Skip to main content
Top
Published in: BioPsychoSocial Medicine 1/2016

Open Access 01-12-2016 | Research

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

Authors: Motoyori Kanazawa, Hiroto Miwa, Ayako Nakagawa, Masanori Kosako, Hiraku Akiho, Shin Fukudo

Published in: BioPsychoSocial Medicine | Issue 1/2016

Login to get access

Abstract

Background

Abdominal 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.

Methods

An 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).

Results

The 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.

Conclusions

A 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.
Appendix
Available only for authorised users
Literature
1.
go back to reference Lovell RM, Ford AC. Global prevalence of, and risk factors for, irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012;10:712–21.CrossRefPubMed Lovell RM, Ford AC. Global prevalence of, and risk factors for, irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012;10:712–21.CrossRefPubMed
2.
go back to reference Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006;130:1480–91.CrossRefPubMed Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006;130:1480–91.CrossRefPubMed
3.
go back to reference Monsbakken KW, Vandvik PO, Farup PG. Perceived food intolerance in subjects with irritable bowel syndrome - etiology, prevalence and consequences. Eur J Clin Nutr. 2006;60:667–72.CrossRefPubMed Monsbakken KW, Vandvik PO, Farup PG. Perceived food intolerance in subjects with irritable bowel syndrome - etiology, prevalence and consequences. Eur J Clin Nutr. 2006;60:667–72.CrossRefPubMed
4.
go back to reference Simrén M, Mansson A, Langkilde AM, Svedlund J, Abrahamsson H, Bengtsson U, Bjornsson ES. Food-related gastrointestinal symptoms in the irritable bowel syndrome. Digestion. 2001;63:108–15.CrossRefPubMed Simrén M, Mansson A, Langkilde AM, Svedlund J, Abrahamsson H, Bengtsson U, Bjornsson ES. Food-related gastrointestinal symptoms in the irritable bowel syndrome. Digestion. 2001;63:108–15.CrossRefPubMed
6.
go back to reference Kanazawa M, Endo Y, Whitehead WE, Kano M, Hongo M, Fukudo S. Patients and nonconsulters with irritable bowel syndrome reporting a parental history of bowel problems have more impaired psychological distress. Dig Dis Sci. 2004;49:1046–53.CrossRefPubMed Kanazawa M, Endo Y, Whitehead WE, Kano M, Hongo M, Fukudo S. Patients and nonconsulters with irritable bowel syndrome reporting a parental history of bowel problems have more impaired psychological distress. Dig Dis Sci. 2004;49:1046–53.CrossRefPubMed
7.
go back to reference van Tilburg MA, Palsson OS, Whitehead WE. Which psychological factors exacerbate irritable bowel syndrome? Development of a comprehensive model. J Psychosom Res. 2013;74:486–92.CrossRefPubMedPubMedCentral van Tilburg MA, Palsson OS, Whitehead WE. Which psychological factors exacerbate irritable bowel syndrome? Development of a comprehensive model. J Psychosom Res. 2013;74:486–92.CrossRefPubMedPubMedCentral
8.
go back to reference Houghton LA, Lea R, Jackson N, Whorwell PJ. The menstrual cycle affects rectal sensitivity in patients with irritable bowel syndrome but not healthy volunteers. Gut. 2002;50:471–4.CrossRefPubMedPubMedCentral Houghton LA, Lea R, Jackson N, Whorwell PJ. The menstrual cycle affects rectal sensitivity in patients with irritable bowel syndrome but not healthy volunteers. Gut. 2002;50:471–4.CrossRefPubMedPubMedCentral
9.
go back to reference Houghton LA, Whorwell PJ. Towards a better understanding of abdominal bloating and distension in functional gastrointestinal disorders. Neurogastroenterol Motil. 2005;17:500–11.CrossRefPubMed Houghton LA, Whorwell PJ. Towards a better understanding of abdominal bloating and distension in functional gastrointestinal disorders. Neurogastroenterol Motil. 2005;17:500–11.CrossRefPubMed
10.
go back to reference Chang L, Lee OY, Naliboff B, Schmulson M, Mayer EA. Sensation of bloating and visible abdominal distension in patients with irritable bowel syndrome. Am J Gastroenterol. 2001;96:3341–7.CrossRefPubMed Chang L, Lee OY, Naliboff B, Schmulson M, Mayer EA. Sensation of bloating and visible abdominal distension in patients with irritable bowel syndrome. Am J Gastroenterol. 2001;96:3341–7.CrossRefPubMed
