DEAR DR. ROACH: Could you please explain the difference between irritable bowel syndrome and irritable bowel disease? What is the treatment for each? I saw in a health magazine that there is a blood test to determine which one someone may have. — ES
ANSWER: Although the two names are very similar, the conditions are very different. Irritable bowel syndrome is a common condition, more frequent in women than in men, of abdominal discomfort and bowel changes, such as diarrhea and/or constipation. It is managed by diet (such as the low-FODMAP diet I have recommended several times), stress management and sometimes medications. It can cause significant changes in one’s social life, in addition to pain and discomfort. IBS is a clinical diagnosis, and there is no blood test to confirm it. Primary-care doctors manage IBS, and severe cases may benefit from the care of a gastroenterologist.
Irritable bowel disease — of which there are two types: ulcerative colitis and Crohn’s disease — is a potentially life-threatening condition of the GI tract. In ulcerative colitis, there is inflammation that’s limited to the colon, whereas in Crohn’s disease, the inflammation can be in any part of the GI tract, from the lip to the anus, though it is most frequent in the far end of the small bowel and the colon.
IBD should be managed by a gastroenterologist, preferably one with special expertise in these diseases. IBD usually is diagnosed by colonoscopy or other endoscopy with biopsy. Many blood tests can be abnormal in IBD, but only the pathologist’s report is definitive. Most people with IBD will need medication treatment, although symptoms and therefore treatment may change dramatically across time.
DEAR DR. ROACH: I am 83 and recently began having sciatica pain down my right thigh. My doctor recommended using a hotwater bottle. Are there any painkillers I can use? Are there any other products I can use? — G.L.B.
ANSWER: The sciatic nerve is a very large nerve that runs down the back of the leg. When the nerve is pressed on in the back — from a herniated disk in the back or from spinal stenosis — there can be intense pain that feels like it is coming from the back, or anywhere from the top of the thigh to the foot. Since other nerves besides the sciatic can be affected, the condition is called lumbar radiculopathy.
A herniated disk is when the shock-absorbing material in between the vertebrae comes out into the space where the nerve root is, on its way out of the spinal column toward the leg. Spinal stenosis is a narrowing of the bony canal through which the nerve travels.
In most cases, people get better within four to six weeks. Standard pain medications, such as acetaminophen (Tylenol) or ibuprofen, can be helpful. If pain is severe and not responsive, there are other treatments, including a short course of steroids and narcotics, which should be given only during that initial period of pain.
Pain that persists for a longer period of time, or pain with weakness, especially with progressive symptoms, needs expert evaluation.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med. cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803. ©2016 North America Synd.