Our day can't start without it.

Ed Delesky, MD (21:26)
yeah.

Like I

Nicole Aruffo, RN (21:32)
Yeah, that's a lot. Did you have any

change in bowel habits or pain?

Ed Delesky, MD (21:38)
No pain. That's that's where I'm at. No pain. So like this doesn't apply to me. No abdominal pain. Not a NOS. NOS.

Nicole Aruffo, RN (21:45)
Nas? I don't know. Nas?

my god. Neither of us can talk today.

We're doing this after work. Usually it's like a weekend, slept in a little, had a morning.

Ed Delesky, MD (22:03)
Ugh, alright.

Nicole Aruffo, RN (22:05)
All right, Ed, how does one get diagnosed with IBS?

Ed Delesky, MD (22:12)
So here's the really exciting thing. There is not one single diagnostic test for IBS. And they should.

Nicole Aruffo, RN (22:19)
They shouldn't make one.

We should invent one. We'd be rich. We'd never have to work again.

Ed Delesky, MD (22:24)
And we could sit here and do this all day. But instead, how it is diagnosed is that clinicians use a formal diagnostic criteria, lists. We use lists of symptoms and timelines and signs to be able to say, is this IBS or is it something else? But the problem with those lists, like you alluded to earlier, is that these symptoms like cross over so many different pathologies that

It's tough to be able to say just from a conversation whether this is IBS or is it something else. And so with that, you do a whole medical history, family history, a little bit of physical examination, and a few tests that may be able to out rule out other medical conditions. Blood tests will probably often be normal. God bless you. Blood tests will probably often be normal.

Some stool tests may be helpful to offer some reassurance that there's no inflammation going on, which is what you so eloquently said earlier. Inflammation would be something that needs to be addressed. Not that IBS doesn't, but you know what I mean. And then for people who are over 40, 45, maybe you take these symptoms with a grain of salt and you're marching your way towards a colonoscopy. I know people even closer than that other person in my life who

have had symptoms like this and have had to go under colonoscopy.

But, you know, to protect their health information, we won't say here.

Nicole Aruffo, RN (24:01)
You

The first one better be listening.

Ed Delesky, MD (24:07)
He better be. I'm not sure if the second one listens all the time. Big supporter of the show, though.

Nicole Aruffo, RN (24:15)
Let's talk about all of the bajillion different ways you could treat IBS

Ed Delesky, MD (24:21)
Yes. and so what we'll, what we normally might do in two weeks, we're going to try to do here in one week. So now we're going to kind of arc over into treatment and management strategies that your specific doctor may recommend for you. We are not recommending. So not from us, didn't hear it from us, but there are different types of treatments and therapies for IBS and it really, you have to be patient. You might have to take some time and

Nicole Aruffo, RN (24:39)
didn't hear it from.

Ed Delesky, MD (24:49)
Trust, which I know is a tough thing these days, to find the right combination because everyone wants it now. communicate with whoever is taking care of you. Communicate with whoever is taking care of you to try to be able to find the right option for you. So maybe we have maybe we haven't talked about symptom diaries on this, but monitor monitoring your symptoms, your daily bowel habits. Take a look at a Bristol stool chart, if you will. It's a chart of poop.

from one to whatever the number goes up to of different shapes, sizes, colors, what have you. That is a standard way to talk to your doctor about poop. And figure out other potential triggers. In this way, we talk about some dietary changes. Now, if you're going to do any sort of elimination diet, you need to talk to your own doctor. But one that's pretty straightforward is that

many people end up having an intolerance to lactose. As we age, the enzyme that people use to break down lactose actually kind of wanes in its availability in your body. The undigested saccharide or a carb can draw in more water and gas into the bowel, making you feel a little more bloated, diarrhea. So if it's lactose, you may try a temporary elimination of milk products.

Really, you have to do this thoughtfully for about two weeks because that's the amount of time it takes to give an honest attempt and see is this actually working? Not all food has the same amount of lactose, like not every dairy product is like, boom, full on lactose. I'm thinking of things like whole milk, like a cup of whole milk has nine to 14 grams of lactose compared to

cheese, like some cottage cheese and a half cup may have 0.7 grams to 4 grams. And this is a dose response thing. So the more you have, the worse off. Cream cheese, 0.1 to 0.8 grams. I'm looking at ricotta cheese, half cup, 0.3 to maybe 6. So maybe that one has a little bit more. Sherbert, 0.6 to 2 grams of lactose. So basically what I'm saying is take a look.

see if the lactose is something that you need to make an adjustment on. Nikki, what other foods can we look at that may bother people a little bit more than others?

