Many Kenyans experiencing constant stomachaches and diarrhoea may have irritable bowel syndrome (IBS) yet they do not know.
Dr Okanga Oranga, a consultant gastroenterologist in Nairobi, defines IBS as a functional disorder of the bowel and a common gastrointestinal disorder affecting the colon.
IBS is characterised by a group of symptoms, including abdominal pain or cramping, bloating, gas, diarrhoea, constipation, or an alternation between these.
To diagnose IBS, Dr Okanga says you must have had these symptoms for at least more than three days a week for the last three months.
This is because abdominal pain is a common symptom of many diseases.
“IBS is a common functional disorder of the gastrointestinal tract. It's not a structural disorder, so most tests for structural disorders will come back normal if you have IBS,” says Dr Okanga.
Causes of IBS
The exact cause of IBS is not fully understood but is linked to a combination of factors.
"There are only theories about the possible causes of IBS. Some people may develop IBS following infections in the gastrointestinal tract, such as H. pylori or diarrhoea, which can make the bowel more sensitive," he says.
Researchers believe that IBS results from a complex interaction between the brain, gut and digestive system. However, factors such as stress, diet, hormones and intestinal muscle contractions are also thought to play a role.
Treatment
Medications for IBS are often used to manage symptoms rather than cure the condition because the exact cause of IBS is not fully understood.
“The type of medication prescribed usually depends on the predominant symptoms, such as diarrhoea, constipation, or both," says Dr Okanga.
IBS is a chronic condition, which means it usually does not go away for good. While there is no cure, with the right treatment and lifestyle changes, symptoms can ease, improve, or even disappear for long periods.
Chronic nature: IBS is related to how the brain and gut communicate (the gut-brain axis), and this connection is not something that can be permanently ‘fixed'.
Triggers: Stress, diet and other factors can trigger symptoms. These triggers can be present throughout life, making it a condition that needs ongoing management rather than something that goes away completely.
Individual variability: IBS affects people differently, and some may experience more persistent symptoms, while others may have long periods of relief.
In addition, if you are at risk of developing IBS or already have symptoms, there are ways to reduce your risk or manage triggers to keep symptoms under control.
“Managing IBS involves lifestyle and dietary changes, such as increasing fibre intake and avoiding trigger foods like fatty foods, caffeine, and certain dairy products. This may include avoiding milk and wheat products. It can be difficult to pinpoint the exact food triggers and to manage stress,” says Dr Okanga.
However, symptoms can improve significantly over time or even disappear for months or years. Many people experience remission where they have little or no symptoms. But it is also common for symptoms to return during periods of stress, dietary change, or illness.
Hormonal changes, particularly those associated with menstruation, pregnancy, or menopause, are thought to play a role. Many women experience worsening IBS symptoms during their menstrual cycle due to changes in oestrogen and progesterone.
Complications of IBS
Although IBS itself does not cause serious complications, Dr Okanga notes that it can cause misery because of the pain and misdiagnoses. “We’ve had patients who are taken for surgery. They go for surgery, and the appendix is removed. The pain is still there. Some go for surgery and the gallbladder is removed because they think the gallbladder is the source of the pain,” he says.
Other complications, he says, are related to the treatment process, which is aimed at the abdominal pain, and can be so costly.
“There’s also the issue of unnecessary investigations because patients come in for CT scans, abdominal scans, endoscopies, colonoscopies, and abdominal MRIs, so it can be financially draining,” he notes.
Other complications of IBS include dehydration and haemorrhoids.
More common in women than in men
Dr Okanga says IBS is more common in women than in men because “women tend to seek help, seek medical attention more than men. Even in other parts of the world, we find that women tend to seek consultation for IBS more than men,” he says.
Dr Okanga advises seeking professional advice.
“If you have had pain for a long time and surgery is being suggested and imaging tests show no abnormality yet a surgeon is ready and wants to take your organ. It's just good to get a second opinion before you agree,” he says.
