"Butterflies in the belly" might have a better ring to it than irritable bowel syndrome, but according to experts, they're often one and the same.
As many as one in five Americans are predisposed to get the butterflies, along with abdominal pain, gas, bloating, diarrhea, constipation and nausea.
"People with irritable bowel syndrome are hard-wired to be more sensitive to things that impact the intestines. It's not that they have more gas than a 'normal' individual, it's that they're feeling it more," explains Dr. Harvey Guttmann, chief of gastroenterology at Abington Memorial Hospital and president of Gastrointestinal Associates in Jenkintown.
In other words, people with IBS have a lower pain threshold when it comes to gut feelings. They aren't necessarily eating too much or eating unhealthy foods compared to someone without the syndrome; they're just overreacting -- at least, their colons are.
" 'Nervous stomach' is the diagnosis my grandmother would have given," says Guttmann. "We've known for a long time that emotional disturbances and bowel complaints go hand in hand."
Stress, it's generally accepted, doesn't cause IBS, but it does exacerbate it. Though there are some studies that suggest intense stress at a young age may correlate to an irritable bowel later in life, for most adults, stress works by influencing the manifestation and the severity of the symptoms.
While the doctor hasn't added up how many patients have visited his office lately versus in past years (he's been practicing in Philadelphia since 1984), his sense is that there's been an uptick, both in the number of patients and the severity of their symptoms. "I see individuals who were handling it fairly well on their own, without need for medical care, but they crossed the line because of worry and stress," he says.
An estimated 20 percent to 40 percent of all visits to gastroenterologists and 12 percent of visits to primary-care physicians are prompted by IBS symptoms, according to the International Foundation for Functional Gastrointestinal Disorders.
"Most people learn on their own what their triggers are, and learn to live with it. They know if they eat certain foods or have an exam coming up, they'll have the symptoms -- and then the symptoms will go away when the stress does," says Dr. David Kastenberg, a gastroenterologist and associate professor at Thomas Jefferson University Hospital.
"We're looking for certain symptoms, and the absence of certain symptoms," explains Kastenberg. "If there's bleeding, weight loss, fevers -- then you want to look for other causes.
"But if someone has the classic symptoms for a long period of time, with no 'alarm symptoms,' then you don't want to do a bunch of unnecessary tests."
Limiting dairy and/or wheat often helps alleviate the symptoms, says Guttmann. If constipation is the major problem, taking a fiber supplement might do the trick, adds Kastenberg.
Equally important is incorporating stress-management techniques into daily life.
If those don't work, it's time for drugs. Low-doses of a class of antidepressants called tricyclics can improve the "visceral hypersensitivity" -- the low-pain threshold -- of people with IBS, explains Guttmann. The tricyclics work on nerve endings, making them less inclined to transmit pain signals.
He also emphasizes the benefits of a good relationship with your health professional: "Having a health practitioner who can communicate and empathize, and show the patient that they're on top of the situation is an extremely important part of feeling better."