What are the complications of IBS?

Canadians have one of the highest rates of irritable bowel syndrome (IBS) in the world. Unsurprisingly, this makes IBS a leading cause of work absenteeism in Canada. And, because it’s typically a lifelong condition, individuals with IBS often require medical support across their lifespan. Without treatment, it can result in a number of complications.

However, the symptoms of IBS can make it hard to access healthcare. Unpredictable diarrhea and uncomfortable bloating and gas can make it hard to travel to an appointment. Moreover, many Canadians either can’t access timely medical care or don’t have a family doctor at all. This can leave them wrestling with severe IBS symptoms alone, sharply affecting their quality of life.

Going it alone doesn’t have to be your only option — we can help. Maple is a virtual care platform that seamlessly connects you with Canadian-licensed doctors and specialists from your phone, tablet, or computer. With Maple, you can ditch the anxiety of having to use a public washroom, or the hassle of lining up for hours at the walk-in clinic. Instead, we can help you connect with an online doctor from home or wherever else that’s most comfortable for you.

What causes IBS?

IBS is a bit of a mystery in more ways than one. Not only is its underlying cause unclear, but testing for it isn’t possible either. This can make it difficult to figure out if you have IBS or something else. As a result, IBS is a diagnosis of exclusion, meaning your provider will only diagnose it after they’ve eliminated other possibilities.

While its exact cause is unclear, doctors think IBS is partly due to your brain being overly sensitive to the sensation of food travelling through your digestive tract. Neuroimaging studies have backed this theory up, showing changes in parts of the brain responsible for attention, emotion, and pain modulation. As a result, it’s referred to as a functional gastrointestinal disorder or a disorder of gut-brain interaction.

Likely, IBS also has something to do with your immune system and the permeability of the mucosal lining of your digestive tract. Due to its high prevalence in women, hormones may also play a role.

Signs and symptoms of severe IBS

IBS can be severe and many report a decreased quality of life as a result of their symptoms. These can include:

Bloating, gas and abdominal pain are common with IBS and can be severe
Constipation causing straining, which can result in hemorrhoids
Diarrhea and fecal urgency, which due to their unpredictability, stool volume, and consistency can cause incontinence
Feeling like you haven’t emptied your bowels completely
Low energy and fatigue due to both connectivity within a network in the brain and immune activation
IBS risk factors and triggers

It’s unclear why certain individuals develop IBS and others don’t. You can have the condition without any risk factors, or have many of them and not develop IBS. Still, you’re more likely to be diagnosed with IBS if you:

Are a current smoker
Are between your teens and your 40s
Have someone in your family with IBS
Are a woman
Were exposed to trauma, such as childhood abuse
Had a gastric event such as a parasite infection or food poisoning
Regularly experience high stress levels
Have a psychiatric comorbidity — somewhere between 50-90% of patients with IBS also have a mental illness, especially generalized anxiety disorder and depression.

While it’s unclear why some develop IBS and others don’t, symptom flare-ups are better understood. It’s a good idea to keep a journal to note your specific triggers, but the following are some of the most general:

Alcohol

Alcohol is rough on the stomach and contributes to faster digestion. This can exacerbate symptoms significantly, especially diarrhea.

Certain foods

While individuals are likely to have their own unique dietary no-go zones, there are no specific foods that cause IBS. Never-the-less, many individuals report issues with fried foods, certain artificial sweeteners, and caffeine. Regularly skipping meals and eating late at night can also be problematic.

If you’re unsure about your trigger foods, it’s a good idea to keep a food journal and consider working with a dietitian to ensure you’re eating a balanced diet while eliminating triggering foods.

Certain medications

Because they change your intestinal flora, antibiotics are frequent causes of IBS flare-ups. Antidepressants, by contrast, can both cause flare-ups and calm symptoms of IBS. Unfortunately, knowing whether an antidepressant will worsen or help your condition may come down to trial and error.

Stress

The gut-brain axis is the bi-directional communication system between your brain and your digestive system. While this is a crucial pathway of information for your body, it also means that stress often serves as a significant trigger for IBS symptoms.

How do you know if IBS is severe?

Because the inside of your colon appears normal with IBS, your doctor has no way of measuring how severe your symptoms are. Ultimately, it depends on how much it’s interfering with your life. If you’re unable to effectively manage your IBS symptoms so you can work, study, sleep, or socialize, your condition is severe.

How to treat severe IBS

There’s no cure for IBS. As a result, treatment for severe IBS centres around minimizing and managing symptoms. This should include dietary interventions and exercise, as both have been shown to reduce symptom severity.

Since fibre absorbs water and helps to bulk up your stool, adding it to your diet can also be helpful whether you’re experiencing diarrhea, constipation, or mixed symptoms. You can do this by eating more fruits and vegetables or by taking a pill or powder fibre supplement. But be warned, increasing your fibre intake without upping your water intake will have the opposite effect, so make sure to drink more water if you choose to do this.

