Bowel disease sufferers at higher risk of anxiety

SINGAPORE — Most acquaintances of 47-year-old Nidhi Swarup would consider her an active and outgoing person. But for about two years after she was diagnosed with a debilitating inflammatory bowel disease in 2011, she became increasingly anxious, reclusive and afraid to venture outdoors.

Inflammatory bowel diseases (IBD), such as Crohn’s disease or ulcerative colitis, cause inflammation in the gut, as well as other parts of the body including the eyes, joints and skin.

Sufferers of the chronic condition experience symptoms ranging from dizziness, headaches and fatigue to acute abdominal pain and persistent diarrhoea, which can severely affect their ability to function normally in their daily life.

“I started cutting down on all my active days to the point where my life came to a standstill. Even going to a nearby mall made me feel panicky and insecure; I didn’t know what would trigger a flare-up and when that happened, the need to go to the toilet can be so urgent,” said Mrs Swarup, who quit her full-time job as executive director of the Foundation of Rotary Clubs (Singapore) to manage her condition.

A condition which used to be rare in Asia and more common in the West, IBD is on the rise here. In Singapore, an estimated 2,000 people have the condition, a figure that has dramatically increased since the fewer than 10 cases reported at a local hospital two decades ago, said Dr David Ong, senior consultant at the Division of Gastroenterology and Hepatology at National University Hospital (NUH).

It is currently not known what causes IBD. Those with a family history tend to have a higher risk of getting it. In Singapore, Indians seem to be more vulnerable to the disease than the Chinese, said Dr Ong.

A possible reason for the increase in cases here could be due to changes in the local environment and lifestyles in the last 50 years, said Dr Ling Khoon Lin, a gastroenterologist at Mount Elizabeth Medical Centre.

“The way we live and what we eat, from only Asian food to a combination of Asian and Western diet, have changed. Our exposure to antibiotics has also increased. These could modify our gut microbiota (gut flora), and in turn change the way the gut responds to different stressors as well as invading bacteria or viruses,” he explained.

A PSYCHOLOGICAL BURDEN

While IBD is not usually life-threatening, its rising trend is a cause for concern due to its huge impact on quality of life.

A recent study by researchers from the University of Toronto found that IBD sufferers are twice as likely to suffer from general anxiety disorders compared to those without the condition.

Patients often experience a “double jeopardy”, they said in a press release. Not only do sufferers grapple with the physical symptoms, which can affect their daily lives and sometimes cause embarrassment, they also experience psychological effects of living with the incurable chronic disease.

The study, which was published last year in the medical journal, Inflammatory Bowel Diseases, also found that women sufferers were particularly vulnerable to anxiety disorders compared to male patients.

For Mrs Swarup, the anxiety began two years before she was diagnosed with Crohn’s disease. In 2009, she began experiencing a host of incapacitating symptoms after a holiday in Europe.

After consulting various doctors, none of whom could pinpoint a cause, Mrs Swarup had wondered if she was dying from an unidentifiable illness.

“It was a confusing time for me. I don’t normally cry easily but once in the middle of a family dinner, I suddenly broke down because I felt like I was on a verge of collapsing from some horrible mysterious illness. At one point, I was preparing for the worst by telling my three children to be independent and start doing things on their own,” she said.

Mrs Swarup was diagnosed in 2011 after severe diarrhoea landed her in the Accident and Emergency department. While a diagnosis provided some relief, she was shocked to learn that she would have to live with the disease for the rest of her life. She now takes at least 11 pills daily.

There is currently no cure for IBD, but effective treatments such as biologics — including a newly available one which specifically targets inflammation in the gut — can help patients suppress inflammation and keep the disease at bay, said Dr Ong.

With the majority of IBD patients requiring medication for life, Dr Ling said anxiety and depression can strike especially when the condition is poorly controlled.

“Moreover, the condition tends to strike during patients’ most productive years, around the 20s and 30s, affecting all aspects of their quality of life,” added Dr Ong.

Both doctors said psychological support should be offered to patients as part of treatment. According to Dr Ong, about 5 to 10 per cent of the IBD patients he sees require some form of psychological support.

To help patients cope with the disease’s emotional effects, a psychologist and social worker are part of NUH’s multidisciplinary IBD service. It also runs an IBD hotline, manned by an advance practice nurse who specialises in the disease and provides advice to patients over the phone to help them cope with the symptoms.

Noting the lack of a non-medical support system for IBD patients after she was diagnosed, Mrs Swarup started the Crohn’s and Colitis Society of Singapore in 2012.

The society organises talks and runs a patient support group. Last year, it launched a “Can’t Wait” card for IBD sufferers, in the hope that they will get priority in toilet queues by flashing it.

“When I learnt that my condition was classified ‘mild’, I wondered how patients with more severe IBD go through it. Living with the disease can be very emotionally traumatic. Through the society, I hope to support fellow patients and help them make sense of this puzzling disease,” said Mrs Swarup.

Crohn’s and Colitis Society of Singapore

For more information or support, visit www.ibd.org.sg or email info [at] ibd.org.sg