IRRITABLE BOWEL SYNDROME

Dr.Krishna Prasad Sreedhar M.A., Ph.D., D. M & S. P. (NIMHANS)

Irritable Bowel Syndrome (IBS) is a gastro intestinal disorder which creates urgency in people to repeatedly visit the toilet especially when they have to go for a journey or even routine actions like going to school or office. IBS occurs when there is no need for the patients to go to the toilet. Have you noticed some people repeatedly running to the toilet before a journey or when they have something important to do? It may happen even before ordinary daily events like going to school or office. This disorder is known as Irritable Bowel Syndrome (IBS). Interestingly IBS may not occur during Sundays. This could be because children do not have to go to school and adults do not have to go to office. There is no tension of getting prepared and rushing to the school or office. Hence, those suffering from IBS are mostly tension free on Sundays. This shows that IBS is a functional disorder.

Fortunately, IBS is not a serious disorder but it is certainly a nuisance. IBS can unnecessarily delay one from leaving home. Think of those people who have to go to the toilet repeatedly to get satisfied. Psychologists have noticed several people who routinely get delayed because of this gastro colic reflex. IBS is just a reflex response like our eye blink response or withdrawal response when we unknowingly touch a hot object. An eye blink response protects our eyes from foreign objects and a withdrawal response protects our body from burning but this gastro-colic reflex does not serve any purpose. It occurs due to undesirable conditioning in tensed up people. Traditionally people believed that this behaviour was a serious disorder but now considered just as a reaction to tension. In IBS no weight loss or gastro colonic injuries occur. Once the daily routine of several bowel movements are over, the sufferers appear to be happy and fit to do any work. Some times people jocularly refer to this as “no confidence motion”. Certainly people with chronic tension have low confidence.

Typically, Irritable Bowel Syndrome is a functional disorder with alternating diarrhea and constipation and sometimes increased mucous in the stools (Engel, 1976). The condition consists of a disorder of behaviour of the bowel in the absence of definite inflammation or other evidence of organic disease.

The intestine is connected to the brain through the nerves. Signals go back and forth between the bowel and brain. These signals affect bowel function and symptoms. The nerves can become excessively active during stress, causing the intestines to be more sensitive. During tension caused by stressors, intestines may contract more.

People with diarrhea will have frequent, loose, watery stools. They often have an urgent need to have a bowel movement, which may be hard to control.

IBS can occur at any age, but it often begins in the teens or early adulthood. It is said to be more common in women as in men.

Clinically the manifestations of this condition are varied. The three main types are as follows:

1. Patients in whom diarrhea is the dominant symptom. These patients have no abdominal pain. Their chief symptom is constant or intermittent diarrhea.

2. Patients in whom pain is the dominant symptom. This is referred to as ‘Spastic Colon’. They have lower abdominal pain and cramps as the main symptom and, in addition, have constipation that alternates with diarrhea or with periods of normal bowel movements.

3. Patients in whom both pain and disturbed bowel function are prominent. Several patients suffer from constipation and experience abdominal pain at that time (Truelove and Reynell, 1972).

The relationship between psychological factors and hyper-motility of the stomach has been shown by Chaudhary and Truelove (1961c). They have demonstrated evidence of motor hyperactivity in a proportion of subjects in the course of interviews in response to highly specific topics. These topics frequently have relationship to psychological factors already noted as probably important in the causation of the condition in particular individuals. White, Cob and Jones (1939) have viewed IBS as a disorder of the function of the colon resulting from an over active parasympathetic nervous system due to neurotic conflicts. Their findings also have indicated that dependency, resentment, sensitivity, anxiety and guilt are the personality traits most commonly found in patients suffering from IBS.

While concentrating on the personality of these patients, it has been observed that neurotic constitution, neurotic illness, and psychological stress causing or aggravating the disorder (Sreedhar, 1978). Depressive disorders and IBS appear to have a more than average relationship. Significantly high percentage of clinical depression is common among patients with IBS. It has been found that majority of the patients improved with anti-depressant therapy (Sreedhar and Ramachandran K. 1998). It was also noticed that patients getting psychopharmacological treatment for Obsessive Compulsive Disorder reporting improvement in their IBS condition also during the treatment (Sreedhar,K.P. and Ramachadran K. 1999).

It is not clear why individuals develop IBS. Some times it occurs after an infection of the intestines. This is known as post infectious IBS. Other factors can also trigger this disorder.

Treatment of IBS is possible with a combination of psychotherapy and drug therapy. In psychotherapy psychologists try to identify the source, the course and the precipitating factors of anxiety resulting in IBS. While the reactions to anxiety may vary from individual to individual and majority chooses to react with tension headaches, why people with IBS choose to react with their bowel is being researched. As some researchers point out patients perceive certain parts of their body to be more important than others due to significant events that might have happened in the past but hidden in the unconscious. In such cases the unconscious motives may have to be unearthed. Behavior therapists feel that unhealthy conditioning could be the cause and that de-conditioning may be instituted to help the patients. Underlying depression, if any, may be modified with Cognitive Behaviour Therapy or drug therapy.

References

Chaudhary and Truelove (1961c) Human colonic motility: A comparative study of normal subjects, patients with ulcerative colitis and patients with the irritable Colon Syndrome III. Effects of emotion. Gastroenterology, 40, 27.

Engel, (1976) Psychopysiological gastro intestinal disorder. II. Intestinal disorder. In Freedman, A. M., Kapalan, H.I., and Sadock, B. J. (Ed), Comprehensive Textbook of Psychiatry, Vol.II (2nd Edn), Baltimore: Wiiams and Wikins. Co., 1976.

Truelove and Reynell, (1972) Disease of digestive system (2nd Edn.), Oxford: Blackwell Scientification.

White, Cob and Jones (1939) Mucous colitis: A Psycholoical medical study of 60 cases. Psychosomatic Mediine, Monograph No.1, Washington D.C.: National Researc Council.

Sreedhar,(1978). Ph.D. Thesis: Personality Factors related to Psychosomatic Disorders University of Kerala, Trivandrum.

Sreedhar, K.P. and Ramachandran K. (1998) Personal communication.

(Sreedhar, 1999).Personal Observation.

U.S. National Library of Medicine. July, (2011).