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Ask Harry: IBS Is a 'Wastebasket Diagnosis'

Ask Harry: IBS Is a 'Wastebasket Diagnosis'

Do you have a burning question for EndoFound’s Honorary Medical Director Emeritus and Senior Medical Advisor, Dr. Harry Reich? E-mail him at harry@endofound.org or visit EndoFound’s official Instagram, Facebook or Twitter, tag us and ask a question with the hashtag #askharry, and you could see your answer featured here!

If you survey a roomful of 100 women with endometriosis, you'll find many have been wrongfully diagnosed with Irritable Bowel Syndrome (IBS). It's a common narrative because America is chock-full of OB-GYN's who don't know or understand endometriosis and its accompanying gastrointestinal signs and symptoms; the result is often a referral to a GI doctor as the delay to endo diagnosis drags on.

IBS is a big umbrella of gripes: it means abdominal pain, gas pains, diarrhea, and constipation. Cramps and bloating. 

It also means that the doctor or surgeon has no idea what’s going on inside of you. No, not even a gastroenterologist knows.

I'll take it a step further: I believe IBS is a wastebasket diagnosis. 

(For an in-depth discussion of IBS versus bowel endometriosis, please refer to this excellent talk by Dr. Ken Sinervo.)

And yet, every single one of us has experienced some bout of IBS! (Not to be confused with Inflammatory Bowel Disease, or, IBD, like Crohn's or Ulcerative Colitis.)

Much of this has to do with our diet.

If one eats more, there is more food for the bacteria in the gut to thrive on.

So this discussion comes down to eating habits.  IBS often results from not eating well.  Too much processed food and a low fiber diet trends toward constipation. If constipation is prolonged, one gets rebound diarrhea. Slow transit of food from overeating or from the nervous system of the bowel wall (peristalsis) results in more bacterial action with resultant pain or cramps or bloating.  The acidity falls, and bacteria numbers rise going from stomach to rectum.

I did know from an in-office examination if the patient has endometriosis or may have endometriosis. I saw patients with pain and a probable diagnosis of endometriosis either from a previous doctor’s examination or previous operative findings. 

I did not ever have to wonder if the patient had IBS.

RELATED: Top Ten Signs You Need a new Endometriosis Specialist

DeAnna E., asks: I've had a laparoscopy, two c-sections, and a hysterectomy. They took my uterus, left ovary, both fallopian tubes and cervix. I had a uterus so bad it looked like [I was] four months pregnant. It had endometriosis, adenomyosis, fibroids, cysts, and polyps. [For] two months post-surgery I had cramps and bleeding. No one would believe me that I [still] have cramps and bleeding from my vagina. My cuff is healed, and everything is normal. My bowels hurt, my bladder hurts. Is there no end to this pain? I had everything taken out, and I'm still in pain. Why? It's been 13 months since my hysterectomy. 

My belief is that you have endometriosis of the vaginal cuff. Whenever you have a hysterectomy, you have scar tissue at the top of the vagina; the cuff is the area where the vagina was previously attached to the cervix. Treatment involves excision of the scar tissue at the top of your vagina. This is best done by laparoscopy with a sponge or probe in the vagina to push it up toward that surgeon. It is also possible that there is some rectal or bladder involvement.

Debbie B., asks: I am a 52-year-old mother of one and have had endometriosis five times in 20 years.  I had a complete hysterectomy in 1998.  It returned in 2007 and 2009, and my doctor had to perform laparoscopic surgery both times.  It made a return in June 2018, and I just went in again in October 2018.  My wonderful doctor is puzzled by me. Says I am getting my estrogens from the environment and my body won’t metabolize it.  I am trying to do everything she says, but I never seem to get ahead of it. Are there any suggestions? 
I don’t believe that you had endometriosis "five times." I believe that it was not wholly excised and persisted through these years. You had a hysterectomy with removal of both ovaries and afterward had two more laparoscopies for endometriosis. Again, as I have emphasized many times, hysterectomy is not the treatment for endometriosis. Excision of the endometriosis is the treatment for endometriosis. So now we come to your present problem. Where is the estrogen coming from? The usual sources of estrogen after menopause are from fat cells and also from endometriosis itself as endometriosis has been proven to be able to regenerate its own estrogen. So, where does that leave you? I believe that a little bit of estrogen is good after the menopause.  Also, it is possible that your pain is from another source.  Depending upon the severity of your pain, you may want to consider an endometriosis specialist surgeon.  Otherwise, I would suggest no surgical treatment for at least the next year.  That may give you some relief. Time will tell. 


Editor’s note: The opinions, beliefs, and viewpoints expressed by Dr. Harry Reich in this column are solely his own and based on his experience.