Coping with an irritable bowel

We have all experienced that occasional tummy ache or diarrhoea, but imagine living with recurring pain in the gut.

You cannot predict when it’s going to strike, and when it does, it can leave you incapacitated.

These are symptoms of Irritable Bowel Syndrome (IBS), a common gut disorder all over the world, which affects five to 10% of the population.

The condition is characterised by abdominal discomfort or spasms, a change in bowel habits such as diarrhoea or constipation, or both, bloating of the stomach, excessive wind (flatulence), and often, an urgent need to go to the toilet.

“IBS doesn’t cause serious complications or mortality, but it has a major impact on quality of life, especially functioning on a day-to-day basis, coping with work, absenteeism from work, etc.

“We don’t know what causes it, but we do know that there is a problem with the motility of the intestine and the sensitivity of the nerves in the intestine.

“The sensitivity of the nerves is altered once it’s triggered by stimuli that normally do not cause pain in other people,” explains consultant gastroenterologist Datuk Dr Mahendra Raj.

Approximately 40% of all visits to gastroenterologists are due to IBS symptoms, which result from a disturbance in the way the gut, brain and nervous system interact, and cause changes in normal bowel movement and sensation.

There are many theories surrounding its possible causes.

“Some patients may have experienced acute gastroenteritis (food poisoning), and somehow, after that episode, something goes awry with the sensitivity of the nerves.

“Or perhaps there is an alteration of the gut microflora. The intestine is rich with a very diverse bacterial population and it changes as we grow older. Anti-biotics immediately alter gut flora, but often just temporarily, although it can also be long term,” he says.

IBS is also referred to as a biopsychosocial disorder, as sufferers are affected by biological (genetic, biochemical, etc), psychological (mood, personality, behaviour, etc) and social factors (cultural, relationships, socio-economic, medical, etc)

“When people suffer from IBS, if they’re under stress or on a particularly bad day, the symptoms can be aggravated. If they’re depressed or unhappy, the symptoms can also be aggravated.

“If someone has very bad IBS symptoms, the suffering can make him/her depressed, but often, that degree of depression is not usually severe. It’s irritating, affects quality of life, but rarely causes clinical depression or causes the patient to become suicidal,” says Dr Mahendra.

It is important to know that IBS doesn’t predispose you to colorectal cancer, says Dr Mahendra. Photo: The Star/Azlina Abdullah

The impact of IBS can range from mild inconvenience to severe debilitation. It can control many aspects of a person’s emotional, social and professional life.

Those with moderate to severe IBS struggle with symptoms that often impair their physical, emotional, economic, educational and social wellbeing. As they struggle to cope, those around them may be unaware of the impact, or even the existence, of the disorder.

While it affects both genders, IBS is predominant in women.

“The onset can occur at any age, but normally, symptoms start in the late teens and early adulthood, though there are people who develop symptoms in middle age. Often, patients say they’ve had a history of a ‘sensitive’ tummy.”

The doctor has to be confident of diagnosing IBS via a global assessment, and where necessary, investigations that vary according to the symptoms and age of the person. Not everyone needs to undergo an endoscopy or a colonoscopy.

Dr Mahendra says, “If you’re a 20-year-old, have had typical IBS symptoms for the last few years, and there are no signs of any serious disease, then the doctor can be confident it’s IBS.

“Most of the commonly used tests will detect nothing.

“But, in a 65-year-old with the same symptoms which only started three or four months prior, then it’s wrong to make a diagnosis without thorough investigations because other more serious conditions can be in the picture.

“We are more likely to investigate older patients.”

IBS and colorectal cancer have very similar symptoms.

“Many people live with the fear that IBS will turn into colorectal cancer. It’s important to know that IBS doesn’t predispose you to colorectal cancer. If you have IBS and there is a change in the pattern, then that should alert you to have it checked out,” Dr Mahendra points out.

The red flag signs and additional symptoms include a short history, weight loss, some rectal bleeding, abdominal mass, pain that disturbs sleep at night, and looking thin and pale.

Unfortunately, while there is a cure for colorectal cancer if detected early, there is no cure for IBS – only management.

Abdominal pain is one of the symptoms of IBS, a common gut disorder which affects five to 10 of the population. Photo: 123rf.com

Often, medications mitigate the symptoms: mild laxatives for constipation, anti-diarrhoea pills to plug the leak, and anti-spasmodic drugs to control the colon muscle spasms.

He adds, “Antidepressants in small doses has benefitted many patients. It is not used as an antidepressant, but helps reduce the sensitivity of the intestinal nerves.

“There is no best treatment and no one-size-fits-all treatment, especially if the discomfort is triggered by emotional and psychological factors.

“Food is another factor, and if you know from experience that certain foods trigger the symptoms, then avoid it. IBS patients may have a boring diet, and getting a balanced diet may be hard. However, there are definitely foods one can eat.

“Yes, there might come a time when something happens to the gut flora and you might be able to tolerate certain foods.

“However, you can only find out by trial and error.”

While diarrhoea and constipation can aggravate haemorrhoids, avoiding certain foods can also lead to malnutrition and fatigue.

There is evidence that a group of short-chain carbohydrates, named FODMAPs (Fermentable Oligo-saccharides, Di-saccha-rides, Mono-saccharides And Polyols) are problematic for those with IBS.

These short-chain carbohydrates are poorly absorbed in the small intestine and are rapidly fermented by bacteria in the gut. The production of gas by these bacteria is a major contributor to symptoms.

So, low FODMAPs food help, though Dr Mahendra says it’s not a panacea and may not be sustainable in the long run.

“Methods such as biofeedback, hypnosis and yoga may have some benefits, but there are not many large studies that have tested these modalities of treatment. The beauty is that these treatments very rarely have any adverse effects, so they’re worth trying anyway. But they are time-intensive and not many people are trained in these modalities.

“The rapport between the doctor and patient, and the time spent talking between them, also has major impact on the success of long-term management. If patients understand their condition and are reassured, they are able to cope better.

“IBS can flare up any time, but patients must be aware that it is not life-threatening and will not necessarily lead to something like cancer. Yes, it is debilitating, but accept that it’s a ‘friend’ for life,” advises Dr Mahendra.

Source : Star2.com