Irritable Bowel Syndrome Awareness Month

What is the most diagnosed gastrointestinal condition and yet is so poorly understood? KB, a young mother in her 20s, reported a longstanding history of recurrent abdominal pain and loose stools since she was a teenager. Over the years, her symptoms have caused her much social and mental distress. She had periods of improvement and worsening, making it even more frustrating. After over a decade of suffering, doctors found that she was suffering from Irritable Bowel Syndrome (IBS).

According to research done by Sayuk et al, about 40% of people who meet the criteria for IBS do not have a formal diagnosis. Other studies say only a small percentage of those affected seek medical attention. Another study done at the University of North Carolina reported that IBS accounted for the second-highest cause for work absenteeism, causing a significant economic burden. It is estimated that 10 to 15 percent of the population of the United States has IBS.

So, what is IBS? It is defined as a functional disorder of the gastrointestinal system associated with chronic abdominal pain and fluctuations in bowel habits. It can affect both genders, but women are slightly more likely to have it. Its presentation can vary widely but typically involves abdominal cramping with varying intensity, often relieved with defecation. Other symptoms include diarrhea, constipation or both in alteration and mucus in your stools.

Although poorly understood, it is thought that IBS is caused by hypersensitivity of the gut wall. There may be a genetic component since individuals suffering from this condition often have a family history of IBS. Other factors associated with IBS are psychosocial in nature, such as anxiety and depression.

By being a functional disorder, it is essentially a diagnosis of exclusion. Meaning other more ominous causes of these symptoms must be ruled out to be able to diagnose IBS. The red-flag symptoms are weight loss, blood in stools, onset after 50 years of age, anemia and family history of colon cancer. These symptoms should prompt immediate medical attention. Your doctor may do several tests to exclude other causes of your symptoms, including blood tests and stool tests for infections, autoimmune conditions and metabolic dysregulations, among others. Your doctor may order imaging such as a CT scan or refer you for a colonoscopy. Your primary care provider (PCP) may even refer you to a Gastroenterologist, a specialist in this condition.

The good news is that IBS is a treatable condition. Once diagnosed, there are several treatments available to help mitigate your symptoms. These include dietary modifications, medications, physical activity and behavioral therapy. Treatment is tailored to the patient, and you may require a trial of different modalities before finding one that is effective for you. This requires working closely with your physician with frequent follow-ups to find the right fit.

As for KB, she was able to work with her doctors to find a regimen of dietary modifications, exercise, medications and behavioral therapy that worked for her. She had also had underlying anxiety, which provided a marked improvement in her symptoms when treated. KB is now living with her children and husband and reports that she is the happiest she has ever been in a long time.

This column was written by a guest contributor from the Choctaw Nation Health Services Authority.