The role of abuse in the development of irritable bowel syndrome: a comparative study

M.A.Irritable Bowel Syndrome is defined as a chronic relapsing functional bowel disorder of unknown causes (Weber & McCallum, 1992). IBS is characterized by attacks of abdominal pain and change of bowel habit resulting in diarrhoea, constipation or both, where no structural alteration of the colon is found (Varis, 1987). The symptoms appear to result from a dysfunction of the intestine and are therefore said to be “functional” (Heaton & Thompson, 1999). The prevalence of IBS in the general population of Western countries is 14-24% of women. It is the most common cause of gut symptoms, and the most common reason that people go to their family doctor with a gut complaint. Despite all of this, physicians are still groping to understand the pathogenesis of IBS. The secret of success with IBS is to recognize it quickly and confidently. This is done primarily from the history, as there are no clinical tests that may be done to diagnose IBS. Once the diagnosis has been made it is of utmost importance that the sufferer is told, the syndrome is explained, and a good relationship is established with the health-care giver. Thereafter it becomes important to search for unspoken agendas in the life of the sufferer. According to the literature, stress can exacerbate IBS, and sexual, physical and emotional abuse can pose complex problems that require the assistance of a skilled counsellor. These problems, if left, may lead to the intensified symptoms of IBS. Society is becoming increasingly abusive and women and children often bear the brunt of physical, emotional and sexual abuse. Studies in America of women who present at medical facilities as well as those sampled from the community have found abuse rates that range from 20-76%. There is no reason to believe that these figures would be that different for South Africa. These studies have also found that abused women report a significantly higher number of medical problems and health-care system usage. A number of researchers have also found that there was a significant association between IBS and sexual abuse and physical abuse in childhood and adulthood. For the counselling psychologist the challenge is to unravel the mechanisms behind the symptoms, and to provide a rationale for therapy. The role that abuse may play in the development of IBS forms the cornerstone of the present study