Problems with the lower gastrointestinal tract – or lower GI tract – are not the sort of things that usually find their way into polite conversation.
That’s not surprising given that those problems can include “constipation, irritable bowel syndrome, hemorrhoids, anal fissures, perianal abscesses, anal fistulas, perianal infections, diverticular diseases, colitis, colon polyps and cancer.”
Add diarrhea and fecal incontinence to that list and whatever you have, it’s probably not the ideal recipe for cocktail party chatter.
For Dr. James Gordon, a gastroenterologist at the Scully Endoscopy Center in Vero Beach, however, it’s precisely his cup of tea. “I’m happy to talk about it,” says the affable, plain-spoken Gordon.
He says irritable bowel syndrome (IBS) is the most common lower GI problem he sees in his Vero Beach practice.
Sometimes called spastic colon, irritable colon or nervous stomach, IBS is usually caused when the colon muscle contracts more often than it should or as a result of intestinal inflammation. Symptoms can include abdominal pain, cramping, bloating and, while seemingly opposite ends of the spectrum, both diarrhea and constipation.
IBS is estimated to affect between 10 percent and 15 percent of the world’s population.
“Some people have [IBS] all their lives. Some people develop it over the course of their lifetime,” Gordon says. “Most people get used to their symptoms and say ‘this is just me,’ and then there are some people who get very anxious about their symptoms.”
That anxiousness is understandable because, as Gordon notes, “you can be somebody that has IBS diarrhea all your life and then someday have IBS constipation too. You can flip between the two and sometimes you can have both.
“Basically,” Gordon continues, “if you develop diarrhea that’s new and lasts for more than a week or so, or lower abdominal pain, or you have bleeding, or you get woken up at night with the diarrhea, then you should see a doctor.”
Do not, however, panic.
“In terms of treatments,” Gordon says reassuringly, “I prefer to use the basic things first, such as Metamucil and Citrucel. I prefer to give a fiber product because it’s cheap and simple and it works.”
In fact, this particular specialist suggests it’s probably better to see your primary care physician first before seeking out a gastroenterologist.
“If somebody’s having diarrhea that they can’t explain, I think talking to their primary care doctor first makes the most sense because a primary care physician can screen them to make sure they don’t have [what are called] structural problems,” Gordon says. Those problems can include disorders such as “small intestinal bacterial overgrowth” in which bacteria migrate from the colon to the small bowel and can cause intermittent diarrhea, bloating and other problems.
Asked if the use of multiple prescription drugs could contribute to such lower GI issues such as IBS, Gordon responds with a resounding, “Absolutely.”
“For example,” he explains, “If somebody’s on pain medications, both non-narcotic and narcotic. Non-narcotics can cause diarrhea, narcotics can cause constipation. Some of the medications that are used for urinary tract problems, meaning having leakage or things like that, can also exacerbate it. Some of the Parkinson’s medications can cause these problems so, yes, you are absolutely correct.”
Johns Hopkins Medicine agrees. It says “medicines taken by mouth can affect the entire digestive system in a number of different ways. Both prescription and over-the-counter medicines, while usually safe and effective, may create harmful effects in some people,” including IBS.
Moreover, says Hopkins, “older people are at greater risk” for those harmful effects.
Fortunately, according to the National Institute of Diabetes and Digestive and Kidney Diseases, conditions such as IBS can often be minimized by maintaining or beginning a healthier diet.
Such a diet, according to Gordon, would likely begin with drastically reducing – if not eliminating – fructose.
Fructose is a type of sugar found in many fruits and vegetables as well as in honey. It is frequently used to sweeten some diet foods and Gordon minces no words about his feelings about it: “Fructose,” he says, “is a really bad player” in lower GI issues in general and IBS in particular.
IBS is the most common gastrointestinal disorder in this country, costing an estimated $1.6 billion per year in health-related spending.
According to the Mayo Clinic, if fiber and diet don’t solve the problem, there is a wide range of medications your doctor can prescribe to deal with the underlying causes and symptoms of irritable bowel syndrome.
Dr. James Gordon is a gastroenterologist with the Indian River Medical Center and the Scully Endoscopy Center. His office is in the Health & Wellness Center at 3450 11th Court, Suite 206 in Vero Beach. The phone number is 772-299-3511.