Causes, Diagnosis, Symptoms and Treatments

Although IBS affects approx 1o % of the population at any given time it is still a very misuderstood condition.  The condition affects almost twice as many women as it does men and is most commonly seen in the 30′s and 40′s age groups.  In older people it becomes equally common between men and women.  Most sufferers will be able to identify foods and life events that may trigger their symptoms, others may need to visit their local doctor for help and advice.  However a percentage of sufferers will need to be referred to a Consultant Gastroenterologist for a definitive diagnosis, tests and medical treatment. Unfortunately many of these individuals do not find that medication relieves  their IBS and the severity of their symptoms affects their relationships, work, career, stress levels and day-to-day functioning.

 

IBS is classified as what is known as a Functional Somatic Condition – this  means a condition with no known cause.  It is diagnosed by a set of criteria known as the Rome III criteria (see below) which the patient must meet in order to be diagnosed with IBS.  However, as there is no inflammation or physical event to be observed, the diagnosis is made by excluding other more serious conditions and identifying a number of symptoms (diagnosis by exclusion).

 Criteria for IBS Diagnosis*: (known as theRome III criteria)

Recurrent abdominal pain or discomfort** at least 3 days per month in the last 3 months associated with 2 or more of the following:

1) Inprovement with defecation

2)Onset associated with a change in frequency of stool

3) Onset associated with a change in form (appearance) of stool

* Criteria fulfilled for the last 3 onths with symptom onset at least 6 months prior to diagnosis

** Discomfort means uncomfortable sensations not described as pain

However these are not the only symptoms involved in the condition which often also includes;

- bloating (sometimes severe)

- vomiting and nausea

- leg pain

- fatigue

- backache

- headache

- full sensation even after a small meal

- social difficulties

- agoraphobia ( often due to need to be near a toilet)

- relationship, career and family difficulties
Doctors will often further sub-divide their diagnosis into 3 main categories:

1 Diarrhoea predominent – diarrhoea is the main symptom

2 Constipation Predominent – constipation is the main symptom

3 Alternating – Main symptom changes between diarrhoea and constipation

 

What Causes IBS?

Because researchers could not find an organic (visible physical) explanation for IBS it was once looked upon as a psycho-somatic condition.  Such a diagnosis caused immense insult and frustration to the many thousands of people who lived with very real constant pain and discomfort. Patients were often told to “be happy it isn’t anything more serious” and were sent on their way.  Fortunately, in more recent years studies have found a number of possible causes of IBS although there still seems to be no one single explanation for  all cases.

These possible causes of IBS include;

- genetics ( which may affect many other possible causes)

- abnormal digestive enzymes

- the colon’s over-reaction to food intake and also emotion

- over-activity / under- activity of the digestive system ( too many / too few contractions)

- over-sensitivity of the central and peripheral nervous systems (nerves becomes hyper -sensitive to pain)

- Gastroenteritis (known as Post-infectious IBS)

- altered hormonal, immune and neural (nervous system) response to stress

- childhood / adulthood abuse

-  abnormal gut mucosa ( basically the “gunk” that lines  the digestive system)

- subtle immune system changes

 Treatment:

Medical treatment for IBS will often involve the use of drugs to either speed up or slow down the speed at which the colon contracts (passes food  through), high fibre diet and laxatives are used in the case of diarrhoea, and probiotics may be prescribed for bloating.  Many patients are upset when they are given  anti-depressant medication and or a referral to a psychologist and feel that this is just confirmation that the doctor thinks the problem is all in their head.  This is not the case!

The idea that the mind (brain) and body are separate entities that work independently of eachother is outdated.  Modern medicine now looks upon the body as an interconnecting network with many systems such as the immune , hormonal and nervous systems.  The brain is included in each of these systems which also affect eachother, so that for example, a change in the imune system will affect the hormonal and nervous systems and a change in the nervous system will affect the hormonal and immune systems.  The study of how the brain affects these bodily systems and visa versa is called Psycho-neuro-immuno-endocrinology (thank goodness there’s a short way of saying this – P.N.I.E.!)

The digestive system is another system that is linked to the brain and other systems.

Why use Psychology and anti-depressant medication? 

One of the hormones that affects not only our mood but also our digestive system is Serotonin. It has sometimes been called the “Happy hormone” due to it’s importance in positive emotions such as happiness.  Abnormal levels of serotonin are found in depression and this is why it is used in anti-depressant medications.  However, although serotonin is involved in our moods, over 90% of it is made in our gut.  Our gut also has so many nerve endings in it that it has been called our body’s “second brain” .  Because our gut (i.e. the nerves in our gut) is so reactive to conscious and unconscious information, we have become used to phrases such as “What’s your gut instinct?”, “What does your gut tell you?” and “butterflies in my stomach”.

Remembering that our body is a network of systems and each affect eachother it is easier to understand how serotonin (and drugs called SSRI’s – selective serotonin reuptake inhibitors) are used for their affects not only on the brain but also on the gut.  Our emotional systems also are connected with our whole body and therefore are another way in which serotonin, mood and pain affect each other.

Ongoing pain, fatique and discomfort affect our emotions which can lead to anxiety and depression.  In turn these conditions cause us to think negatively which increases pain and so the cycle continues.  While a doctor tries to break this cycle at the physical symptoms, psychologists target the psychological aspects – it’s just a different place to cut the same cycle.  Psychological therapies do require committment and motivation and for this reason are often not prescribed unless medications have failed (refractory IBS).  Some people can easily see how stress worsens their symptoms, others don’t see the connection.  For those who have suffered abuse psychological intervention helps in many aspects of their lives, not just their IBS symptoms.  Interestingly however, the psychologist doesn’t have to delve deeply in to their abuse history to help their IBS symptoms.

Psychological treatments for IBS usually include relaxation training, stress management techniques and cognitive therapy (changing unhelpful thoughts patterns).  Hypnotherapy for IBS  has been very well studied  and found to be extremely useful for refractory IBS patients (those who find little or no benefit with medication).

If you would like to participate in an upcoming study of a home based E-Learning programme for IBS sufferers please send your contact details to us at info@accesspsychology.ie.

More information on all aspects of IBS will be published soon.  In the meantime you can contact us at 01-235 100 or by leaving a message on the Contact us page.