Irritable bowel syndrome (IBS) is a commonly occurring disorder consisting of alternating constipation, diarrhea and abdominal pain.

It is considered a psychophysiological disorder.

Most people have experienced loose stools or diarrhea when they are very nervous and many have experienced constipation when they are depressed.

In those with IBS these symptoms occur with less extreme changes in anxiety or mood.

It is not clearly understood why some people are more prone to gastrointestinal symptoms in response to emotions than others. No specific abnormalities of the gastrointestinal tract have been confirmed in these patients.

Conditioning or learning may be involved in some cases since it is a common occurrence for this problem to arise following a physical illness in which the patient has experienced these symptoms for some physical reason, such as an infection.

When diarrhea is present the large bowel is contracting less frequently allowing the contents to move through more quickly and thus allowing less water to be absorbed.

With constipation, on the other hand, there tends to be more frequent segmenting contractions in the large bowel which slows the transit of stool through the digestive tract allowing more fluid to be absorbed and the stools to become harder and dryer.

Pain is caused by distention of the bowel. If the large bowel contracts at two separate but close locations simultaneously, causing the area between to balloon out, this will be associated with pain.

In experiments where balloons are inflated in the large bowel of patients with IBS and they are asked to report when they first feel the balloon and when they first feel pain, patients with IBS report pain at lower volumes and are therefore more sensitive to pain. This could be a learned phenomenon.

IBS is also referred to as a functional disorder since there is no structural lesion as there would be, for example, if a patient has cancer or colitis.

IBS is not life-threatening and does not lead to other disorders such as ulcerative colitis or Crohn’s disease. It can, however, be quite disabling for some.

Some patients develop secondary problems related to IBS because they are fearful of being unable to get to a bathroom on time when they have a sudden and powerful urge to go.

They may develop avoidance behaviour such that they are fearful of going anywhere unless they know exactly where all the bathrooms are.

There is another related condition called proctalgia fugax that is often associated with IBS in which there is very intense pain in the rectal area that is associated with contraction of certain muscles in that area; it is not dangerous but quite unpleasant.

Unfortunately, treatments for IBS are often only partially effective. Although high fiber diets are often recommended their effectiveness is not supported by clinical trials.

Given that this is a psychophysiological disorder, it is perhaps not surprising that antidepressants and relaxation therapy are among the most effective treatments.

Where phobic avoidance is an issue, as described above, patients should be encouraged to go about their business in spite of their symptoms and not avoid situations because of fear.

This is quite appropriate unless actual incontinence has occurred. In that case there is another problem in addition to IBS which will need to be corrected.

If you have these symptoms, you are not alone. By all means discuss them with your doctor but once IBS has been confirmed, it is best to try and maintain a normal diet and not to alter your lifestyle because of these symptoms unless it is to reduce your stress and consider whether some other emotional state may be contributing.

Paul Latimer is a psychiatrist and president of Okanagan Clinical Trials.

250-862-8141

dr@okanaganclinicaltrials.com