Effects Of Irritable Bowel Syndrome (IBS)
Can IBS cause weight gain or weight loss?
IBS typically is not associated with significant change in weight whether it be weight gain or weight loss. In fact one of the alarm signs, or what we call red flags, to suggest that the patient doesn't have IBS and they may have what we call an organic or structural gastro-intestinal condition is weight loss. So, unintentional weight loss, say for example ten pounds, would be unusual for IBS. I have seen some with severe IBS where they'll develop weight loss but its pretty atypical and its actually classified as an alarm sign. There are no studies to show that IBS is associated with weight gain but my experience is that there are a lot of patients who report that they don't eat that much food because they can't tolerate that much but they will have weight gain.
Is IBS painful?
IBS isn't thought to cause any damage. There might be some underlying microscopic damage, meaning that you can't see it to the naked eye. For example, if you had a colonoscopy you usually don't see anything abnormal, but under the microscope, if you had a piece of tissue, it might look abnormal. That's one of the areas of research right now. Not everybody has that, but this condition is not thought to cause damage to the bowel. The bowel's already damaged or not working properly, and that's why you have the symptoms. Can it worsen with time? Probably, in some patients.
Can IBS damage the colon or other parts of the digestive system?
Well, Irritable Bowel Syndrome (IBS) is characterised by having abdominal pain. Now, some patients won't have pain, they will have discomfort, but that is a predominant symptom. If you don't have predominant pain or discomfort in your abdomen it is unlikely you have Irritable Bowel Syndrome (IBS).
Can IBS lead to other health problems?
If a patient has very severe symptoms and it's impacting their quality of life, you can just imagine that they're going to feel some distress about that, and a lot of patients will say, "Well, I didn't really have depression, or my mood wasn't really bad before, it's just that I feel so impaired in my life." They can have lower self esteem, and it really affects their functioning in that way, and also IBS is associated with non-gastrointestinal symptoms. Now whether those occur at the same time or with just greater severity or acceleration of IBS developing, but for example, one very common symptom is fatigue. Another common symptom is sleep disturbances, there are patients that do not sleep well, and if you don't sleep well, which is a time the body restores itself, it's associated worse with bowel symptoms the next day, and that's actually has been shown in studies.The other aspect of IBS, is that it coexists with other conditions, where you have symptoms that are outside of the GI tract, so if Fibromyalgia which is a chronic pain condition of the muscles, patients have chronic muscles pain and chronic back pain, and so even though that's outside the GI tract, they can develop other conditions, IBS patients can develop other conditions where they will have other symptoms, and a patient who becomes more severe they will tend to have more of these non-gastrointestinal symptoms, either related to a diagnosable medical condition like migraine headaches or Fibromyalgia, sometimes it's not.
Is there a connection between IBS and mood disorders?
There is a connection with mood disorders and irritable bowel syndrome. There had been two studies that have been conducted. If you survey a community population of the individuals who have IBS symptoms and look at their psychological profiles, it‘s pretty normal compared to the general population. If you survey IBS patients who seek healthcare so they're IBS patients and not non-patients, they actually have more abnormal psychological profiles. That tells you that having an abnormal psychological profile or psychological disorder is not a primary cause of IBS. There are a lot of individuals with those symptoms who don't have psychological disorders. If you look at the healthcare seeking population, particularly tertiary care referral patients, they'll have a higher prevalence of depression anxiety. It's been estimated that depression is seen in about 20% of IBS patients and anxiety in 20-40% of IBS patients. What's interesting about the association of anxiety and IBS is that some individuals actually don't have general anxiety disorder, meaning that they don't necessarily develop anxiety symptoms due to different stimuli or causes. There's a term that we have raised as 'visceral anxiety', 'visceral' meaning your organ systems. We developed a questionnaire for patients with IBS that determines if they have anxiety specifically related to what's going on in their gut. They may be sensitive or very attentive to sensations in their abdomen or their gut, but it doesn't mean they have general anxiety. You have to think that that's a protective mechanism for IBS patients if they're having pain or symptoms. They're going to be vigilant or attentive to anything going on in the gut. It's just a protective mechanism and is something that we all have.
What is 'fibromyalgia'?
Fibromyalgia is a chronic condition where patients have pain in the muscle areas, but it's not associated with muscular changes that you can see pathologically. It's like having irritable bowel syndrome, but of the soma or of the muscles. There are certain criteria that you have to have, but they must have symptoms for at least 3 months, and it has to be chronic widespread pain meaning that you have to have pain in all 4 quadrants of the body. So, right side of the body, left side, above and below the diaphragm, and somewhere along the axial skeleton. So whether it's neck, mid-back or lower-back, they have to meet these certain criteria. They also have to have 11 out of 18 tender points, or when you apply a certain amount of pressure at these pre-defined tender points, that the patient will experience pain.
Is there a connection between fibromyalgia and IBS?
There is a strong connection or association between IBS and fibromyalgia. In studies, if you use the standard diagnostic criteria for both conditions, it's been estimated that in fibromyalgia, about 30% of fibromyalgia patients will have GI symptoms compatible with IBS. If you look at an IBS population, about 30% have fibromyalgia. In my experience in doing research in IBS and fibromyalgia, I feel that the prevalence of IBS in the fibromyalgia community, or other GI conditions such as constipation, is much more common in fibromyalgia. While in the IBS patient population, I don't see as much fibromyalgia, even though it's been estimated to be as high as thirty percent.
