Irritable bowel syndrome

 

Irritable bowel syndrome

Irritable Bowel Syndrome (IBS) is the most common bowel problem affecting an estimated 20% of the population. It accounts for over half of all patients attending specialist bowel clinics. The intestine is a thirty-foot muscular tube. Its job is to break down and absorb food. Contents are propelled by regular waves of contractions of the muscle (peristalsis), squeezing the contents along.

If peristalsis becomes uncoordinated, the digestive process is disturbed, leading to fermentation (gas), reduced absorption of salts and fluids (diarrhoea), and sluggish bowel movements (constipation). The gut stretches if gas builds up resulting in spasm of the muscle in the bowel wall causing colicky pain. This is IBS.

Who gets it?

Descriptions of patients with IBS date back to the mid 1700's. It is estimated that up to 12 million people in the UK are affected by IBS at some time in their lives.

Women tend to seek help for it more often than men, but it is actually just as common in both sexes. It commonly starts between 15 and 40 years, but it can start at any age.

What are the causes?

No single cause of IBS has been found. It has been shown that the intestines are more sensitive to distension (eg by gas build up) in those with IBS.

The symptoms are often triggered by stress and anxiety: the bowel (like lung and skin) develops from the same forerunner tissue in the embryo as the brain and nervous system, so a physical link between emotion and IBS is not hard to understand.

About 10% of people with IBS initially developed symptoms after an acute bout of diarrhoea. This type of IBS has a good outlook: most patients are free of symptoms within five years. Diet itself doesn't cause IBS, but spicy, very high fibre and high fat foods may all worsen the symptoms.

 

What are the symptoms?

These vary from person to person, and one, some or all of the following may be experienced.

Pain

Most sufferers get this. It can start immediately after eating a meal, or within two to three hours. It can be anywhere in the abdomen, and is typically colicky (griping). It is characteristically (though not always) relieved by opening the bowels or passing wind.

Bloating

This is very common. Many sufferers have to loosen their clothing. Some cannot finish their meals because of feeling full early. Loud tummy rumbles (borborygmi) are common.

Constipation and diarrhoea

One or other is nearly always present, and some people can get both. Constipation is commoner in women. Mucus is sometimes passed with the faeces (a sign that the bowel is irritated: rather like a runny nose in hay fever). There may be a feeling that the bowels still have to be emptied, even after passing faeces (tenesmus).

Secondary symptoms

Other less common symptoms include nausea, vomiting, belching, flatulence, back pain, indigestion and heartburn. These are secondary symptoms, and if present on their own without the main symptoms, then IBS is unlikely to be the cause.

Blood in the bowel motion is NEVER a sign of IBS, but it should prompt a swift visit to a doctor for further investigation This is particularly important if you think the blood is mixed with your motion.

What are the risks?

Although IBS can be a very painful and distressing ailment it is not serious in the medical sense and does not lead on to more serious bowel problems. Anxiety and stress not only cause IBS, but obviously may result from it as well. A self-feeding vicious cycle can be set up which can be very hard to break without outside help of some kind. Left unchallenged, the effects of IBS can be very destructive to social, work and private life, quite apart from the depressing effect on the individual sufferer.

 

What tests are useful?

IBS is frequently diagnosed by the doctor based on the symptoms described by the patient and a physical examination. However, sometimes the doctor may want to perform tests to exclude other possible causes of the same symptoms. These may include the following:

Blood tests

  • A full blood count (FBC) should be normal in IBS
  • The erythrocyte sedimentation rate (ESR: a broad measure of inflammation or infection) should be normal
  • Liver, kidney and thyroid function should all be normal

Bacteriology and microscopy

  • the stool samples should show normal bacteria only

X-rays

  • a barium enema is a special x-ray that involves inserting special dye into the bowel to show up the lining of the bowel. This should be normal in IBS.

Endoscopy

  • a direct look at the bowel lining is a good way to establish physical normality. Tissue samples can be taken and analysed for confirmation

In severe or difficult cases a specialist may organise a special test which measures the pressure waves inside the bowel. This is usually called 'manometry' and is frequently abnormal in IBS, showing that the normal peristalsis mentioned above is disrupted in this condition.

 

What treatments are there?

Good doctor-patient communication

The most important part of treatment is a good explanation of the disorder and how symptoms are produced. It is important to understand that though it is troublesome, it is not serious in itself, nor does it lead to serious complications. This in itself should help relieve some anxiety and improve coping with symptoms.

A good rapport is more likely to lead to fruitful discussions uncovering underlying causes such as marital unhappiness, work stresses and financial problems.

Diet

A high-fibre diet is a help for many people but in about 20% of IBS sufferers more fibre can make the symptoms worse. Fat stimulates colonic contractions and can make pain worse. Probably the best diet is the one which suits the individual, and personal experience is the only guide to what makes things worse.

Drug treatment

Antispasmodics include alverine, mebeverine and peppermint oil. They act directly on the gut, calming the bowel and helping restore coordinated peristalsis. Peppermint oil has the benefit (for some people) of being entirely natural. Fibre supplements are available in powdered, liquid and tablet form, on their own or combined with antispasmodics.

If anxiety and depression is the underlying problem, then directly treating this cause of the IBS with appropriate psychological and drug therapy will reduce or abolish the symptoms in time. A commonly used treatment is a drug called Amitriptylene which, although more commonly prescribed for depression, has been found to be very effective for the treatment of IBS in some sufferers.

What are the treatment side effects?

Antispasmodics have no serious adverse effects, but should be avoided in physical causes of IBS-like symptoms (e.g. intestinal obstruction, severe constipation). Peppermint oil can occasionally cause heartburn. This can be avoided by using the enteric-coated formulation.

As with most drug treatment, allergic rashes are a possibility, though rare. Fibre supplements can cause bloating and wind, and as stated previously may make some sufferers' IBS worse.

 

What self-help strategies are there?

Information

A good understanding of IBS can be achieved through using some of the resources listed below as well as discussion with a GP. This is the major step to overcoming IBS and regaining control.

Relaxation

Lifestyle may need review: ensure adequate time for leisure and relaxation, and time with family and friends. Techniques such as yoga or self-hypnosis may be useful to accelerate reaching a relaxed state.

Time management

Rushing around and meeting deadlines produces adrenaline surges which further stimulate the bowel and IBS. Good planning can reduce the sense of stress.

Diet

Stick to a balanced diet, avoiding trigger foods, and eat regular meals.

Where can I get further information?

Apart from contacting your own GP, the following organisations and literature may be of help:

The Gut Trust (Formally IBS Network)
Unit 5
53 Mowbray Street
Sheffield
S3 8EN
Telephone: 0114 272 3253 (10am-3pm General Enquiries)
(Mon - Fri 6pm-9pm Med Info for RN's)
(Sat 10am-12am)
Website: www.theguttrust.org
Email:Debbie@theguttrust.org

Holistic Resources Ltd
St James' Centre
8 St James' Square
Bacup
Lancashire
OL13 9AA
Telephone: 01706 871730
Website:www.holisticresources-friends.com
Email:info@realtd.co.uk