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Stress Therapy Can Help Irritable Bowel

Don't Just Put Up With Symptoms; Treatments Can Improve Life Quality

From the WebMD Archives

Sept. 13, 2004 -- Tense, tired, depressed: For people with irritable bowel syndrome (IBS), dealing with their disease takes a mental and physical toll. Emotional state and energy level -- not just bowel problems -- need a doctor's attention, a new study shows.

Many doctors do a poor job of addressing their patients' fears and concerns and understanding how quality of life is affected, writes lead researcher Brennan M.R. Spiegel, MD, MSHS, a gastroenterologist with The David Geffen School of Medicine at UCLA and the VA Greater Los Angeles Healthcare System.

His paper appears in the latest Archives of Internal Medicine.

"There's a disconnect between how patients and doctors view the disease," Spiegel tells WebMD. "Doctors are trained to think about bowel movements -- their frequency, their color, texture. But this study shows that our patients feel we are underestimating the severity of the effect on their quality of life."

It's very clear that IBS can reduce quality of life, he adds. "It causes what we refer to as 'vital exhaustion' -- loss of vitality, sleep disorders, sexual dysfunction, feeling tired all the time, dispirited, low energy -- all the things that interfere with quality of life."

Picture of Health

Spiegel has developed a quality-of-life survey that busy doctors can use. He used the survey on 770 patients with irritable bowel syndrome. Each completed the questions: Do you feel low in energy? Nervous? Hopeless? Tense? Tire easily? Have sleep difficulties? Not interested in sex? Feel there is something seriously wrong with your body? They also answered questions related to their bowel problems.

Physical health-related quality of life is related to the severity of bowel problems, frequency, and pain, he explains. But mental health-related quality of life is related to sexuality, mood, and anxiety.

His study showed that how patients felt physically and mentally affected their quality of life. Patients who got tired easily had a 9% lower physical health-related quality-of-life score, compared with those who didn't tire easily. Patients whose symptoms flared up for a day had a 4% lower physical health-related quality-of-life score. If they had both problems, they lost 13% in quality-of-life scores.

Mental health had a similar impact; patients who felt tense had a 14% lower mental health-related quality of life. When their IBS symptoms interfered with their sexual function, they had a 4% lower mental health-related quality of life. For those who had both problems, their mental health-related quality of life was 17% lower.

"We have to spend some time talking about these emotional issues," Spiegel tells WebMD. "Sometimes, all that's necessary is letting a patient know it's not cancer, that it will not cause cancer. That in itself can help relieve the depression and anxiety."

Stress Therapy, Medications Help

Many people put up with symptoms of IBS without getting treatment. "Yet the quality-of-life impact of IBS has been shown to be comparable to congestive heart disease and may be as great as diabetes," says William E. Whitehead, PhD, director of the Center for Functional GI and Motility Disorders Center at the University of North Carolina School of Medicine.

"The anxiety and stress can impact how well a patient interacts with friends and family," he tells WebMD. "Also, work absenteeism is three times higher for irritable bowel patients, compared to rest of the population."

There are a range of effective treatments for irritable bowel, says Whitehead. "Treatments range from low doses of antidepressants, hypnosis, [stress] therapy to dietary changes, medicines for constipation and diarrhea, a whole spectrum of treatments."

It's true that "with IBS one symptom can make other symptoms seem worse," says Ryan Madanick, MD, a gastrointestinal specialist at the University of Miami School of Medicine. "It's like when you're under stress, you tend to respond more negatively to stimuli that don't normally cause you problems, they irritate you. With IBS, it seems to be the same thing going on in the intestine.

"Antidepressants and anti-anxiety medications probably help the most, because unfortunately stress-related disorders and IBS go hand in hand," Madanick tells WebMD. "If you can decrease the stress, you're breaking the cycle and improving overall quality of life."

Also, make regularly scheduled visits for irritable bowel problems, not visits on an emergency basis, he advises.

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Sources

SOURCES: Spiegel, B. Archives of Internal Medicine, Sept. 15, 2004; vol 164: pp 1773-1780. Brennan M.R. Spiegel, MD, MSHS, gastroenterologist, The David Geffen School of Medicine, UCLA, and the VA Greater Los Angeles Healthcare System. William E. Whitehead, PhD, director, Center for Functional GI and Motility Disorders, University of North Carolina School of Medicine. Ryan Madanick, MD, gastrointestinal specialist, University of Miami School of Medicine.
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