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DocSpot: Irritable bowel syndrome

Dear Dr Margaret
I certainly hope you can shed light on my problem. I get sudden attacks of diarrhoea. The attacks are not due to emotional upset. (Once it happened as we were on our way out to dinner, and I had to take off from a traffic light and cross several lanes to get to a public toilet – very quickly.) The attacks are not due to a parasite or other bug (I had ‘it’ analyzed). Sometimes I can tie it to something I have eaten (like burning after a Mexican dinner), but most of the time it just is. I have vegetables in my diet and a good amount of fibre, so I don’t think that is a cause. I understand my mother had this problem also. She never had colon cancer or any other diagnosed colon problem.

Obviously I cannot say with certainty what your problem is, but irritable bowel syndrome would be high on my list. It is certainly a very common condition (affecting 1 in 10 people). It is interesting that your mother had similar symptoms, because you are more than twice as likely to get irritable bowel syndrome if a close relative has it.
 
The term ‘irritable bowel syndrome’ covers various combinations of tummy symptoms. A common pattern is a sensation of distension and discomfort after food, often with wind and tummy rumbles. Constipation or diarrhoea or a combination of the two is another common pattern. The faeces may be pale and watery and may appear to contain mucus (but never blood), or they may have the consistency of toothpaste or resemble rabbit pellets. The almost explosive urgency that you describe is a very typical, and some people have pain in the abdomen beforehand, or a feeling of incomplete emptying afterwards.
 
You do not mention any discomfort, but many people with the syndrome do have abdominal pain. It can be anywhere in the abdomen, and may be gone after a few minutes or may last for hours.
 
All sorts of treatments have been tried, and a treatment that works for one person may be hopeless for someone else. For example, increasing fibre may help some people, but worsen the feelings of distension in others. Various ‘anti-spasmodic’ medications can relieve symptoms: ask your doctor or pharmacist for advice. In a very few people who have chronic, painless diarrhoea, a lactose-free diet may help.
 
Although irritable bowel is common, people with bowel symptoms should not assume it is the cause without talking to their doctor. If you have other symptoms as well as the gut symptoms (bleeding from the back passage or blood in the faeces, persistent tiredness, fever, arthritis, loss of weight, a lump in the abdomen, severe pain, worsening pain, diarrhoea in the night), or if you are over 40 when the symptoms start, you should see your doctor without delay.
 
 
Dear Dr Margaret
For the past 2 years I have had a really embarrassing problem. I suddenly have to rush to empty my bowels without any warning. It can happen anywhere and any time. It’s got to the point where I’m afraid to travel anywhere in case there’s no loo. I never go on the London Underground because there are no loos. It’s awful to lose control over your bowels at my age - I’m only 29. Is there anything I can do, without having to discuss it with my GP?
 
It’s most likely that you have irritable bowel syndrome (IBS), particularly if you also have tummy pain. IBS causes a wide range of symptoms. Almost everyone with IBS has some abdominal pain, often relieved by defecation. Many people have the urgent need to defecate that you describe. A ‘morning rush’ is common - you have to defecate urgently several times on rising and after breakfast, and then the bowels settle for the rest of the day. The faeces may be loose with the texture of toothpaste, or normal or pellety. Some people have constipation, or a feeling that they cannot empty their bowel completely. A sense of abdominal bloating is also very common, and often gets worse throughout the day. There are some simple measures that you can take to try to alleviate your symptoms, but you should also see your doctor, as some other conditions can produce similar symptoms. Read on for a full answer to this problem.
 

What is IBS?

Normally, the muscles in the wall of the gut contract rhythmically, pushing food and then faeces along (food in the upper part of the gut, faeces in the lower part as you get nearer to the rectum). In IBS, these contractions tend to be excessive and also irregular.
People with IBS are also more sensitive to feelings from the gut. Normally, the brain is not very aware of what is happening in our intestines, unless there is something wrong (such as an infection or excessive wind). In people with IBS, the brain seems to be oversensitive to normal signals from the nerves in the wall of the gut. This doesn’t mean that IBS is in the imagination - it is more likely to be an imbalance of the chemicals involved in signalling between nerve cells.
 

Food and IBS

IBS is not a food allergy, but some foods may trigger symptoms. Try keeping a food diary for a few weeks to see if spicy or fatty foods or any particular fruit or vegetable (such as onions, cabbage, grapes, plums) make it worse for you. But don’t make any really drastic alterations to your diet without consulting your GP, or you could end up with a dietary deficiency as well as IBS.
Fibre in the diet has pros and cons for people with IBS. In general, a diet high in fibre from fruit and vegetables helps to stabilize the gut. On the other hand, many IBS suffers find that it worsens wind and discomfort, particularly if they add extra wheat bran. Peppermint tea can help ease wind or pain. Canadian expert Dr Grant Thompson points out that how you eat may be as important as what you eat: ‘Coffee for breakfast, nothing for lunch and high-stress gorging at dinnertime exaggerate the gut’s already-sensitive reflexes. In addition, not allowing enough time for defecation inhibits a healthy gut rhythm’.
 

Why you should see your doctor

Although IBS is the most likely diagnosis (because you’re under 45 and have had the symptoms for some time) you should talk to your GP. There are two reasons.
Firstly, your doctor will want to rule out more serious conditions such as Crohn’s disease, ulcerative colitis or coeliac disease that can have similar effects. So you will be asked about additional symptoms, such as loss of weight, anaemia, bleeding from the back passage; these might indicate a more serious problem.
Secondly, although there is no simple cure for IBS, your GP can give you more detailed advice about diet and lifestyle, and perhaps prescribe anti-spasmodic medication.
Ask your doctor about hypnotherapy; it’s one of the best treatments, but is not yet widely available. It probably works by reducing stress and anxiety and re-educating the brain pathways that are over-responding to stimuli from the nerves in the wall of the gut. Antidepressant drugs may be helpful because they affect neurotransmitter chemicals in the gut.
 

Overcoming your embarrassment

 You’re not alone in being reluctant to talk to your doctor. Last year a survey by the private health care company BUPA showed that although 86% of people would consult if they had bowel symptoms, 43% said they would be embarrassed to talk about their symptoms in detail. And the under-35s were twice as embarrassed as the over 55s. In fact, you shouldn’t be shy because IBS is incredibly common, so your GP will be very used to the problem. About 10% of all GP consultations are about gut problems, and a quarter of these are IBS. Almost half the patients seeing specialist gastroenterologists in hospital clinics have IBS, and in the USA it accounts for about 3.5 million visits to physicians every year.
 

Helping yourself

Try cutting out caffeine, alcohol and smoking. You have probably noticed the problem is worse when you are anxious or stressed. In normal people, anxiety makes the stomach churn, but in IBS it can provoke violent diarrhoea. Avoiding stress is easier said than done, but your public library should have books on relaxation and reducing stress. Regular exercise is also beneficial.
 
Further information
The Digestive Disorders Foundation has a leaflet on IBS.  Send a stamped addressed envelope to PO Box 251, Edgeware, Middx HA8 6HG, UK or go to www.digestivedisorders.org.uk/leaflets/ibs.html
The IBS Network provides practical information about living with IBS. Send a stamped addressed envelope and a £1 coin as a donation to Northern General Hospital, Sheffield, S5 7AU
phone the Helpline on 01543 492192 (6 pm - 8pm) or go to www.IBSnetwork.org.uk
The IBS Self Help Group has a helpful website go to www.ibsgroup.org/
 
April 9, 2001
 
For more information see Dr Phil Hammond's Expert guide to Cheeky bowel syndrome, in rhyme

Last updated; Thursday, June 10th 2010 at 7:51 am


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