Educationals

Studies have consistently revealed the presence of psychiatric illness, mainly depression in the patients with IBS. Symptoms of Irritable Bowel Syndrome are often preceded by psychological distress or depression. Moreover effective treatment of depression relieves gastrointestinal symptoms. It has also been observed that the patients Irritable Bowel Syndrome are much more likely to have had a history of anxiety, somatization disorder or major depression than those with inflammatory bowel disease.

Personality Characteristics

The personality traits of orderliness, punctuality, cleanliness, rigidity and obsessive complusiveness are present in the patients suffering from Irritable bowel syndrome. These traits correspond to the concept of anal personality according to Freudian psychoanalysis. Others have observed that conflicts regarding giving, receiving and aggression result into the symptoms of diarrhoea and constipation. Constipation was seen as withholding a manifestation of stubbornness, and diarrhoea suggested unconscious aggressive urges. However further work needs to be done before we come to any definitive conclusion.

Diagnosis

Any patient complaining of abdominal pain and persistent alternating diarrhoea and constipation should undergo a thorough medical and psycho social evaluation including necessary investigations, laboratory tests and speciality consultations. When disorders such as carcinoma, tuberculosis peptic ulcer disease, inflammatory bowel disease, lactose intolerance, gall bladder and heart disease have been satisfactorily ruled out; the diagnosis of Irritable Bowel Syndrome should be considered. It must be remembered that patients are often reluctant to accept or identify psychosocial stresses in their lives and would rather prefer a physical diagnosis other than a psychogenic one. As such both the patients and treating physicians tend to avoid psychiatric consultations which result into palliative symptomatic physical approaches, inadequate psychiatric assessment and intervention that leads to chronicity and unnecessary suffering to the patient.

Management

The patient should counseled that IBS is a biological vulnerability that worsens with psychosocial stress. A multimodal treatment plan consisting of medical psychopharmacological and psychotherapeutic modalities would be beneficial. All the contributing factors should be identified and should be taken care of. Customary medical treatments include antispasmodics and analgesics, anticholinergics, bulk forming agents, diet modifications etc. A patient suffering from IBS having an identifiable depressive disorder will benefit from treatment of his depression.