Stress management - best way to combat IBS

Text and pix by Nilma DOLE

Dr. Karunasena Nanayakkara

Dr. Rohana Siriwardana

Dr. Karunasena Nanayakkara, the Consultant Gastrointestinal Surgeon of the Kalubowila Teaching Hospital and his Assistant Dr. Rohana Siriwardana spoke to the Sunday Observer about the lack of awareness of the Irritable Bowel Syndrome.

Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome is a functional gastrointestinal disorder, Dr. Nanayakkara said, "IBS is also known as spastic colon which is a functional bowel disorder detected by chronic abdominal pain, discomfort, bloating, and change in bowel habits".

The doctor said that about 10% of the patients who come to the clinic suffer from IBS and this trend is growing. "Most of those from the affluent society tend to have IBS due to psychological problems like stress," said Dr. Siriwardana. IBS tends to affect more women than men.

Symptoms

Dr. Nanayakkara said that IBS symptoms differ from person to person even though it starts with abdominal pain. "In some cases some patients have constipation while others have diarrhoea or a combination of both", "We notice that some may pass stools in various forms like ribbon or pellets and we treat them according to their condition." "There is no medical evidence to say that the disease is hereditary. There may also be an urgency for bowel movement, a feeling of instability in the bowels, bloating, abdominal distention or headache. "We highly recommend for those over 50 years of age to seek prompt medical advice by preferably doing an endoscopy", said Dr. Siriwardana.

The warning signs of IBS can have drastic consequences if not treated promptly meaning they will be long-term. Patients over 50 years of age need to seek expert medical advice if they have weight loss, a family cancer history or if the irstools are peculiar, warned Dr. Siriwardana.

Diagnosis

There is no specific laboratory or imaging test to diagnose IBS. "It is sometimes difficult to pinpoint what could be wrong with a patient because the symptoms vary. However, it should be emphasised that it is not cancer-causing and can be treated because IBS can occur on and off", said Dr. Nanayakkara. Patients should do a full blood count, tests on the stools, ESR (erythrocyte sedimentation rate) and talk with a psychologist.

Medical opinion

"We advise the general public to go to one doctor to diagnose and havet the problem attended to then and there. Often these patients suspect they might have cancer and the doctor doesn't treat it properly so they go for a second opinion". Doctors are of the view that an adequate knowledge on the part of patients and a good doctor-patient relationship are also important. Dr. Nanayakkaa said.

Treatment

Although there is no cure for IBS, there are treatments to relieve symptoms, including dietary adjustments, medication and psychological interventions, Dr. Nanayakkara said, "The exact cause of IBS is not known but the most common theory is that IBS is a disorder of the interaction between the brain and the gastrointestinal tract". We can use anti-spasm drugs to treat some cases of IBS but it should be carefully monitored.

A good diet chart should be maintained with the results of what triggers the condition, he noted

"People should avoid fatty, oily and spicy food and shouldn't smoke, drink alcohol or caffeine" warnd Dr. Nanayakkara. Most people can control their symptoms by taking anti-diarrhoea medicines, antispasmodics, or antidepressants, reducing stress, and changing their diet.

"Increase the fibre content in your diet gradually because some people feel bloated and develop gastric complications if they increase their fibre intake too quickly", said the doctor. Gas and bloating usually improve as you get used to eating more fibre. The best way to increase your fibre intake is to eat a wide variety of fibre rich foods.

How stress causes IBS

People who have IBS are prone to stress being mentally or emotionally depressed triggering off colon spasms. The colon has many nerves that connect it to the brain. Like the heart and the lungs, the colon is partly controlled by the autonomic nervous system, which responds to stress. These nerves control the normal contraction of the colon and cause abdominal discomfort at stressful times. People often experience cramps or "butterflies" when they are nervous or upset.

In people with IBS, the colon can be overly responsive even to slight conflict or stress. Stress makes the mind more aware of the sensations that arise in the colon, making the person perceive these sensations as unpleasant.

The best way to combat IBS is stress reduction (relaxation), training and relaxation therapies such as meditation, counselling and support, regular exercises such as walking or yoga, elimination of stressful situations in your life and adequate sleep.

IBS does not lead to more serious conditions in most patients but it is a source of chronic pain, fatigue and other symptoms.

IBS is also regarded as a chronic illness that could dramatically affect the quality of life.

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Dr. Siriwardana's Comments on IBS

1. The affluent society tends to have IBS probably due to stress, anxiety and lifestyle

2. Some may pass loose stools and mucous

3. Apart from bowel symptoms other non specific generalized symptoms like headache, myalgia , generalized weakness is seen in about 30%

4. In the case of red signs, patient needs to be investigated further by a specialist to exclude other possible pathologies which can be dreadful if untreated

5. If a patient is over 50 years of age with a short history of symptoms, anaemia, blood mixed with stools then it is a red sign

6. Doctors do investigations to exclude other possible conditions that can give rise to similar symptoms

7. We advise IBS patients not to keep on shifting from one doctor to another since IBS has its own natural history where sometimes it worsens and some times it comes down

8. We don't want to prevent patients from seeking second opinion especially when we face doubtful situations but we tell patients not to go to many doctors for a small problem

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Common symptoms of IBS:

* Bloating and gastric complications

* Mucus in stool

* Constipation

* Diarrhoea, especially after eating or first thing in the morning

* Feeling the need to have a bowel movement after you've already had one

* Feeling a strong urge to have a bowel movement

* Abdominal pain and cramping that may go away after having a bowel movement

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Tips on controlling IBS:

* Consume a mixed diet and avoid high fat foods

* Drink plenty of water

* Have 6 small meals a day rather than 3 large ones

* Learn new and better ways to deal with your stress

* Avoid using laxatives which may weaken your intestines and make you to be dependent on them

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Stem cell study leads to breakthrough in understanding infertility

'Hidden stage of human development' is opened up by Stanford University scientists

Scientists have turned human stem cells into early-stage sperm and eggs in research that promises to give doctors an unprecedented insight into the causes of infertility.

