Irritable bowel syndrome is one of
the most common bowel disturbances in the developed world. Its exact cause
is still unknown, but there are many ways to manage and relieve this
Irritable bowel syndrome is one of the commonest causes of abdominal pain
and disturbed bowel action. It has been estimated that as many as half of
all people referred to specialist gastroenterologists have the condition.
No one knows exactly what causes
irritable bowel syndrome ( IBS ), but currently there is an epidemic in
developed countries -- it is much less common in Africa and Asia.
In the past, IBS has been known by a variety of different names. These
include mucus colitis, spastic colon, non-inflammatory bowel disease,
irritable colon and nervous diarrhoea. However, today it is called irritable
bowel syndrome, because it is now known that the whole bowel is in fact
affected, even though most of the symptoms tend to occur in the colon ( the
large bowel ).
IBS occurs in women much more frequently than in men and is most common
between the ages of 20 and 40. Symptoms usually begin early in adult life,
though they can strike at any age, even in children as young as three or
The symptoms of IBS are so common -- 47 per cent of women and 13 per cent
of men report three or more symptoms -- that doctors are unable to decide
whether it is truly a disease or simply a variation from the norm.
WHAT IS IT ?
IBS is what is known as a
functional disorder. In other words, the bowels look perfectly normal, but
the way in which they work is disturbed. In other bowel disorders, such as
ulcers and colitis, the problems cause visible changes in the body tissues.
Such illnesses are termed organic.
The bowel is a muscular tube which propels food from the mouth to the
anus, allowing nutrients from food to be digested and absorbed along the
way. When its normal way of working is affected, symptoms occur. For
example, if the muscle propels its contents too fast, diarrhoea is the
result, while if it works too slowly, constipation occurs. If the muscle
goes into spasm, cramp-like pains are felt.
Symptoms and their severity vary from one sufferer to another. One of the
most frequent complaints is abdominal pain, usually gripy or colicky in
nature, which tends to come in bouts lasting anything from a few minutes up
to a few hours.
PAINS AND SWELLING
The pain is often worse after eating and is quite often relieved after
opening the bowels or passing wind from the anus. Most sufferers also
complain of a swollen abdomen, rumbling in the stomach, severe wind and
often flatulence with a foul-smelling odour.
Bowel habits are usually disturbed by diarrhoea or constipation, or
constant fluctuations between the two. Other symptoms include urgency -- a
need to rush and open the bowels -- and even faecal incontinence ( leakage
of stools ). A feeling that the bowel has not been emptied completely (
tenesmus ) is another symptom, as is a tender abdomen and proctalgia fugax
-- a sharp, fleeting pain which occurs low down inside the rectum.
Some digestive upsets such as indigestion, feelings of fullness, nausea,
burping and occasionally vomiting may also occur. Other clues include
lethargy, backache, and a desire to urinate frequently.
Blood in the bowel motions can be a symptom. But even if you suspect the
cause is IBS, it is a symptom that should never be ignored. Always inform
your doctor, especially if your stools are tarry or black.
Some IBS sufferers experience anal soreness, weight fluctuations, back
pain, tension headache, bleeding between periods, chest pains, pelvic pain,
hyperventilation (breathing too deeply and quickly), frequent attacks of
diarrhoea and constipation; teeth grinding, anxiety and depression.
A swollen abdomen is one of the most troublesome symptoms of IBS. It's
not known exactly why this happens, though it has been suggested that it
could be due to excess gas in the stomach, fluid retention, curvature of the
spine, and depression of the diaphragm.
Studies have shown that the girth of the abdomen does actually increase
throughout the day in IBS patients, and this is linked to a slight rise in
the amount of gas inside the stomach and in the bowel.
Some experts believe that this measurable increase in abdominal gas
levels is due to a reduction in the muscle tone of the gut.
THE MENSTRUAL CYCLE
Many female IBS sufferers find their symptoms are worse at certain times
during their menstrual cycle, especially just before their period. They also
seem to have more with problems with their periods. Other women date the
start of symptoms from the time of their hysterectomy. However, studies have
failed to show any direct link.
In many sufferers, there's a clear link to stress, depression and other
emotional problems. Conflicts in personal relationships, particularly with
parents, are common too. IBS has also been linked with traumatic experiences
such as abuse in childhood, rape, sexual abuse and bereavement or loss in
Food intolerance is thought to be a factor in many cases of IBS. Poor
diet and nutritional shortages may also be contributing factors.
REACHING A DIAGNOSIS
It's not always easy for a doctor to diagnose IBS, as a number of conditions
have similar symptoms. He may suspect irritable bowel if you have three or
more typical symptoms, are under 40, or if you have suffered for many years.
If you are under 40, the doctor may diagnose and treat the condition
without investigation. However, if you are older or have atypical symptoms,
he may wish to make some tests to rule out other possible bowel problems.
These investigations may include an examination of the rectum and a
vaginal examination for women, since the pain may mimic or be confused with
pains caused by problems in the uterus or ovaries.
Blood tests to check for other problems such as anaemia may also be
indicated. Occasionally, it may also be necessary to examine stool samples
for weight, fat content, signs of candida and the poor absorption of fat or
You may also be referred for a sigmoidoscopy (visual examination of the
rectum), a bowel X-ray or a test called arectal biopsy, which involves
taking a small sample of tissue from the rectum to examine it for evidence
of inflammatory bowel diseases or signs of cancerous changes.
Although IBS is troublesome, it isn't actually serious. Changes in your
diet and lifestyle are often the most effective treatment.
Drug treatment can sometimes help. Antispasmodic drugs, such as those
known as anti-muscarinics, may be prescribed for pain relief. Agents which
relax the gut, such as peppermint oil, may also be prescribed. Some people
find relief from antidepressants, which relieve stress and act on nerve
chemical receptors in the gut.
Many IBS sufferers find that a high fibre diet helps. However, coarse wheat
bran can actually worsen symptoms such as bloating and colic, so try to step
up the amount you eat gradually and go for non-wheat sources of fibre, such
as bananas, avocado pears, vegetables, kiwi fruit, oats, brown rice, and
pulses. Linseed soaked in water can be soothing and, in severe cases, fibre
supplements containing psyllium husks can help.
If you increase your dietary fibre, you must also drink more fluids. Try
substituting herbal teas, filtered water and dandelion coffee for tea,
coffee and cola.
Cutting down on dairy foods helps about 50 per cent of all sufferers and
this suggests that lactose, or milk sugar, could be a culprit. Reducing
wheat-based foods helps about a quarter of sufferers while some find that
cutting down on citrus fruits, coffee or alcohol relieves their symptoms. In
severe cases, exclusion diets, where foods are avoided altogether and then
gradually reintroduced, can identify a particular food allergy.
Many IBS sufferers find that, the condition settles on its own with time
and patience, so it's worth trying to reduce stress in your life. At the
same time, it is important to respect your own bowel habits and not to worry
unduly. The time to be alert is when your bowel habits change from what is
normal for you.