Irritable bowel syndrome: How one woman meets the challenge

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Irritable bowel syndrome: How one woman meets the challenge

Irritable bowel syndrome — Symptom management, not cure, is the goal.

Photo of Lori Stahnke
Lori Stahnke manages her symptoms of IBS through lifestyle changes.

Despite her nagging symptoms, Lori Stahnke put off seeing the doctor for three years. She had an active preschooler, a new baby, and at 26, she just didn't have the time.

But when abdominal pain, nausea and chronic constipation began to keep her up some nights, Lori — a part time obstetrics-gynecology nurse — decided she couldn't wait any longer. After several appointments and numerous tests, she was diagnosed with irritable bowel syndrome (IBS), a condition that affects about one in 10 Americans — mostly women in their early 20s.

Following the diagnosis, Lori had to make another choice: change her lifestyle or continue to suffer from the troublesome symptoms of IBS.

Years of escalating symptoms

Lori doesn't remember exactly when she started having IBS symptoms. In her late teens or early 20s, however, she had frequent bouts of constipation, which she treated with saline laxatives, giving little thought to a possible underlying condition.

But her signs and symptoms eventually increased. Laxatives no longer helped. She frequently had abdominal pain and cramping, hard stools, and rectal pain and pressure. Lori says she'd go several days without a bowel movement. And when she did pass stool, it was small and worm-like and often accompanied by mucus, which is common with IBS.

Lori suspected something might be wrong, but for years she didn't tell anyone, including her husband, Bill. Lori says that she was uncomfortable talking about her symptoms and didn't want to go through all the required tests.

That's a common reaction among people with IBS and related conditions, according to G. Richard Locke III, M.D., a gastroenterologist at Mayo Clinic, Rochester, Minn. "People don't like talking about their bowels," he says. "And they don't like the idea that if they do talk about their bowels, chances are good they'll be getting tests they aren't looking forward to."

Fewer than half the people with IBS actually seek medical help. Yet it's important to see a doctor if symptoms are severe or last more than several weeks.

Circumstances didn't allow Lori to avoid the doctor for much longer. She awoke one night with severe abdominal cramping and rectal pain followed by vomiting. "I was in the bathroom at three in the morning. I hadn't had a bowel movement for two or three weeks, and the only thing I had been passing was mucus and scant amounts of stool," says Lori. "I couldn't have a bowel movement no matter what I did." She says the pain was unbearable. Lori decided it was time to see her doctor.

Tests confirm the cause

The next day her doctor did a thorough exam and conducted several tests, including blood tests. But the tests didn't point to a cause of her pain and constipation. So her doctor referred her to a specialist in digestive disorders.

The specialist suspected that she had IBS, a disorder characterized by abdominal pain, bloating, constipation and diarrhea. But because these signs and symptoms can accompany other conditions — such as inflammatory bowel disease, celiac disease, cancer, a bowel obstruction or infection — the specialist conducted further tests. Lori had a fecal occult blood test, a colonoscopy, a computerized tomography (CT) scan of her abdomen and a colonic transit study. All reports came back normal, indicating that Lori had IBS.

IBS is a functional disorder, meaning the intestines appear normal but don't function properly. Layers of muscles in the wall of the intestines normally contract and relax with a coordinated rhythm. But with IBS, they may contract for a longer time and with more strength than normal, causing pain. Food waste may be forced through the intestines too quickly, producing gas, bloating and diarrhea. Sometimes, as in Lori's case, the opposite occurs. Passage of waste slows, leading to dry, hard stools (constipation).

A definitive cause of IBS remains unknown. IBS isn't life-threatening, doesn't trigger inflammation or other changes in the bowel, and doesn't increase your risk of colorectal cancer. Treatment usually includes lifestyle changes, such as eating a healthy diet, exercising regularly and reducing stress. Some people don't achieve symptom relief with lifestyle changes alone, so doctors may prescribe medications such as nortriptyline (Pamelor).