11.
go back to reference Törnblom H, Van Oudenhove L, Sadik R, Abrahamsson H, Tack J, Simrén M. Colonic transit time and IBS symptoms: what’s the link? Am J Gastroenterol. 2012;107:754–60.CrossRefPubMed Törnblom H, Van Oudenhove L, Sadik R, Abrahamsson H, Tack J, Simrén M. Colonic transit time and IBS symptoms: what’s the link? Am J Gastroenterol. 2012;107:754–60.CrossRefPubMed
12.
go back to reference Houghton LA, Lea R, Agrawal A, Reilly B, Whorwell PJ. Relationship of abdominal bloating to distention in irritable bowel syndrome and effect of bowel habit. Gastroenterology. 2006;131:1003–10.CrossRefPubMed Houghton LA, Lea R, Agrawal A, Reilly B, Whorwell PJ. Relationship of abdominal bloating to distention in irritable bowel syndrome and effect of bowel habit. Gastroenterology. 2006;131:1003–10.CrossRefPubMed
13.
go back to reference Whitehead WE, Burnett CK, Cook 3rd EW, Taub E. Impact of irritable bowel syndrome on quality of life. Dig Dis Sci. 1996;41:2248–53.CrossRefPubMed Whitehead WE, Burnett CK, Cook 3rd EW, Taub E. Impact of irritable bowel syndrome on quality of life. Dig Dis Sci. 1996;41:2248–53.CrossRefPubMed
14.
go back to reference Patrick DL, Drossman DA, Frederick IO, DiCesare J, Puder KL. Quality of life in persons with irritable bowel syndrome: development and validation of a new measure. Dig Dis Sci. 1998;43:400–11.CrossRefPubMed Patrick DL, Drossman DA, Frederick IO, DiCesare J, Puder KL. Quality of life in persons with irritable bowel syndrome: development and validation of a new measure. Dig Dis Sci. 1998;43:400–11.CrossRefPubMed
15.
go back to reference Kanazawa M, Drossman DA, Shinozaki M, Sagami Y, Endo Y, Palsson OS, et al. Translation and validation of a Japanese version of the irritable bowel syndrome-quality of life measure (IBS-QOL-J). Biopsychosoc Med. 2007;1:6.CrossRefPubMedPubMedCentral Kanazawa M, Drossman DA, Shinozaki M, Sagami Y, Endo Y, Palsson OS, et al. Translation and validation of a Japanese version of the irritable bowel syndrome-quality of life measure (IBS-QOL-J). Biopsychosoc Med. 2007;1:6.CrossRefPubMedPubMedCentral
16.
go back to reference Whitehead WE, the Validation Working Team in association with the Rome Questionnaire Committee. Development and validation of the Rome III diagnostic questionnaire. In: Drossman DA, Corazziari E, Delvaux M, editors. Rome III: the functional gastrointestinal disorders. 3rd ed. McLean: Degnon Associates; 2006. p. 835–53. Whitehead WE, the Validation Working Team in association with the Rome Questionnaire Committee. Development and validation of the Rome III diagnostic questionnaire. In: Drossman DA, Corazziari E, Delvaux M, editors. Rome III: the functional gastrointestinal disorders. 3rd ed. McLean: Degnon Associates; 2006. p. 835–53.
17.
go back to reference Kanazawa M, Nakajima S, Oshima T, Whitehead WE, Sperber AD, Palsson OS, et al. Validity and reliability of the Japanese version of the Rome III diagnostic questionnaire for irritable bowel syndrome and functional dyspepsia. J Neurogastroenterol Motil. 2015;21:537–44.CrossRefPubMedPubMedCentral Kanazawa M, Nakajima S, Oshima T, Whitehead WE, Sperber AD, Palsson OS, et al. Validity and reliability of the Japanese version of the Rome III diagnostic questionnaire for irritable bowel syndrome and functional dyspepsia. J Neurogastroenterol Motil. 2015;21:537–44.CrossRefPubMedPubMedCentral
18.
go back to reference Lee OY, Mayer EA, Schmulson M, Chang L, Naliboff B. Gender-related differences in IBS symptoms. Am J Gastroenterol. 2001;96:2184–93.CrossRefPubMed Lee OY, Mayer EA, Schmulson M, Chang L, Naliboff B. Gender-related differences in IBS symptoms. Am J Gastroenterol. 2001;96:2184–93.CrossRefPubMed
19.
