PORTSMOUTH — On the topic of irritable bowel syndrome (IBS), a less than delicate topic for general conversation, knowledge can mean real relief from a chronic, yet manageable condition.

"IBS is an extremely common condition characterized by two main things," said Dr. Aris Damianos, a gastroenterologist at Atlantic Digestive in Portsmouth. "There is chronic abdominal pain or bloating, with the discomfort centered in the abdomen. Then, there are altered bowel changes, diarrhea or constipation or the conditions may flip flop."

Damianos said IBS is diagnosed in people who have these symptoms chronically for more than six months. The symptoms may not be there all the time; they can be recurrent but continue to happen. This is important because medical tests will usually come back normal.

"Blood tests, endoscopy, colonoscopy, enzymes and proteins will all come back as they should," Damianos said. "That is good because it does allow us to rule out other conditions that might share the same type of symptoms such as celiac disease or an intolerance to gluten. Those will show classic clues in the blood work."

Dr. Hillary Tompkins of Core Gastroenterology in Exeter said there is "no known cause" of IBS.

"It is the most diagnosed condition in our practice," she added. "About 10-15 percent of the population suffers from this, and that's a pretty significant number."

Tompkins said IBS is recognized as a chronic gastrointestinal disorder, characterized by pain and an altered bowel condition.

"We listen carefully to the patient's history and their family history," she said. "We can hear signs that point to other conditions and signs that lead to IBS. The cause is uncertain. Research has looked at genetics, food, allergies, all with no clear conclusions. The problem is an altered intestinal tract, at times being faster or slower. There can be hypersensitivity, an increased sensitivity to symptoms that arise."

IBS seems to be more prevalent in women than in men. It can target people of any age, race or gender.

"Upwards of 30 percent of women have this," Damianos said. "Far more women than men see their doctor for this."

In talking with patients, Damianos said he stresses two things. First, it is a life-long syndrome, with no cure.

"Patients will have on and off occurrences, not a constant condition," Damianos said. "We discuss ways to manage their symptoms."

"This really is a nuisance disorder," he said. "I can assure my patients that IBS does not lead to any other disease. It will not result in ulcers, colon cancers or Crohn's disease."

Most of the time, a flare-up of IBS is not long lasting. Because of that, Damianos said some patients will have actually had the syndrome for months or even years before they seek help.

Help is available

"Patients need to first realize that while this is frustrating, it is not dangerous," Damianos said. "It does interfere with a person's lifestyle. We can turn the volume knob down on the symptoms. We can manage the condition by dealing with what symptoms each individual is having."

Medications are available to address the pain, bloating, diarrhea or constipation.

"Diet can help in some cases," Damianos said. "Diet is controversial because we can't point to any one food that contributes. It is different for everyone. We can use anti-spasm medication and low-dose antidepressants for pain. The key is to find what works for each person."

There is some thought that periods of stress can cause a flare-up of symptoms, Tompkins said.

"With treatment, we start conservatively," she said. "We do some education and provide assurance that this will not lead to a more serious condition. We might try some basic dietary modification by asking them to note what they eat before a flare-up. Some people report dairy, sugars, some fibers and some vegetables as a catalyst. We advise increased exercise. If that doesn't work, we can turn to medications to target the most bothersome symptoms."

Tompkins said the goal in treating IBS is for the condition to improve over time, through treatment.

"Everyone affected has to work with their own doctor, through trial and error to find what works," she said. "It can be a long process and that can be frustrating. The bottom line is that IBS is not hopeless and people do not have to suffer through the waxing and waning of symptoms."