Sarah Ballou, PhD, on 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.
GASTRO CON: What are the clinical implications of your study?
SB: These findings highlight the importance for clinicians to ask about and understand the day-to-day implications of IBS for each of their patients. It is important to know how a patient has modified their lifestyle to accommodate their symptoms and how we can help patients improve their quality of life, while simultaneously working to treat the patients’ symptoms. A biopsychosocial approach to the management of IBS would likely improve not only patient outcomes but also patient satisfaction. More specifically, these findings are important when considering the development of future GI psychology treatments for IBS. Cognitive behavioral therapy (CBT) is one highly effective evidence-based therapy for the management of IBS, and it has been tested in randomized controlled trials among patients with all subtypes. With these findings in mind, perhaps we could tailor CBT protocols for the management of specific subtypes, with certain cognitive and behavioral strategies recommended for IBS-C and others for IBS-D.
GASTRO CON: How can a gastroenterologist help patients with IBS improve their daily quality of life?
SB: Gastroenterologists can help patients with IBS improve their daily quality of life in several ways. First, by validating the impact of IBS on patients’ lives and by expressing interest in how IBS has affected each patient individually. With this understanding, physicians can then help patients set realistic goals tailored to each individual. Second, gastroenterologists can make a point to provide a clear explanation of the brain-gut axis and how stress can impact, not cause, IBS symptom experience. If gastroenterologists address IBS from a biopsychosocial perspective and explain to their patients early and often that this is a disorder that is best managed with a multidisciplinary approach, then patients will have a better understanding of their symptoms. As a result, future referrals to nutritionists, physical therapists, and/or psychologists are less likely to be seen as a last resort. Finally, encouraging patients to make efforts to regulate their physiologic arousal and to manage stress at home by starting a daily practice of diaphragmatic breathing, meditation, or yoga can also be beneficial to manage symptoms.
Reference:
Ballou S, McMahon C, Lee H-N, et al. Effects of irritable bowel syndrome on daily activities vary among subtypes based on results from the IBS in America survey [published online August 13, 2019]. Clin Gastroenterol Hepatol. doi:10.1016/j.cgh.2019.08.016