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Irritable bowelIrritable Bowel

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 distressing condition

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.

UNKNOWN CAUSE

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 four.

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.

WARNING SIGNS
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 childhood.

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 nutrients.

OTHER TESTS
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.

DIETARY CHANGES
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.

     

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