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IBS: Irritable Bowel Syndrome

The chances are that if you suffer from constipation or diarrhoea, you don’t talk about it. The state of your bowels is not a IBS - block nerves?subject you would casually drop into a lull in the conversation. This is probably the reason why nobody knows for sure just how many people suffer from recurrent bowel problems.  It is thought to range from 20-30 per cent of the population, affecting twice as many women as men. Most people will experience the odd bout of “dickey” tummy; the cause can usually be put down to over indulgence in food that the stomach is not accustomed to. These occurrences quite often happen on foreign holidays, sometimes at home too, but at least the reason is known. If it happens on a regular basis, with a normal diet, it tends to be known as Irritable Bowel Syndrome, or IBS. (A syndrome is a group of symptoms connected with a particular disease or condition.)

In IBS the symptoms can range from so mild as to be almost unnoticed, to excruciatingly painful and embarrassing. It can leave some house-bound for days or even weeks at a time.  Next to the common cold, it is the highest cause of absenteeism among the working population.

The symptoms typically alternate between diarrhoea and constipation, with stomach cramps, bloating and wind. Abdominal pain from mild to severe is usual, which sometimes eases with opening the bowels, passing wind or eating, and sometimes worsens. With many the pain recurs at a particular time of day, bringing the urgent need to open the bowel. The stools can vary from loose and watery to hard pellets. If the main problem is diarrhoea it is because food passes through the digestive system faster than normal.  Other symptoms include nausea, vomiting and indigestion. There can also be associated problems such as back and groin pain, disturbed sleep, the urgent need to urinate, which can sometimes be painful. In women, pain during sexual intercourse and painful periods are not uncommon.

IBS has probably been around for as long as man (and woman) but until relatively recently it has been ignored by the medical profession. At best it was put down as “psychosomatic”, or “all in the mind.” Although doctors now accept that it exists they don’t really knows what causes it; medical tests do not reveal abnormalities, which makes finding a cure next to impossible. It is classified as a functional disorder, which is to say, that although they can’t find anything wrong, the gut is not working as it should be.

Food is moved along the gut through muscular contractions (propulsion), followed by a hold-up (segmentation). The combination of these two alternating in cycles is called peristalsis. You would be unaware of this under normal conditions. Peristalsis is activated by the nervous system acting on the muscles of the bowel wall. The process involves the neurotransmitter serotonin, which is also present in the brain, but about 95% of it is in the bowel. The serotonin has to transfuse across a small gap between the nerve end and special receptors in the muscle. The exact process is not completely understood, but it is thought that the serotonin receptors may not be functioning properly in IBS sufferers.

In the majority of sufferers there is a combination of psychological and physical factors. Many can trace the on-set of symptoms to an important life event, such as moving house, divorce, loss of job or bereavement. All of these can be times of elevated stress levels. Anxiety and depression are also known to be contributing factors, and frequently a part of the life events mentioned above. In some, the symptoms follow a severe bout of gastroenteritis.  The first occurrence is usually between the age 18-35, and most think that it is happening to only them.

Diagnosis is by the symptoms. Tests carried out by your doctor are usually to eliminate serious conditions that have the same or similar symptoms. Knowing that you are not suffering from a life threatening disease is, in itself, a relief of part of the problem. Doctors will reassure you that your condition is unlikely to progress to cancer or other nasty disease as a matter of course. IBS is painful, possibly embarrassing and might wreck your social life, but it is not life threatening.

Once the diagnosis has been confirmed, your doctor can offer a range of pharmaceutical drugs that will alleviate the symptoms, but will do nothing to eliminate the cause because, of course, they don’t know what that is.

However that need not be the end; there is quite a lot that you can do for yourself. The first and obvious thing is to eliminate the foods that cause you problems. These will include hot and spicy dishes, so often tried for the first time on holiday, sometimes by default as we don’t know exactly what we are ordering. Fried or greasy food and alcohol and coffee, too, feature high on the list of known irritants. Whole meal bread, and any cereal with bran, will likely cause problems. Bran is probably the best known dietary fibre that we are all encouraged to eat because roughage is good for us. Not for the IBS sufferer. It has no nutritional value and is used as a bulking and scouring agent in the gut to ensure you have regular bowel movements. White bread, freshly baked, without additives and “improvers” if possible, will add soluble fibre to absorb fluid and bulk out the stools without compacting them. Fruit and vegetables will also help in this area, as well as providing essential nutrients. It would be wise to keep a diary of what you eat and whether it has a soothing or irritating effect on your bowel. You could also include those things that cause you to become stressed or emotionally up-tight. Once you have discovered all the known irritants, the diary can be discontinued.

Exercise can benefit everyone, but more so the IBS sufferer. Exercise aids digestion, lifts the spirits and encourages the elimination of toxins. It strengthens the heart, improves lung function and increases bone density. It creates a healthy tiredness which leads to a good night’s sleep. Not a bad return for the energy expended. When you are fit everything functions better, including your bowel .Walking is an excellent exercise; it can be done anywhere and does not require special equipment, except appropriate shoes.

It appears that most working people do not even take the full time that is allowed for lunch. Many do not leave their desk or continue to work while eating. Such a policy does not lead to greater productivity, quite the reverse. It is important to take adequate rest and recreation; to recharge the inner, if not the outer, person. So get out at lunch time. There is probably a park or at least a square with a few trees within reach of most people. Trees give off oxygen and absorb carbon dioxide; no wonder we feel better in the countryside! You will go back to your work with more energy and get more done. When you get home in the evening resist the temptation to flop out in front of the TV. Get out into the fresh air; go walking or jogging or simply lie down in the grass and watch the clouds go by. It will not be time wasted; you will start to feel that stress oozing out of you. Stress, remember, is a primary component of IBS.

Complementary medicine has a lot to offer the IBS sufferer. Herbal teas, such as chamomile and peppermint, have been used for hundreds of years to calm and soothe the digestive tract. Valerian and St. John’s Wort, likewise, have been employed to relieve stress and depression, but please do not self medicate. Just because these are classified as herbs does not mean that they are always safe for everyone. If you are pregnant, suffering from other conditions or on medication these and other herbs may be harmful. Therefore it is wise to consult a qualified medical herbalist, who will take a full medical history before prescribing herbs that will not harm you or interfere with medication from your doctor.

Hypnotherapy and acupuncture have both been cited by IBS sufferers to be beneficial in bringing about relaxation. Meditation and Yoga help to stop tension getting into the system.  From my own experience Craniosacral Therapy is very effective. Its aim is to bring about relaxation of the deep connective tissue. This stress induced tension can have a profound effect on the way your gut operates, restricting peristalsis and squeezing your intestines. . Most people report a reduction or absence of symptoms after a few treatments.