“I used to feel lethargic all the time,” says Nuzhat*, a professional in her 30s, who works for a private firm. “Gastro-intestinal [GI] issues had become a norm for me. I decided to see a doctor who got some blood work done and diagnosed that I have irritable bowel syndrome [IBS].”

IBS is a chronic and unpredictable condition where the patient experiences a variety of GI issues ranging from diarrhoea, constipation, bloating, gas, food intolerance and pain. It can also lead to nutrients not being absorbed properly through the stomach, leading to fatigue and listlessness. People suffering from IBS often become reclusive because it is not easy to talk about this condition, let alone have it conclusively diagnosed and deal with it.

IBS can affect people of all ages, but it is usually seen in young people between the ages of 20 and 40. There is very limited data available on the prevalence of IBS in Pakistan, and little awareness about the condition. According to various recent studies, it affects around 33-34 percent of the population, while women experience it more than men.

Fizza*, who is in her forties and works for a multinational company, was crippled by severe GI issues. Home remedies, antibiotic rounds — nothing helped her. She had joint and muscular pains, and brain fog that came and went. She felt listless and started avoiding social meets, as she was afraid she may have to run to the washroom the minute she would eat.

Irritable Bowel Syndrome or IBS is difficult to diagnose and often makes life miserable for those suffering from it. But lifestyle changes can help people to manage it

“I would always worry about what I had eaten. Either it didn’t suit me or it must have been off, I would think,” she says. “I decided to consult a doctor who advised a series of lab tests, scopes, scans and antibiotics. The diagnosis was IBS. Given the state and availability of public toilets in the country, I started staying home a lot because, quite often, I needed to use the toilet urgently and also because of the malabsorption of nutrients, I felt listless.”

“In our part of the world, we see more cases of diarrhoea than constipation,” explains says Prof Dr Ghulam Ali Mundrawala, gastroenterologist at Anklesaria Hospital, Karachi. “Primary GI symptoms lead to secondary GI and overall symptoms. It can get so overwhelming that people have to take time off from work.”

As to what causes IBS, there are several theories. “It is not yet known what causes IBS, but a disrupted brain-gut connection is linked with it,” he says. “The brain controls the GI system and stress leads to IBS. Some experts even describe it as a psychological problem.”

Signals between the brain and digestive tract may play a role, while some researchers are also studying to see if certain bacteria in the bowels are responsible for the condition.

Since a definite cause of IBS is not yet known, there is no definite diagnostic tool. “Before confirming that a person has IBS, it is important to exclude everything else that could cause the symptoms,” says Dr Mundrawala. “Blood tests, colonoscopy, endoscopy, etc. may be required for diagnosis, depending on the severity of issues. When all else has been investigated and the symptoms persist, then we conclude that it is IBS.”

Problems that need to be ruled out are food allergies, ulcerative colitis or Crohn’s disease, celiac disease, thyroid problems, etc.

“Medicines are prescribed according to the symptoms, i.e. for diarrhoea, anti-diarrhoeals are given and for constipation, laxatives are prescribed,” says Dr Mundrawala. “But since stress plays a major role, it is important to explain to the patient that it is a condition that people can manage themselves.”

IBS is a chronic and unpredictable condition where the patient experiences a variety of GI issues ranging from diarrhoea, constipation, bloating, gas, food intolerance and pain. It can also lead to nutrients not being absorbed properly through the stomach, leading to fatigue and listlessness.

Some people’s digestive systems do not accept dairy products (especially milk), wheat, fructose (sugar in fruits), fatty foods, and carbonated drinks. But there is no proof that any of these foods cause IBS, though they may trigger symptoms. The key to managing IBS symptoms is to avoid triggers such as irritating foods or stressful situations that trigger the symptoms.

Nuzhat was told that the main cause of IBS with her was stress, junk food and a disturbed sleep routine. “I was under a lot of stress and fatigue when the symptoms initially began,” she says. “Now I avoid fried food, bakery stuff, beef, spices and anything that aggravates stomach acidity.” Nuzhat only takes her prescribed meds when she feels the symptoms coming on.

“I couldn’t pinpoint what was going on with my digestive system but it was horrible,” says Shahnaz*, a 50-plus banker. “Then my lactose intolerance became aggravated, which meant more GI issues.” She consulted a specialist who ran a battery of tests to rule out other things and prescribed some medicines that didn’t help.

When multiple trips to the washroom resulted in anal fissures with debilitating pain, a friend urged her to consult a surgeon. “I had surgery for fissures and finally my meds are working,” concludes Shahnaz who now avoids dairy and eggs. “IBS should not be ignored because it creates malabsorption that affects your entire well-being.”

IBS is often associated with lactose intolerance, as one in three people with IBS don’t feel good after eating dairy. It could also be because dairy irritates the already sensitive intestines of people with IBS.

Living with a condition such as IBS can sometimes be challenging. One has to adjust one’s lifestyle. “Some days are good, some bad,” says Fizza. “Some days I feel as normal as any other person, and some days I can’t go out, meet my friends, and even have to miss special events.”

Nuzhat believes that life gets better if you adhere to the rules. “As long as I avoid stress and eating out or very spicy home-cooked food, I have no trouble. If I get slack then it affects my life badly.”

Symptoms that keep changing and are hard to talk about add to the challenge of living with IBS. It affects not only the person who suffers, but also the person’s family, friends and co-workers. But millions of people live with their disorder every day and manage through not-always simple or straightforward ways.

Finding out what works best and healthy living are obviously important in managing this enigmatic disease.

*Name changed to protect privacy

The writer is a freelance journalist and tweets @naqviriz

Published in Dawn, EOS, April 24th, 2022