Yes, IBS is tied to the mind, but that’s no reason to dismiss it
WHILe irritable bowel syndrome affects one in five people at some point in their lives and can be debilitating, it is very poorly understood and services specialising in it are few and far between.
IBS is complex. It is a term used to describe a set of unpleasant and wearing symptoms such as bloating, abdominal cramps, diarrhoea and constipation. Often doctors diagnose IBS when all other likely conditions have been ruled out.
While there is no clear cause for IBS, it can follow an attack of gastroenteritis, a course of antibiotics or an upsetting or traumatic event. This seems to disrupt the normal functioning of the gut, causing inflammation and depleting ‘good’ bacteria, which can make it very sensitive.
But there is also a very important psychological component, as stress, anxiety and low mood can all trigger flare-ups.
Though symptoms are often crippling and can dramatically impact people’s lives, many GPs don’t see IBS as a ‘real’ illness and dismiss it as ‘all in the mind’.
So the news this week that a large study — by the University of Southampton, King’s College London and King’s College Hospital in London — has shown that psychotherapy can significantly improve symptoms for sufferers offers real hope.
The research revealed that patients who were given cognitive behavioural therapy (CBT), a type of talking therapy most commonly used to treat anxiety and depression, fared the best.
The study focused on giving advice about healthy eating, managing stress and challenging ‘unhelpful thoughts’.
Around three-quarters reported a significant improvement in their symptoms, with some having no symptoms at all by the end of the treatment. While this is great news for sufferers and conclusively shows that with the right treatment patients can be helped, there’s still the big hurdle of getting doctors to take the condition seriously.
We know that the mind and body have a close connection, and many physical health problems have a psychological component — and vice versa. Just because something is partly psychological doesn’t make it any less ‘real’.
For me, this is at the root of the stigma around mental illness — that problems with your mind are somehow less serious or worthy of help and sympathy than problems with your body. Too many patients are branded ‘neurotic’ and sent out with a leaflet and little else, leaving them to battle the symptoms on their own.
I have seen many patients with IBS who have been referred to my eating disorder clinic because they are dangerously underweight and eating unhealthy diets. IBS is not a classic eating disorder like anorexia, but many people with it develop a fear of food because they haven’t received the right support or advice. One middle- aged woman referred to me was incredibly underweight. She ate exactly the same food every day and could manage only a tiny portion each time. Her hair had started to fall out and her skin was blotchy.
She told me that several years ago she had developed crippling pains in her stomach. She became painfully bloated after meals and had diarrhoea several times a day — which meant she had to keep taking days off work and stopped going out with friends.
All tests came back negative, and eventually she was given a diagnosis of IBS. She was then immediately discharged from the gastroenterologist, with no help or support.
‘Maybe cut out foods that make the symptoms worse’ was the unhelpful advice given to her.
So she tried various ‘elimination diets’, cutting out more and more foods until she was left with just a few that seemed not to exacerbate her symptoms. It was not a healthy diet, but she was scared to start eating properly again.
I have seen this time and time again, and patients often spiral into suicidal depression. Yet much of this could be prevented with proper support — as this new research so clearly shows.
What we need is dedicated, specialist nHS services for IBS around the country which every patient has access to.
I find it astonishing that despite it being such a common and distressing condition, so little is being done to help sufferers.