Irritable bowel syndrome, commonly known as IBS is one of the most common diagnoses in medicine, says Dr. Cynthia Rudert. Typically patients suffer with gas, bloating, abdominal pain and episodes of diarrhea and urgency. Some patients may have constipation as a predominant symptom or constipation alternating with diarrhea. Dr. Rudert discusses the symptoms and diagnosing of IBS, as well as the value of a second opinion consult below.
How are patients diagnosed with IBS?
Dr. Rudert answers: IBS is primarily a diagnosis of exclusion. Meaning most, if not all, testing comes back normal yet patients continue to have symptoms. Since the symptoms often overlap with many other conditions it is imperative that you have a thorough evaluation.
My doctor has tried several therapies yet I continue to have symptoms.
Dr. Rudert answers: Don't always assume your diagnosis is correct. It is estimated that one in every six individuals with a diagnosis of any illness is wrongly diagnosed. Many patients I have seen tell me they were evaluated for celiac prior to their IBS diagnosis, yet when I review their testing it is incomplete. It is imperative to exclude celiac disease with proper testing and evaluation since it is the most common autoimmune illness of humankind and has increased four fold over the past 40 years.
What else could be missed?
Dr. Rudert answers:
When I see patients I take a very detailed history. It is like being a detective and putting the pieces of a puzzle together. There are many treatable disorders with identical symptoms. Sometimes the culprit is a medication. It is surprising how many medications, both over the counter and prescription, can lead to a variety of gastrointestinal side effects. Some medications, like those for acid suppression, may cause diarrhea, gas, bloating and abdominal pain. They should be weaned and eventually discontinued, but only under the care of a physician. Those same medications and others, including antibiotics, can cause SIBO (small intestinal bacterial overgrowth). Of course there are other treatable causes as well that are hidden under the all inclusive "IBS umbrella".
Are antidepressants helpful for IBS?
Dr. Rudert answers: If someone is depressed and if they feel antidepressants might be of benefit that is an entirely different topic. I do not ever recommend those medications to treat diarrheal disorders of any kind. Many of my patients have told me antidepressants were commonly recommended often as first line therapy.
What are the available therapies for IBS?
Dr. Rudert answers: Depending on the cause of your symptoms there are many potential treatment options. I have seen dozens of treatable causes of symptoms that were incorrectly attributed to IBS. The goal of therapy is to treat the underlying disorder and not just put a band aid over it!
A Pearl to Remember from Dr. Rudert! During my lectures to physicians I often mention a symptom that when present is never IBS. Patients with nocturnal loose stools never have IBS. Waking up at night to have bowel movements is not common; however, when present, is never IBS.
Contact our office for more information on a second opinion consult with Dr. Cynthia Rudert.