Chronic Irritable Bowel Syndrome: When to Seek Medical Help

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder that affects millions of people worldwide. In India, many individuals often seek help from non-medical practitioners, which can lead to mismanagement of the condition, late diagnosis, and advanced disease.

In this blog we will read about the long-term symptoms of IBS, emphasizing when it is crucial to seek professional medical help. We will discuss chronic IBS, its severe symptoms, and the importance of proper diagnosis and treatment.

What is Irritable Bowel Syndrome?

Irritable Bowel Syndrome is a chronic condition characterized by a combination of symptoms, including abdominal pain, bloating, and changes in bowel habits. IBS is classified into different subtypes based on the predominant symptoms:

• IBS with diarrhea (IBS-D)
• IBS with constipation (IBS-C)
• Mixed IBS (IBS-M)

The exact cause of IBS remains unclear, but it is believed to involve a combination of gut-brain interactions, gut motility issues, and psychosocial factors.

What is Chronic Irritable Bowel Syndrome (IBS) and Its Symptoms?

Chronic IBS is defined as experiencing symptoms for at least three months, with symptoms often fluctuating in intensity. The chronic nature of this condition can lead to significant discomfort and impact the quality of life. Common chronic IBS symptoms include:

• Abdominal Pain: Often relieved by bowel movements.
• Chronic Diarrhea: Frequent loose or watery stools.
• Constipation: Infrequent or difficult bowel movements.
• Bloating and Gas: A feeling of fullness or swelling in the abdomen.
• Pelvic Pain: Discomfort in the pelvic region, which can be associated with IBS.

Severe Symptoms of IBS

While many individuals experience mild to moderate symptoms, some may suffer from severe IBS symptoms that require immediate medical attention. Severe symptoms include:

• Severe Abdominal Pain: Intense pain that disrupts daily activities.
• Persistent Diarrhea: Frequent episodes that lead to dehydration.
• Weight Loss: Unintentional weight loss due to malabsorption or dietary restrictions.
• Anemia: Low iron levels due to chronic blood loss or malnutrition.
• Changes in Bowel Habits: Sudden changes that last for more than a few days.

When to Seek Medical Help for Irritable Bowel Syndrome?

It is essential to recognize when IBS symptoms warrant a visit to a healthcare professional. Here are some key indicators:

• Persistent Symptoms: If symptoms persist for more than three months without improvement, it is crucial to consult a doctor. Chronic IBS symptoms can mimic other gastrointestinal disorders, such as inflammatory bowel disease (IBD) or colorectal cancer.
• Severe Symptoms: Experiencing severe abdominal pain, chronic diarrhea, or significant changes in bowel habits should prompt immediate medical attention. These symptoms may indicate a more serious underlying condition.
• Weight Loss: Unexplained weight loss can be a red flag. It is essential to investigate the cause, as it may indicate malnutrition or a more severe gastrointestinal issue.
• Anemia Symptoms: If you experience fatigue, weakness, or pale skin, it is essential to seek medical help. Anemia can result from chronic blood loss or nutritional deficiencies related to IBS.
• Family History: A family history of gastrointestinal diseases, such as colorectal cancer or IBD, increases the importance of seeking medical advice when experiencing IBS symptoms.
• Mental Health Impact: IBS can significantly affect mental health, leading to anxiety and depression. If you find that your symptoms are impacting your mental well-being, it is crucial to seek help.

Long-Term Outcomes and Related Conditions

Chronic Irritable Bowel Syndrome (IBS) itself is not directly linked to causing other diseases, but it can increase the risk of or be associated with certain conditions due to ongoing inflammation, altered gut function, and stress on the digestive system. Below are insights on the possible long-term outcomes and related conditions:

1. Increased Risk of Certain Conditions

• Diverticulitis: While IBS does not directly cause diverticulitis, individuals with IBS may have an increased risk of developing diverticular disease, which can progress to diverticulitis in some cases. This is especially true for IBS patients with a history of constipation, as increased pressure in the colon can lead to the formation of diverticula (small pouches in the colon wall).
• Small Intestinal Bacterial Overgrowth (SIBO): IBS, particularly the bloating and diarrhea-predominant types, is often associated with SIBO, where there is an overgrowth of bacteria in the small intestine. This can exacerbate IBS symptoms and cause malabsorption issues.
• Inflammatory Bowel Disease (IBD): Though IBS and IBD are distinct, misdiagnosis or an overlap in symptoms might delay proper identification of IBD conditions like Crohn’s disease or ulcerative colitis.
• Gastroesophageal Reflux Disease (GERD): Many individuals with IBS report a higher prevalence of GERD symptoms, such as acid reflux and heartburn, potentially due to altered motility and gut-brain interaction.

