For April’s IBS Awareness Month, our expert shares information on the causes, symptoms and treatments for irritable bowel syndrome.
Irritable bowel syndrome (IBS) is an intestinal disorder affecting about 11 per cent of the global population. Canada is one of the countries with the highest prevalence of IBS in the world at an estimated 18 per cent. Vancouver Coastal Health Research Institute (VCHRI) neurogastroenterologist Dr. Sarvee Moosavi strives to increase awareness about this growing area and educate both clinicians and patients around the signs, symptoms and treatment approaches for IBS.
Q: Who is most affected and how can IBS negatively impact their quality of life?
A: IBS can affect individuals of all ages, but the population most affected by IBS includes women in their teenage years or early adulthood, usually around the age when individuals are going to school, starting their careers or having families. IBS negatively affects quality of life, which reflects in increased work and school absenteeism, decreased work productivity, with significant impacts on the health care and socioeconomic systems. There is also a two-way connection with mental health conditions, where IBS can exacerbate underlying anxiety and depression, and vice-versa.
Q: What are some early warning signs of IBS and when do symptoms typically develop?
A: IBS is a complex, chronic disorder of gut-brain interaction that can occur at any stage of life. To diagnose IBS, health practitioners obtain careful history, perform thorough physical examinations and order tailored, relevant workups only if needed. Diagnosis is based on evidence-based criteria, put forward and periodically updated by the ROME Foundation. It is characterized by a change in frequency and consistency of bowel movements and associated abdominal pain, in the absence of any alarming symptoms, such as rectal bleeding, unintentional weight loss or significant family history of inflammatory bowel disease or colorectal cancer. Symptoms such as bloating, abdominal cramps or gas may also be present.
Q: How can I distinguish between IBS and inflammatory bowel disease (IBD)?
A: Inflammatory bowel disease (IBD) affects nearly 260,000 Canadians. IBD has two sub-types: Crohn’s disease and ulcerative colitis. Patients with IBD often have rectal bleeding, mucus in their stool, urgency with bowel movement, abdominal pain, diarrhea, nocturnal bowel movement and potential weight loss.
While abdominal pain and diarrhea could be symptoms of either IBS or IBD, patients with IBS do not have rectal bleeding. If there is any blood in the stool or black or tarry stool, new onset of anemia or unintentional weight loss, the patient should inform their primary care providers.
Q: What are the main causes of IBS, and are there lifestyle risk factors that make it worse?
A: Several factors contribute to the disorder. There may be a genetic predisposition to IBS. Gastrointestinal infections and antibiotics exposure can predispose an individual to developing IBS later on. Recent studies also show an increase in the prevalence of IBS among patients who contracted the COVID-19 virus. Any disturbances in gut microbiome can increase the risk of developing the disorder.
Environmental factors such as a lack of psychosocial support and diminished coping strategies with life stressors can also be confounding factors. Co-existing mental health disorders may also exacerbate gastrointestinal symptoms in IBS. Other factors include diet, hormones and medications. Certain foods can trigger the symptoms of IBS, especially for people who have difficulty digesting fructose, lactose, gluten, alcohol or caffeine.
Q: What treatment options are available for managing IBS, and is it a lifelong condition?
A: IBS is a chronic condition that can wax and wane. Flare ups can occur after an infection, or after experiencing a period of stress, travel, diet or medication change.
There are four main IBS management recommendations for everyone affected by the condition, regardless of severity of their symptoms:
- Dietary approaches such as adoption of a low FODMAP diet, NICE diet, eating regularly and avoiding trigger foods including caffeine, alcohol, fermented sugar, high carbohydrates and refined sugar;
- Stress reduction;
- Good quality sleep; and
- Exercise.
Several non-pharmacologic options, such as cognitive behavioural therapy, mindfulness or GI hypnotherapy have shown to be beneficial. Various pharmacologic options are available to treat global IBS symptoms. Talk to your doctor to further explore these options.
Q: If I have IBS, does it increase my risk of developing other diseases or cancer?
A: A recent study actually showed that patients with IBS had a lower risk of developing colorectal cancer. More research is needed to determine whether this is because patients seek medical help early on and are assessed by health care providers due to bothersome symptoms or whether there is another biological cause.
