In L.H., the placebo effect is likely exhausted and therapy directed solely at the gut is destined to fail. Burkitt and others have suggested that IBS and other Western intestinal diseases may be due to our refined, low-fibre diet. Nevertheless, bran and psyllium are effective in constipation. In concert with other measures, fibre may give her a sense of control over her symptoms and help build her confidence in the diagnosis and her physician. The benefits of psychological support in IBS are difficult to prove.
Controlled studies pose obvious difficulties.
Svedlund and Guthrie provide evidence that supportive psychotherapy such as can be done by any caring physician may provide lasting benefit. The fact that she has overcome difficulty to achieve a degree, get a job and care for her son suggests that she may be motivated to accept such help. Once established, a diagnosis is a safe one and seldom needs alteration over time, unless symptoms change. While no more at risk for cancer or other disease than the normal population, IBS patients are not immune either. Diverticula are present in about half of Canadians by age 65, but most have no gut symptoms.