However, all of these interventions take time to achieve results, making them effective long-term solutions, but not much help during an acute attack. So, what should you do when IBS pain is severe? Research suggests that peppermint oil can successfully reduce pain and bloating.

Many individuals also swear by heat. They report that applying a heating pad or hot water bottle to their stomach helps to soothe discomfort. Over-the-counter diarrheal medications are another alternative to relieve cramping.

Irrespective of your management techniques, if severe IBS symptoms have become the norm, or you’re experiencing symptoms onset after 50, rectal bleeding, nocturnal diarrhea, unexplained weight loss, or progressive abdominal pain, it’s best to speak to a doctor to rule out the possibility of another medical condition. You should also inform them if you have a family history of inflammatory bowel disease or colorectal cancer.

If needed, they can prescribe medications like Lotronoex (alosetron) or Viberzi (eluxadoline) to minimize cramping and stomach pain. Alternatively, they may suggest antidepressants in smaller doses, which can be effective for blocking pain.

Health Canada has also approved alternative therapies for use in treating IBS, including prescription digital therapeutics like cognitive behavioural therapy (CBT).

Complications of IBS during pregnancy

While IBS complications aren’t life-threatening, they can complicate your pregnancy. For example, data suggests that having IBS increases your risk for preeclampsia and deep vein thrombosis (a blood clot in a vein) during pregnancy. It may also increase the risk of miscarriage and ectopic pregnancy, along with the possibility of congenital birth defects in the baby.

Beyond that, pregnancy precipitates hormonal changes, which can worsen IBS symptoms. And, pregnancy food cravings can drive you to eat things that can cause severe IBS flare-ups. Moreover, trying to manage your symptoms through diet can deprive you and your baby of needed nutrients. This makes connecting with a dietitian an invaluable resource to ensure you’re eating optimally for your health and your child’s.

What happens if IBS is left untreated?

If you’re wondering if untreated IBS can lead to something serious like a higher risk of colon cancer, the answer’s no. IBS won’t impact your overall life expectancy or turn into another type of digestive disorder.

But, IBS can affect your quality of life. As such, the dangers of untreated IBS include physical health complications as well as mental ones. These are some of the most common.

Hemorrhoids

Caused by increased pressure from straining during a bowel movement, hemorrhoids are often a chronic issue with IBS. While hemorrhoids are treatable, they’re likely to recur unless you resolve the underlying constipation causing them.

Severe cramping and pain

It’s common to experience cramping and severe stomach pain with IBS. In extreme cases, the severity of symptoms can affect your ability to sleep, work, or even leave the house.

Bowel incontinence

Almost one in five IBS patients reports an episode of bowel incontinence at least once a month. This can cause significant distress, impacting your ability to work and your mental health.

Pelvic floor dysfunction

Regular constipation can strain your pelvic muscles, leading to pelvic floor dysfunction. This can further exacerbate existing constipation, cause back pain, and give rise to urinary urgency and incontinence. In women, this can sometimes lead to pelvic floor prolapse, when one or more of the organs inside your pelvis — like your uterus, bladder, or bowel — move down into the vagina.

Inadequate nutrition

Many individuals find relief from their IBS symptoms by managing their diet. However, sticking to a restrictive regimen like the low-FODMAP diet without replacing problem foods with nourishing alternatives may leave you nutritionally deficient.

Mental health issues

The mental health complications of living with severe IBS are well documented. Symptoms can be unpredictable, leaving you reluctant to venture too far from a bathroom and restricting your behaviour. This can make it hard to socialize, study, or work, causing mental health issues such as anxiety and depression.

When to see a doctor for your IBS and how Maple can help

You should speak to a healthcare provider anytime your IBS symptoms change or get worse. While IBS doesn’t increase your risk of colorectal cancer, both conditions share symptoms such as chronic diarrhea, constipation, gas, and bloating, making it possible to miss the initial signs of colon cancer if you have IBS.

In the same vein, if you have rectal bleeding, blood in your stool, or are experiencing unexplained weight loss, speak to a healthcare provider right away. These aren’t the expected complications from an IBS flare-up and may indicate other health issues.

Even if your symptoms haven’t changed, if they’re causing you to avoid activities or you’re finding it difficult to manage them, you should seek out medical advice.

Seeing an online doctor can provide the help you’re looking for without the disruption or anxiety of leaving the house. What’s more, if you need a prescription, they can issue one during your appointment and send it to the pharmacy you choose for pick up or delivery to your doorstep.

Alternatively, if you’re looking for comprehensive dietary support for your IBS, it’s a good idea to speak to an online dietitian. A dietitian can help you control your symptoms while still ensuring your body gets the vitamins, minerals, and calories it needs to stay healthy. And, you don’t have to take time off work or fight the traffic to do it.

If you feel like you’re not in control of your IBS, it’s time to make a change. With support, symptoms are manageable. Reach out to speak to a doctor today and stop IBS from having power over your life.

This blog was developed by our team and reviewed by a medical professional.