By Aiden Hannah, Research Analyst, Deloitte Centre for Health Solutions

Despite being a common condition affecting approximately 10 to 20 per cent of UK adults, Irritable Bowel Syndrome (IBS) is poorly understood.¹ No direct tests for IBS exist and the exact underlying causes of the chronic condition are still unknown. Receiving a diagnosis can be difficult and many individuals do not receive appropriate support to help manage their condition. As April is IBS Awareness Month, this week’s blog highlights the realities of the condition through my own lived experience and summarises management strategies that may help individuals optimise their quality of life.

What we know about IBS

In 1997, the International Foundation for Gastrointestinal Disorders (IFFGD) designated April as IBS Awareness Month to increase public awareness of the condition and reduce the stigma surrounding it.² The IFFGD hoped that increasing awareness would improve outcomes for people living with the condition, including greater support, more effective care, and investment in research. 

IBS is a chronic, relapsing, and often life-long disorder of the lower gastrointestinal tract, thought to be caused by the gut and the brain ‘miscommunicating’.³ The composition of the gut microbiome is believed to have a central role, with an increasing amount of research into this potential link. Currently, however, the lack of an identifiable structural or biochemical cause means a diagnosis is typically made based on the presence of key clinical symptoms, such as recurring stomach cramps and abdominal pain, bloating, diarrhoea, constipation, and fatigue.^{4 5}These symptoms can fluctuate, lasting from periods of days to months at a time, and can be exacerbated by factors such as stress, infection, and consuming certain foods or drinks.⁶ Triggers such as these act in addition to a variety of predisposing factors such as genetic and epigenetic factors.

Different types of IBS can be categorised based on the presence of certain symptoms, with the most common being the diarrhoea predominant subtype (IBS-D).⁷ While there is not currently a diagnostic test for IBS, in many instances doctors may order blood tests or stool tests to rule out other health problems which can display similar symptoms. Other tests range from hydrogen breath tests to check for small intestinal bacterial overgrowth or problems digesting certain carbohydrates, such as lactose intolerance, to upper GI endoscopy with a biopsy to check for celiac disease or a colonoscopy to check for conditions such as colon cancer or inflammatory bowel disease.⁸ Crucially, there can be a large delay between the onset of symptoms and diagnosis, with one study finding an average time to IBS diagnosis of 6.6 years.⁹

How IBS impacts quality of life

In addition to the potentially debilitating physical symptoms associated with the condition, IBS can have a significant psychological and social impact upon patients. Importantly, studies have revealed an increased prevalence of depression among those with IBS (with estimated prevalence rates frequently over 38 per cent), in addition to an overall lower quality of life when compared to control populations.¹⁰

For individuals who experience severe or unpredictable symptoms, IBS can have a large impact upon multiple aspects of their lives. Often, they must manage a variety of symptoms, with poor understanding of their condition from those around them, which can result in social isolation. Furthermore, individuals with IBS have been found to have greater levels of work absenteeism, presenteeism and greater overall work productivity losses than their counterparts.¹¹

Management strategies and support

I know from my own experience of living with IBS that finding your own unique symptom management strategy can be a lengthy journey of trial and error. There is certainly not a one-size-fits-all approach, and what works for one flare up may not be as effective for another. However, individuals can use a combination of approaches to provide symptom relief, including:

• monitoring dietary triggers and limiting consumption of these items
• eating slowly and regularly
• exercising regularly
• focusing on relaxation techniques
• trialling probiotics
• taking medicines to control certain symptoms.

