Irritable Bowel Syndrome (IBS) is the most commonly diagnosed Gastrointestinal disorder that prevails in Western populations and affects 15-20% of adults and adolescents. IBS is second only to the common cold as the most common cause of work absenteeism. Prevalence is reported to be higher in women.
There are three types of IBS: IBS-D (with diarrhea as the major symptom), IBS-C (with constipation as the major symptom) and IBS-M (mixed type, patients have alternating diarrhea and constipation). In the US, approximately 28 million people are believed to suffer from IBS of which roughly nine million are thought to have IBS-D. Approximately 67% of patients who visit a physician’s office to seek help for IBS-D symptoms receive a prescription. Even though IBS does not cause an increase in death rate, it leads to a decreased quality of life, frequent clinic visits, and missed workdays.
It is not very clear why patients develop IBS, though experts believe it is related to an abnormality in muscle activity in the intestines, along with a hypersensitive reaction to food or other external stimuli that cause stress. Psychosocial stress is well known to cause worsening of IBS symptoms. Patients with IBS are also commonly known to have other psychiatric disorders. Researchers have also noted maladaptive coping style in patients who suffer from IBS.
The major symptoms of IBS include: Chronic abdominal pain which is usually described as crampy, with periodic exacerbations from stress, eating, located mostly in the lower abdomen, with relief with defecation. Other symptoms include: change in bowel habits, diarrhea (frequent loose stools, usually after meals), incomplete evacuation, constipation, urgency right after eating is common, and alternating bowel habits are common. Patients also complain of reflux, feeling full soon after starting to eat, dyspepsia, nausea, bloating and gas. Patients with IBS also commonly complain of symptoms like impaired sexual function, pain with sexual intercourse, and Increased urinary frequency/urgency.
Diagnosis of IBS should be made with a very detailed patient history and ruling out other causes of abdominal pain and diarrhea/constipation like colon cancer, diverticulitis, infectious diarrhea, lactose intolerance. Only limited treatment options are available to treat IBS. Patients use several over the counter medications to treat abdominal pain and diarrhea or constipation, but none work very well in controlling symptoms over extended periods of time. Antidepressants are also used, and may work well in certain patients.
The major focus in treatment of IBS involves careful reassurance of the patient since this is a chronic condition and currently there is no cure. Focus of treatment is symptom relief and addressing patient concerns. Patients are usually able to determine exacerbating factors by keeping a detailed food dairy where they record all food types taken during the day. Patient education is very important and support should be provided for the following: Dietary modification, lactose free diet, exclude foods that promote gas (beans, onions celery, carrots etc), increase fiber intake and last but not least, psychosocial therapy.