Two views: Irritable bowels

TRADITIONAL: SUSAN REID, general surgeon at McMaster University Hospital in Hamilton, Ont.

Irritable bowel syndrome (IBS) is chronic abdominal pain associated with a change in bowel habits. You have either diarrhea or constipation, or a combination of both.

When I first see patients with these symptoms, I do a careful history and physical exam. Mainly I’m ruling out colon cancer, colon polyps, Crohn’s disease, ulcers, gallstones, kidney stones and a mass in the ovaries. If the patient has a lot of diarrhea, I test a stool sample for bowel infections. If the patient has a family history of polyps or colon cancer, I might order a colonoscopy.

For treatment, I ask patients to keep a food diary of what they eat and their symptoms. It might take a couple of weeks’ worth of data to see a pattern, such as an allergy or food triggers. I also suggest that patients with constipation add more fibre to their diet. This has to be done slowly and with lots of water, or else it can cause symptoms similar to IBS. For patients with diarrhea, I recommend over-the-counter or prescription medications. Some medications can have an opposite effect; for example, anti-diarrhea drugs can cause constipation. It’s trial and error. Although IBS is commonly treated by family doctors, I might refer a patient to a specialist, called a gastroenterologist, if their case is severe and the common treatments aren’t working.

I’ve heard that acupuncture may be effective for some medical illnesses, but nothing has been proven yet, so I wouldn’t recommend to my patients that they try acupuncture for their IBS.

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ALTERATIVE: JENNIFER SALIBHUBER, naturopath, traditional Chinese medicine practitioner and acupuncturist in Dartmouth, N.S.

With a condition like IBS, it’s important to take into account all of the patient’s symptoms, not just their bowels. Everyone has chi, or energy, flowing through their body. If this vital life force is obstructed, then we become ill.

For a patient suffering from IBS, I start by doing a physical exam. I examine the patient’s tongue, looking at its colour, texture and thickness to evaluate how well the digestive system is functioning. I measure the patients pulse, which can indicate a state of disharmony within the internal organs.

Then I ask the patient about symptoms, including temperature, food cravings and aversions, patterns of urination and elimination and so on. Finally, I create a point prescription for the acupuncture I do; in other words, I map out where I’m going to place each needle. A standard treatment is once or twice a week for six to 10 weeks. Within the first few treatments, most patients feel better.

Along with acupuncture, I also prescribe herbs. A common one for this condition is peppermint. But nobody should take herbs without consulting a qualified health practitioner. Most herbs have potentially harmful side effects if they’re not used properly.

Conventional medicine involves a diagnosis of exclusion: Once the serious conditions have been ruled out, patients may be diagnosed with IBS. By then, a patient has suffered for a long time. Most of my patients haven’t had success with medications. This is one area where alternative therapy has something to offer.