go back to reference Tuteja AK, Talley NJ, Joos SK, Tolman KG, Hickam DH. Abdominal bloating in employed adults: prevalence, risk factors, and association with other bowel disorders. Am J Gastroenterol. 2008;103:1241–8.CrossRefPubMed Tuteja AK, Talley NJ, Joos SK, Tolman KG, Hickam DH. Abdominal bloating in employed adults: prevalence, risk factors, and association with other bowel disorders. Am J Gastroenterol. 2008;103:1241–8.CrossRefPubMed
20.
go back to reference Francis CY, Morris J, Whorwell PJ. The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress. Aliment Pharmacol Ther. 1997;11:395–402.CrossRefPubMed Francis CY, Morris J, Whorwell PJ. The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress. Aliment Pharmacol Ther. 1997;11:395–402.CrossRefPubMed
21.
go back to reference Agrawal A, Houghton LA, Lea R, Morris J, Reilly B, Whorwell PJ. Bloating and distention in irritable bowel syndrome: the role of visceral sensation. Gastroenterology. 2008;134:1882–9.CrossRefPubMed Agrawal A, Houghton LA, Lea R, Morris J, Reilly B, Whorwell PJ. Bloating and distention in irritable bowel syndrome: the role of visceral sensation. Gastroenterology. 2008;134:1882–9.CrossRefPubMed
22.
go back to reference Agrawal A, Houghton LA, Reilly B, Morris J, Whorwell PJ. Bloating and distension in irritable bowel syndrome: the role of gastrointestinal transit. Am J Gastroenterol. 2009;104:1998–2004.CrossRefPubMed Agrawal A, Houghton LA, Reilly B, Morris J, Whorwell PJ. Bloating and distension in irritable bowel syndrome: the role of gastrointestinal transit. Am J Gastroenterol. 2009;104:1998–2004.CrossRefPubMed
23.
go back to reference Thoua NM, Murray CD, Winchester WJ, Roy AJ, Pitcher MC, Kamm MA, Emmanuel AV. Amitriptyline modifies the visceral hypersensitivity response to acute stress in the irritable bowel syndrome. Aliment Pharmacol Ther. 2009;29:552–60.CrossRefPubMed Thoua NM, Murray CD, Winchester WJ, Roy AJ, Pitcher MC, Kamm MA, Emmanuel AV. Amitriptyline modifies the visceral hypersensitivity response to acute stress in the irritable bowel syndrome. Aliment Pharmacol Ther. 2009;29:552–60.CrossRefPubMed
24.
go back to reference Naliboff BD, Waters AM, Labus JS, Kilpatrick L, Craske MG, Chang L, et al. Increased acoustic startle responses in IBS patients during abdominal and nonabdominal threat. Psychosom Med. 2008;70:920–7.CrossRefPubMedPubMedCentral Naliboff BD, Waters AM, Labus JS, Kilpatrick L, Craske MG, Chang L, et al. Increased acoustic startle responses in IBS patients during abdominal and nonabdominal threat. Psychosom Med. 2008;70:920–7.CrossRefPubMedPubMedCentral
25.
go back to reference Nozu T, Kudaira M, Kitamori S, Uehara A. Repetitive rectal painful distention induces rectal hypersensitivity in patients with irritable bowel syndrome. J Gastroenterol. 2006;41:217–22.CrossRefPubMed Nozu T, Kudaira M, Kitamori S, Uehara A. Repetitive rectal painful distention induces rectal hypersensitivity in patients with irritable bowel syndrome. J Gastroenterol. 2006;41:217–22.CrossRefPubMed
26.
go back to reference Fukudo S, Nomura T, Muranaka M, Taguchi F. Brain-gut response to stress and cholinergic stimulation in irritable bowel syndrome. A preliminary study. J Clin Gastroenterol. 1993;17:133–41.CrossRefPubMed Fukudo S, Nomura T, Muranaka M, Taguchi F. Brain-gut response to stress and cholinergic stimulation in irritable bowel syndrome. A preliminary study. J Clin Gastroenterol. 1993;17:133–41.CrossRefPubMed
27.
go back to reference Kanazawa M, Palsson OS, Thiwan SI, Turner MJ, van Tilburg MA, Gangarosa LM, et al. Contributions of pain sensitivity and colonic motility to IBS symptom severity and predominant bowel habits. Am J Gastroenterol. 2008;103:2550–61.CrossRefPubMed Kanazawa M, Palsson OS, Thiwan SI, Turner MJ, van Tilburg MA, Gangarosa LM, et al. Contributions of pain sensitivity and colonic motility to IBS symptom severity and predominant bowel habits. Am J Gastroenterol. 2008;103:2550–61.CrossRefPubMed
28.
go back to reference Dumitraşcu DL, Grănescu S. Colonic transit investigated by radiopaque markers in females with irritable bowel syndrome: no correlation with symptoms and chronic stress. Rom J Intern Med. 1996;34:225–31.PubMed Dumitraşcu DL, Grănescu S. Colonic transit investigated by radiopaque markers in females with irritable bowel syndrome: no correlation with symptoms and chronic stress. Rom J Intern Med. 1996;34:225–31.PubMed
