Wednesday 20 June 2018

IBS: Battling the pain and stigma of an irritable bowel

Affecting up to one in five people in Ireland, irritable bowel syndrome can be physically and emotionally debilitating.

New research is focusing on the internal environment and the microbiome that live in our gut
New research is focusing on the internal environment and the microbiome that live in our gut
Katie Byrne

Katie Byrne

The tests came back clear. You don't have coeliac disease or gluten-intolerance and there's no evidence of Crohn's disease or ulcerative colitis.

A diagnosis of exclusion leads your doctor to conclude that you probably just have irritable bowel syndrome (IBS). This is supposed to be good news, but after months of crippling pain and moments of social isolation, it can be hard to see it that way…

IBS isn't a dire diagnosis but it can be a severe impairment that causes abdominal cramping, bloating and gas and irregular bowel habits of diarrhoea and constipation.

To make matters worse, the exact causes are unclear. IBS is a disorder, not a disease, and without a definitive treatment, the symptoms can only be managed.

IBS affects up to one in five people in Ireland and, as in other populations, it affects considerably more women than men and more younger women (18-40) than older women.

The symptoms vary. For some it's mild and infrequent. For others, it's severe and devastating. Some IBS sufferers experience backache, headache, fatigue and nausea alongside their digestive symptoms. Others have bladder and/or gynaecological problems.

For some, the symptoms are so severe that they simply have to retire to bed until they feel better.

The social stigma compounds the problem. It can be an embarrassing condition to suffer from. A recent study carried out on behalf of Alflorex found that 29pc of IBS sufferers believe there is still a big stigma associated with the syndrome.

Of the 1,250 IBS sufferers in Ireland and the UK that were interviewed, 49pc said they had lower self-confidence as a result of their IBS, 39pc felt depressed and 13pc felt lonely or isolated.

Commenting on the study, consultant gastroenterologist, Dr Deirdre O'Donovan, of the Blackrock Clinic in Dublin, said: "IBS significantly affects quality of life and patients can end up being isolated from friends, family, colleagues and even their partners as a result of IBS flare-ups.

"Symptoms such as unpredictable bowel movements mean they constantly need to be within reach of a toilet."

IBS is a physically and emotionally debilitating condition, so it's no surprise that it's linked to a higher prevalence of anxiety and depression.

It's frustrating too. A diagnosis of IBS doesn't happen overnight. It can be a slow, painstaking process during which more sinister diseases are ruled out.

Gastroenterologist Professor Colm O'Morain, Dean of the Faculty of Health Sciences at Trinity College Dublin, says the first port of call is the GP. "If [the doctor] has a relationship with the patient and they know their medical history, I'm happy for them to do a triage," he explains.

If the patient is then referred to a gastroenterologist, they will undergo some simple blood and/or stool tests to rule out inflammatory disease.

"The big differential diagnosis would be inflammatory bowel disease (IBD): Crohn's disease or ulcerative colitis," explains O'Morain. "Although, sometimes these diseases can overlap with IBS."

Once the possibility of an underlying medical condition is ruled out, IBS is usually diagnosed.

The Rome IV criteria for the diagnosis of IBS require that patients have had recurrent abdominal pain at least one day per week during the previous three months, that is associated with two or more of the following:

• Related to defecation

• Associated with a change in frequency of stool

• Associated with a change in form (appearance) of stool.

For treatment, IBS is divided into four types, depending on whether diarrhoea is common, constipation is common, both are common or neither occurs very often.

Once the type of IBS has been identified, it's up to patient and doctor to identify the triggers.

"Lifestyle would be the main thing to address in the beginning," explains Prof O'Morain. "The patients themselves often admit that lifestyle has a major role to play. And diet and stress can certainly precipitate things.

"The low FODMAP diet [see page 10] has been shown to be effective but it doesn't suit everyone," he continues. It might be an avenue to explore and if you're exploring that avenue, it should be done professionally by a dietician rather than with something you read in a magazine."

Probiotics are also proven to treat the symptoms. "There is a lot of interest in the internal environment and the microbiome that live in our gut," he explains.

"The problem is that we have so many bacteria in our gut that what suits one person might not suit the next. In the future, we'll probably be able to identify the exact microbiome that you lack or have in excess, and give you a precision medication."

Stress is the other common trigger and recent research suggests that the brain and gut are more connected than we may have previously thought.

In the past, doctors may have written off IBS as a psychosomatic disorder. Nowadays, they are more likely to think of the gut as the "second brain", and treat an anxious mindset and a hypersensitive gut as one and the same thing.

If the patient is stressed or anxious, they will be advised to reduce their stress levels. In other cases, they may be prescribed a low dose of an antidepressant.

"This has been shown to be effective in clinical trials," explains Prof O'Morain, especially in patients who have diarrhoea- predominant IBS."

Of course, what works for one IBS patient may not work for another. All IBS sufferers have different triggers and viable treatment options are only identified through trial and error. On the plus side, doctors are beginning to recognise IBS as a legitimate illness and patients no longer feel the need to prove their credibility. The syndrome that dare not speak its name is slowly being destigmatised as it gets more talk time in mainstream and social media.

Prof O'Morain sums it up: "IBS affects quality of life and people can be miserable with it. So [IBS sufferers] shouldn't be dismissed. They should be taken seriously."

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