Complications of irritable bowel syndrome (IBS)

 Key Takeaways

• IBS goes beyond intestinal issues like constipation, diarrhea, and abdominal pain to non-intestinal symptoms like headaches, loss of energy, and back pain.
• IBS can cause complications, such as sleep disturbances, hemorrhoids, and anxiety, which can affect people’s work productivity, mental state, physical health, and relationships.
• Dietary and behavioral changes are important to curb the symptoms of IBS and quicken your response to the administered treatment.

Irritable bowel syndrome (IBS) is a gastrointestinal disorder that causes diarrhea, constipation, stomach pain, and changes in bowel function. IBS can affect people of all ages, but it is more common in younger people and people assigned female at birth. Since there is no specific test for it, the primary way to tell if someone has IBS is by observing their symptoms.

 Physical complications of IBS

Prolonged IBS can lead to serious gastrointestinal issues. Here are some of the physical complications of IBS:

 1. Hemorrhoids

Hemorrhoids, commonly known as piles, occur when the veins in the lower part of the rectum or anus swell and become inflamed. The cause of this disorder is unknown, but a recent 2019 research indicates that continuous or prolonged symptoms of IBS are risk factors for hemorrhoids. Hemorrhoid bleeding becomes visible when constipation from IBS causes bleeding from the rectum.

 2. Rectal prolapse

Rectal prolapse occurs when the rectum slips past the muscular opening that marks the end of the digestive tract. With diarrhea and constipation from IBS, there is a possibility that you may have rectal prolapse. Alongside these symptoms, you may also notice a leakage of poop or blood from your anus.

 3. Anal fissures

Constipation causes hard stools that can tear the anus. When it occurs repeatedly, the internal sphincter muscle just beneath the tear starts to cramp, causing pain and extreme discomfort. One prominent sign of anal fissures is experiencing pain during or after a bowel movement.

 4. Fecal impaction

A hard stool might get stuck in your rectum as a result of constipation, and this can be dangerous when left untreated. You may experience back pain, the need to poop, or abdominal pain as additional symptoms of this complication.

 5. Malnourishment

People with IBS may begin a strict diet and avoid certain foods that can worsen symptoms like diarrhea and cramping. This may cause them to miss out on vital nutrients that aid growth and development, leaving them looking sickly. In addition, prolonged diarrhea may reduce the time needed for nutrients to be adequately absorbed from food.

 6. Sleep disturbances

The pain of IBS symptoms may interrupt a person’s nighttime rest. In severe cases, a health professional may prescribe sleeping pills in addition to other treatments for this disorder.

 Mental complications of IBS

The symptoms of IBS may go beyond physical effects and negatively impact patients' mental health by causing mental health conditions like depression, anxiety, and fear of public places. 

 1. Depression

People with IBS experience mood disorders that cause sadness and other behavioral changes. You can tell this by noticing changes in how they talk, act, or react to things going on around them. Sleep disturbance, which is a physical complication of this gastrointestinal disorder, can contribute to depression.

 2. Anxiety

The symptoms of IBS leave people who suffer from this health condition uneasy about their actions, especially in public places, affecting various aspects of their lives.

 3. Agoraphobia

Agoraphobia is a fear of public places, and people with IBS will always avoid being in public places because of the need to use the restroom frequently. They may also feel slight embarrassment while doing so.

 Lifestyle complications of IBS

IBS can also affect a person's lifestyle in the following ways:

 1. Withdrawal from family and friends

The anxiety from the symptoms of IBS and being in public makes people gradually withdraw from their family and friends. This anxiety can also be due to embarrassment about the situations these symptoms can put them in.

 2. Work interruptions

For some people, IBS can last for days or weeks, while for others, it can last for years. These long-lasting symptoms may interrupt their productivity at their workplaces.

 Common symptoms of IBS

IBS can cause a range of symptoms. But here are the most common ones.

