Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a common disorder which affects about one in five people all over the world. It affects people of all ages, women more frequently than men. It is not life-threatening or hereditary and does not develop into any other condition such as cancer.
There are various common symptoms of irritable bowel syndrome (IBS).

• Abdominal pain
• Diarrhoea
• Constipation
• Alternating diarrhoea and constipation
• Bloating and flatulence
• Mucus with stools

There can be other features associated with IBS. People suffering from IBS often complain of a variety of symptoms which are not related to the gut. These include sluggishness, backache, urinary problems, gynaecological problems, nausea, joint pains, pain and clicking in the jaw and pain in the muscles while chewing.

What causes IBS?

The exact cause of IBS is unknown, but the evidence suggests it is due to a combination of factors. Abnormal movements of the intestines and altered gut sensation are both thought to be important, as are psychological factors like stress, anxiety or depression. Gut infections and food poisoning seem to start off symptoms in some people.

Your GP may diagnose IBS after discussing your symptoms and without any further investigations. If investigations are necessary, they are likely to include blood tests, barium X-rays and endoscopies. Your GP will explain what these are.

Different types of IBS

IBS is classified according to which symptoms are the most frequent. There are several classifications; the following one is used at the Central Middlesex Hospital.

Spastic colon (spasms in the large bowel). This causes constipation and abdominal pain, which is most often on the left side and relieved by opening the bowels. In some people, spastic colon may be associated with diarrhoea.

Functional diarrhoea (attacks of diarrhoea, mostly in the mornings). The first bowel movement is often formed, followed by a rush of diarrhoea. This may be explosive and urgent.

Foregut dysmotility (abnormal movement in the small bowel). This causes abdominal bloating and discomfort, frequently after eating. Visible stomach enlargement is often a problem and any pain is more often experienced on the right side.

How can IBS be treated?

The symptoms of IBS are most often short-lived and go away without any treatment. When you need medication this is best tailored to the symptoms causing the most discomfort or inconvenience.

Pain is frequently caused by colonic spasm. Peppermint oil relaxes muscles and is often helpful. Antispasmodic drugs, such as mebeverine, are also used for relieving pain in IBS. They may be used regularly or taken just when it strikes.

If you have constipation the first thing you should do is to increase the amount of fibre you have in your diet. It is important for you to increase liquid intake at the same time.

If increasing the amount of fibre in the diet causes problems such as bloating, then a supplement based on ispaghula husk can be useful in normalising bowel function.

If this is ineffective on its own then there are various laxatives available, although stimulant laxatives are best avoided and only used when absolutely necessary.

The main treatment for diarrhoea is loperamide which works by reducing the water in the motions. Codeine also works but side-effects such as nausea are common.

Unfortunately there is no particular treatment for bloating . However, bloating is often associated with constipation and treating this is often helpful. For some people treatment with drugs known as prokinetic agents (such as cisapride and domperidone) is helpful.

Does stress affect IBS?

Stress does not cause IBS, but IBS symptoms can be affected by anxiety and worry. It is important to recognise this, and stress-reducing strategies and relaxation techniques can have a beneficial effect on the symptoms of IBS.

Should you change your diet?

Many people with IBS notice that certain foods make their symptoms worse - particularly pulses like beans, lentils and peas, onions, foods high in roughage or bran; heavy beers or red wine. Food intolerance like these are, however, idiosyncratic. What affects one person may have no effect on another.

Has complementary medicine anything to offer?

Homeopathic medicines may have a beneficial effect in IBS - particularly those which relax the bowel or the psyche. Other techniques like hypnosis are sometimes suggested but there is little scientific evidence as to their benefit. It is unwise to begin complementary techniques until you have discussed your symptoms with your doctor.

Understanding IBS is essential to overcoming it. There is helpful advice contained in IBS Bulletins published every three months by the IBS Appeal. It is available from IBS Appeal Subscriptions, PO Box 18 East Sussex TN16 1ZY

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