9 Psychosomatics: irritable bowel syndrome

Question 1

What is psychosomatic disorders?

Answer 1

Disorders where emotional or psychological factors can impact on the symptoms

Question 2

What are some examples of psychosomatic disorders?

Answer 2

• Asthma
• Atopic dermatitis
• Tension-type headaches
• Chronic fatigue syndrome
• Irritable bowel syndrome

Question 3

What is IBS?

Answer 3

Irritable bowel syndrome a common digestive condition

Question 4

What are the signs and symptoms of IBS?

Answer 4

• Abdominal pain and cramping - may be relieved by defecation
• A change in bowel habits – e.g. diarrhoea, constipation, or sometimes both
• Bloating and swelling of your stomach
• Excessive wind (flatulence)
• Occasionally experiencing an urgent need to go to the toilet
• A feeling that you have not fully emptied your bowels after going to the toilet
• Passing mucus from your bottom

Question 5

What is the occurrence rate of IBS?

Answer 5

• 20–30 yearsold
• More common in women
• 10 – 20% of the population

• Main symptom varies 
– abdominal pain
– diarrhoea
– constipation
– diarrhoea alternating with constipation

Question 6

How is IBS diagnosed?

Answer 6

1. Rome III Criteria:

In the last 3 months, with symptom onset at least 6 months prior to diagnosis, the individual experiences recurrent abdominal pain or discomfort at least 3 days/month in the last 3 months associated with 2 or more of the following:

• Improvement with defecation
• Onset associated with a change in frequency of stool
• Onset associated with a change in form (appearance) of stool

2. In UK:
   +2 of the following:
   • A change in how you pass stools (urgency, not emptied bowels)
   • Bloating, hardness or tension in abdomen
   • Symptoms worse after eating
   • Passing mucus from rectum

Question 7

4 impacts of IBS on patients

Answer 7

• Work
• Visits to health professionals
• Health Related Quality of Life (HRQoL)
• Psychological health

Question 8

What are the causes of IBS? (7)

Answer 8

Psychological:
• Emotional stress
• Psychological disorders
• Hyper-reactivity in the brain-gut interface

Physiological:
• Infection
• Food intolerance
• Abnormal muscle contraction 
• Serotonin receptors

Question 9

Describe the common sense model of IBS

Answer 9

• Health messages (e.g. abdominal pain, disturbed bowel habit) affected by:

• Gastrointestinal infections
• Food intolerances
• Abnormal guy physiology
• Affect the cycle of coping procedures to deal with emotional reaction to life events and representation of illness risk
• Perceptions of treatment impact the emotional response to treatment

Question 10

IBS management, 4 main approaches?

Answer 10

1. Diet/ lifestyle (physical activity) changes approach
2. Drug treatments approach:
   • Treat the symptoms
3. Psychological approaches (>12 months)
4. Complementary therapies approach

Question 11

Outline the diet/lifestyles approach to treating IBS?

Answer 11

• Food diary:
- Monitor food intolerances
- Encourage healthy diet
• Assess activity levels

Question 12

What are the first line and second line drugs for treatment of IBS?

Answer 12

1. First line:
   • Antidiarrhoeal (loperamide) • Laxatives (not lactulose)
   • Antispasmodics

2. Second line:
• Laxatives (linaclotide)
• Antidepressants (second line)
 – TCAs (if first line ineffective) 
 – SSRIs (if TCAs ineffective)

Question 13

Outline the psychological approach to treating IBS?

Answer 13

> 12 months:
• Cognitive behavioural therapy
• Hypnotherapy
• Psychological therapy

Question 14

Outline the complementary therapies approach to treating IBS?

Answer 14

• Nutraceuticals
• Chinese herbal medicine
• Probiotics

Question 15

Communication when dealing with psychosomatics

Answer 15

• Be optimistic but realistic
• Targets could be:
– reducing disability
– improving coping
– reducing dependence on health care
• Listen to your patient