BOWEL DYSFUNCTION, GENERAL

GENERAL BOWEL DYSFUNCTION

INFLAMMATORY BOWEL DISEASE (IBD)

The Intestine

The gastrointestinal (GI) tract (the digestive system) is a tube that extends from the mouth to the anus. It is a complex organ system that first carries food from the mouth down the esophagus to the stomach. There, acids and stomach motion break food down into particles small enough so that nutrients can be absorbed by the small intestine, which is, despite its name, the longest part — about 20 feet — of the GI tract. Food passes from the stomach into the small intestine, first entering the duodenum, then the jejunum, and finally the ileum. Next, residual material passes in liquid form into the large intestine, which consists of the colon and rectum and is about six feet long. The waste matter travels through the colon, forming into solid feces as the water is slowly absorbed. The first portion of the colon, which is located in the lower right quadrant of the abdomen, is called the cecum. From here, the large intestine travels to the upper right quadrant (where it is called the ascending colon), then across the abdomen to the upper left quadrant (the transverse colon), then down (the descending and sigmoid colon) to the rectum, which stores the feces until the sphincter muscles in the anus relax, allowing the solid waste matter to pass from the body.

Inflammatory bowel disease (IBD) or COLITIS is a general term that includes both ulcerative colitis and Crohn’s disease, disorders of unknown causes that result in inflammation of the large or small intestines.

IRRITABLE BOWEL SYNDROME (IBS)

Irritable bowel syndrome (IBS) is another bowel dysfunction, also known as “spastic colon,” is a motility problem (involving intestinal muscle contractions and movement of stool) with no known cause. In IBS, the bowel is hypersensitive; it overreacts to mild stimulation by going into spasms, perhaps in response to eating or to distension caused by gas or to the presence of stool itself.

Because no evidence of disease can be seen when the colon is examined, IBS is known as a “functional disorder.” IBS causes no permanent harm to the intestines and does not lead to more serious conditions, such as intestinal bleeding or cancer. While stress and depression may contribute to flare-ups, IBS is not the result of a personality disorder.

In some people, IBS is a mild annoyance; in others, it can be debilitating-affecting someone’s ability to socialize, work or travel. Unlike many intestinal disorders, irritable bowel syndrome can be greatly affected by stressful circumstances.

At some time or another, almost everyone has a change in bowel habits, particularly during periods of stress. One out of every nine schoolchildren is estimated to suffer a painful episode of IBS-like symptoms at least once in the past three months. With IBS, the colon not only is more sensitive, but its reactions are stronger than in most people. Certain medications and foods may trigger spasms; also, women with IBS may experience more symptoms during their menstrual periods, perhaps because reproductive hormones somehow increase the colon’s susceptibility to spasm.

Symptoms of IBS

* Diarrhea
* Constipation
* Constipation alternating with diarrhea
* Abdominal pain
* Bloating
* Gas pain
* Excessive flatulence
* Increased belching
* Mucous in the stool
* Small stools (rabbit like pellets) or flat, “ribbon” stools

Symptoms tend to worsen during times of stress.

Treatment

Treatment varies greatly, depending on your doctor and the degree of symptoms. First, many patients are greatly helped simply knowing that this disorder has a name, that it is benign and that it is not a manifestation of a personality disorder. IBS symptoms often improve with a high-fiber diet (see above) and fiber supplements that contain psyllium, although at first, the increase in fiber can cause more bloating and distension. Also, your doctor will probably recommend that you screen your diet to identify and avoid foods that aggravate your symptoms.

ULCERATIVE COLITIS (UC)

Ulcerative colitis (UC) is an unexplained inflammatory disorder of the colon and rectum, due to damage caused by the body’s immune system that cannot be attributed to any other pathogen. There appears to be a genetic component: Fifteen percent of people with UC have a family history of the disease and another two to three percent have a family history of a similar condition called Crohn’s disease. Although diagnosed most commonly in early adulthood, it can develop at any age.

Ulcerative colitis is a medical “diagnosis of exclusion”: A doctor pinpoints the problem by first determining what it is not. (UC is not linked to psychological stress.) Thus, the first step is to investigate infectious causes of symptoms, such as Salmonella, Shigella, amoeba, gonorrhea, and to rule out Crohn’s disease, which can be hard to distinguish from UC. UC can also be accompanied by other problems, such as joint pain or biliary disease, in which the bile ducts become scarred.

