Pharmacy teams can play an essential role for patients with Irritable Bowel Syndrome (IBS) by helping them identify symptoms, discussing possible treatment options, and educating them about the disease.
Counter assistants and staff can help to recognize patients who likely have IBS and either attempt to self-medicate with various OTC products such as herbal supplements or have prescriptions for antidiarrheals or laxatives.
Proactive questioning of the patient will allow pharmacy staff to assess the appropriateness of the medications or identify a need for referral to other health care professionals for further evaluation. Finally, it is also important to reassure the patient that IBS remains a manageable illness for the most part.
Irritable bowel syndrome (IBS) is quite common with as many as 1 in 5 people affected. It is twice as common in women as men and happens most often to people in their 20s and 30s.
IBS is a disorder of the gut whereby the function of the gut is disturbed. However there are no physical or structural abnormalities. It causes a variety of symptoms, which are discussed in further detail below. It usually first appears in teenagers and young adults.
Symptoms of IBS include loose, frequent stools, constipation, bloating, and abdominal pain and cramps. Patients may notice symptoms following the intake of specific foods or that symptoms, such as stool consistency or pain location, change over time. Patients may also present with headache, lethargy, nausea, bladder symptoms or faecal incontinence.
Pain and discomfort may occur in different parts of the abdomen. Pain usually comes and goes. The length, severity and timing of each bout of pain can also vary greatly. The pain often eases when passing stools (motions or faeces) or wind. Many people with IBS describe the pain as a spasm or colic.
Bloating and swelling of the abdomen may develop from time to time. Sufferers may pass more wind than usual. Other symptoms can sometimes occur and include: nausea (feeling sick), headache, belching, poor appetite, tiredness, backache, muscle pains, feeling quickly full after eating, heartburn, and bladder symptoms (an associated irritable bladder).
Some people have occasional mild symptoms. Others have unpleasant symptoms for long periods. Many people fall somewhere in between, with flare-ups of symptoms from time to time.
Diet
Most IBS sufferers believe that certain foods cause or exacerbate their symptoms and thus exclude these foods from their diet. Insufficient evidence exists, however, to support exclusion diets or food allergy testing once lactose intolerance and celiac sprue are excluded.
Alternatively, some may find it helpful to keep a food diary to determine if gas-producing foods (eg, beans, cabbage, onions, broccoli), carbonated drinks, sorbital, lactose, or wheat aggravate their symptoms and then avoid or limit them to determine if symptoms improve.
Many IBS patients who seek medical care suffer from anxiety or depression and benefit from psychological therapies, including cognitive-behavioural therapy, hypnotherapy, and dynamic psychotherapy.
Pharmacologic treatment is aimed at relieving the predominant GI symptom, but the goal should be to improve the overall or global symptoms, including altered stool frequency and consistency, abdominal pain and discomfort, bloating, and quality of life.
Antispasmodics may provide short-term relief of abdominal pain and discomfort in IBS, but support for long-term efficacy is not available. Antispasmodics are associated with adverse effects (eg, dry mouth, blurred vision, dizziness, urinary retention), which may limit their use and should be avoided in IBS-C or IBS-M, as they may worsen constipation.
IBS and Heartburn
As many as 2 out of 3 people with IBS also have symptoms of GERD. GERD and IBS both impact segments of the digestive tract, but the connection between the two is unclear. Theories explaining the overlap include:
• Pain sensitivity: Both conditions arise when nerves in the gut become over-sensitive (visceral hypersensitivity). This causes changes in the muscle contractions of the intestines and esophagus.
• Confusion over symptoms: IBS patients with GERD symptoms may actually have functional dyspepsia (indigestion). This is a milder form of GERD. Tests such as ambulatory oesophageal pH monitoring can confirm a diagnosis of GERD.
• The broad definition of GERD: GERD symptoms vary in severity. IBS-like symptoms may be part of the same spectrum of GERD, leading to patients reporting symptoms of both conditions.
Pharmacy Considerations:
– Am I aware of guidance which states sufferers should try to eat at about the same time each day to help regulate bowel function?
– Am I aware of food triggers for IBS?
– Am I aware of the associated conditions and appropriate OTC medications which may help?
– Ensure there is a discreet area within the pharmacy for customers to discuss their condition in a confidential manner
– Diet and lifestyle changes can go a long way to minimise IBS flare-ups, am I confident in advising these changes to customers?
