5 Questions About the Impact of IBS Symptoms on Daily Function

Irritable bowel syndrome (IBS) is associated with significant disease burden and decreased quality of life.

A study by Sarah Ballou, PhD, a clinical psychologist in the Division of Gastroenterology at Beth Israel Deaconess Medical Center in Boston, Massachusetts, and colleagues evaluated the effects of IBS on different areas of daily function and compared them among disease subtypes.1 The results showed differences in specific areas of daily function between individuals with constipation-predominant IBS (IBS-C) and diarrhea-predominant IBS (IBS-D).

Gastroenterology Consultant caught up with Dr Ballou about the research and how gastroenterologists can help improve the quality of life of patients with IBS.

Gastroenterology Consultant: What is the biggest challenge in the management of IBS-C and IBS-D?

Sarah Ballou: IBS is a disorder that is associated with dysregulation of the brain-gut axis. As a result, there is a complex interplay between symptom experience, quality of life, health behaviors, and stress/anxiety. This relationship—where stress can impact symptoms/behaviors, and symptoms/behaviors can cause stress—is different for each individual. In the management of IBS, it is very important to develop a biopsychosocial conceptualization of each patient where providers take into account not only biological abnormalities, but also psychological and central processing mechanisms that can influence the brain-gut communication. In order to carefully consider and treat each of these aspects, a multidisciplinary treatment team consisting of physicians, psychologists, nutritionists, physical therapists, and other specialists is ideal. Unfortunately, a multidisciplinary team is not always available to patients, which poses a challenge in the management of IBS.

GASTRO CON: What prompted you to conduct your study?

SB: I am a health psychologist with expertise in gastrointestinal (GI) psychology. In graduate school, I was especially interested in the day-to-day impact of IBS on patients’ lives. I found that although there had been a significant amount of research to document the emotional and financial burden of IBS, very little research had been conducted to evaluate the practical impact of IBS on daily activities. As a result, I conducted a small online survey to begin to characterize the impact of IBS on daily functioning. At about the same time, the American Gastroenterological Association (AGA) was conducting their own larger survey with similar questions. The current study is based on the findings of the AGA survey.

GASTRO CON: In the study, individuals with IBS-C and IBS-D reported differences in specific areas of daily function as a result of their IBS symptoms. Why do you think this is?

SB: It makes sense that the day-to-day experiences of a patient with IBS-C would be different from a patient with IBS-D. The 2 conditions do share similar symptoms, including abdominal pain, but the disorders are different regarding bowel habits. We found that individuals with IBS-C were more likely to report internalized and interpersonal impairment such as avoiding physical intimacy, reporting feeling self-conscious about their bodies, and reporting difficulty concentrating. Individuals with IBS-D were more likely to report avoidance of activities outside of the home such as traveling and going places without easily accessible bathrooms. Our findings regarding IBS-D are likely explained by the nature of diarrhea, which can limit a patient’s willingness to commit to activities where their access to bathrooms may be less than ideal. Our findings regarding IBS-C, however, are likely a result of a variety of issues with both physiologic and psychological explanations. For example, avoidance of sex may be due to pelvic floor symptom distress and/or related to dissatisfaction with their own body image, which may be impacted by other symptoms such as bloating, distension, or comorbid anxiety or depression.

Clinical implications >>

Irritable bowel syndrome (IBS) is associated with significant disease burden and decreased quality of life.

A study by Sarah Ballou, PhD, a clinical psychologist in the Division of Gastroenterology at Beth Israel Deaconess Medical Center in Boston, Massachusetts, and colleagues evaluated the effects of IBS on different areas of daily function and compared them among disease subtypes.1 The results showed differences in specific areas of daily function between individuals with constipation-predominant IBS (IBS-C) and diarrhea-predominant IBS (IBS-D).

Gastroenterology Consultant caught up with Dr Ballou about the research and how gastroenterologists can help improve the quality of life of patients with IBS.

Gastroenterology Consultant: What is the biggest challenge in the management of IBS-C and IBS-D?

Sarah Ballou: IBS is a disorder that is associated with dysregulation of the brain-gut axis. As a result, there is a complex interplay between symptom experience, quality of life, health behaviors, and stress/anxiety. This relationship—where stress can impact symptoms/behaviors, and symptoms/behaviors can cause stress—is different for each individual. In the management of IBS, it is very important to develop a biopsychosocial conceptualization of each patient where providers take into account not only biological abnormalities, but also psychological and central processing mechanisms that can influence the brain-gut communication. In order to carefully consider and treat each of these aspects, a multidisciplinary treatment team consisting of physicians, psychologists, nutritionists, physical therapists, and other specialists is ideal. Unfortunately, a multidisciplinary team is not always available to patients, which poses a challenge in the management of IBS.

GASTRO CON: What prompted you to conduct your study?

SB: I am a health psychologist with expertise in gastrointestinal (GI) psychology. In graduate school, I was especially interested in the day-to-day impact of IBS on patients’ lives. I found that although there had been a significant amount of research to document the emotional and financial burden of IBS, very little research had been conducted to evaluate the practical impact of IBS on daily activities. As a result, I conducted a small online survey to begin to characterize the impact of IBS on daily functioning. At about the same time, the American Gastroenterological Association (AGA) was conducting their own larger survey with similar questions. The current study is based on the findings of the AGA survey.

GASTRO CON: In the study, individuals with IBS-C and IBS-D reported differences in specific areas of daily function as a result of their IBS symptoms. Why do you think this is?

SB: It makes sense that the day-to-day experiences of a patient with IBS-C would be different from a patient with IBS-D. The 2 conditions do share similar symptoms, including abdominal pain, but the disorders are different regarding bowel habits. We found that individuals with IBS-C were more likely to report internalized and interpersonal impairment such as avoiding physical intimacy, reporting feeling self-conscious about their bodies, and reporting difficulty concentrating. Individuals with IBS-D were more likely to report avoidance of activities outside of the home such as traveling and going places without easily accessible bathrooms. Our findings regarding IBS-D are likely explained by the nature of diarrhea, which can limit a patient’s willingness to commit to activities where their access to bathrooms may be less than ideal. Our findings regarding IBS-C, however, are likely a result of a variety of issues with both physiologic and psychological explanations. For example, avoidance of sex may be due to pelvic floor symptom distress and/or related to dissatisfaction with their own body image, which may be impacted by other symptoms such as bloating, distension, or comorbid anxiety or depression.

Clinical implications >>