About Irritable Bowel Syndrome (IBS)
What is 'irritable bowel syndrome' or IBS?
Irritable bowel syndrome or IBS is a chronic, recurrent gastrointestinal condition where patients will experience abdominal pain or discomfort, and that pain or discomfort is associated with a change in bowel habits, whether it's diarrhoea or constipation, or alternating between diarrhoea and constipation.
What does 'irritable' mean in terms of IBS?
Irritable' means that the bowel is not functioning normally. So, whether it's the motor function, the way that it contracts and moves, or the sensation or the secretion, which are all part of its normal function - if that's altered or deregulated that's what the term 'irritable' means. It's distinctly different from inflammatory where you have discrete inflammation. It's usually referring to when you can see it grossly, and so it's different from inflammatory bowel disease. Sometimes, people confuse inflammatory bowel disease which we term IBD from 'irritable' bowel syndrome which is IBS, but they are very different disorders.
What is a 'bowel'?
Bowel refers to the gastrointestinal tract, which is part of the small intestine and a large intestine, so it's called small bowel or large bowel. And we usually term the large bowel, the colon. When we talk about a bowel disorder it's really referring to intestine, which is only part of the gastrointestinal tract.
What is a 'digestive track'?
The digestive track is really referring to the gastrointestinal track whose function is to allow us to eat food and water and digest the food, absorb it for nutrients, and to expel what we don't need. So it's comprised of the oesophagus where we swallow food, goes into the stomach where it's broken down, and the small intestine which basically receives food from the stomach and is where we do the majority of our absorption of nutrients. And then it goes from the small bowel, and it empties into the colon, or the large intestine, or large bowel, where its main function is to store stool, to absorb water, so the stool becomes more firm, and then it's expelled through the rectum.
Is IBS a disease?
It's right now termed as a disorder, which means you have symptoms but it's not completely understood. The pathophysiology, or the cause of it, is not completely understood, and if we did understand it, it would probably be termed a disease. Is it a disease because it causes symptoms and has some pathology associated with it? Yes. Do we completely understand the pathology? Not completely.
How common is IBS?
IBS is actually very common. It occurs in ten to twenty percent of the population and it has a worldwide prevalence. However, the prevalence is different depending on the methodology of the study, how you diagnose and how you conduct the study. In general, in the United States it's estimated to be about 10%. What's interesting about IBS is that the majority of individuals who actually have symptoms compatible to IBS do not seek healthcare.
What are other names for IBS?
IBS has been termed with different names in the past before it was really accepted as IBS. Conditions such as spastic colitis, mucous colitis, and spastic colon are all terms that physicians have given patients with the condition. Other times patients will not be given this diagnosis but will term their IBS symptoms as sensitive stomach or nervous stomach, even though that is really not the name of the condition.
What are secondary symptoms of IBS?
There are secondary symptoms. They're not utilized anymore in the diagnostic criteria. But they include straining, urgency, bloating, distension, and a sensation of incomplete evacuation, which means that you go to the bathroom but you don't feel empty; even though you've passed stool.
Are there varying degrees of IBS?
There are varying degrees of IBS, rated by different levels of severity. You have actually patients in remission. It's a fluctuating condition, so you can have symptoms at one time but not at another. Even though it's not curable, you can go into periods of remission where you don't have any symptoms. The way we rate severity is fairly general - it's either mild, moderate, severe or very severe.
Does IBS affect men and women differently?
IBS is more common in women. If you look at community studies, the ratio of women to men is about 1-2 women for one man. If you go into the health care seeking population, it's about 2-4 women for one man. So women are more likely seek healthcare for this symptoms. If you look at the different sub groups of IBS, where there's IBS with predominantly constipation, IBS predominantly with diarrhea and IBS mixed which means you have diarrhea and constipation. The female predominance or increase in female prevalence is mainly in the constipation subgroup, and other causes of constipation like chronic functional constipation is much more common in women. In general, women are more likely to be constipated than men. If you look at the IBS with diarrhea subgroup, that is pretty equal between men and women. And the mixed patterns, a little bit more women to men.
Does IBS affect children differently than adults?
The diagnosis of functional gastrointestinal disorders such as irritable bowel syndrome in the paediatric population, up until recently, it was not really well described. It was termed functional abdominal pain or what is known as "RAP": recurrent abdominal pain, but now, with the Rome Foundation, which developed all these symptom-based diagnostic criteria for these disorders, just came up with a whole host of paediatric conditions, and names for these conditions. Now it is termed functional abdominal pain. If you only have pain as a child but no change in your bowel habits, but it is term IBS in children now if you have pain and it leads to a change in bowel habits.
What are some myths about IBS?
There are a lot of myths about IBS. One is that it's all in your head; that it's all imaginary. That's not an incorrect statement if you think that it's all in your head or not all in your head, but that it is involved in your brain, and the brain communication with the God. That is actually true - it is involving that. Another myth is that - I hate to say this but people say it - it only occurs in a middle aged neurotic women. I hate when I hear that. That is a myth because that's not true.