Dietary therapies are a common first-line treatment for IBS, with trained practitioners supporting these interventions. It has been estimated that up to 90 per cent per cent of IBS sufferers exclude certain foods from their diet to reduce symptoms.¹² Common ‘trigger’ items include fatty, spicy or processed foods, and overconsumption of fresh fruit, coffee and alcohol. Diets such as the low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet have growing clinical evidence of their efficacy, with this particular diet restricting the intake of short-chain carbohydrates that can be difficult for the body to digest. ^{13 14}Foods typically limited in this diet include items such as wheat-based products, certain fruits and vegetables (including garlic and onion) and foods containing sweeteners. It is, however, important for individuals to gradually reintroduce foods to determine which foods they are sensitive to, to avoid unnecessarily limiting food choices and enjoy a nutritionally balanced diet.¹⁵

For people living with IBS, symptom management can often be a difficult and isolating process. Self-help guides and toolkits, such as those provided by the NHS and IFFGD, can provide valuable support. ^{16 17}Charitable organisations such as the IBS Network also provide access to support groups across the UK.¹⁸ Furthermore, initiatives like the Great British Public Toilet Map can be essential to those living with IBS, providing the peace of mind that enables them to travel and socialise.¹⁹ Implementing new models of care, such as adopting an online patient management portal for individuals to record their symptoms and communicate remotely with specialists may prove beneficial, as is the case with inflammatory bowel disease (this features as a case example in our 2019 report Shaping the future of UK healthcare: Closing the digital gap).

Conclusion

IBS Awareness Month, held in April each year, aims to increase public understanding of a common but poorly understood condition. From personal experience I have found that a lack of awareness of the condition, coupled with a limited diagnostic process, made it harder to understand and manage my condition. By increasing awareness, I hope that outcomes for people living with the condition can be improved through greater support, care and improved speed of diagnosis. Moreover, recent research into the impact of the body’s microbiome on overall health, the brain-gut axis, and advances in understanding of genetic and epigenetic factors, may start to provide some light at the end of the diagnostic tunnel.²⁰

Aiden Hannah, Research Analyst

Aiden has a background in physics and biomedical engineering, and a strong technical knowledge of diagnostics and digital healthcare. Most recently working as an academic researcher, he undertook a range of multidisciplinary projects involving close collaborations between MedTech companies and clinicians; supporting the development of novel biosensors and low-cost diagnostics, including clinical trial design and conduct. Aiden has focused on the health technology investment pipeline and the medical device regulatory processes as part of his doctorate industry placements.

Email | LinkedIn

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¹ https://www.nice.org.uk/guidance/CG61/chapter/introduction

² https://aboutibs.org/living-with-ibs/ibs-awareness-month/

³ https://gutscharity.org.uk/2022/04/irritable-bowel-syndrome-awareness-month-2022/

⁴ https://cks.nice.org.uk/topics/irritable-bowel-syndrome/background-information/definition/

⁵ https://www.nhs.uk/conditions/irritable-bowel-syndrome-ibs/symptoms/

⁶ https://cks.nice.org.uk/topics/irritable-bowel-syndrome/background-information/causes/

⁷ https://cks.nice.org.uk/topics/irritable-bowel-syndrome/background-information/definition/  

⁸ https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/diagnosis

⁹ https://aboutibs.org/what-is-ibs/facts-about-ibs/#:~:text=The%20impact%20of%20IBS%20can%20range%20from%20mild,their%20physical%2C%20emotional%2C%20economic%2C%20educational%20and%20social%20well-being.

¹⁰ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040097/#:~:text=While%20IBS%20is%20not%20life-threatening%20for%20most%2C%20it,anxiety%20disorder%20occur%20in%2038%E2%80%93100%25%20of%20patients%20%5B8%E2%80%9311%5D.

¹¹ https://pubmed.ncbi.nlm.nih.gov/28196491/

¹² https://pubmed.ncbi.nlm.nih.gov/33518164/

¹³ https://pubmed.ncbi.nlm.nih.gov/33518164/

¹⁴ https://health.clevelandclinic.org/low-fodmap-diet/

¹⁵ https://www.gloshospitals.nhs.uk/media/documents/FODMAP_dietsheet_for_website.pdf

¹⁶ https://www.wsh.nhs.uk/CMS-Documents/Patient-leaflets/ColorectalandStomaCare/5339-2-IBS-Self-Help-Guide.pdf

¹⁷ https://aboutibs.org/living-with-ibs/

¹⁸ https://www.theibsnetwork.org/self-help-groups/

¹⁹ https://www.toiletmap.org.uk/about

²⁰ https://pubmed.ncbi.nlm.nih.gov/2993586