Nicole Aruffo, RN (27:27)
So you might want to make an adjustment. You personally might want to make an adjustment to your favorite gas producing foods like legumes or cruciferous vegetables, which include beans. And then those vegetables are including cabbage, Brussels sprouts, cauliflower, broccoli, which honestly like.

I feel like even without IBS, if you eat a raw cruciferous vegetable, your stomach is wrecked.

Ed Delesky, MD (28:01)
yeah, and those parts are nasty at the end of the day.

Nicole Aruffo, RN (28:02)
interesting.

And then also some people might have some issues with onions, celery, carrots, raisins, bananas, prunes.

and some wheat and sprouts.

Ed Delesky, MD (28:20)
Yeah. And see, like, this isn't an indictment on these foods. These are good foods. right. You're looking at the I'm looking at these and I'm like, wow, that those are good options. So just talk to your doctor. Be careful. And that's all I got to say about that. There are some foods that may be better tolerated in people with IBS. We're going to throw a couple of those out at you here now.

It's kind of an extensive list, but water is not a bad idea. I'm not trying to be a smart aleck here. Ginger ale or Sprite, Gatorade. Soy milk, rice milk may be better. Plain pasta, plain noodles, trying to avoid sauces and gravies. That sounds like no fun at all. A boiled or baked potato. You could do a lot with a baked potato.

Nicole Aruffo, RN (29:13)
love a pote.

Ed Delesky, MD (29:14)
And I'm surfing this list, a soft boiled egg. We love that every morning. And I'm seeing margarine, jams, jellies, peanut butter.

Yeah, it's kind of a long list, but there's a lot of options out there. This really impacts your daily life and you need to think about what foods you can enjoy if you are suffering from IBS.

If one is to have a constipation predominant IBS, there are a lot of moves to be made with fiber. A quick search online at the risk of listing too many foods on this episode, a quick search online will tell you a lot about what foods have high fiber. But something you may consider having a conversation with your doctor about is a fiber supplement, which is rather natural.

and it could be something like psyllium or methylcellulose. Very simple addition because sometimes while you're trying to find those foods, you need to start working towards a solution today. And maybe the option is a fiber supplement. So it can cause bloating and discomfort in some people with IBS. Like we were talking about, no one really knows what's going on. So be careful, start low, go slow.

Don't have a ton of fiber. If you got your Metamucil not sponsored in the in the closet, you're not dumping tablespoons in there. Try a little bit. See where you're going. Take it day by day. There's no rush. So we're exiting the food adjustment section and we're moving into stress and anxiety management, which goes nicely with our episodes last week. We mentioned earlier briefly how stress and anxiety can worsen IBS symptoms.

I really encourage anyone who's listening, who's thinking that they may fall into this category to go have an open conversation with whoever's taking care of you and get started working on these things. Because the treatment for this is treating, the treatment for underlying IBS because of anxiety or stress is treating the anxiety and stress. And the best way is to do that. We will have an upcoming episodes, but you can refer to our last episode, like formal counseling.

or an antidepressant or anti-anxiety medicine or cognitive behavioral therapy. And so that might be a big leap, like I have a stomach ache and my mind isn't quite right, but it's true. It exists, it's real, so we should take care of it.

So then we exit that part and enter what everyone a lot of the times is interested in. How can I work on this with a medication? And so medications can relieve symptoms, but they don't cure IBS. As we get to that point of like there are so many things that could be going on. And so medications are usually offered when a conservative measure like changes in diet or addition of fiber don't help. And so there are different classes that we'll go over here.

Really, they should always be like a lot of them are prescription, but you should be having these conversations with your own doctor. Anticholinergic medications can reduce severe cramping and irregular contractions. Thinking of medicines, generic name, Dicyclamine, a brand name, Bentol, perhaps you've heard of, or another one, Hyocyanin with a brand name, Levson. There's also encapsulated oil of peppermint, which

seems rather natural and can be very effective. These medications can be particularly helpful when taken preventatively. So before you have symptoms and that's why it's so important that you should find out what triggers your symptoms and predict when they're most likely to happen. I should say in elderly individuals these medicines probably aren't the best and common side effects include dry mouth, dry mouth, dry eyes, and blurred vision.

Earlier we talked about mood being related to the symptoms of your IBS and so antidepressants, but specifically like we mentioned last week, a tricyclic antidepressant. This is one of those specific situations that I mentioned last week where while they're not widely used anymore for management of depression, management of IBS is a place where maybe tricyclic antidepressants have their home. They can be used for pain relief.

and as well as selective serotonin reuptake inhibitors. Like we said, they're mainly used to treat depression, but they can have that pain relieving effect.

