April is the Irritable Syndrome (IBS) awareness month in Canada. IBS is a disorder affecting the intestine, involving problems with motility (movement of digested food through the intestines) and sensitivity (how the brain interprets signals from the intestinal nerves), leading to abdominal pain, changes in bowel patterns and other symptoms. Although often disruptive, debilitating and embarrassing, it may be some comfort to know that IBS is not life-threatening, nor does it lead to cancer or other more serious illnesses. Canada has one of the highest rates of IBS in the world, estimated 18% vs 11% globally. However, it is thought that IBS often remains under diagnosed. More than 70% indicate that their symptoms interfere with everyday life and 46% report missing work or school due to IBS. People with IBS frequently report feeling depressed, embarrassed and self-conscious. Their inability to predict symptoms places significant burden on daily living. IBS limits productivity and performance at work, has a negative effect on the quality of relationships, and limits participation in routine social activity.
The underlying cause of IBS is still unclear and there is no diagnostic disease markers for IBS. Guidelines recommend doctors make a positive diagnosis using criteria that are based on person’s symptoms.
Currently the treatments for IBS include pain management as well as diarrhea/constipation relief.
Endometriosis is a chronic inflammatory disease that mostly affects women in their reproductive age. According to a most recent estimate, over half a million Canadian women are affected by endometriosis. Women with endometriosis experience a range of symptoms, including pelvic pain and cramping during menstruation, non-menstrual pelvic, painful intercourse, heavy menstrual bleeding and chronic fatigue. Infertility is also commonly associated with endometriosis. The endometriosis-related symptoms considerably affect all aspects of women’s quality of life. The real cause of endometriosis is not known. The disease is characterized by spread of the uterine tissue in different organs within the body. As the monthly variation of hormone levels affect the function of the uterus, in women with endometriosis, the tissue that is localized outside the uterus reacts as well thus causing inflammation, pain and discomfort. The typical symptoms of endometriosis can often be confused with other chronic pain conditions and as a result there are often difficulties in getting it diagnosed. The traditional gold standard for definitively diagnosing endometriosis is through mini-surgery (laparoscopic visualization of lesions and histologic confirmation), and only recently has there been a push towards nonsurgical methods of diagnosis in Canada. For these and other reasons, many women experience a significant delay from the time of the onset of their symptoms to the diagnosis of the disease. In Canada, women with endometriosis reported an average delay of 5.4 years from onset of symptoms to final diagnosis.
The link between IBS and endometriosis: what do we know?
According to recent findings including Canadian research, a great number of women diagnosed with endometriosis are also affected by IBS. Because the symptoms of endometriosis and IBS are quite similar, the patients may be easily misdiagnosed or underdiagnosed.
Here are overlapping elements for both IBS and Endometriosis as per latest research data:
|Pelvic pain Lower back pain Abdominal cramps Quality of life: Irritability, anxiety, poor concentration, sleep disorders, depression, social disruptions, work absence|
|Cause not known Inflammatory process Chronic and debilitating Non-life threatening (benign) Affected by lifestyle mode, stress and diet Affect mostly lower abdomen Greater co-existence of both diseases in women|
|Screening and diagnostics:|
|Lack of diagnostic markers Delayed diagnose/misdiagnose|
|Symptomatic Pain management Diet and lifestyle|
There are currently few hypotheses as to why these two disorders co-exist in a significant number of women. The fact that presently there is no known cause for IBS and/or endometriosis means that the treatments are mainly symptomatic and there is a great need for more in-depth research. In this regard, according to recently published findings, the specific dietary changes employed to treat IBS have also improved endometriosis symptoms in patients affected by both disorders. This fact outlines a need for a closer review of existing treatments in order to offer a more evidence-based and individualized options to the patients. Indeed, there is a need for multidisciplinary approach towards diagnostics and management of endometriosis and/or IBS.
In perspective, the new findings linking endometriosis and IBS take us one step closer to uncovering the underlying mechanisms which control not only these two disorders, but also other disorders which share the same pathological pathways. The ongoing research will contribute towards improving the current clinical practice and will enable the development of more targeted treatments.
- Schomacker ML, Hansen KE, Ramlau-Hansen CH, Forman A. Is endometriosis associated with irritable bowel syndrome? A cross-sectional study. Eur J Obstet Gynecol Reprod Biol. 2018 Dec;231:65-69. doi: 10.1016/j.ejogrb.2018.10.023.
- Moore JS, Gibson PR, Perry RE, Burgell RE. Endometriosis in patients with irritable bowel syndrome: Specific symptomatic and demographic profile, and response to the low FODMAP diet. Aust N Z J Obstet Gynaecol. 2017 Apr;57(2):201-205. doi: 10.1111/ajo.12594.
- Lee CE, Yong PJ, Williams C, Allaire C. Factors Associated with Severity of Irritable Bowel Syndrome Symptoms in Patients with Endometriosis. J Obstet Gynaecol Can. 2018 Feb;40(2):158-164. doi: 10.1016/j.jogc.2017.06.025.
- DiVasta AD, Zimmerman LA, Vitonis AF, Fadayomi AB, Missmer SA, Overlap between Irritable Bowel Syndrome Diagnosis and Endometriosis in Adolescents, Clinical Gastroenterology and Hepatology (2020), doi: https://doi.org/10.1016/j.cgh.2020.03.014.
- Singh, Sukhbir et al.Prevalence, Symptomatic Burden, and Diagnosis of Endometriosis in Canada: Cross-Sectional Survey of 30 000 Women Journal of Obstetrics and Gynaecology Canada. https://doi.org/10.1016/j.jogc.2019.10.038
- Lovell RM and Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: A meta-analysis. Clin Gastroenterol Hepatol. 2012 Jul;10(7):712-21.e4
- https://cdhf.ca/digestive-disorders/irritable-bowel-syndrome-ibs/what-is-irritable-bowel-syndrome-ibs/ [accessed 16 Apr 2020].