Functional Gastrointestinal Disorders

Irritable bowel syndrome (IBS) is a disorder of the colon or lower bowel area characterized by abdominal pain associated with defecation, in addition to altered bowel habits, including change in form or frequency of bowel movements. The change in bowel movements may be classified as constipation or diarrhea, or a mix between the two. IBS does not have a singular cause, but many factors trigger symptoms, including certain foods, medicines or emotional stress.

Symptoms

Symptoms of IBS can occur continuously or recurrently and can be similar to other disorders, like Inflammatory Bowel Disease (IBD).

Here is a chart to help you navigate your symptoms.

Diagnosis

The evaluation of IBS requires a thoughtful and skilled gastroenterologist’s evaluation. Depending on symptoms, evaluation might include diagnostic testing such as bloodwork, colonoscopy, breath testing, and close and frequent follow-up.

Treatment

Our Functional Gastrointestinal Disorders Program addresses the challenges patients face with sometimes-lifelong gastrointestinal disorders, including IBS. Our specially trained gastroenterologists can help manage your symptoms by:

• Prescribing necessary medications
• Suggesting dietary changes (low FODMAP diet) and making a referral for the appropriate nutrition support services
• Offering support via mental health providers to gain control over symptoms by using techniques such as cognitive behavioral therapy (CBT) and hypnotherapy
• Working alongside our skilled advanced practice providers and physical therapists for pelvic floor retraining and biofeedback

Changes to diet and activity may help, but treatments vary for everyone. It can be helpful to document what foods you consume in order to figure out which might trigger IBS symptoms.

Indigestion, also known as Functional dyspepsia, is diagnosed by ruling out gastroesophageal reflux disease (GERD). Functional dyspepsia may be caused by factors including excessive alcohol intake, chronic vomiting, stress or use of certain medications; although in many cases, the cause is unknown.

Symptoms

While symptoms can vary, the most common include:

• Bloating
• Chest pain behind the breast bone or sternum
• Excessive gas or belching
• Feeling full after eating
• Hiccups
• Indigestion
• Nausea
• Pain in the upper abdomen

Diagnosis

Your doctor will perform a thorough evaluation of your symptoms, review your medical and family history as well as perform a physical exam. Since the diagnosis of functional dyspepsia is one of exclusion, a number of tests may be necessary before arriving at the appropriate diagnosis. Often a trial of acid suppressive medication is needed; endoscopy (EGD), and manometry and pH testing are often recommended too.

Treatment

Therapies that target the parts of your brain that have to do with pain and discomfort may help to relieve the most bothersome symptoms. Our Functional Gastrointestinal Disorders Program addresses symptoms by:

• Offering support via mental health providers to gain control over symptoms
• Prescribing necessary medications to improve your body’s response to pain signals
• Suggesting dietary changes and making a referral for the appropriate nutrition support services

Bowel movement form and frequency vary from person to person. Constipation occurs when bowel movements are less frequent or stool becomes hard or difficult to pass. Constipation may exist as part of a diagnosis of Irritable Bowel Syndrome (IBS). Changes in diet or routine often affect bowel movements. If bowel movements become difficult or painful or there has been an extended period of time since your last bowel movement, your constipation should be treated by a gastroenterologist.

Symptoms

Some signs of constipation may include:

• Dry and/or hard stool
• Feeling like your bowel is not fully emptied
• Lower abdominal pain
• Painful and difficult to pass bowel movements
• Using maneuvers to evacuate stool, such as pressure or digital manipulation

Common causes

Constipation can be caused by many different factors and is not the same for everyone. It is important to note that constipation can occur from infancy to geriatric age groups, but may get worse due to pregnancy, when taking certain medications or by having a digestive disorder. Typical causes are:

• Anorectal (outlet) blockage
• Changes in routine (traveling, time you eat, sleep pattern)
• Getting little to no exercise
• Inadequate fiber intake
• Improper functioning of pelvic floor muscles
• Not drinking enough water
• Resisting or withholding bowel movements
• Slow transit of stool within your intestines
• Stress, anxiety, depression, etc.

Diagnosis

If you are experiencing issues with bowel movements or have pain, talk to your doctor. They will ask about your medical history, routine, diet and bowel movement history. A physical examination that includes a thorough rectal examination may be done to see if there are any underlying causes. Your doctor will review any current medications or supplements you are taking to see if the dosage or medication needs to be changed. Other tests such as diagnostic lab testing, imaging including X-rays or MRI defecography as well as anorectal manometry may be performed.

Treatment

In some cases, constipation is manageable at home with proper eating and drinking habits, including the appropriate amount of fiber in your diet. There are a number of over the counter and prescription medications available to treat constipation. If certain causes of constipation are found, like pelvic floor dyssynergia, working with our advanced practice providers and physical therapists for biofeedback and pelvic floor retraining will be helpful.

Diarrhea is the frequent passing of loose and/or watery stools. This condition can be either acute or chronic and can be classified as a subgroup of those with irritable bowel syndrome (IBS). Many underlying causes contribute to diarrhea.

Diarrhea can lead to serious complications if it is very severe or becomes chronic, including:

• Dehydration
• Electrolyte imbalance
• Kidney failure

Symptoms

You should contact your gastroenterologist if you are experiencing diarrhea along with symptoms such as:

• Abdominal pain
• Blood in the stool
• Bowel movements that wake you from sleep at night
• Dark urine
• Dizziness or nausea
• Fever
• Headaches
• Incontinence (loss of stool)
• Rapid heart rate

Diagnosis

Your doctor will evaluate your medical and family history, including medications and dietary habits, and perform a physical examination, which includes a thorough rectal examination. Keeping a careful record of what you eat can help track foods that may be leading to diarrhea. Blood tests and stool analysis may be ordered along with diagnostic procedures, such as endoscopy or colonoscopy. This combination of testing will allow the physician to examine the first part of the small intestine and colon to help exclude other causes of chronic diarrhea, such as infections or inflammation of the small intestine and colon.

Treatment

Treatments are aimed at avoiding triggers for diarrhea, healing inflammation and relieving symptoms of diarrhea. The treatment may be different depending on different causes of diarrhea. For mild cases of diarrhea, over-the-counter medication may be helpful along with dietary modifications. If your diarrhea is chronic and/or caused by underlying conditions or infection, specific therapies may be needed to better treat symptoms.