The Physical and Mental Impact of IBS
Madison, Wisconsin - Everyone experiences digestive troubles at some time. Perhaps it was a few too many onion rings, or Uncle Bob's three-alarm chili. The results can be uncomfortable and occasionally embarrassing. But, there are times when the gas and bloating can be a sign of something more.
During a recent presentation at UW Health's Digestive Health Center, Dr. Sumona Saha, gastroenterologist, and Janice Singles, PhD, health psychologist, discussed one of the most common causes of gastrointestinal, or GI, problems – Irritable Bowel Syndrome, more commonly known as IBS.
"While occasional digestive problems are normal, there are times when they can be symptoms of underlying conditions," explained Saha. "The challenge is that there are numerous possibilities."
Common causes of GI symptoms such as excessive gas, bloating, diarrhea or constipation can range from inflammatory bowel disorders such as Crohn's disease, to gynecologic disorders, infections, medication side effects, thyroid issues and more.
IBS is the most common of functional GI disorders, and is not technically a disease but a group of symptoms. Dr. Saha explained that IBS occurs in 10-15 percent of Western adults, the majority of whom are women, yet only a minority seek medical care. Estimates suggest that the cost of IBS to the U.S. health system approaches $30 billion a year. But it can be difficult to diagnose properly.
"IBS does not damage the lining of the intestines like inflammatory bowel disorders do," explained Saha. "But it does affect the way the digestive tract functions."
The criteria for diagnosing IBS include symptoms that occur for 12 weeks or more in the past 12 months, and include abdominal pain or discomfort with at least two of the following:
- Pain is relieved by a bowel movement.
- Onset of pain is related to a change in frequency of stool.
- Onset of pain is related to a change in the appearance of stool.
The cause of IBS isn't entirely clear, and treatment options vary significantly between individuals. While many different diets have been studied, Dr. Saha explained that no single diet has been shown to resolve all of the symptoms of IBS.
Dietary Changes and Treatment Options
"A low-FODMAP diet looks the most promising," she said, but cautioned that it is a very detailed diet best approached under the care of a trained dietitian.
FODMAPs, or Fermentable Oligo-, Di-, Monosaccharides Polyols, are short-chain carbohydrates that are poorly absorbed in the small intestine. These carbohydrates, found in foods such as broccoli, cabbage, beans, apples, cherries, and others, pass into the large intestine, where bacteria ferments them resulting in gas. This gas can result in bloating and flatulence.
"Unlike an elimination diet that removes a few foods at a time, this approach essentially takes all food away that falls within the particular categories," Saha said.
While dietary treatments are one approach, there are other treatment options based on predominant symptoms whether it's constipation, diarrhea or a combination of the two. Fiber, often thought to be a common treatment for IBS, has actually been shown to have little benefit in several studies.
Anti-spasmodic medications, and even anti-depressants, can be effective depending on symptoms. And, studies have shown probiotics to be effective as well. However, Dr. Saha cautioned that not all probiotics are the same.
"Probiotics are not regulated by the FDA," she said, "So there is not a lot of quality control. Look for probiotics containing both lactobacillius and bifidobacterium."
Mind-Body Techniques Can Be Effective
While diet is certainly an important part of treating IBS, Dr. Singles pointed to another key factor – mind-body techniques.
"A common symptom of IBS is chronic abdominal pain, which can make individuals anxious, depressed and stressed," said Singles. "The problem is that stress can actually make IBS symptoms worse. It's a vicious cycle."
Because there is a significant relationship between stress and GI symptoms, treatment plans that include cognitive therapies have been shown to be very effective. This is largely because of how stress affects the body.
"The autonomic nervous system includes the parasympathetic, or "rest and digest" branch and the sympathetic, or "fight or flight" branch. When we are stressed, there is a chain reaction throughout the body that affects our breathing, heart rate, and more. An individual's beliefs about their IBS symptoms (e.g., this will only get worse and worse, etc.) can actually be associated with poor treatment outcomes and increased IBS symptoms," she explained.
Cognitive therapies help disrupt the negative thoughts by helping individuals identify the beliefs that cause stress. Pyschodynamic psychotherapy and Cognitive Behavioral Therapy have been shown to improve symptoms by as much as 80 percent. Hypnosis has been shown to improve symptoms by as much as 100 percent. But she quickly explained that hypnosis has nothing to do with clucking like a chicken.
"Hypnosis is a state of inner concentration and focused attention," Singles explained. "It works because it helps quiet the mind and body's hyper-reactivity."
Hypnosis is often effective when other methods have failed, and individuals can be taught self-hypnosis techniques. And another benefit – the effects appear to be long-lasting, according to clinical studies.
Date Published: 11/15/2013