Digestive Disorders

Irritable bowel syndrome occurs more frequently in women under age 35, and often begins in late adolescence. It may be related to psychological stress and is commonly marked by an abnormally active--even spastic--lower bowel. Its symptoms are similar to a number of other illnesses, including diverticulosis and lactose intolerance. These symptoms include uncomfortable abdominal sensations and periodic diarrhea or constipation, sometimes occurring alternately. Some patients come to depend on laxatives and even enemas to alleviate the constipation. For others, the only symptom is painless diarrhea. Treatment includes a diet high in fiber and low in fat. Certain gas-producing foods, such as those in the cabbage family, should be avoided, as should any other suspected irritants. For constipation, a bulk-producing product may be recommended; for diarrhea, diphenoxylate with atropine (Lomotil) or loperamide (Imodium) are possibilities. As a last resort, antispasmodics such as propantheline (Pro-Banthine) may be prescribed.

Inflammatory bowel disease is a blanket term covering three serious disorders: ulcerative colitis, proctitis, and Crohn's disease.

Ulcerative colitis is an inflammation of the colon that produces ulceration of the inside wall. Its primary symptom is bloody, chronic diarrhea, often containing pus and mucus, and associated with abdominal pain and weight and appetite loss. When confined to the rectum, it's referred to as ulcerative proctitis. Though there is no known cause of ulcerative colitis, it does tend to run in families and is more common in Jews and caucasians than other ethnic or racial groups.

Sometimes known as ileitis, Crohn's disease is an inflammation of the small and/or large intestine, with accompanying pain, cramping, tenderness, gas, fever, nausea, and diarrhea. Though usually mild, bleeding may occur and may sometimes be massive.

Proctitis, an inflammation of the rectum, is characterized by bloody stools, a frequent urge to defecate but inability to do so, and sometimes diarrhea. Possible causes are ulcerative colitis, Crohn's disease, trauma, infection, or radiation.

Ulcerative colitis and Crohn's disease are generally chronic and have no known cures. Treatment usually consists of symptom relief and reduction of inflammation. When there are acute flare-ups, the patient should avoid stimulants such as caffeine, citrus fruits, and foods high in fiber. Medical therapy includes steroids such as prednisone (Deltasone) and drugs such as olsalazine (Dipentum) that have both anti-inflammatory and antibacterial properties. These medications can control symptoms and often produce long-term remissions. Steroids should be used only when necessary, and under a physician's guidance, to avoid serious side effects. If attacks of ulcerative colitis become severe enough to be life-threatening, surgical removal of the colon can save the patient's life. Surgery also is sometimes performed for very severe complications of Crohn's disease, but will not cure the disease itself.

Diverticulosis , a condition most common in men over 40, is present in up to 50 percent of people aged 60. Though generally silent until bleeding and inflammation occur, it can be marked by alternating constipation and diarrhea. The disease occurs when bulging pouches (diverticula) form at weak points in the wall of the colon. If they become inflamed, they can cause severe pain, fever, nausea, and vomiting; if small vessels at the base of the pouch become disrupted, there may be significant intestinal bleeding. When symptoms occur, they can be alleviated by a liquid or bland diet and stool softeners. After symptoms subside, a high-fiber diet is usually effective in preventing recurrence and progression of the disease. When infection is present, treatment includes a broad-spectrum antibiotic and bowel rest.

Intestinal polyps , abnormal growths that may occur anywhere in the GI tract, are most often found in the large intestine. Though they generally cause no symptoms, a major sign is rectal bleeding. Polyps are rare in underdeveloped countries, suggesting that our high-fat, low-fiber diets may be partially responsible. They are more frequent in individuals with a family history of polyps or cancer of the colon. No current treatment is known to prevent recurrence. Reducing the fat content of your diet by 25 percent and consuming fiber-containing foods on a daily basis are both recommended. Because polyps are thought to be precursors of colon cancer, it's important to have them removed. This can be done with colonoscopy on an outpatient basis. An annual examination for polyps is advisable from age 50 onward.

Colon cancer , silent in its earliest stages, becomes evident as it progresses. Symptoms include bleeding, at times invisible to the naked eye, with resultant anemia, as well as a change in bowel habits, often accompanied by pain, weight and appetite loss, weakness, and a general decline in health. The risk for colon cancer increases with age, doubling with each decade after 40. Its exact causes are unknown, but it appears to be related to diets high in fat and low in fiber, and is known to occur more frequently in those with a family history of colon cancer. Surgery, sometimes followed by chemotherapy and radiation, are the current treatments for this type of cancer.

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