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Ask Harry: IBS Is NOT a 'Wastebasket Diagnosis'

Jeffrey Roberts

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Jeffrey Roberts


Dear Dr. Reich,

I have seen your credentials and I know that you are a very skilled doctor in your field. When it comes to your medical opinion of Irritable Bowel Syndrome (IBS) you are very wrong. Your comments about IBS as being a wastebasket diagnosis is hurtful and harmful for the 20% of the nation that suffers from IBS. IBS is not a collection of gripes as you have described. Rather the quality of life for an individual who suffers from IBS is equivalent to someone with kidney disease, forever tied to a bathroom versus a dialysis machine. What is even more disturbing is that more women than men are diagnosed with IBS in western medicine. Given your field of work, we would have expected someone like yourself to have a little more insight about IBS. Gastroenterologists who manage IBS follow a patient's history and symptoms using the Rome Criteria to diagnose an individual with IBS. It is not a wastebasket diagnose given that many researchers have spent most of their careers trying to unravel the cause and to find treatments for the millions of sufferers nationwide. IBS is not caused by diet and specifically by not eating well. We all wish it was a simple as that because then we would all be cured. I am personally surprised and disappointed that an expert in your field would not have first done a morsel of research before answering this question about IBS versus endometriosis. It is true that many women due seek help for symptoms which could be confusing. Some even have unnecessary surgery when IBS is really the cause. We ask that you please be a little more sympathetic and please spend some time doing some research around current papers on Irritable Bowel Syndrome.


Jeffrey Roberts, MSEd, BSc

Founder, IBS Patient Group


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.

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  • 2 weeks later...
Jeffrey Roberts

Thank you to the Endometriosis Foundation of America and Dr. Reich for their reply:





Thank you for your very informative letter, Jeffrey. I agree with almost everything you say. My communication is an opinion column, not a researched fact as per medical literature columns.
My practice dealt with extensive endometriosis. My focus, while seeing most patients, was my pelvic examination. If I felt no pain or tenderness, I questioned the diagnosis of endometriosis and sent the patient elsewhere unless she insisted on a laparoscopy, which most times proved to demonstrate no endometriosis. I agree that sometimes pictures documenting no endometriosis is just as good as wondering if you have it. My practice also dealt with extensive adhesions. These were patients who had undergone multiple laparotomies, often more than 10. The patients presented with pain and partial bowel obstruction symptoms. Thus, these were patients with severe cramping of their intestines. These symptoms could be confused with IBS. However, I operated on the basis of the patient’s symptoms and previous surgery. These operations were long and tedious as I attempted to separate intestinal adhesions from the small intestine down to the rectum. Usual operating time was greater than four hours, and most patients experienced significant relief. Incidentally, this procedure still has no billing codes, and many surgeons wait until the patient becomes completely obstructed before doing the operation.

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. 



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  • 3 months later...

Jeff, I get where you are coming from. People who suffer with IBS tend to be very careful what they eat and eat healthily. I know I do! I do not eat foods with additives, preservatives etc, live on a wholefood veggie diet, very low starch, no wheat etc. I drink mineral water and decaff coffee. Do not drink alcohol or smoke. I gave up smoking in April 2017 ( I vape now)  and yes I have more physical energy now,  but it has made no difference to frequency of IBS episodes. 

I know people who eat junk food diets,  no fresh veg etc, drink alcohol regularly, smoke etc and they hardly ever have indigestion never mind IBS type symptoms! They only get bad guts when they got a virus. 




Edited by HattiehatesIBS
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