Is IBS a Psychological Issue?

There are multiple causes, including one that affects mood.

Photo by Kat Jayne on Pexels.com

It’s no fun to have trouble with your bowels. Banish any embarrassment and talk to your doctor about irritable bowel system (IBS). There are ways you can feel better. It also isn’t solely or mainly a psychological problem you’d take to a therapist or psychiatrist instead, though it may have a trigger that also affects mood. 

Between 7 and 21 percent of Americans have IBS, or irritable bowel syndrome. If you often get a stab or cramp in your lower abdomen after eating a meal and have to run to the bathroom, you may have IBS with diarrhea (IBS-D). Some feel a similar pain but have constipation (IBS-C) and many people alternate between the two (mixed IBS).

Don’t confuse IBS with IBD, or inflammatory bowel disease, which causes some of the same symptoms. Your doctor will conduct tests to rule out IBD.

To be diagnosed with IBS, your symptoms usually must occur over at least three months. IBS often sets in after a temporary stomach virus.

It’s unclear what causes IBS in whom. We may eventually learn that the diagnosis—a collection of symptoms –has lumped together several problems, and you might have just one or two or more.

For example, pain is a nerve problem—the pain with IBS can be sharp, possibly caused by extra-sensitive nerves in your gut, according to the National Institute of Diabetes and Digestive and Kidney Diseases.  

You may be stressed out. It’s common for people to have acute bowel reactions to stress. We know that IBS is more common in people who have post-traumatic stress disorder and people with IBS often have anxiety and depressionHypnosis has helped many patients. Does this mean IBS is a psychological problem? Well, it affects your psychology but that doesn’t mean you can manage it entirely with your attitude.

You may have a serotonin disturbance, possibly linked to your microbiome. How would that work? Microbes in the gut may increase the production of serotonin (yes, that’s the same serotonin boosted by common anti-depressants). Most of the body’s serotonin is actually in the gut, and we know that serotonin levels play a role in IBS.

Diarrhea seems to have its own chain of causes.  Up to a third of patients diagnosed with IBS-D have a condition called bile-acid malabsorption. The liver uses bile to break down fat. Too much bile entering the colon can trigger diarrhea. The extra bile may occur because of a shortage of the ileal hormone, which normally regulates this system.

You may have an overgrowth of bacteria in your small intestine (SIB0). Some research suggests that SIB0 is common in patients with IBS-D.

Digestion may occur lower down in the colon than normal. Some people with IBS do better on a diet restricting FODMAPS (Fermentable Oligo-, Di-, Mono-saccharides And Polyols). These short-chain carbohydrates, poorly absorbed in the small intestine, are normally fermented near the top of the large intestine, or colon. Millions of bacteria go to work to break them down, acquiring energy, and the process releases needed short-chain fatty acids. But in some people with IBS, the fermentation process may occur lower down in the colon, early research suggests, so the acids aren’t released in the same way. 

You may lack needed bacteria. Your microbiome is as individual as a fingerprint. Small differences may aggravate IBS symptoms. 

Treatment ideally would vary with a good understanding of the cause. However, right now IBS treatment is trial-and-error. You might be offered a low dose of an anti-depressant. You might try the low-FODMAPS diet or probiotics.  Hypnosis is worth a try, too.

So is IBS a psychological problem? As with many conditions, the answer is Yes, and No. You do have a possibility of changing your symptoms by managing your responses to stress. But anyone who says “it’s all in your head” is ignorant about medicine, generally.  The mind affects the body, which affects the mind, which affects the body. 

A version of this story appears on Your Care Everywhere.

Temma Ehrenfeld is a New York-based science writer, and former assistant editor at Newsweek.Online:Temma Ehrenfeld’s writing portfolioLinkedIn

Published by Psychology Today on September 10th, 2020. To read from original link, please click here.

About Anna Pons

Certificat (CPPD), Post Graduat Certificat (PGCert) i Post Graduat Diploma (PGD) en Hipnoteràpia Clínica, London College of Clinical Hypnosis (LCCH) i Universitat de West London (UWL)
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