During colonoscopy, the damage from UC appears contiguous. Your doctor will see disease beginning in the rectum, continuing into the colon and sometimes reaching all the way to the ileum. Ulcerative colitis increases the risk of developing is linked to colon cancer, and you should undergo a full colonoscopy (which allows doctors to see much more of the large bowel) instead of a flexible sigmoidoscopy for surveillance of colon cancer periodically.

Ulcerative Proctitis: This is a form of ulcerative colitis limited to the rectum only. (There are other causes of proctitis, including temporary irritation and inflammation that can develop from rectal intercourse or infection.)

Toxic megacolon: In severe ulcerative colitis, the colon becomes enlarged and dilated, and doesn’t contract well. This serious condition, known as toxic megacolon, is usually associated with fever and abdominal pain. The concern is that the colon will perforate – a medical emergency that could result in peritonitis and death.

Symptoms of UC

* Blood in the stool or black, tar-like stool (which suggests intestinal bleeding)
* Chronic diarrhea
* Abdominal pain
* Weight loss
* Joint aches or pains
* Unexplained fever
* Eye pain when you look at bright light
* Persistent canker sores in the mouth

UC can be frustrating and even debilitating at times. However, many patients are greatly helped by taking charge of their symptoms – by learning as much as possible about the latest research and treatment – and by talking to others experiencing the same problems. For more information, or to find out about a support group near you:

The Crohn’s and Colitis Foundation of America, Inc.
National Headquarters:
386 Park Avenue South 17th Floor
New York, NY, 10016-7374
Phone: (212) 685-3440
(800) 932-2423
www.ccfa.org

NOTE: If symptoms of any of the conditions described here do not remit or if you have uncontrolled bleeding or pain you need to contact your personal physician immediately.

CROHN?S DISEASE

No one knows what causes Crohn’s disease, but it is believed to be an abnormal immune response, characterized by inflammation in the gut, to something in the digestive tract – to the food and/or bacteria in the intestines, or even to the lining of the bowel itself. This illness itself is not simply inherited; scientists believe that more than one faulty gene is needed for this disease to develop. However, there is an inherited tendency to Crohn’s disease. Ten to fifteen percent of people with Crohn’s disease have a family history of this disorder; an additional five to seven percent of these people have a family history of ulcerative colitis. For those with a family history of inflammatory bowel disease (both Crohn’s and ulcerative colitis), early onset in the teens and 20s is more likely; but 90 percent of individuals with Crohn’s disease develop symptoms before age 40.

Symptoms

Diarrhea, abdominal pain, blood in the stool or black, tar-like stool (another indication of intestinal bleeding); unexplained fever; anal fissures and fistulas; weight loss; in children, failure to grow. Less commonly, aches and pains in the joints; rarely, light hurting the eyes (the result of a disrupted immune system), persistent mouth ulcers.

DIVERTICULOSIS and DIVERTICULITIS

Diverticulosis – the development of numerous tiny pockets, called diverticula, in the colon (generally in the sigmoid portion of the lower left side of the abdomen) – is the most common condition affecting the colon. By age 80, an estimated half of all Americans have at least some degree of diverticulosis. The problem seems to originate when two or more of the muscular bands that encircle the colon begin to contle) at the same time, hindering the colon’s ability to move its contents (a mixture of gas, liquid and waste) along to the rectum. When this material becomes trapped, it tends to press against the wall of the colon, creating diverticula.

For most people, this condition never produces any troublesome symptoms. However, complications from diverticulosis develop in as many as 20 percent of people. One of these is rectal bleeding; the other is diverticulitis, inflammation caused when one or more of these diverticula become infected. In severe cases, diverticulitis can lead to a hole or abscess in the intestine, causing peritonitis, in which intestinal material spills into the abdominal cavity – a medical emergency. There is no definite cause of diverticulosis, which can take years to develop; however, some evidence suggests that the disease is more likely to develop in people who eat very little fiber.

Symptoms

Diverticulosis usually has no symptoms, but may cause mild changes in bowel habits (constipation or diarrhea), abdominal discomfort or rectal bleeding.