 Alterations in bowel movements

Abnormal bowel movements can cause a person’s stool to be hard or watery, and this is a result of the small intestine absorbing too much or too little water from the stool. It is important to observe stools for signs that may indicate IBS, such as  unusual colors, and the presence of mucus or blood

 Bloating

IBS can cause a person to experience bloating. Bloating is the buildup or accumulation of gas in your gut, which interrupts the usual process of digestion. You may fart more than usual or feel discomfort because your gut is unusually full. This can occur if you have IBS-C, which is the constipation-predominant subtype.

Other non-intestinal symptoms of IBS include:

• Tiredness 
• Fever 
• Loss of sleep 
• Nausea with or without vomiting 
• Weight loss or, in some cases, weight gain 
• Back pain 
• Changes in skin conditions

 Types of IBS

Health professionals categorize IBS based on its prominent symptoms—which are constipation and diarrhea.

 IBS-D (Diarrhea)

This subtype of IBS involves loose bowel movements that cause severe stomach discomfort, abnormal bowel movements, and serious stooling. A 2020 study showed that one-third of IBS patients are classified as having IBS-D, and people with this subtype reported a generally reduced quality of life.

 IBS-C

The most common pointer of this subtype of IBS is a hard stool. However, several other factors can cause constipation, so you may need to take stool or lower GI series tests to confirm that it is an IBS-related issue. You may also experience occasional bowel movements as well as other non-gastrointestinal symptoms like depression.

 IBS-M

This subtype is a mixture of diarrhea and constipation. However, you don't get these symptoms simultaneously; instead, they alternate at different time intervals. These symptoms can last for a few days or even longer, and people who experience them observe both loose and hard stools.

 Diagnosis of IBS

There are no specific tests for IBS. Instead, your doctor will ask about your medical history and the symptoms you are having. If you notice other severe symptoms, you may need to do more tests to find out if you have IBS or some other health problems.

Doctors may diagnose IBS based on two basic criteria: according to the type of IBS or based on the Rome criteria.

Type of IBS: By observing the prominent and recurring symptoms, which can be diarrhea, constipation, or both, your doctor can diagnose you with IBS. However, they look out for other symptoms that may indicate different and underlying health conditions. Some of these symptoms include

• Recurring symptoms in individuals over the age of 50
• Gastrointestinal or rectal bleeding
• Unusual weight changes
• Low iron level or anemia
• Severe pains that interrupt night rest

Rome criteria: This criterion considers stomach or abdominal discomfort accompanied by defecation, change in stooling texture and patterns, and the frequency of defecation. You can observe these symptoms within days and months.

To further rule out the possibility of other health complications, doctors may insist on taking further tests. Some of the tests they may conduct include:

• Abdominal CT scan: The results provide a clear image of your abdominal region to confirm your diagnosis of IBS and rule out the possibility of any other health issues.
• Colonoscopy: This test examines the inside of your bowels for any abnormal changes.

 Treatment for IBS

The approach taken to treat IBS is by addressing the symptoms. Medical professionals achieve this by evaluating the type of IBS present and other symptoms that accompany it. It is important to inform your doctor of anything, including mental changes, that may help administer the appropriate treatment. You can take dietary and behavioral approaches to curb these symptoms alongside medication.

 Dietary changes

• Hydrate by drinking plenty of water
•  In this 2017 study [5], physicians recommend that you take more fiber to reduce abdominal pain and regulate bowel movements,
• Consume less lactose, fructose, and sucrose to reduce gas production.
•  Consume fewer caffeinated foods and beverages.

 Behavioral and lifestyle changes

• Exercise more. 
• Get enough sleep. 
• Avoid foods that trigger symptoms.

 Medications

There are some medications medical professionals can prescribe for IBS patients, including: 

• Fiber supplements: To control the effects of constipation. 
• Antidiarrheals: To regulate bowel movements. 
• Laxatives: To help with bowel contraction and move stool. 
• Antibiotics: To maintain gut health and prevent the development of infections. 
• Antidepressants: To alleviate a dull mental state.

 A quick wrap up

IBS is a common gastrointestinal disorder that affects many individuals. Although it may seem severe, it does not pose a threat to your future health conditions as it does not increase your risk of cancer or other bowel-related health conditions.  IBS can be treated with appropriate prescriptions, dietary changes, and lifestyle adjustments.