question (dbab)

Hi mdgirl :)

There are some docs that will not go through all the tests and will give you an IBS diagnosis without them. These docs are mostly not gastroenterologists though, these would mostly be your family docs. It is true that most doctors can have a good hunch that you have IBS based on your symptoms and are usually right on the money after they ask you questions however the good doctors will rule everthing out. A "diagnosis of exclusion" is exactly that. They will exclude everything before giving you an IBS dx. They can't exclude without doing tests. Now the extent of tests vary from doctor to doctor. I have heard of doctors only doing a fecal occult blood test to rule out other things before giving an IBS dx. My doctor did more though. I have had a fecal occult blood test, thyroid test (they do this when constipation is an issue), barium enema, and colonoscopy. I will tell you that I have had IBS for 16 years and was just given a Ulcerative Colitis diagnosis this year. I also have diverticulosis which would have never been found without doing my barium enema (my UC would not have been found without my colonscopy).

A colonoscopy is really not that bad. The worse part is the prep and now thats really not that bad if you get the right prep. I don't like the golightly and phospho which I have used many times and for my last colonoscopy, I was given the option of the pills. I'm so glad I did, swallowing pills was much better. I would suggest some testing to rule out other things and to give you peace of mind.

I hoped this helped a little.

If you need to know the name of the pills, they are called Visicol. Also I would take the colonscopy over the barium enema for two reasons... the barium enema is somewhat unpleasant (you are fully awake and no anesthesia whatsoever and it can be quite uncomfortable) and the colonoscopy is a more thorough test as they can see your colon visibly for any color abnormalities and they can do a biopsy if needed.

Just wanted to throw in my two cents too...a doctor may not go through a rigamarole of testing if your symptoms aren't very severe.  For instance, if you have bouts of diarrhea occasionally, some bloating, and minor abdominal pain they may just do some quicky tests and say you have IBS.  If you are spewing the goods out >10 times a day, have blood or nocturnal symptoms, they'll probably want to give you a more thorough exam.

I chose not to have my last scheduled colonoscopy because I thought it was unwarranted. One, I had had one already and it showed up nothing (because it was my gall bladder, not my colon that was the problem at the time). I have a family history of Crohn's, and was quite sick with my gall bladder, so it's not like it was a shot in the dark to think I might need one. But this last time I was presenting with IBS symptoms and my doctor (a different one from the first colonoscopy) jumped right to giving me a colonoscopy. She didn't even want to do blood work or a stool sample first. She even told me she was pretty certain I had IBS. I heard $$$ ringing up in the background, so I decided not to do it. I was quite sure I did not have an IBD because I never had blood in my stool or on my toliet paper (and an occult blood sample proved negative too), and I had stopped hurting and was starting to get some better, although I hadn't yet figured out what was making me better (calcium). I didn't want to go through yet another colonoscopy that would show up nothing at all just to prove that I was right in the first place (I thought it was my gall bladder when they were scoping me the last time). That and they wouldn't give me the pills. They said they didn't clean you ought good enough and I said how clean did they need me to get, seeing how I had diarrhea every day anyways? The nurse just gave me this "What a stupid layperson you are" look and went on talking about the phospho soda stuff.

Long story short, make sure you feel comfortable with your docotor and staff before going through the procedure. If you feel that they treat you like you are a complete and total idiot not worthy of having things explained to you, then find another doctor. If you are recommended for a colonoscopy, be sure to ask why exactly the doctor thinks you need one. If he's already sure you have IBS, why have an uncomfortable, costly procedure? A lot of people forget that doctors are not God and you don't have to do what they say. In fact, they're not really "saying" anything, they're making suggestions.

If he legitimately thinks you might have an IBD or your family history includes cancer of the digestive tract and/or IBDs, then do as he recommends. If you do have a family history of colon cancer, then get used to having one every 10 years or so as a preventitive thing; you definitely should have one in that instance. And in that case, you'll at least put your mind to rest when the test comes back clear. But if you have a clean family background when it comes to digestive cancers and your problems are not very serious, as Sarita mentions, then, if it was me, I would expect the doctor to do a whole lot of convincing as to why I would need a colonoscopy, otherwise I would opt out. It's not that they are that bad or painful or anything, but who wants to spend a day going without food and pooping continuously? It's just not something anybody WANTS to do, so, in my opinion, I need a really good reason for doing it.

You all make very valid points....
There is the Prometheus Lab. I forgot to mention that in my post. A couple of my 14 vials of blood got shipped off to Los Angeles for the IBD, Celiacs and Lactose Intolerance tests. That could be a good way for results without a scope. Although, I must agree that I do think a scope is important (to be absolutely sure).