Understanding Irritable Bowel Syndrome: The Second Most Common Cause of Absence from Work

Understanding Irritable Bowel Syndrome: The Second Most Common Cause of Absence from Work

• by Dr. CP Tanwar, Associate Consultant- Gastroenterology , Fortis Escorts Hospital, Jaipur

Irritable bowel syndrome (IBS), as the name suggests, can cause immense physical discomfort, and hamper day-to-day work. In fact, IBS is the most commonly diagnosed gastrointestinal condition and is second  to the common cold as a cause of absence from work. It is a chronic condition of the digestive system manifested by bowel-related symptoms such as abdominal pain, bloating, or discomfort that is either improved or aggravated by passing stool or flatus and changes in bowel habits (e.g. constipation and/or diarrhoea). The symptoms can be associated with change in the form or frequency of stool as well as urgency, straining, and feeling of incomplete defecation. IBS patients may complain of meal-related symptoms, including abdominal pain, bloating or distension. Prevalent in men as in women in most Asian countries, IBS can show dyspeptic symptoms such as upper abdominal pain and may result in a misdiagnosis of functional dyspepsia.

What causes IBS?

According to research conducted in the field, IBS affects about 4 per cent of people in rural India while 7.7 per cent of people in urban India are affected by IBS[1]. There can be more than one reason as to what causes IBS, some of them are:

• Abnormal contractions of the colon and intestines (also known as "spastic bowel") may sometimes casue IBS. Vigorous contractions of the intestines can cause severe cramps, which may explain why some treatment approaches, such as antispasmodics and fiber (both of which help to regulate the contractions of the colon), relieve symptoms in some cases.
• Food intolerances are common cause of IBS and is at times associated with food sensitivity or allergy. The best way to detect an association between symptoms of IBS and food sensitivity is to eliminate certain food groups systematically (a process called an "elimination diet") – but only under the guidance of a doctor or nutritionist. Otherwise, without guidance can lead to omission of important sources of nutrition and unnecessary dietary restrictions can have a negative impact on quality of life. Certain foods which are known to cause symptoms that mimic or aggravate IBS include dairy products containing lactose, legumes, and cruciferous vegetables (such as broccoli, cauliflower, Brussels sprouts, and cabbage).
• People with IBS who seek medical help are more likely to suffer from anxiety and stress than those who do not seek help. Stress and anxiety are known to affect the intestine; thus, it is likely that anxiety and stress worsen symptoms of IBS. However, stress or anxiety is probably not the underlying cause. As much as 80 per cent of these patients are female and present anxious temperaments.
• IBS is believed to be caused by heightened sensitivity of the intestines, medically known as "visceral hyperalgesia." The nerves in the bowels are overactive in people with IBS, which forces normal amounts of gas or movement to be perceived as excessive and painful. Some patients with severe IBS feel better when treated with medications that decrease pain perception in the intestine (such as certain antidepressants).

Treatment of IBS

Anyone aged 45 years or older, having blood in stools, unintended weight loss, nocturnal symptoms, fever, family history of colorectal cancer or a presence of anemia should be cautious of a possibility of IBS. Treating IBS can take time; during this process, it is important to communicate with your healthcare provider about your symptoms, concerns, and any stressors or other problems that develop.

• Monitor symptoms and change in diet: The first step in treating IBS is usually to monitor symptoms, daily bowel habits, and any other factors that may affect your bowels to identify factors that worsen symptoms in some people with IBS, such as lactose or other food intolerances and stress. Try eliminating foods that may aggravate IBS.
• Modify dietary intake: In addition to the most common gas-producing foods are legumes and cruciferous vegetables (such as cabbage, Brussels sprouts, cauliflower, and broccoli), some people have trouble with onions, celery, carrots, raisins, bananas, apricots, prunes, sprouts, and wheat. Increase dietary fiber (either by adding certain foods to the diet or using fiber supplements) may relieve symptoms of IBS, particularly if you have constipation.
• Psychosocial therapies: Stress and anxiety can worsen IBS in some people. The best approach for reducing stress and anxiety depends upon your situation and the severity of your symptoms. Have an open discussion with your clinician about the possible role that stress and anxiety could be having on your symptoms, and together decide upon the best course of action.