When you're new to IBS, it's natural to have questions! In fact, over the last few weeks, I've answered lots of common questions as part of my frequently asked questions series. But for my final post in this series, I want to talk about ten questions you should ask your doctor.
Why Are You Confident Irritable Bowel Syndrome is the Right Diagnosis for Me?
A long time ago, irritable bowel syndrome was considered a catch-all diagnosis for people with digestive problems that couldn't be explained. These days, however, doctors use a specific workflow to diagnose people with IBS.
That being said, your doctor may not communicate the process they've used to determine you have IBS. This may leave you feeling like your doctor has diagnosed you because they're out of tests. Not because you meet the specific diagnostic criteria for irritable bowel syndrome. If your doctor hasn't outlined why they believe IBS is the correct diagnosis for you, ask them.
Understanding the process your doctor used to confirm you have IBS and to eliminate other possible illnesses or disorders can reduce anxiety that your doctor has missed an underlying issue. You can also use this answer to decide if you're comfortable with an IBS diagnosis, or if you'd like to seek a second opinion.
Should I Have A Colonoscopy? Why or Why Not?
This is a surprisingly controversial subject! Some people strongly believe everyone with digestive symptoms should have a colonoscopy. While others think only people who have “red flag” symptoms or are above a certain age should have colonoscopies as part of a routine IBS diagnosis.
Like any other medical procedure, a colonoscopy comes with risks. So, you need to consider the benefit versus the possible risk before you give your consent.
If your doctor is confident you meet the criteria for IBS and has screened for signs of other illnesses or diseases, they may not recommend a colonoscopy for you, because you would exposed to the risks of the procedure, but you likely won't receive any benefit – because they expect the test to come back normal.
If, however, you have “red flag” symptoms for another illness or disease, your doctor may recommend a colonoscopy, just to be safe. In this case, a symptom you've reported may be an indicator of something like bowel cancer, celiac disease, or inflammatory bowel disease. All of which can damage the body. In this case, the benefit of catching an illness or disease as quickly as possible outweighs the risk associated with the procedure.
Whatever your doctor recommends, make sure you understand why they believe that decision is right for you. If you disagree, talk it out with them or get a second opinion.
May I Have a Referral to a Gynecologist?
Are you part of the XX club? Unfortunately, this DNA combo can create some additional complications in the body – especially in the digestive department. If you were diagnosed by your family doctor or a gastroenterologist, ask for a referral to a gynecologist as well.
Having a second opinion from someone well versed in the way your body functions and what can potentially go awry can save you a lot of time and heartache in the long run. For example, 1 in 10 North Americans develops endometriosis – a reproductive disorder where uterine tissues develop outside of the uterus leading to pain during menstruation, digestive issues, and chronic inflammation, among other things.
Endometriosis, along with many other diseases and disorders specific to female reproductive organs can mirror IBS symptoms and often develop in the same age range (20-30 years old). The treatment and management of most reproductive disorders differ from the management of IBS. So, get a second opinion from someone who specializes in the unique aspects of your body before you jump on the IBS train.
How Do I Tell the Difference Between My IBS Symptoms and Something Else?
While IBS does not develop into other illnesses or diseases, having IBS does not mean you're exempt from developing other conditions (or catching the flu). So, it's critical for you to know up front what symptoms to expect as part of your IBS, and what signs and symptoms you should report to your doctor for further investigation.
Many illnesses and diseases mimic IBS symptoms in their early stages, so it may be challenging to separate new symptoms from your IBS. Since time is your best weapon when dealing with destructive diseases like bowel cancer, having clear instructions on what to look for can save you precious time if you do develop a secondary issue.
Should I Be Tested for SIBO?
If you experience symptoms like abdominal pain or cramping, excessive bloating less than 90 minutes after eating, watery diarrhea, or indigestion, you may be suffering from small intestinal bacterial overgrowth (SIBO).
