at Hollywood Specialist Centre
13/95 Monash Ave, Nedlands, Western Australia
Irritable bowel syndrome is the commonest bowel disorder. It is also known as spastic colon, colitis, spastic bowel, nervous colitis or mucous colitis. About 20% of people have it at some time throughout their life and at any time about 5% of adults have symptoms consistent with IBS.
What is Irritable Bowel Syndrome?
If you have at least three months of
then you have Irritable Bowel Syndrome.
Similar symptoms include loose or watery stools, rushing to the toilet, needing to go to the toilet just after going, and needing to loosen clothes after eating, passage of too much wind or gas.
- abdominal (stomach) pain with one or more of the following
- relief by defaecation (opening the bowels, passing stool)
- change in frequency
- change in consistency of stool (waste/motions)
- irregular pattern of defaecation for at least two days a week which involves at least three of:
- altered stool frequency
- altered stool form (hard/loose)
- altered stool passage (straining/urgency/sense of incomplete evacuation [emptying of the bowel])
- passage of mucus (slime)
- bloating or feeling of abdominal distension (swelling)
What causes Irritable Bowel syndrome?
This is not known but in many people it follows an episode of a bowel infection. It seems that people with irritable bowel syndrome have an increased sensitivity to the normal motion of food and fluid through the bowel.Every minute of every day our bowel is pushing food and fluid through as we digest our food. This tends to occur in waves of muscle action. The process could be likened to the sight of a snake swallowing and digesting another animal, with the food being slowly pushed through the snake.
When one thinks about it like that it is surprising that more of us do not feel some discomfort as the 3 or more meals we eat each day are digested.
In people with Irritable Bowel Syndrome something increases our sensitivity to this process and when this troubles us we have the disease. Additionally some people with Irritable Bowel Syndrome have been shown to have stronger or more irregular contractions in their bowel as the food is being digested.
Who gets Irritable Bowel Syndrome?
The problem is more common in women, and often occurs in early adulthood. It may last for years or even life. However, there tend to be good and bad periods as the symptoms fluctuate.
Can it lead onto more serious disease?
People with Irritable Bowel Syndrome have been found to have a lower chance than others of developing more serious or life-threatening bowel diseases.
This is reassuring to many people, but does not mean serious diseases cannot occur separately. Therefore any new symptoms, especially developing in later life after years of Irritable Bowel Syndrome should be evaluated by a doctor.
What can be done about Irritable Bowel Syndrome?
Some foods may worsen the symptoms, but different patients find different things cause trouble. Keeping a diary of symptoms related to foods eaten may help some people find out which things disagree with them and should therefore be avoided.
However, fatty foods strongly stimulate the bowel to contract and are commonly found to cause problems by people with Irritable Bowel Syndrome. Avoidance of oils, butter, margarine, cream, sausages and fatty meats may help.
Beans and legumes are causes of problems for some.
Artificial sweeteners may cause problems as can the sugars in certain fruits and, if so, should be avoided.
Caffeine in tea and coffee, and alcohol may aggravate symptoms in some people.
In occasional cases people may also have a disease called lactose intolerance which prevents them being able to take unprocessed milk products.
A good diet is usually one high in carbohydrate, low in fat, and often high in fibre.
Does stress play a part?
Stress may intensify bowel contractions and there is some evidence that people with Irritable Bowel Syndrome cope less well with stress than do other people. This is not surprising given that sufferers do not feel well. In fact, it may be surprising that people with Irritable Bowel Syndrome are not more stressed!
Managing stress effectively, especially when it relates to one's health, is an individual matter. Breaking any feedback cycle which could be playing a role is, however, important.
Remembering that Irritable Bowel Syndrome is not associated with any more serious or life-threatening underlying bowel disease is a good place to start.
Help may be found through relaxation perhaps just by taking regular physical exercise. Adequate sleep and avoidance of fatigue should be sought. Meditation may be of assistance and learning to cope with life's stresses may be needed by some people. Avoiding stressful situations, learning new ways of coping with them or using biofeedback to control one's response may all have roles to play.
DIET TREATMENT OF TYPES OF IBS
|DIARRHOEA PREDOMINANT||CONSTIPATION PREDOMINANT|
|increase fibre||increase fibre|
|low fat foods||increase bran|
|avoid artificial sweeteners||increase fruit|
|decrease fruit||increase water|
|avoid alcohol||increase exercise|
|avoid caffeine||take fruit juices|
|BLOATING AND GAS PREDOMINANT||PAIN PREDOMINANT|
|decrease cabbage||increase exercise|
|decrease beans and legumes||decrease gas forming foods|
|decrease fibre||increase fibre|
If you do adjust your diet, begin gradually, excluding things which your diet diary has revealed cause you trouble. Importantly, if you discover exclusions which work and which you plan to continue, remember to consider the possibility that important essential vitamins and minerals may have been included in those foods, and that alternative sources must be provided. This is especially important for people who avoid milk products as they may miss out on adequate calcium. These people should take additional calcium supplementation.
DRUG TREATMENT OPTIONS
- immodium (eg loperamide)
- cholestyramine (eg questran)
- prokinetic drugs
- fibre products (eg fybogel, metamucil, granocol)
BLOATING AND WIND PREDOMINANT
- anti-gas medications
- simethicone (eg phazyme)
- prokinetic agents
- antispasmodic drugs
- hyoscine (eg buscopan)
- dicylomine (eg merbentyl)
- belladonna alkoaloids (eg atrobel, donnatab)
- penthienate (eg monodral)
- propantheline (eg pro-banthine)
- prokinetic agents
- smooth muscle relaxants
- mebeverine (eg colofac)
- peppermint oil (eg mintec)
Antidepressants are the only drugs shown in any studies to have any benefit beyond the short term. Examples are:
- amitriptyline (eg endep)
- sertraline (eg zoloft)
- imipramine (eg tofranil)
- paroxetine (eg prozac)
Anxiolytics have also been used and are helpful sometimes for short periods. Examples include:
- diazepam (eg valium)
- chlordiazepoxide (eg librax)
Apart from antidepressants there are no data supporting long term benefits from any of these drugs. However, individuals may gain benefit, especially in the short term. Discussion with your doctor is essential before embarking on long term drug or diet therapy.
Could it be anything else?
The diagnosis of Irritable Bowel Syndrome tends to be one of exclusion in people who have the symptoms. Exclusion of other diseases requires consultation with your doctor and a thorough history of your symptoms and a complete examination. In some cases this will include a rectal (anal) examination.
Symptoms of weight loss, bleeding from the bowel, persistent vomiting and a change in symptoms are strong indicators that further investigations should be considered.
Such investigations might include blood tests, a gastroscopy, a colonoscopy, biopsies and XRays of the bowel.
Presented by Dr Lindsay C MollisonRiverview Endoscopy Home Page
Created 31 January 1997
Updated 14 May 2010