Diverticulitis may cause:

* Significant rectal bleeding (bright red blood)
* Fever
* Abdominal pain
* A change in bowel habits
* Rarely, passing air during urination or the presence of stool in the urine or vagina.

General Pre-Disposing Factors:

a. Psychological stress.

b. Food allergy/sensitivity (especially dairy products, gluten containing grains, citrus, shellfish and gelatin).

c. Infection. (Clostridium difficile)

d. Genetic pre-disposition.

e. Parasites.

f. Bowel inflammation and bacterial imbalance (primary or secondary to HCL insufficiency and biliary/pancreatic insufficiency).

g. Some studies have shown possible Vitamin D deficiency associated with inflammatory bowel disease.

Dietary Suggestions:

a. Sip 2 to 3 oz. (1 mouthful) of distilled or filtered water every 30 minutes, while awake, daily (no well water or water containing fluoride or chlorine); more if you are perspiring.

b. Increase fresh vegetables; however, avoid lettuce and foods in the cabbage family (broccoli, brussel sprouts, cabbage, collard, kale, kohlrabi) until the flatulence and diarrhea are under control.

c. Avoid beef initially. Use chicken, fish, veal and lamb in lieu of beef.

d. Eliminate all dairy products (except butter) and gluten containing grains.

e. Eliminate all refined carbohydrates, alcohol and caffeine containing foods such as coffee, tea, cola and chocolate.

f. Increase foods high in fiber; but do not use gluten-containing grains.

g. Use only freshly squeezed vegetable juice (no fruit juice) and insure juice is diluted 50 percent with bottled water.

h. Avoid all chemically hardened fats, especially margarine.

NUTRITIONAL SUPPLEMENTS

Primary Nutrients:
1. BIO-MULTI PLUS without IRON – 1 tablet, 3 times daily after meals.

2. BIO-C PLUS 1000 – 1 tablet, 3 times daily after meals.

3. M S M POWDER – 1/2 teaspoonful 2 to 4 times daily depending on the severity of symptoms. NOTE: Always take MSM with your Vitamin C.

4. BIO-D-MULSION FORTE — 5 to 8 drops by mouth once daily after a meal (especially for inflammatory bowel disease). NOTE: You should get a blood test first to determine if you are deficient in Vitamin D. The test is called 25(OH)D or also known as 25-hydroxyvitamin D.

5. IODIZYME-HP — 1 to 2 tablets daily as directed by your physician for Iodine.

6. HYDRO-ZYME – 4 to 5 tablets, with each meal for about 6 weeks. Then only when you eat out.

Specific Nutrients: When symptoms or condition begins to subside, gradually, as needed, wean yourself from the Specific Nutrients & stay on the Primary Nutrients. If any symptoms re-occur resume taking Specific Nutrients.

7. BUTYRIC-CAL-MAG – 2 capsules, 3 times daily after meals (for 3 months, then discontinue).

8. I P S (Intestinal Permeability Support) – 2 capsules, 3 times daily after meals (for 3 months, then discontinue).

9. L-GLUTAMINE — 2 capsules, 3 times daily after meals to nuture the intestinal tract.

10. I A G Powder — One teaspoonful once daily.

11. LACTOZYME – 10 tablets, once daily at bedtime on empty stomach.

12. COLON PLUS CAPSULES – 5 capsules, 2 times daily after a meal for abour 1 month to normalize bowel function. (OPTIONAL)

With CROHN’S Disease add:

13. BIO-AE-MULSION FORTE — 5 drops daily for about 6 weeks, then discontinue.

ADDENDUM

Inflammatory bowel disease (IBD), often referred to generally as “colitis,” can strike men, women, and children at any age. IBDith not be prevented and can lie dormant between reoccurrences. Although its cause is unknown, different forms of it are more prevalent in certain populations.

With proper treatment, chronic colitis can be controlled to varying degrees. In some cases, major surgery can cure it and prevent its reoccurrence. Johns Hopkins Gastroenterologist Mark Donowitz, MD, advises patients to seek the best medical care available and offers hope for lives free of pain and encumbrances of any kind.

What are Inflammatory Bowel Diseases?

