Talking to Your Physician about IBS and Constipation

In a review published recently in the Journal of Clinical Gastroenterology,1 researchers identified reasons why patients with irritable bowel syndrome (IBS) or chronic constipation might have difficulty communicating with their physicians.

IBS is a chronic, often debilitating, functional gastrointestinal disorder with symptoms that include abdominal pain, bloating, and altered bowel behaviours (constipation and/or diarrhea, or alternating between the two extremes). Research suggests that IBS results from a complex combination of factors involving the brain, digestive tract, and environmental influences, but its exact cause is unknown. Similarly, the development of chronic constipation often has no known cause (idiopathic).

The review’s authors say physicians and patients must both start by acknowledging and accepting that these conditions are chronic and have serious effects on sufferers’ lives. Recent research shows that only 25-30% of IBS sufferers seek professional medical care. Most individuals attempt to self-treat, usually unsuccessfully, with over-the-counter medications and many suffer for years with IBS or chronic constipation before finally seeking professional help. Once they do, they might still under relate symptoms to physicians who feel frustrated by a lack of specific biological markers for which they can test. Physicians may be reluctant to rely on patients’ subjective descriptions of symptoms, but this is what they need to do so they can diagnose these conditions accurately and recommend appropriate treatments.

Physicians might ask mostly yes or no questions, thinking it maximizes the limited time they have with each patient. However, research shows that open discussions about symptoms are more beneficial. When physicians ask open-ended questions, they often interrupt patients within the first 18-23 seconds, missing valuable information and leaving patients feeling disrespected and reluctant to be forthcoming when disclosing symptoms in the future. Most patients only require about 90-120 seconds to answer open-ended questions and these explanations usually supply 80% of the specific symptom information the physician needs to know.

When discussions are more open, patients might also bring up important issues. For example, patients with chronic conditions often fear the development of more serious complications, such as cancer. It’s better when physicians hear the patients’ concerns, so they can advise regarding potential risks and assuage unwarranted fears, thus improving care.

Even if your physician asks yes or no questions, try answering by providing clear and concise descriptions of your history and symptoms. The review authors also suggest that nonverbal behaviour might be just as important as the things you both say. You will appear more cooperative and confident if you keep your head up and look into your physician’s face. Uncross your arms and legs, keep your hands open, rather than clasped tight, and lean forward slightly, toward your physician.

Myth Buster: Chronic Constipation Does NOT Lead to Cancer

A new literature review of 23 studies, published in the American Journal of Gastroenterology, concludes that chronic constipation is not a risk factor for cancer and that, without other exacerbating GI symptoms, it does not necessitate cancer screening.2 In eight surveys reviewed, constipation as the primary reason for colonoscopy was actually associated with a slightly lower prevalence of colorectal cancer (CRC) compared to the results of colonoscopies performed for other reasons. Three high-quality cohort studies also showed a decrease in risk for CRC among individuals with chronic constipation. Most of the other 17 studies reviewed were unreliable for a number of reasons, including the fact that many do not distinguish between the onset of chronic constipation before and after CRC diagnosis.

First published in the Inside Tract® newsletter issue 186 – 2013
1. Di Palma JA et al. The role of Effective Clinician-Patient Communication in the Management of Irritable Bowel Syndrome and Chronic Constipation. Journal of Clinical Gastroenterology. 2012;46(9):748-51.
2. Power AM et al. Association Between Constipation and Colorectal Cancer: Systematic Review and Meta-Analysis of Observational Studies. The American Journal of Gastroenterology. 2013;108(6):894-903.