- General Surgery
- Hernia Surgery
- Colorectal Surgery
- Bowel Conditions
- Anal Conditions
- Common Operations
- Upper Gastrointestinal Surgery
- Gall Bladder
- Stomach and Oesophagus
- Laparoscopic Surgery
- Enhanced Recovery Programmes
- Information Downloads
- Who Should Be Looking After Me?
- What is?
A significant proportion of people investigated for disordered bowel habit will have Irritable Bowel Syndrome (IBS). It may affect up to 20% of people during their lifetime. It is more common in younger people and in women and frequently identified in more than one family member. The diagnosis is made based on symptoms but many of the effects of the condition may mimic significant bowel pathology and referral to a specialist is often indicated to exclude these.
Investigations undertaken are almost invariably “normal” but despite this very real symptoms exist. Patients with IBS have abnormal speeds and poor coordination of the muscle contraction which is responsible for moving intestinal contents from one end of the bowel to the other. Excessive amounts of intestinal gas are also produced.
Not only is the muscle in the in the bowel wall likely to be hypersensitive to stimulation by gut contents but sufferers also have an unusually heightened awareness of any muscular activity or the presence or gas within the bowel which worsens the experienced symptoms. Some have lower thresholds for first sensation and urge to defaecate. Some evidence exists that patients may have disordered combinations of gut bacteria which influence gas production and intestinal transit. Treatment is directed towards relieving symptoms and addressing underlying precipitant factors.
Symptoms of Irritable Bowel Syndrome
- Abdominal Pain or discomfort (often relieved by opening the bowels)
Often including the following:
- Bloating and abdominal distension
- A feeling of incomplete evacuation
And effects of disordered evacuation
- Rectal bleeding
- Mucous discharge
May be associated with:
- Dyspepsia, nausea, belching and anorexia
- Often none are identified
- Psychological Stress
- Disordered coping strategies
- Anxiety and Depressive disorders
Investigation should be carried out by a specialist in clinic and the diagnosis is usually clear after taking a detailed history and examining the patient. Occasionally where doubt may exist a limited endoscopic examination of the bowel with biopsy may be undertaken. Blood tests for inflammatory conditions, disorders of thyroid function and coeliac disease is often performed.
Critically important to treatment success is an empathic and effective relationship between doctor and patient. Identification of the causes listed above and correction with psychological and behavioural therapies where possible should improve the symptoms of the majority of patients. Regular exercise has been shown to be beneficial.
In addition fibre may be used to bulk the stools and regulate intestinal motility if bloating is not a feature. It is sensible to avoid foodstuffs that individuals find initiate or worsen symptoms and the lengthy process of “elimination dieting” often proves effective. Fatty or spicy foods, caffeine and alcohol have all implicated at one time or another. The avoidance of foods containing certain complex sugars (which ferment in the large bowel) in the FODMAP diet has been found to be very useful for some.
Antispasmodic drugs and probiotics are easily available, cheap and largely without side effects. They all have a place in effective symptom control for many patients.
Laxatives both softening and stimulant (lactulose and senna respectively) may have a place for those with symptoms predominantly of constipation. A novel therapy using Linaclotide is showing promise. Conversely antimotility agents (immodium and codeine) useful when diarrhoeal symptoms are dominant.
Antidepressant and psychoactive drugs are commonly used for the management of recognised conditions that may or may not be at the core of IBS symptoms but these are administered only by doctors with specialist training.
- Apples, cherries, nectarines, blackberries, plums and peaches
- Broccoli, Brussels sprouts, cabbage, cauliflower, onions and peas
- Pulses and beans
- Artificial sweeteners
- Fructose and Lactose containing foods
- Peppermint Tea/ Colpermin capsules
- On prescription: Buscopan/ Mebeverine
Probiotics in capsule form
- Lactobacillus Acidophilus, lactis
- Bifidobacterium breve, longum
- And many others often in combination