Irritable Bowel Syndrome: Unexplained Abdominal Symptoms
Many people suffer with persistent physical symptoms that frustratingly elude a satisfactory explanation. It’s estimated that up to 30% of people seeing their GP will have at least one symptom for which an explanation will not be found, and these symptoms can be a source of great distress for the patient and a source of immense frustration for the doctor. The current preferred term for these symptoms is ‘Symptoms Without Apparent Disease’, but they have variously been known as ‘medically unexplained symptoms’, ‘somatoform disorders’, ‘functional disorders’ and ‘dissociative symptoms’. The struggle to agree on what to call these problems should indicate to you just how uncomfortable these symptoms make us.
These symptoms include dizziness, pelvic pain, breathlessness, headaches, even epilepsy-like seizures, to name just a few. But one of the commonest is the condition we know as ‘Irritable Bowel Syndrome’. Perhaps as many as 20% of us suffer with irritable bowel syndrome (IBS) and I would guess almost all of us have experienced unexplained abdominal discomfort at some point in our life.
Even the term IBS is vague. One person’s experience of IBS will be very different from another’s. Some people experience it mainly as constipation (IBS-C), others as diarrhoea (IBS-D), for some it is recurrent bouts of abdominal pain, and others may suffer persistent bloating. Many people will experience all of these symptoms at different times. Three things unite all these different experiences. Firstly, they can be a source of immense distress. Secondly, there is no specific test to help make the diagnosis. Thirdly, there is no cure, so treatment is aimed at managing symptoms.
That second problem is sometimes the most significant for people. The fact that there is no test that can categorically confirm that you are suffering with IBS leaves some people feeling that something is being missed, potentially something serious.
So how do we diagnose IBS? Mainly, we listen to the story. What we expect to hear is a story of symptoms that have been near enough life long, or at least have been present to some extent from teenage years or early adult life. The symptoms fluctuate rather than progress, and you may already have identified that they have specific triggers such as stress or particular foods. There should also be no ‘alarm’ features, which include bleeding when you open your bowels, unexpected weight loss, or relentlessly progressive abdominal pain. IBS does not cause these symptoms.
Having listened to the story, and made ourselves happy that it is consistent with IBS, the next step is to exclude other worrying illnesses that can cause similar symptoms. This is often what people are most keen to do. Most people worry that these symptoms might be something nasty such as inflammatory bowel disease, coeliac disease (gluten intolerance), liver disease or, most worryingly, cancer. This is where blood tests play an important role.
An IBS screen should help to exclude all of the above and this is usually done with a set of blood tests. Inflammatory bowel diseases (such as ulcerative colitis, or Crohn’s disease) can be checked by looking at ‘inflammatory markers’ such as the protein CRP, levels of which rise in the blood if there is any inflammation in the body. Coeliac disease is checked by looking for an antibody, although it should be noted that this only works if your diet contains gluten at the time of the test. Liver disease and kidney disease can be looked for by testing the function of those organs. To exclude bowel cancer, we check the full blood count which will tell us if there is any sign of blood loss and we do this because bowel cancers will usually cause some blood to be lost in the bowel, even if this cannot be seen in the motions. In women, it is also important to check a blood test called CA125 which is a marker of ovarian cancer. Sometimes ovarian cancer presents as abdominal bloating or other vague abdominal symptoms, and it is easy to miss.
If the story sounds right, and the blood tests are normal, we can confidently make a diagnosis of IBS. Many people worry that perhaps the blood tests are being done too soon, that whatever disease they are suffering from hasn’t progressed far enough to show up in the blood tests. If the symptoms have been present for months or years, this is actually very rare, perhaps about 1% of people will eventually turn out to have another problem. The important thing to remember is to re-assess if your symptoms are changing, or the symptoms are becoming progressive rather than intermittent, or you develop any of the alarm symptoms mentioned above.
The other thing that is very important to remember is that, just because we have no specific test for IBS, does not mean that it is not a real illness. It is not imagined or feigned. The symptoms are real, and the suffering is real. One day I suspect we will understand IBS much better and will have specific treatments for it, but for now, we have to make do with managing the symptoms. And there are many different ways to manage the symptoms including medication, dietary changes, and psychological support. If you have IBS, there is no need to continue suffering, your doctor can usually find a way to make you feel much better.