The Irritable Bowel Syndrome

The Irritable Bowel Syndrome (IBS) is a very common condition, which causes cramp or spasm of the intestine with changes in bowel patterns.  It accounts for more than half of all gastro-intestinal illnesses.  It is important to understand how it happens.  It should not be confused with more serious intestinal conditions like ulcerative colitis and cancer.  It does not cause either.

WHAT IS AN IRRITABLE BOWEL?

Your intestines are like a muscular tube.  They sometimes contract too tightly.  This is like sportsmen getting cramp in the leg muscles and is uncomfortable or painful.  It can occur at any age, but often starts in early adult life or adolescence.

WHAT CAUSES IRRITABLE BOWEL SYNDROME?

There are a number of theories about how and why IBS develops, but despite intensive research, the cause remains unclear.  It may have something to do with over activity of part or parts of the gut. Food is passed along by regular contractions (squeezes) of the muscles in the wall of the gut. Pain and other symptoms may develop if the contractions become abnormal or overactive. Some people develop IBS after a severe gastrointestinal infection.  Others have no specific trigger. People who seek medical advice for IBS are more likely to suffer from stress and anxiety related conditions. Symptoms tend to become worse during times of stress or anxiety. The area of over activity in the gut may determine whether constipation or diarrhoea develops.

Intolerance to certain foods may play a part in some cases. However, this is thought to be only in a small number of cases.  Foods that may aggravate symptoms are most commonly dairy products, beans, nuts and green vegetables.

IBS is not caused by an ongoing gut infection. However, in about 1 in 6 cases, the onset of symptoms seems to follow a bout of gastroenteritis (a gut infection which can cause diarrhoea and vomiting). So, perhaps a virus or other germ may sensitise or trigger the gut in some way to cause persisting symptoms of IBS.

Also, in some cases, symptoms get worse after taking a course of antibiotics. Antibiotics kill certain harmless or good bacteria in the gut, which changes the balance of bacterial types in the gut.

WHAT ARE THE COMMON SYMPTOMS?

Abdominal pain is the commonest symptom.  It is often relieved by passing wind or a bowel action.  Occasionally a bowel movement may start pain.  Pain radiating to the back is a very common symptom.  Some people will notice an association between the abdominal pain and their menstrual cycle.

Abdominal bloating is very common, particularly after meals.  Bloating can be aggravated by certain foods or when constipated.  Some also experience severe gaseousness.

Diarrhoea may occur, usually in the morning.  Constipation is also common, but it may alternate with diarrhoea or normal stools.  The stools are often small, like pellets, so you have to push hard.  There is often mucus in the stool.  Feeling that you haven’t really emptied your bowels properly is common.

Other symptoms outside the abdomen are often experienced.  These include headaches, tiredness, backache and even neck pain.

WHAT ARE THE LESS COMMON SYMPTOMS?

Loss of appetite
Occasional vomiting
Nausea
Sweating
Bringing up wind
Flushing and faintness
Abdominal gurgling
Eye symptoms

WHAT IS THE USUAL PATTERN OF SYMPTOMS?

It varies widely between individuals.  Each person seems to follow their own pattern.  Symptoms may last for a number of days, weeks or even months, according to the regular pattern for that person.  Although one particular symptom may dominate others, diarrhoea and constipation frequently alternate.  The pain varies from mild to severe and occurs at irregular intervals.

DO I NEED ANY TESTS?

There is no test that confirms the diagnosis of IBS. A doctor can usually diagnose IBS from the typical symptoms.

However, a blood sample is commonly taken to do some tests to help rule out other conditions such as ulcers, colitis, coeliac disease, gut infections, etc. The symptoms of these other diseases can sometimes be confused with IBS. Tests done on the sample of blood commonly include:

•Full blood count (FBC) – to rule out anaemia, which is associated with various gut disorders.

•Erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) – which can show if there is inflammation in the body (which does not occur with IBS).

•Antibody testing for coeliac disease.

More complicated tests such as gastroscopy and colonoscopy are not usually needed. However, they may be done if symptoms are not typical, or if you develop symptoms of IBS in later life (over the age of about 45) when other conditions need to be ruled out.  Other tests like X-rays and scans are not needed.

Patients are often referred to urologists to exclude a kidney stone or chronic bladder infections.  The tests done by the urologists are typically normal.

HOW IS THE IRRITABLE BOWEL SYNDROME RELATED TO STRESS?

Stress is a normal part of life.  A little stress makes people concentrate and get more out of life.  Too much stress makes your body react badly.  Minor stomach upset like loose stools during exam times are very common amongst students.  Some people get headaches or have breathing problems.  Changing jobs, moving house, trouble with friends or family are all causes of stress.  A constant feeling of anxiety can cause a flare-up of your irritable bowel symptoms.  Because you then have the symptoms to worry about, you get even more stressed.

IS THE IRRITABLE BOWEL SYNDROME DANGEROUS?

In many people it is just an intermittent nuisance, but it can interfere with normal activities, and in a few people it really upsets their ability to cope with life.  It doesn’t cause any more serious illness, however.

HOW IS THE IRRITABLE BOWEL SYNDROME TREATED?

It helps to understand that an irritable bowel is causing your symptoms, and not some other dangerous condition.  Simply knowing that it is not dangerous may make it easier to put up with your symptoms.

Because it is not a serious threat to health, and tends to come and go, treatment is aimed at relieving symptoms.  There is no specific cure for Irritable Bowel Syndrome, and different people find different treatments effective.  There is no recipe of treatments that will work for everyone and therefore each patient must try different therapies to help to find the specific therapy that will make their symptoms tolerable, and not necessarily take all symptoms away.  As there are so many different treatments, including diet changes, exercise programmes stress relief programmes etc., it is often most useful to visit Internet chat sites on IBS to see what has worked for others.  You will find numerous different therapies, because no specific one works for all.  Try different things one by one to see what works for you.

Diet Changes:

It is reasonable to try eliminating certain foods that may aggravate your symptoms.  Eliminate one group of foodstuffs at a time; thereby systematically find if the elimination of certain foods relieves symptoms.  Start by temporarily eliminating milk products.  Try this for at least two weeks.  Avoid foods that may cause gas like beans, nuts and green vegetables.  Internet sources have many tips for foodstuffs that are easier to digest.

Pain:

For painful bloating, lying down with a hot water bottle on your stomach may help. If you get bad abdominal cramp, an antispasmodic like Buscopan, which is safe and cheap, may help.  Some people with constipation find that a regular daily laxative makes them more comfortable, and we now know that it is quite safe to take a laxative regularly.  People with really inconvenient diarrhoea may find that loperamide (Imodium or Gastron) tablets help this.

If chronic, on-going abdominal pain persists even after all other therapies have been tried, one may find relief from regular pain medication.  Your GP must assist you in prescription of regular pain medications according to the South African Guidelines for the Management of Chronic Pain.

HOW CAN YOU DEAL WITH STRESS?

You can’t avoid stress, but you can help your body to relax.  Regular exercise helps a lot.  Many people find swimming very helpful.  Another approach is to set aside a few minutes each day to do relaxation exercises.  Tense different muscles for a few seconds then relax them.  When you are tense, do breathing exercises by inhaling as deeply as you can and then slowly breathing out.  When you are fully relaxed your heart rate and breathing will slow down.  There are books dealing with relaxation, biofeedback, and living with stress and stress-related illnesses.

A few people find it really hard to handle stress.  If you want to learn to do this better, you will progress faster if you are taught by a skilled professional.

WILL MY CONDITION TURN TO CANCER IF NEGLECTED?

No, it will not.  There is no relationship between cancer and irritable bowel.