This article discusses the common condition of Irritable Bowel Syndrome (IBSirritable bowel syndrome, a combination of abdominal pain and constipation, diarrhoea, or bouts of each that occur in the absence of any other diagnosed disease) and outlines steps we can all take to prevent IBS and its related symptoms of constipationa common condition where stools are not passed as frequently as normal, diarrhoeaWhen bowel evacuation happens more often than usual, or where the faeces are abnormally liquid. and abdominalRelating to the abdomen, which is the region of the body between the chest and the pelvis. pain.
An extremely common bowelA common name for the large and/or small intestines. condition that leads to symptoms such as diarrhoea or constipation. Investigations (such as endoscopyExamination of the inside of the body using a tube equipped with a light source and either a small camera or an optical system.) do not show any structural abnormality of the bowel.
Bloating/wind Diarrhoea – urgency (having to rush to loo), frequent and loose stools that may be painful. Often having to go to the toilet soon after eating. Constipation – nothing for days/passage of pellets. Often having to return to the loo shortly after going to pass another pellet. Abdominal pain
The gut is a long pipe surrounded by muscleTissue made up of cells that can contract to bring about movement. and filled with nerveBundle of fibres that carries information in the form of electrical impulses. endings. Normal muscle contractions (peristalsis) propel food/fluid and faeces in a coordinated manner down the entire length of our gut. In IBS weak contractions mean that the food and stool isn’t propelled down efficiently, leading to constipation. Conversely, over-active contractions can lead to diarrhoea. The gut is normally collapsed but can become distendedSwollen due to pressure coming from the inside with air resulting in bloating. The nerve endings in the gut wall may become more sensitive to stretching resulting in pain.
IBS can run in families and is more common in women.
A previous episode of food poisoning can make people proneLying face-downwards. to this condition.
Previous antibiotic use/anti-inflammatoryAny drug that suppresses inflammation use (NSAIDsA group of drugs that provide pain relief and reduce inflammation.) may lead to IBS.
It may be related to a previous physical or emotional illness.
Stress/anxiety can affect gut contractions.
1. A fast eater? (air swallower)
2. A gum chewer? (this leads to swallowing of air with saliva)
3. A lover of fizzy drinks? (this can fill you full of gas)
4. Eating too much fibre?
If the answer is yes to any of these – cut back!
Fibre is a carbohydrate present in fruit and vegetables. Fibre is not absorbed into the body by the gut but enters the bowel where our natural bacteriaA group of organisms too small to be seen with the naked eye, which are usually made up of just a single cell. break it down into gas that causes symptoms of wind. Cutting back on wholemeal bread, fruit and fibre cereals and also cutting back on onions, mushrooms, leafy green vegetables and pulses (peas and beans) can have a dramatic effect on symptoms. Fatty meals tend to slow down the emptying of food from the stomachthe organ or the body where food is stored and broken down and this can also cause bloating, so rich meals are best avoided.
I suggest you look at your intake of the following and cut back:
1. Too much coffee/caffeine? These are gut stimulants and must be cut back.
2. Do you chew low sugar gum? This contains sorbitol and is a laxative.
3. Do you drink above the recommended limits of alcohol? Alcohol can cause diarrhoea.
4. Too much dairy such as cheese/cream/chocolates? This can cause diarrhoea.
5. Too many vegetables especially beans/cabbage/mushrooms/onions? Cut back.
6. Too much anxiety? This is difficult to treat, but try living life more slowly.
Increasing consumption of white rice may help (through mopping up water in the gut in the same way it absorbs water when cooked).
Avoid anti-inflammatories (aspirinOne of the most used medicines. and similar pain killers) and antibioticsMedication to treat infections caused by microbes (organisms that can't be seen with the naked eye), such as bacteria..
Consider using small doses of loperamide (immodium) available over the counter to reduce bowel frequencyApplied to urination, needing to urinate more often than normal, for whatever reason..
Relaxation therapy/meditation/hypnosisA sleep-like state induced by a hypnotist. may help you relax.