The work will allow researchers to study human reproductive cells from the moment they are created in embryos through to fully-mature sperm and eggs.

Understanding the details of how sperm and egg cells grow will help scientists develop treatments for people who are left infertile when the process goes wrong. The research may also lead to treatments that can correct growth defects before a child is born.

Genetic glitches that happen early in the growth of sperm and eggs are a major cause of infertility in men and women. The process has been practically impossible to study until now though, because the sex cells form early on, before an embryo is two weeks old.

"This achievement opens a new window into what was only recently a hidden stage of human development," said Susan Shurin at the National Institute of Child Health and Human Development, which part funded the research.

A team led by Renee Reijo Pera at Stanford University in California developed a technique that turned human embryonic stem cells green when they started growing into sperm and eggs.

After isolating the reproductive cells, the scientists worked out which genes made them grow properly by switching different genes on and off.

Writing in the journal Nature, the scientists describe how that one gene, called DAZL, is involved in the formation of sex cells from the start. Two related genes are switched on later to steer the cells to full maturity.

The main significance of the work is not to attempt to generate gametes for couples who do not produce them naturally.

Rather, the work describes a system in which various aspects of germ cell development can be studied in a dish. In the current study, they have gained insight into the function of three genes in which they specialise."

Darren Griffin, a geneticist at the University of Kent, said the work was important because it gave researchers a way to study human sperm and egg development in a dish, instead of having to rely on tissues taken from animals or "removing bits of people's gonads".

"In future, a range of genetic and environmental factors could be studied, including the effects of pollutants on our fertility. Only through understanding such factors at a basic scientific level can we hope to develop novel diagnoses and therapies.

The potential is enormous," he said.

Allan Pacey, an andrologist at Sheffield University, said: "Ultimately this may help us find a cure for male infertility.

Not necessarily by making sperm in the laboratory - I personally think that it is unlikely - but by identifying new targets for drugs or genes that may stimulate sperm production to occur naturally.

This is a long way off, but it is a laudable dream.

Guardian.co.uk

Weight loss eases sleep apnea symptoms

by Madeline ELLIS

It's well known that overweight adults are at greater risk for a myriad of health problems and that losing weight can reduce that risk.

Just a 10 percent reduction in weight can improve heart function, lower blood pressure and levels of blood cholesterol and triglycerides, and decrease the risk of diabetes and cardiovascular diseases. And new research shows that obese people with sleep apnea who lose 10 percent of their weight can significantly improve their symptoms and potentially rid themselves of the disorder.

Gary Foster, director of the Center for Obesity Research and Education at Temple University in Philadelphia, and researchers at four other medical centers and universities analyzed data on 264 obese patients with type 2 diabetes and sleep apnea in varying forms. The participants were divided into two groups. One group participated in a diabetes management program while the other group followed an intense lifestyle treatment program that included a combination of a group behaviour modification, a portion-controlled diet with liquid meal replacements, and 175 minutes of weekly physical activity.

After a year, the treatment group had lost an average of 24 pounds, or about 10 percent of their starting weight, compared with a one-pound average weight loss in the other group. The treatment group also saw a significant reduction in the number of sleep apnea episodes they experienced; many moved to a less severe category, from moderate to mild for example, and about 14 percent had complete remission of the disorder. Men, those with severe apnea and those who lost the most weight saw the greatest benefit. In sharp contrast, those in the second group experienced a worsening of their sleep apnea symptoms.

"This is good news because it shows that a little bit of weight loss can go a long way when it comes to improving sleep apnea," said Foster. "And a reduction in sleep apnea has a number of benefits for overall health and well-being."

Sleep apnea affects more than 18 million Americans and has the potential for serious, life-threatening complications. People with sleep apnea literally stop breathing for brief periods during their sleep, usually for ten to twenty seconds but often for a minute or longer and as frequently as 30 times or more per hour. People who are overweight or obese are much more likely to have obstructive sleep apnea (OSA), the most common form of the disorder, because excess weight can cause the airway to collapse during sleep. "The soft palate in the back of mouth falls down and blocks the airway," explains Dr. Mitchell Roslin, chief of bariatric surgery at Lenox Hill Hospital in New York City. "When you get to people with serious levels of obesity, it's virtually impossible to find those without sleep apnea."

Sleep apnea often goes undiagnosed. Doctors usually can't detect it during routine office visits and there are no blood tests for the condition.

The majority of people who have sleep apnea aren't aware they have it because it only occurs during sleep. Sleep apnea often results in feelings of fatigue and excessive daytime sleepiness, since the ability to reach deep, restorative sleep stages is impaired.

Untreated, sleep apnea can increase the risk for high blood pressure, heart attack, stroke, obesity, diabetes and premature death. "It really has tremendous detrimental effects on the cardiovascular system," Roslin stressed.

Weight loss is often recommended for obese patients with sleep apnea, but evidence for this recommendation has been limited, with most studies being small, nonrandomized, and focusing on surgically induced weight loss. "This is one of the first and certainly the largest study ever conducted," Foster said. "It's been clear that obesity increases the risk of sleep apnea but less clear that if obese people or people with type 2 diabetes lost weight, it would result in significant improvements in their sleep apnea-and it did."

Foster recommends that obese people who want to lose weight keep track of what they eat, using portion-controlled meals such as Lean Cuisine and Healthy Choice, and walk 30 minutes each day.

Healthnews.com