IBS Updates 2020
Irritable bowel syndrome (IBS) is so common that it’s likely you know at least one person affected by it. In 2003, the Canadian Society of Intestinal Research advocated to mayors in major cities across Canada and succeeded in having April declared as IBS Awareness Month by Health Canada. Read on for information on new IBS research as well as an infograph on the causes of IBS. Don’t forget to follow us on social media and share our posts to help spread awareness of this condition.
IBS Basics
One of the most common gastrointestinal conditions in the world, IBS affects approximately 13-20% of Canadians. It is a functional disorder, which means that, at this time, there is no measurable physical change, such as inflammation, to explain the condition. Symptoms of IBS include abdominal pain, bloating, and altered bowel habits, such as constipation and diarrhea, which can have a drastic effect on quality of life. Treatment for IBS can be complex and often involves a combination of dietary modifications and medications that target specific symptoms.
The Prevalence of Anxiety and Depression in IBS
Research indicates that IBS is strongly associated with mental health conditions, such as anxiety and depression, with some studies reporting that as many as 50-60% of those with IBS experience these comorbidities.1 This leaves them in a vulnerable position as they are at an increased risk of impaired social function, poor quality of life, personal suffering, decreased treatment adherence, and even increased risk of suicidal behaviour.
A recent study by a group of researchers in Iran assessed the prevalence of anxiety and depression in individuals with IBS and compared the data to that of a healthy control group. In contrast to previous studies that investigated the levels of anxiety and depression, which they stated merely shows the severity of the existing problem, they chose to investigate the prevalence of anxiety and depression, which physicians need to be aware of in order to facilitate early detection and appropriate treatment strategies.
The results were significant, indicating that individuals with IBS are much more likely to experience anxiety (39%) and depressive symptoms (29%) than those without the condition. Interestingly, another study from China showed that those with IBS often experience mental health symptoms that are more severe and more frequent than those without IBS.2
According to the study results from Iran, anxiety and depressive symptoms were equally prevalent in men and women.
In addition, individuals who had constipation-predominant IBS (IBS-C) were the group with the highest prevalence rate of both anxiety and depression. According to the researchers, this might be due to an imbalance of serotonin secretion. Serotonin is a neurotransmitter that has many functions in the body, but it is most well-known for its effects on mood and mental health regulation. However, it also plays a crucial role in gastrointestinal motility, and low responsiveness to serotonin might increase constipation. Therefore, a serotonin imbalance might lead to both gut symptoms and mental health problems.3
The study authors concluded that abdominal symptoms influence anxiety and depression, while psychological factors simultaneously increase the risk of IBS symptoms. They explained that the relationship between IBS and these mental health disorders reinforces the known brain-gut axis correlation, which, if dysfunctional, can lead to an irritable bowel.
Due to the negative impact IBS has on quality of life, it can also be associated with stress and work impairment, which further aggravate mental disorders. Therefore, it is vital that physicians assessing anxiety and depression also assess patients in terms of IBS. Early diagnosis and treatment of a gastrointestinal disorder might speed up the improvement of the mental health elements too. Similarly, if their mental health disorder is treated, gastrointestinal symptoms might also improve.
Work Productivity and Activity Impairment in IBS
Many IBS research studies arrive at the same conclusion: individuals with IBS tend to have a poor quality of life when compared to the general population and those with other GI conditions. This is not only due to gastrointestinal (GI) symptoms, such as abdominal pain and altered bowel habits of constipation and diarrhea, but also non-GI physical symptoms such as headache, back pain, urinary urgency, and, as noted above, psychological comorbidities such as anxiety and depression.4
These symptoms have a severe impact on the ability to work and can cause a type of impairment when at work (presenteeism) or the inability to attend work (absenteeism). Many with IBS report that abdominal pain is the most challenging symptom to deal with because it can make moving and lifting uncomfortable – and; therefore, physical work – difficult.5
A group of researchers from Sweden conducted a study on the rates of work productivity and activity impairment while at work. Using questionnaires, the researchers retrieved data from 525 individuals with IBS. They examined the percentages of several areas, including absenteeism, presenteeism, total work productivity loss (overall work impairment), and impairment in daily activities at work (activity impairment).
More than 20% of participants reported being absent from work during the previous week due to IBS, while more than 85% reported work productivity impairment during the same time frame. The researchers found an association between GI-specific anxiety and absenteeism as well as a strong association between general fatigue and presenteeism.6 IBS symptom severity, fatigue, and GI-specific anxiety impacted overall productivity loss, and IBS symptom severity also led to activity impairment. In addition, they found that non-GI symptoms, such as depression, contributed to work impairment and productivity loss. Researchers included the Irritable Bowel Syndrome Severity Scoring System (IBS-SSS) in their study, which led them to the finding that work productivity and activity impairment in those with IBS relates directly to the severity of their symptoms.
They noted that presenteeism accounted for the majority of the overall loss of work productivity, which supports the assumption that IBS patients go to work even while they are suffering from severe symptoms. Because of this, those with IBS might find it more difficult to achieve satisfactory work results and are less likely to assume more responsibility in their workplace, thereby limiting advancement potential.
In summary, the researchers demonstrated that IBS negatively affects individuals at work, and that both GI and non-GI symptoms contribute to this impairment. Some studies reported that adequately treating IBS symptoms decreased work impairment. Particularly, certain non-pharmacological treatments, such as dietary modification, and drug treatment options, such as linaclotide (Constella®) were effective for those with IBS-C.7 Therefore, it is vital that physicians thoroughly assess individuals with IBS and provide effective treatment strategies. The researchers recommend a multidimensional treatment approach that not only treats the IBS symptoms, but also addresses fatigue, GI-specific anxiety, and other physical symptoms.