At a crossroads: Taking charge

Lori's doctor outlined a plan to help reduce her symptoms over time. He recommended that she eat more fiber, avoid fatty and spicy foods, manage her stress, and start a daily exercise program. He also recommended that she attend a patient education class on IBS.

At first, Lori was frustrated. She wanted immediate relief from her pain and constipation, and she knew that lifestyle changes would take time and effort. Before long, though, she decided to take charge of her health.

She reviewed the information she'd been given and searched the Internet for self-care strategies. Using her doctor's recommendations and information from the patient education class and the Internet, Lori developed a plan.

She started with small changes: She took Citrucel — a fiber supplement that helps make stool soft and bulky — three times a day and drank two 32-ounce bottles of water every day. She avoided foods and drinks that made her symptoms worse, such as pizza and alcohol, and ate more foods high in fiber, such as brown rice and whole-grain breads.

After a month, Lori's symptoms improved. So she began walking around her neighborhood for 45 minutes every day. Then, she added another goal to her list: to achieve a healthy weight. Lori says she wanted to lose about 35 pounds — a goal she eventually achieved.

Six months later she joined a health club. The constipation, abdominal cramping and nausea were all but gone.

"Exercise seems to help people in general," says Dr. Locke. "And sustained low-level exercise, such as walking or jogging for 30 minutes a day, three or more days a week helps people's bowels." Exercise stimulates the rhythmic contractions of the intestines, helping them function normally.

Photograph of Lori Stahnke
Lori Stahnke exercises on an elliptical trainer to help manage her symptoms of IBS.

A year later, Lori and her family moved to a small community without a health club. Her exercise routine faltered, and she found herself gaining weight and having a recurrence of abdominal pain and constipation. Her solution was to buy an elliptical trainer — a low-impact exercise machine that combines the motion of stair stepping with cross-country skiing. "That's my godsend," she says.

Now she exercises five days a week for about 30 minutes a day on the machine. "I just know I have to exercise. I know I have to take care of myself," she says.

Treating the mind and the body

Lori had one last obstacle to tackle: managing her stress. Her doctor had told her that stress could worsen IBS symptoms, and had suggested that she see a psychologist. At the time, however, Lori didn't think a psychologist could help — she felt her illness was physical, not psychological.

Stress is triggered mentally — for example, feeling tense, angry or overwhelmed — but felt physically, says Dr. Locke. "Your gut works differently under stress than not. And if you have chronic stress, you're gut isn't going to work as well."

Photograph of Lori Stahnke and family
Lori Stahnke with her husband, Bill, and their children, Nick and Ashlyn

Lori eventually recognized that her life was especially stressful when her symptoms were at their worst. She had a 3-year-old and a new baby — and a demanding professional career. "It was a really hard transition," she says. "I was stressed at home with the kids. I was stressed at work."

Dr. Locke agrees that treating IBS involves both the mind and the body. "People who do really well managing this condition are people who recognize the role that stress plays in their condition," he says. "I find that to make someone better, we really have to work on the mind and the body. And if we just work on the body, it doesn't work."

Moving forward: Permanent lifestyle changes

Several years after her diagnosis, Lori still has symptoms about twice a month. But they're manageable. "If I have a symptom, I know how to treat it. I get it under control right away."

She exercises five days a week and avoids foods that might cause trouble. She takes a fiber supplement when she feels the early twinges of abdominal pain. And she's learned to reduce stress as much as possible.

For Lori, managing IBS is a choice. "It will get better, but it's your choice," she says. "Really, it's up to you if you're going to feel better or not."

Editor's note: Since first sharing her story in 2003, Lori has had occasional bouts of IBS symptoms, mainly in response to stress and anxiety. After a particularly bad flare-up at the end of 2005, her doctor prescribed a low dose of an anti-anxiety medication, and Lori arranged to switch from full-time to part-time work. Within three months, she was symptom-free again.

Last Updated: 04/10/2007
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