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Irritable Bowel Syndrome (IBS)

Irritable Bowel Syndrome (IBS)

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Published by Lija Manoj

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Published by: Lija Manoj on Oct 31, 2010
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For more information about irritable bowel syndrome or similar gastrointestinal disorders: Irritable Bowel Syndrome and the

Mind-Body Brain-Gut Connection. (1997) W. Salt Parkview Publishing Or contact: International Foundation for Functional Gastrointestinal Disorders (414)964-1799 or write IFFGD, PO Box 17864 Milwaukee WI 53217. Consultation with or referral to a registered psychologist can help guide you as to the use of these therapies. For a list of psychologists in your area, please http://www.cpa.ca/cpasite/showPage.asp?id=3&fr=
This summary has been created for the Clinical Section of the Canadian Psychological Association by Dr. Lesley Graff, Associate Professor, Department of Clinical Health Psychology, Faculty of Medicine, University of Manitoba, and staff psychologist at Health Sciences Centre, Winnipeg, Manitoba.

What is Irritable Bowel Syndrome?
Symptoms of Irritable Bowel Syndrome (IBS) include pain in the lower abdomen (below the stomach area), changes in bowel habits with frequent, urgent diarrhea or constipation, bloating, and cramping. It is a medical disorder of the lower µgut¶ (the stomach and intestines), which is one part of the gastrointestinal (GI) tract. It is thought to occur because of communication problems between the brain and the gut. Research suggests that people with IBS experience abnormal gut motility (changes in the rate of contractions of the gut muscles) and enhanced visceral sensitivity (an increased sensitivity in the brain to normal and painful gut activity such as painful swelling in the gut). It is not clearly understood what causes IBS. For some people it begins in childhood with a µsensitive stomach¶ that develops into more intense symptoms in adulthood; while for others, the GI problems start suddenly during a period of stress or persist after a parasitic infection in the stomach or bowel. Irritable Bowel Syndrome is very common. It is estimated to affect up to one in five Canadians, and occurs much more frequently in women than men. The impact on the individual and on society is significant. Life with IBS can be quite miserable. The pain, cramping and urgent trips to the washroom disrupt work and home activities. The bloating and gas are embarrassing so people often suffer in silence. IBS is the second most common reason for workplace absences. Over one-third of the patients that are seen by gastroenterologists (the µgut¶ specialists) have Irritable Bowel Syndrome. In Canada, IBS has been estimated to cost about $352 million in direct and over $1 billion in indirect health care costs each year.


time pressures. gut motility agents. Up to 70-80% of people with IBS have reported significant improvements following psychological treatments. These treatments are provided by professionals trained in psychological interventions for health problems. but it does appear to play a particularly important role in triggering IBS symptoms. emotional state. likely because of the close communication via nerves and chemical pathways between the brain and the gut. stress) that exacerbate the symptoms. For the most up-todate information on medication treatments as they apply to your situation. for those with moderate to severe symptoms. job interviews. use of over-thecounter medications and changes in lifestyle that ensure more regular eating and sleep routines. 2 3 . Treatments usually target specific symptoms (such as the diarrhea) or aim to decrease the triggers (for example. Once IBS develops. you are encouraged to discuss the use of these medications with your family doctor. Recent research suggested that the amount of improvement relates in part to the effort and time the individual puts in to develop better ways of coping. as well as teaching techniques to change thought patterns by challenging automatic. and medications that act on biochemicals in the GI tract and central nervous system. In therapy. tend to cease to have an effect when patients stop taking the medicine. and even hormone fluctuations. the individual is helped to identify and deal with challenging interpersonal situations and interpersonal stressors. In fact. Stress does not cause IBS. or family issues can aggravate the gut. psychological and medical interventions are recommended. but have been disappointing overall in their impact. Several specific psychological treatments have been found to be effective in providing relief of IBS symptoms as well as reducing the distress and coping difficulties that often occur when dealing with a chronic illness. Can Psychology Help? Absolutely. a healthier diet with increased fibre and water intake. However. exams. as well as more regular aerobic exercise are usually sufficient to provide some relief. It often includes information to ensure a better understanding of the illness.While many people think certain foods must be the culprit. CBT also typically includes relaxation training. however. and the numbers are even higher for people with IBS. ‡Brief Dynamic Therapy focuses on significant personal relationships. in contrast. reviews of the effectiveness of the medication treatments have concluded that they are helpful for small subsets of people with IBS. Medication treatments. ‡Relaxation training teaches ways to relax the body and mind. stress. At this point. two-thirds of healthy individuals without IBS report GI symptoms of pain or bowel upset in response to stress. ‡Cognitive Behavioral Therapy (CBT) incorporates a number of steps aimed at changing behavior to improve health and coping. As well. These psychological therapies focus on ways to decrease stress and cope differently so that the stress doesn¶t µgo to the gut¶. For those with milder IBS symptoms. Research suggests that both µacute stressors¶ such as deadlines. Conventional medical treatment has included fibre supplements. Evaluation studies have typically shown that psychological treatment led to greater improvement than the usual medical treatment. What Psychological Treatments are Effective? Four approaches have been carefully evaluated over the past number of years and have been found to be of benefit. there is no evidence to support the idea that IBS is a food allergy or food sensitivity type of disorder. the psychological therapies have long lasting effects months to years after treatment was completed. the bowel is over-reactive to or easily triggered by a variety of things including diet. distressing and self-defeating thoughts that can trigger gut reactions. or conflict with others as well as µchronic stressors¶ such as financial concerns. antispasmodics. ‡Hypnotherapy uses mental imagery to specifically reduce gut sensations and foster a state of calmness.

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