The dose of tricyclic antidepressant is actually much lower than it is used for treating depression. So there's some solace in that. And it's believed that these medicines reduce pain perception when used in low doses. But truthfully, not everyone knows exactly why they're working the way they do. Common names include amitriptyline or a brand name Elaville, imipramine or a brand name Impril, disipramine,

or a brand name noreprimen and nortriptyline, which is a brand name Pamelor. It's very common to experience fatigue when starting a tricyclic antidepressant. And sometimes this isn't always an undesired effect. And so sometimes it can improve sleep when taken in the evening. And usually they're started in small doses and increased gradually. Usually they're started in low doses and increased gradually.

And their full effect may not be realized until three to four weeks in, like we've seen with all of these other mood medications. Tricyclic antidepressants also can slow movement of contents through the gastrointestinal tract by its anti-cholinergic property. That's kind of like Medical School Physiology 101. For all of you listening out there, you don't really... I don't know how much... how important that is to you. And probably is most helpful with people with the diarrhea predominant.

IBS.

Stepping away from the tricyclic antidepressants and selective serotonin reuptake inhibitors, we arrive at anti-diarrheal medications. What a beautiful thing. Anti-diarrhea. Used of course for diarrhea predominant IBS. And a major key piece here is major key, DJ Khaled, don't exceed the dose. I'm talking about medications that go by the name loperamide or very commonly heard brand name, Imodium or

diphenoxylate atropine brand name Lomotil These can help slow the movement of stool through the digestive tract. They're most helpful in the diarrhea predominant IBS, but experts usually recommend that these meds should only be used rather, these meds should only be used as needed rather than a continuous basis. If you take loperamide, you should be careful not to exceed the dose on the label.

unless specifically instructed by your doctor. Usually this can lead to heart problems if you do that. So don't mess around with it.

There are several other medications that are above my pay grade and probably like fellowship gastroenterology level that I in fact would probably have a tough time pronouncing, but just know that if none of those options help you, there are more out there. There is more help to get. They're more expensive, less available, but there is more help out there.

And if you've made it this far, stick with us a little bit longer because you probably have seen several commercials on TV recommending or advertising different herbal remedies or natural therapies. And so when it comes to these, there happens to not be a lot of evidence supporting these treatments that are herbal remedies. Probiotics, chamomile tea, evening primrose oil, and fennel seeds

are largely unproven options for IBS. People may refer to small studies or flawed studies with positive findings, but all in all, these are likely unhelpful in this situation that you might find yourself in. Worse than being unhelpful, there are options that can actually be dangerous. And so for some reason, people are out here trying wormwood.

as a potential agent, but that can lead to nervous system problems. And I don't know anyone who wants to stop their diarrhea and acquire, not that this would even stop your diarrhea, but get nervous system problems. There's also Comfrey, which can cause liver problems, but is often used in these situations. And

specifically acute liver failure and other liver problems with medications that I have seen on our TV a lot, IberoGast. Bloating, IberoGast. Indigestion, IberoGast. It's a catchy commercial, but it largely is probably not helpful or at least there's no evidence, which, you know, it is what it is.

All right, Nikki, they have been listening to me on my diatribe for minutes now. Is there any good news? Tell us about IBS, the prognosis of IBS. What do you got?

Nicole Aruffo, RN (39:25)
Well, the great news is that most people with IBS can control their symptoms and have a totally normal life. And fewer than 5 % of people who are diagnosed with IBS will later be diagnosed with another gastrointestinal condition.

Ed Delesky, MD (39:44)
That's nice. Yeah. That's kind of reassuring. Once you nail this diagnosis, it's probably the thing that's ailing you. defining something, there's power in that. That's nice. Right. Not wondering, like, what could this be? Because I've had that. I've seen that a lot. And so in conclusion for today's episode, we just wanted to say that IBS is a manageable condition with the right approach. And there are multiple options out there available to reduce your symptoms. And just be patient.

and work with your doctor to be able to come up with the best option for you. And so thank you for listening this week. Please share with a loved one or someone else. Hopefully this week you were able to learn something for yourself, a loved one or

Nicole Aruffo, RN (40:32)
a neighbor with crampy abdominal pain and diarrhea and or constipation.

Ed Delesky, MD (40:37)
Please check out our website, find us on Instagram, send us an email near checkuppod at gmail.com. And until next time, stay healthy, my friends. I'm Ed Delesky Thank you, goodbye. Bye.

Nicole Aruffo, RN (40:49)
I'm Nicole.

Ed Delesky, MD (40:57)
This information may provide a brief overview of diagnosis, treatment, and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments, or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use.

This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for a complete information tailored to you. In short, I'm not your doctor. I am. And make sure you go get your own checkup with your own personal doctor.

Nicole Aruffo, RN (41:34)
not your nurse.