IBD describes a group of chronic disorders that cause inflammation or ulceration in the small and/or large intestines. The most common ones are Crohn’s disease and ulcerative colitis. Crohn’s Disease can occur anywhere from the esophagus to the rectum; ulcerative colitis is limited to the colon and rectum. Colitis describes, in general, an inflammation of the mucus membrane of the colon.

What causes it?

There is no known cause for IBD, but some infectious or viral agents are suspected. Although the cause is unknown, the tendency to develop ulcerative colitis and Crohn’s disease appears to run in families, and is thus thought to be inherited.

Ulcerative colitis is most common in young adults, and is especially common in people of Jewish descent. About 20% of people with Crohn’s disease have a blood relative with some form of inflammatory bowel disease, and there is evidence that people with the disease have abnormalities of the immune system.

What are the symptoms?

General symptoms include abdominal pain, diarrhea and/or constipation, and possibly rectal bleeding, weight loss or fever. When these symptoms are subtle, however, they resemble those of other, more benign conditions such as irritable bowel syndrome and spastic colon, and are thus often misdiagnosed as such.

“A patient should seek immediate medical attention at the first signs of bloody diarrhea, persistent abdominal pain, and a systemic sense of ill health,” Dr. Donowitz advises. “If prescribed treatments fail, and pain persist, they should be aggressive in seeking a more comprehensive medical evaluation.”

The earlier IBD is treated, he says, the greater the chance of avoiding surgery. “You should make your physician separate acute infection from chronic, inflammatory disease.”

How is it finally diagnosed?

Infections will respond to treatment. Chronic pain and diarrhea generally indicate that standard treatment has failed and is thus an indication of potential IBD. Methods of diagnosis vary, depending on the symptoms. An authoritative diagnosis of ulcerative colitis can be made by performing a colonoscopy which provides a full view of the entire colon. Other diagnostic tools for colitis include an upper gastrointestinal (GI) series, a small intestinal study, and a barium enema intestinal x-ray.

How is IBD treated medically?

There is no cure medically, but there are treatments NUTRITIONALLY to control it and possibly cure it if we can get the missing essential nutrients to the tissues that need them. When caught early, IBD can be kept from progressing. The four most common MEDICAL treatments are steroids, antibiotics, immunosuppressors, and five amino salicylic acids. These medicines can help control outbreaks and stem reoccurrence. Sometimes, dietary changes may help, such as avoiding milk products; but few have proven effective. The only “cure” for colitis, however, is surgery to remove the colon, when the colitis is located there. (Because Crohn’s disease, for example, can occur beyond the colon, surgery may be helpful, but can not cure the disease.)

When is it necessary to remove the colon?

Dr. Donowitz list three y kidences in which removing the colon is advisable.

1. The colitis cannot be controlled with medicines or other treatments.
2. The patient is in chronic pain and inflammation so severe that a colon rupture is possible
3. The ulcerative colitis has continued for ten years, at which point the risk for colon cancer accelerates.

If I have colitis, am I likely to get colon cancer?
Patients with chronic, long-term ulcerative colitis do have an increasing risk of colon cancer. Chronic ulcerative colitis is a high risk factor for colon cancer. Colon cancer, however, can be prevented by removing the colon.

If my colon is removed, will I have to have a ileostomy or “bag”?

Most likely, no. A new procedure, sometimes referred to as an “anal pull-through,” is replacing the older surgical method of the ileostomy. With an ileostomy, once the colon is removed (termed a “colectomy”), the small intestine is hooked to a small waste-collection bag on the outside or the inside of the body. In the newer procedure, the small intestine is attached, instead, directly to the anus, and digestive and elimination functions remain the same. People with this treatment can continue to live their lives with no medical restrictions or encumbrances.

ALSO:

Inflammatory bowel disease (IBD), often referred to generally as “colitis,” can strike men, women, and children at any age. IBD cannot be prevented and can lie dormant between reoccurrences. Although its cause is unknown, different forms of it are more prevalent in certain populations.

With proper treatment, chronic colitis can be controlled to varying degrees. In some cases, major surgery can cure it and prevent its reoccurrence. Johns Hopkins Gastroenterologist Mark Donowitz, MD, advises patients to seek the best medical care available and offers hope for lives free of pain and encumbrances of any kind.

LINKS:

Crohn’s Disease Resource Center

IBS Central

What to Eat

Ulcerative Colitis