Iritable Bowel Syndrome Page

Irritable bowel syndrome (IBS) is a chronic disorder, featuring recurrent abdominal pain and intermittent diarrhoea, often alternating with constipation.  There is normally no obvious cause.

This disorder most commonly affects people between the ages of 20 and 30 and is twice as common in women as in men. The syndrome can be divided into four types depending on which is the main symptom - abdominal pain, diarrhoea, constipation or diarrhoea alternating with constipation. IBS is known by a variety of other terms: spastic colon, spastic colitis, mucous colitis, nervous diarrhoea, nervous colon and nervous or functional bowel. Some of these names misrepresent the condition.

The syndrome is not the same as Ulcerative Colitis. Colitis is an inflammation of the colon, whereas in IBS, the colon is not inflamed.

IBS is very common and is present in perhaps 60% of patients that see a specialist in gastroenterology.

The incidence (frequency) of the condition in the general population is estimated to lie somewhere between 10 and 20 per cent. The true incidence may be higher than this, because it is thought that many people with IBS symptoms do not seek medical advice.

The diagnosis of IBS is made after full investigation has failed to reveal any underlying cause and the symptoms are strongly suggestive of irritable bowel syndrome.

Full medical investigation, including a rectal examination, a barium meal X-ray, and sometimes a gynaecological examination, shows no other abnormalities.

Sometimes the colon is seen to be in a state of unusual activity, contracting and relaxing in an abnormally rapid manner.

Guidelines for the diagnosis have been proposed. The affected person should, for at least 12 weeks in the last 12 months, have suffered abdominal discomfort or pain for which no other cause is found. The 12 weeks need not be continuous but may be a total. The person should also show at least two of the following three features:

• Pain is relieved by defecation (opening the bowels)
• Pain is associated with a change in the frequency of bowel movement, either an increase or a decrease
• There is a change in the form of the stool - it is watery, loose or pellet-like.

The condition features repeated abdominal pain and occasional diarrhoea, often alternating with constipation, rapid transit of food with frequent bowel motions, a sense of fullness (bloating), abdominal tenderness and swelling, an awareness of the bowel action and often headache and anxiety.

Bowel contents are moved along by a succession of rhythmical tightening and relaxation of segments of the intestine. This is called peristalsis. In the irritable bowel syndrome peristalsis is stronger and more frequent than normal.

The effect of this may be to make bowel activity much more noisy than normal. Bowel noises - loud abdominal rumblings and squeaking - caused by gases being propelled through the intestines by peristalsis are called borborygmi. This may be embarrassing to people with the syndrome.

The pain is usually felt in one of the four corners of the abdomen, especially the lower left corner. It is sometimes brought on by eating, and is often relieved by going to the toilet. The stools are often ribbon-like or pellet-like and may contain mucus. Often, soon after a meal, there is extreme and embarrassing urgency to empty the bowels

Other symptoms include:

• Burping
• Bad breath
• Excessive gas production
• Headache
• Tiredness
• Nausea
• A sense of incomplete emptying after going to the toilet

• Diet:

Making changes to the diet can help to control the symptoms of IBS. Keep a note of what you eat over a couple of weeks to help you to identify the foods that seem to trigger your symptoms. Try avoiding these foods for a while to see if there is any improvement.

It can be helpful to cut out spicy and fatty foods from the diet, as well as gas producing vegetables such as beans. Try to drink less alcohol and swap tea and coffee that both contain caffeine for herbal teas such as peppermint and chamomile. Cutting out products that contain an artificial sweetener called sorbitol can help some people.

Try to eat more fruit and vegetables to increase the amount of dietary fibre (roughage) in your diet, this helps to prevent constipation. It is also important to drink plenty of water to flush waste products out of your body.

Special diets (e.g. one that contains no wheat or cows milk products) may help some people, but these should be undertaken only with the supervision of a medical professional.

• Drug treatments:

Several drugs are effective in quieting down the excessive bowel activity and relieving the pain. Antispasmodic drugs can slow contractions in the bowel, which helps with diarrhoea and pain.

Effective antidiarrhoeal drugs such as loperamide and diphenoxylate can be used when necessary. For constipation, an osmotic laxative is preferred over stimulant laxatives. For patients with severe pain, it is common to take antidepressants, which are used to block the transmission of pain from the gut to the brain.

• Complementary therapies:

There is some evidence that acupuncture, peppermint oil capsule or Chinese herbal medicine may be helpful.

Surveys of the available scientific research suggests that being taught a self-hypnosis technique can also help to relieve the symptoms in some people.