Abdominal bloating is the most bothersome symptom in irritable bowel syndrome with constipation (IBS-C): a large population-based Internet survey in Japan

Abstract

BackgroundAbdominal bloating is a common symptom in patients with irritable bowel syndrome with constipation (IBS-C). However, it is not included among the required items in the Rome III diagnostic criteria for IBS. Little is known about an impact of abdominal bloating seen in patients with IBS-C. Using a large population-based sample, the aim of the present study was to investigate what is the most bothersome symptom in subjects with IBS-C.MethodsAn Internet survey of 30,000 adults drawn from the general public throughout Japan was conducted to identify subtypes of IBS using the Rome III diagnostic questionnaire. Consecutively, the screened subjects with IBS-C and the same number of age- and sex-matched non-IBS subjects who were randomly selected as controls were asked to answer a questionnaire on the degree of anxiety they experienced in their daily lives, thoughts about bowel habit, and their dominant gastrointestinal symptoms together with exacerbation factors (for IBS-C only).ResultsThe screening survey showed that the prevalence of overall IBS was 16.5 % (female 17.4 %, male 15.5 %) and that 2.8 % met the criteria for IBS-C, 4.5 % for IBS with diarrhea (IBS-D) and 8.2 % for mixed IBS (IBS-M). Seven hundred and fifty-nine of 835 (90.9 %) subjects with IBS-C and 746 of 830 (89.9 %) control subjects completed the consecutive questionnaire. IBS-C subjects felt a higher degree of anxiety in their daily lives (p < 0.01) and considered bowel habit to be an indicator of health (p < 0.01) to a greater extent than control subjects. In IBS-C, the degree of anxiety was significantly associated with abdominal discomfort (p < 0.01), pain (p < 0.01) and bloating (p = 0.02), but not with the frequency of bowel habit (p > 0.1). Abdominal bloating was the most bothersome symptom (27.5 %), which was more likely to occur after a meal (52.2 %), at work/school (29.2 %) and during times of stress (26.8 %). Only 4.5 % of IBS-C subjects reported abdominal pain as the ‘most bothersome’ symptom.ConclusionsA large population-based Internet survey suggests that abdominal bloating has a great impact on the daily lives of subjects diagnosed with IBS-C. Not only bowel movement/abdominal pain but also abdominal bloating should be evaluated in patients with IBS-C.Electronic supplementary materialThe online version of this article (doi:10.1186/s13030-016-0070-8) contains supplementary material, which is available to authorized users.

Impact of symptoms by gender and age in Japanese subjects with irritable bowel syndrome with constipation (IBS-C): a large population-based internet survey

“…While the aim of the previous study was to identify the most bothersome symptom in patients with IBS-C [13], the aim of the present study was to investigate the prevalence of IBS-C symptoms by gender and age. Details of the survey are described in the previous report [13].…”

How much bloating in the irritable bowel syndrome?

“…Similar data come from the Far East: thus, in a Japanese online survey, Kanazawa et al reported that up to 30% of healthy subjects and almost all IBS patients may be affected by bloating [34].…”

“…In the majority of studies, the prevalence is higher in constipation-predominant IBS patients compared with diarrheapredominant IBS patients, while some investigators found no relation of bloating to any of IBS subtype [35,36]. A strong correlation between the severity of abdominal bloating and the degree of abdominal distension only in patients with constipation predominant IBS suggest that the pathophysiology may be different between subtypes of IBS [34,37]. Using plethysmography it has been demonstrated that most patients with abdominal distension also report abdominal bloating and that patients with bloating alone have lower sensory thresholds in the rectum compared to healthy subjects, since those with abdominal bloating and distension have normal or higher sensory thresholds [38].…”

“…But then, the increase in abdominal girth has been reported directly correlated with orocecal and colonic transit times, and inversely correlated with stool consistency [39]. Accordingly, abdominal bloating alone is rather the consequence of perturbed visceral sensitivity [34].…”

“…Bloating occurs or is exacerbated postprandial in approximately two-thirds of patients [48,49]. The presence of the symptom following meals intake is explained by increased visceral perception, increased gut contractions and impaired propulsive movement in response to the nutrition [34].…”