Between 10 and 20 per cent of the general population suffers from a puzzling and uncomfortable condition called irritable bowel syndrome (IBS). It is one of the most common disorders seen in general practice and it affects more women than men.
As the name suggests, this is an illness that affects the bowel and the body’s ability to eliminate.
Symptoms of IBS usually include pain and bloating and either constipation or alternating constipation and diarrhea. It does not involve bleeding or inflammation of the bowel and does not progress to Crohn’s disease or ulcerative colitis.
These are not pleasant experiences and you may be wondering at this point exactly what any of this has to do with mental health. Well, for many years it has been acknowledged that there are psychological aspects to this common illness of the bowel.
Although no exact cause or even diagnostic test has been discovered for IBS, the hallmark symptoms, chronic nature of the disorder and the elimination of other possible illnesses make it possible to diagnose according to consensually agreed upon diagnostic rules.
People with irritable bowel syndrome also tend to be more prone to psychological symptoms including anxiety or depression than the general population. It is sometimes referred to as a psychophysiological disorder. Just as tears are a physical symptom of an emotional state, so changes in bowel activity accompany emotional states.
Depending on the strength and duration of the emotional state and the genetic predisposition of the individual, the symptoms may be more or less severe. Most people have had the experience of nervous diarrhea in particularly stressful situations, but for most this is situation specific and short-lived. In IBS, bowel symptoms are a chronic problem.
Some evidence suggests that more severe and lasting symptoms may result from a disturbance in the interaction between the bowels, the brain and the autonomic nervous system. This part of the nervous system is known to regulate bowel motility and is also involved in the body’s response to psychological stress. It is possible that this disturbance may be learned or conditioned rather than hard wired in some, if not all cases.
Because emotions can initiate or exacerbate these symptoms, stress management is a very important part of IBS treatment. Techniques such as relaxation training can help to reduce stress. Other stress management strategies can include counseling, support, regular exercise, changes to stressful situations in life and getting adequate sleep.
In addition to stress management, other ways to help minimize the effects of IBS can include avoiding things that seem to make symptoms worse. Avoiding foods that make symptoms flare up can be helpful, but unfortunately there is no specific diet for IBS that has been proven effective.
As always, education about the nature of the symptoms and how they occur is important and eliminates unnecessary worry.
Medications sometimes used in irritable bowel syndrome treatment are laxatives, anti-diarrheals and antidepressants. However, although laxatives and anti-diarrheals can relieve symptoms temporarily, there is little evidence that they are effective as long-term treatment and they can be overused. There is better evidence for antidepressants.
Dr. Latimer is president of Okanagan Clinical Trials and a Kelowna psychiatrist.