29.
go back to reference Okami Y, Kato T, Nin G, Harada K, Aoi W, Wada S, et al. Lifestyle and psychological factors related to irritable bowel syndrome in nursing and medical school students. J Gastroenterol. 2011;46:1403–10.CrossRefPubMed Okami Y, Kato T, Nin G, Harada K, Aoi W, Wada S, et al. Lifestyle and psychological factors related to irritable bowel syndrome in nursing and medical school students. J Gastroenterol. 2011;46:1403–10.CrossRefPubMed
30.
go back to reference Simrén M, Abrahamsson H, Björnsson ES. An exaggerated sensory component of the gastrocolonic response in patients with irritable bowel syndrome. Gut. 2001;48:20–7.CrossRefPubMedPubMedCentral Simrén M, Abrahamsson H, Björnsson ES. An exaggerated sensory component of the gastrocolonic response in patients with irritable bowel syndrome. Gut. 2001;48:20–7.CrossRefPubMedPubMedCentral
31.
go back to reference Deiteren A, Camilleri M, Burton D, McKinzie S, Rao A, Zinsmeister AR. Effect of meal ingestion on ileocolonic and colonic transit in health and irritable bowel syndrome. Dig Dis Sci. 2010;55:384–91.CrossRefPubMedPubMedCentral Deiteren A, Camilleri M, Burton D, McKinzie S, Rao A, Zinsmeister AR. Effect of meal ingestion on ileocolonic and colonic transit in health and irritable bowel syndrome. Dig Dis Sci. 2010;55:384–91.CrossRefPubMedPubMedCentral
32.
go back to reference Miwa H. Prevalence of irritable bowel syndrome in Japan: Internet survey using Rome III criteria. Patient Prefer Adherence. 2008;2:143–7.PubMedPubMedCentral Miwa H. Prevalence of irritable bowel syndrome in Japan: Internet survey using Rome III criteria. Patient Prefer Adherence. 2008;2:143–7.PubMedPubMedCentral
33.
go back to reference Kubo M, Fujiwara Y, Shiba M, Kohata Y, Yamagami H, Tanigawa T, et al. Differences between risk factors among irritable bowel syndrome subtypes in Japanese adults. Neurogastroenterol Motil. 2011;23:249–54.CrossRefPubMed Kubo M, Fujiwara Y, Shiba M, Kohata Y, Yamagami H, Tanigawa T, et al. Differences between risk factors among irritable bowel syndrome subtypes in Japanese adults. Neurogastroenterol Motil. 2011;23:249–54.CrossRefPubMed
34.
go back to reference Jung HK, Halder S, McNally M, Locke 3rd GR, Schleck CD, Zinsmeister AR, Talley NJ. Overlap of gastro-oesophageal reflux disease and irritable bowel syndrome: prevalence and risk factors in the general population. Aliment Pharmacol Ther. 2007;26:453–61.CrossRefPubMed Jung HK, Halder S, McNally M, Locke 3rd GR, Schleck CD, Zinsmeister AR, Talley NJ. Overlap of gastro-oesophageal reflux disease and irritable bowel syndrome: prevalence and risk factors in the general population. Aliment Pharmacol Ther. 2007;26:453–61.CrossRefPubMed
35.
go back to reference Krogsgaard LR, Engsbro AL, Bytzer P. The epidemiology of irritable bowel syndrome in Denmark. A population-based survey in adults ≤50 years of age. Scand J Gastroenterol. 2013;48:523–9.CrossRefPubMed Krogsgaard LR, Engsbro AL, Bytzer P. The epidemiology of irritable bowel syndrome in Denmark. A population-based survey in adults ≤50 years of age. Scand J Gastroenterol. 2013;48:523–9.CrossRefPubMed
36.
go back to reference Whitehead WE, Palsson O, Jones KR. Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications? Gastroenterology. 2002;122:1140–56.CrossRefPubMed Whitehead WE, Palsson O, Jones KR. Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications? Gastroenterology. 2002;122:1140–56.CrossRefPubMed
Metadata
Title
Abdominal bloating is the most bothersome symptom in irritable bowel syndrome with constipation (IBS-C): a large population-based Internet survey in Japan
Authors
Motoyori Kanazawa
Hiroto Miwa
Ayako Nakagawa
Masanori Kosako
Hiraku Akiho
Shin Fukudo
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BioPsychoSocial Medicine / Issue 1/2016
Electronic ISSN: 1751-0759
DOI
https://doi.org/10.1186/s13030-016-0070-8

Other articles of this Issue 1/2016

BioPsychoSocial Medicine 1/2016 Go to the issue