When we look at our health, particularly ill health, we often try to pinpoint what made us unwell in the first place. The need to understand the cause of illness is deeply ingrained with us and promoted by the medical approach to illness – if I can determine what caused it, then I can take steps to solve it or avoid it next time. In many illnesses there isn't one sole factor that contributes to symptoms, one of these is irritable bowel syndrome (IBS). This can feel complex and overwhelming as how do you begin to manage something when there isn't one specific change that will solve the symptoms. People can end up feeling stuck as a result.
The best way for us to understand what started off and maintains IBS symptoms is to take a holistic approach. We can look through a wider lens and capture more of what's going on by using a biopsychosocial model. The biopsychosocial model may sound complex but it's been around for a while. It was first identified by George Engel in 1977 where he said that the best way for us to make sense of a person’s condition is to look at the biological, psychological, and social factors involved and the interaction between them. Yet we find that many health conditions (including IBS) are still viewed and treated predominantly from a biological perspective. IBS affects the function of the bowels and so that means there isn’t a specific medical test that can pick it up. Instead tests are done to rule out any potential infections of the gut or other issues that can be observed. Given that we know this, it almost sounds bizarre that it would be treated purely from a medical standpoint without consideration of other factors.
Biological factors refer to the physiological changes that occur in the gut and nervous system and do have a role to play in the development of IBS. A bout of food poisoning, gastroenteritis or other bacteria or virus could kick off bowel symptoms and increase sensitivity of the gut. The changes that occur affect how the digestive system functions and even once the initial infection clears up, the symptoms persist. This means that what started off the symptoms may not necessarily be what is keeping them going. For some people there is a clear physiological trigger point and for others it may not be so clear. During the experience of symptoms, psychological and social factors get added into the mix, which is why people with IBS often have difficult symptom journeys.
The psychological element includes factors such as stress, thoughts, emotions and beliefs. Feeling anxious, low, or stressed, whether about the gut symptoms and/or other issues can make symptoms worse by affecting the physiology of the gut. People can also adopt ways to cope and habits that are not so helpful for the gut and keep the symptoms going.
Both the biological and psychological factors occur within a social context. Social factors include social support, lifestyle, and environmental factors. As part of the social factors is societal norms and how we’ve been raised to look at toileting behaviours and bowel symptoms. That could incorporate ideas such as going to the toilet is unclean and people shouldn’t talk about it because it’s taboo. The different attitudes that people hold and articulate can contribute to the way people feel about their symptoms and ultimately how they cope once they start to get symptoms. A common worry in IBS is how the symptoms will be viewed by others, what if they occur in a social setting, will they be judged etc. You can see how this links in with the psychological factors and emotions like embarrassment, anxiety and stress.
All of the factors overlap and considering only one of the above doesn't take into account the interactions and how that can keep symptoms going. Taking a biopsychosocial approach to IBS recognises that each person’s symptom journey is unique, and a holistic approach is needed to effectively manage symptoms. A degree of influence and control is given back to individuals as they can be supported to explore their personal models and make changes specific to their own experiences.