Approximately 20 million Canadians suffer from digestive disorders, and 5 million alone are cases of irritable bowel syndrome (IBS), and IBS with constipation (IBS-C). Digestive problems costs Canada roughly 18 billion dollars a year on direct medical costs: diagnosis and treatment. While IBS cost Canada 10 billion dollars a year, which includes absenteeism but not OTC cost. Having said that, it’s still one of our least discussed health issues.

It’s in your gut, not your head

One of the reasons irritable bowel syndrome is largely ignored by the public is due to certain myths concerning diagnosis. Some people feel IBS isn’t actually real, and is essentially a construct of the patient, but this is false and occasionally dangerous misinformation.

According to Dr. Chris Andrews, Director, Centre for Digestive Motility, University of Calgary, IBS is a very real and serious issue. “There was a perception that it was a diagnosis that doctors were making when they didn’t know what was going on but that’s changed a lot,” says Dr. Andrews. “In the past, a lot of symptoms would get called IBS that probably were not, but these days it’s relatively straightforward to make a diagnosis of IBS and move forward with it. A lot of people think that if you get diagnosed with IBS, you’re hysterical or it’s all in your head, but the science has shown that IBS really is a gut disorder. There are changes in the way the nerves function in the gut, which sends a signal to your brain. So, this is a real issue we’re dealing with.”

Finding the right solution

Luckily, there are a number of treatment options available for people with IBS(-C) and chronic constipation. Generally, the first thing to look at are dietary modifications. “There have been some studies looking at a specialized diet, like the FODMAP system, which is shown to cause improvement in the overall abdominal symptoms of patients with IBS,” says Dr. Liu, Director, Clinical Motility Unit, UHN. “It is very difficult to comply with, however, because it’s very restrictive. So it’s not a long-term solution, and it doesn’t necessarily benefit all patients either. There are also the gluten-free diet and the typical IBS diet, but patients have to figure out which one works best for them.”

In a similar vein to dietary approaches are probiotics, which essentially modify the bacteria in the gut, aiding the reduction of gas formation and bloating. Though the effects of probiotics are relatively modest, they remain a safe option. “Probiotics can certainly help with bloating and abdominal discomfort,” says Dr. Liu. “A recent study published earlier this year demonstrated that probiotics helped overall quality of life and general discomfort, but there’s no clear evidence to show that they improve abdominal pain. So, while they may help with other abdominal symptoms associated with constipation, they can’t help the pain aspect of something like IBS-C.”

The third route available is a pharmaceutical one, which is the more recent of the three, but is nevertheless making waves in this field. “Prescription medications have actually been tested to a very high standard of scientific rigour,” says Dr. Andrews. “They don’t go on for decades, but there are what we call long-term studies that go on for two or maybe three years testing their safety.  And there are some tested medications with excellent safety profiles that can certainly give long-term relief to large amounts of people. Really, just in the past five or six years, we’ve had a number of medications emerging that can not only assist movement in the gut but reduce gut sensitivity too, and that’s a real advancement. Still, the number one tool here is awareness. If people understand they can get their constipation or irritable bowel syndrome sorted out by seeing their doctor, then that’s a huge step forward.”