Let’s Talk About Irritable Bowel Syndrome
Bowel movements, bloating, and other digestive issues may not be the easiest topics to discuss with your doctor, but having a conversation is the first step to improving your quality of life says Laurence Bailen, M93, a gastroenterologist and clinical associate professor of medicine at Tufts University School of Medicine.
Patients experiencing these symptoms may be diagnosed with one of the most prevalent gastrointestinal conditions, especially in those ages 50 or younger: irritable bowel syndrome or IBS.
To be diagnosed with IBS, a patient must have recurrent abdominal pain at least one day per week for three months, and the pain must be associated with two of the following: defecation or bowel movements, a change in the frequency of bowel movements, or a change in the form of bowel movements.
The criteria is part of the Rome IV criteria, developed by a group of health care providers and researchers to help diagnose disorders of gut-brain interaction (DGBI), and published in 2016.
Bailen says that anywhere from 20-40% of patients and referral volume at his practice is from people who have been diagnosed with irritable bowel syndrome or who present with IBS-related symptoms like bloating, stabbing pain, diarrhea, or constipation. But even with that volume, most people are suffering on their own.
A lot of people can be dismissive when they know someone who receives an IBS diagnosis and say, ‘Oh, what you have isn’t real.’ But I always tell patients that those people are wrong. And remind those patients that they are not alone.
Laurence Bailen, M93, gastroenterologist and clinical associate professor of medicine at Tufts University School of Medicine
“A lot of people can be dismissive when they know someone who receives an IBS diagnosis and say, ‘Oh, what you have isn’t real.’ But I always tell patients that those people are wrong,” Bailen says. “And remind those patients that they are not alone.”
IBS is estimated to affect 5-10% of people worldwide, and 10-15% of people in the United States, Bailen says, but it’s rare they seek medical attention. The range of symptoms someone might face is broad, from a recurring painful abdominal reaction to certain foods, to debilitating symptoms that can cause someone to spend hours each day on the toilet.
“Having IBS can be embarrassing and socially isolating,” Bailen says. “It can make people late for work or have to leave social gatherings to use the bathroom. I’ve had to write letters to employers to allow patients to have accommodations at work to help treat symptoms. IBS can really take a toll.”
Before Bailen runs any tests, delivers a diagnosis, or develops a treatment plan, he sits down with patients and listens to their concerns.
“One of the first steps is validating that having IBS is a highly prevalent problem, that it is underdiagnosed because people don’t seek medical attention, and that a diagnosis is a real thing,” Bailen said. “IBS patients should be treated like someone diagnosed with a disease like diabetes, or high-risk conditions like high blood pressure.”
IBS Screening and Diagnosis
To screen for IBS, Bailen will review the patient’s history and test to exclude other disorders that sometimes have similar symptoms to IBS, like celiac disease, infections, inflammatory disorders, cancers, or food intolerances. Tests may include blood tests, which typically come back normal for someone with IBS.
“Patients with IBS should not be anemic or have low blood counts,” Bailen says. “They should not have a lot of rectal bleeding; they should not be losing tons of weight. Those are symptoms that should warrant more testing for other disorders.”
The biggest difference between IBS and these other conditions is the role gut-brain interactions play in symptoms. Oftentimes those suffering from a disorder of gut-brain interaction like IBS are also battling other health conditions, including mental health issues like anxiety, stress, or depression.
“The autonomic nervous system, which controls the functioning of the GI tract, has nerve pathways that go from the central nervous system to the brain and vice versa,” Bailen says. “So, in patients with certain mental health issues, signals to the gut can stimulate intestinal contraction or the absence thereof and then cause bowel problems.”
Treatment options for IBS vary depending on the primary symptom, but in many cases, Bailen will begin a treatment plan by assuring the patient that their condition is not life-threatening, which can help assuage worries and mental health issues and, in turn, help with digestion.
Additional treatments include stress management through yoga, meditation, complimentary therapies like acupuncture, exercise, and trying a diet low in fermentable, oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP), which reduces intake of gas-causing foods.
If someone thinks they may have IBS and is considering reaching out to a health care provider, Bailen suggests asking themselves questions like, “Am I regularly absent from work or school because of my symptoms? Am I missing out on social activities? Am I afraid to leave the house because I may not be near a bathroom?”
If the answer to these questions is yes, and symptoms are persistent and causing concern, Bailen recommends reaching out to your primary care doctor or gastroenterologist.
“Providers can evaluate them and provide help to control symptoms,” Bailen says. “And this is something that we hear about and deal with every day. These issues are common and there are resources, education, nutrition, and medications that can really help.”