2. Gut-Related Complications

• Hemorrhoids: Chronic constipation associated with IBS can increase the likelihood of developing hemorrhoids due to straining during bowel movements.
• Rectal Prolapse: In severe constipation cases, chronic straining can lead to rectal prolapse, where part of the rectum protrudes through the anus.
• Leaky Gut Syndrome: Although not universally accepted as a diagnosis, chronic IBS may contribute to increased intestinal permeability, potentially leading to systemic inflammation and immune dysregulation.
• Colorectal Cancer: IBS itself is not a direct cause of colorectal cancer. However, persistent symptoms should be monitored to rule out other serious underlying conditions.

3. Secondary Issues

• Chronic Fatigue Syndrome (CFS): IBS is often part of a broader spectrum of conditions, including CFS and fibromyalgia, suggesting systemic involvement beyond the gut.
• Mental Health Disorders: Long-term IBS can lead to or exacerbate anxiety, depression, and stress due to the chronic nature of symptoms and their impact on quality of life.

Diagnosis and Treatment

A healthcare professional will typically conduct a thorough evaluation, including a physical examination, medical history, and possibly diagnostic tests such as blood tests, stool tests, or imaging studies. The diagnosis of IBS is often made based on symptom patterns and the exclusion of other conditions.

Treatment Options

Treatment for chronic IBS may include:

• Dietary Changes: Identifying and avoiding trigger foods can help manage symptoms. A low-FODMAP diet is often recommended for IBS patients.
• Medications: Depending on the symptoms, medications such as antispasmodics, laxatives, or anti-diarrheal agents may be prescribed.
• Psychological Therapy: Cognitive-behavioral therapy (CBT) and other forms of psychological support can help manage the mental health aspects of IBS.
• Probiotics: Some studies suggest that probiotics may help improve gut health and alleviate IBS symptoms.

The Role of Non-Medical Practitioners

In India, many individuals turn to non-medical practitioners for IBS management. While some may provide relief through alternative therapies, it is essential to approach such treatments with caution.

Non-medical practitioners may lack the necessary training to diagnose and treat underlying conditions effectively. Relying solely on non-medical help can lead to misdiagnosis and delayed treatment of more serious gastrointestinal disorders.

Conclusion

Long-term IBS symptoms can significantly impact an individual's quality of life. Recognizing when to seek medical help is crucial for effective management and treatment. If you experience chronic IBS symptoms, severe abdominal pain, unexplained weight loss, or any other concerning signs, it is essential to consult a healthcare professional. Early diagnosis and appropriate treatment can help alleviate symptoms and improve overall well-being.

Dr. Pranav Shukla

MBBS, MD Anaesthesia.

References

• Lacy BE, et al. "Irritable Bowel Syndrome: A Comprehensive Review." American Journal of Gastroenterology, vol. 113, no. 1, 2018, pp. 1-18.
• Ford AC, et al. "Efficacy of prebiotics and probiotics in irritable bowel syndrome: a systematic review and meta-analysis." American Journal of Gastroenterology, vol. 108, no. 8, 2013, pp. 1361-1371.
• Chey WD, et al. "Irritable bowel syndrome: a clinical review." JAMA, vol. 313, no. 9, 2015, pp. 949-958.
• Drossman DA. "Functional gastrointestinal disorders: history, pathophysiology, clinical features, and Rome IV." Gastroenterology, vol. 150, no. 6, 2016, pp. 1257-1269.
• Staudacher HM, et al. "Dietary management of irritable bowel syndrome: a systematic review." Journal of Human Nutrition and Dietetics, vol. 30, no. 5, 2017, pp. 634-646.

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