The pain of IBS is usually due to increased gut contractions. Treating the diarrhoea or constipation first is often the way forward. If this fails then you could try anti-spasm medication such as
Merbentyl/mebeverine before meals
Buscopan for attacks of pain
Amitriptyline low dose at night
Things to think about:
Are you in a dehydrating environment? A warm environment will cause more water to be absorbed from your colonThe large intestine. and hence your stool will become harder.
Are you drinking enough fluid? At least two litres of plain water per day should be drunk.
Are you drinking too much caffeine (diuretic)? This will cause you to pass more urine and become dehydrated.
Are you exercising? Exercise sends signals to the gut to keep it contracting and helps with regular bowel actions.
Are you eating enough fibre in your diet? Fibre in the form of wholemeal foods and nuts, peas and beans acts as a good laxative but be careful because too much causes bloating ( see above ).
Eating regularly? Eating regular meals sends signals from the stomach to the bowel to keep it contracting and helps with regular bowel actions.
Do you deny yourself? Sometimes you get the signal to open your bowels but don’t like the look of the toilet and as human beings we can resist the urge to go. The problem is that for people with sluggish bowels you might not get another signal for hours or even days.
Are you bearing down properly? When expelling stool, breathe in and blow your tummy out (make it fatOne of the three main food constituents (with carbohydrate and protein), and the main form in which energy is stored in the body.). This should help you relax your pelvic floor musclesThe muscles of the perineum surrounding the vaginal opening and acting as a sling supporting the uterus, bladder and rectum. and allows you to bear down with pressure. Also try placing your feet on a small step 15–20cm high, this again helps to relax the pelvisThe bony basin formed by the hip bones and the lower vertebrae of the spine; also refers to the lower part of the abdomen..
1. Drink at least two litres of water daily.
2. Eat regular meals, especially breakfast.
3. Avoid coffee.
4. Exercise regularly.
5. Eat fibre but don’t overdo it!
6. Avoid too much white rice which can be constipating.
7. Don’t ignore mother nature and go when you have the urge!
If you need help then a laxative is the answer. This may be in the following forms available from chemists:
1. A suppositoryMedicine in a solid preparation administered via the rectum, the last part of the large intestine. (a small tablet placed into the bottom).
2 An enemaThe introduction of a liquid into the bowel via the anus either to deliver a drug or to wash out the contents of the rectum. (liquid inserted up the bottom).
3 Senna – tablets that help the gut to contract. These should not be taken long term.
4 A stool softener such as Milpar to help expel the stool.
5 A more effective laxative is a macrogol such as Movicol that comes in sachet form. This laxative does not get absorbed but instead works within the gut to help produce a soft, easy to expel stool. The precise dose you need varies between individuals.
If you have bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid./pusA pale yellow or green,creamy fluid found at the site of bacterial infection. in your stool.
If you are getting up at night with diarrhoea.
If you have a change in bowel habit and are over 45.
If you have a change in your “normal” IBS symptoms.
Then you should discuss these symptoms with your GP for possible referral.
1. We will discuss your symptoms and focus on diet in particular.
2. We will agree a treatment strategy.
3. If your symptoms are new/changing I might consider blood tests to check for blood count, proteinCompounds that form the structure of muscles and other tissues in the body, as well as comprising enzymes and hormones. level and markers of inflammationThe body’s response to injury.. A wheat allergyVarious conditions caused by exaggerated reactions of the immune system (hypersensitivity reactions) to a variety of substances. test might also be taken.
4. If your symptoms warrant it then perhaps a colonoscopyExamination of the colon and rectum with a colonoscope, an imaging instrument that is inserted through the anus. (bowel examination) will be required.
IBS symptoms can be troublesome but are treatable and with the correct review of your diet it should be possible to help your symptoms get better.
CORE – Charity supporting research into gut and liverA large abdominal organ that has many important roles including the production of bile and clotting factors, detoxification, and the metabolism of proteins, carbohydrates and fats. disease