In 2013, I was provisionally diagnosed with irritable bowel syndrome (IBS) after no other cause for my chronic abdominal pain and alternating diarrhea and constipation had been found. I don’t have a severe case of it, having mild to moderate abdominal pain a few times a week but rarely severe pain. I am usually not significantly disabled by my symptoms either. I also happen to respond quite well to mebeverine (Colofab), an antispasmodic that relaxes the bowel muscles. Nonetheless, it is frustrating that there are still many common misconceptions about IBS. Here, I will share some of these.
1. IBS is just a fancy way of saying abdominal pain. It is true that the diagnosis of IBS is commonly based on symptom assessments and exclusion of other disorders, since there is no laboratory test to prove someone has IBS. However, IBS has many symptoms other than abdominal pain, and besides, the abdominal pain suffered by IBS patients is chronic and can be severe. It is not like, if you have bowel cramps for a day, you have IBS. Other core symptoms of IBS are diarrhea and/or constipation, feeling bloated, straining or urgency to defecate. Many sufferers have additional fatigue, acid reflux, etc.
2. IBS is all in the head. It is unclear what causes IBS, and stress could be a factor. That doesn’t mean it’s all in the head though. Stress can cause physical symptoms that are no less real just because stress causes them. It is also correct that IBS is associated with problems in the communication between the brain and the gut, but that could be both a brain and a gut problem. For example, people with IBS may be hypersensitive to abdominal discomfort. This however does not mean they choose to be in pain or are overreacting. It is an interplay between biological and psychosocial factors that cause people to experience the symptoms of IBS.
3. There is no clear definition of iBS. Like I said, there is no test for IBS, but there is a definition. For several decades, the Rome criteria have been in use for determining who has IBS. These criteria require that patients have had recurrent abdominal pain or discomfort at least three days per month during the previous three months that is associated with two
or more of the following:
- Relieved by defecation.
- Onset associated with a change in stool frequency.
- Onset associated with a change in stool form or appearance.
When these criteria are met, only limited tests are recommended based on the individual’s situation. In my own case, it was hard to determine whether I met these criteria, as my pain certainly wasn’t relieved by defecation and I wasn’t sure of the other two.
4. IBS is caused by poor diet and lifestyle. Just [insert lifestyle habit or diet here] and you’ll be fine. While some people have food sensitivities that contribute to their abdominal discomfort, others do not. Also, indeed, some people find that exercisng more, not drinking alcohol, not smoking, etc. helps them. Others do not. Besides, even for those who do find that their diet or lifestyle contributes to their IBS symptoms, it may not be easy or may even be extremely hard to adjust their lifestyle or diet. I for one seem to be sensitive to sugary foods, but, as regular readers of my blog will know, I cannot seem to stop eating too much candy.
5. My [family member’s, friend’s, …] IBS was cured by [intervention], so yours can be cured too. Every person with IBS is different, and because many things contribute to IBS symptoms, there are many possible treatments. Mebeverine, the antispasmodic I use on occasion, has few side effects, but also is not very effective with most people. I am lucky that it helps me somewhat, but others wll not find relief from their symptoms with it. Same for diet, lifestyle changes, other medications (eg. antidepressants), psychological interventions, etc. They work for some but not othes.
6. IBS is the same as inflammatory bowel disease (IBD). Inflammatory bowel disease refers to Crohn’s Disease and ulcerative colitis. These are diseases which cause chronic inflammation to the digestive tract. Though some IBS sufferers have minor inflammation, especially if their symptoms set on after infection, it is not nearly as bad as with IBD. I for one had elevated calprotectin, an inflammation marker, when I was first tested for this. This led the doctor to think I might have IBD and get me a colonoscopy. Turns out I didn’t have IBD and on later tests, my calprotectin was normal again. It could’ve been I had an infection contributing to my symptoms.
7. IBS increases the risk of colon cancer. This is another difference between IBS and IBD: while IBD patients have a markedly increased risk of developing colon cancer, IBS patients do not.
8. IBS is not a serious concern. It is true, like I said above, that IBS does not cause cancer or suchlike. However, that doesn’t mean it’s not serious. Many people with irritable bowel syndrome find their symptoms to be severe and disabling. Besides, because IBS is so often misunderstood, many people experience social stigma. This can lead to further suffering. Get educated and stop stigmatizing people who have IBS.