SIBO occurs when some of the gut bugs that usually live in your large intestine creep up into your small intestine and multiply. Because these bugs have access to food before your small intestine can absorb it, symptoms of SIBO often appear much faster than typical IBS symptoms. SIBO can be tested using a breath test, or by taking a sample of your intestinal fluid.
Treatment for SIBO usually involves antibiotics that are poorly absorbed by the digestive system. This means they stick around in your gut instead of being absorbed into your bloodstream and kill off the bugs in your small intestine.
Because your gut bugs quickly ferment high FODMAP foods, many people with SIBO follow the low FODMAP diet during treatment. By keeping high FODMAP foods out of your digestive tract, you may be able to reduce some of your symptoms during your antibiotic course.
Should I Be Tested for BAM?
If you suffer from symptoms like watery diarrhea, urgency, or loss of control over your bowel movements, or if you've had your gallbladder removed, ask your doctor about being tested for bile acid malabsorption (BAM).
BAM occurs when the bile used to help break down your food can't be reabsorbed by the intestine. If too much bile acid stays in your digestive system, your colon can't form stools properly. This can lead to watery and urgent diarrhea, sometimes called bile acid diarrhea.
The symptoms of BAM are typically treated with a combination of specific medications and dietary changes. So, if you do have BAM, you and your healthcare team will need to make adjustments to your overall symptom management plan.
Should I Consult a Physiotherapist About Pelvic Floor Dysfunction?
The pelvic floor is a layer of muscles in your pelvic cavity that support the pelvic organs (like the bladder, bowel, uterus, and prostate). If these muscles become uncoordinated or develop weaknesses, they can cause both constipation and diarrhea.
Pelvic floor dysfunction can occur for many reasons, including childbirth (both vaginal and via cesarean section), injury to your pelvic area, being overweight, and nerve damage, among other things.
If you're consistently straining during bowel movements, have small, frequent bowel movements, or are having issues with incontinence, speak to your doctor about investigating pelvic floor dysfunction.
If you suffer from constipation, the muscles you use to poop can become uncoordinated (called dyssynergia). In this case, muscles that should relax to allow your stool to pass tighten during bowel movements. In this case, a physiotherapist can use several tools and exercises to help you retrain your muscles and brain to re-coordinate themselves.
If you suffer from diarrhea or incontinence, the pelvic muscles you use to hold your stool until you can reach a bathroom may lack strength, endurance, or control. In this case, a physiotherapist can provide physical therapy and motor control exercises to build a more functional pelvic floor.
What Symptoms Should I Report to My Doctor?
Your base-IBS symptoms will likely shift over time. So, you'll need to keep your healthcare team up to date on your daily symptoms as they shift.
Ask your doctor if there are specific changes in your symptoms they would like you to track or report. This will help keep your medical history up to date and help you and your healthcare team identify unexpected changes in your symptoms that may indicate a second issue is brewing.
When Should I Seek Medical Attention?
When dealing with a chronic illness, it can be hard to tell the difference between a rough patch and a legitimate illness.
Ask your doctor for clear guidelines on what you can treat from home and when you should consult your healthcare team or head to your local ER. Having rules established in advance will save you time (and Googling) in the case of an emergency (like a case of appendicitis or bowel obstruction).
What Should I Do If I See Blood in My Stool?
For the record, unexplained blood always means doctor. Whether you've been wiping too hard, are developing hemorrhoids or an anal fissure, or you're experiencing internal bleeding, you need to know where it's coming from and the best way to treat it. This information should come directly from your doctor (no, Dr. Google doesn't count).
Because certain types of bleeding require emergency medical attention, it's important to have a conversation with your doctor about how to deal with unexpected blood up front. That way, when you see red, you'll know if you need to schedule an appointment with your family doctor or head directly to your local emergency room. Safety first, friend!
I hope these ten questions to ask your doctor about IBS help you take control of your diagnosis and gain confidence in guiding your long-term care. If you like this article don't forget to share it! Together we'll get the low FODMAP diet down to a science!
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© 2019 Amy Agur – The FODMAP Formula
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