Irritable Bowel Syndrome (IBS)

WHAT IS IBS?

There are 4 main symptoms of IBS, abdominal pain, diarrhoea, constipation and bloating.  Other symptoms frequently found include mucus in stools, increased wind, nausea and belching.

These symptoms can vary in frequency and intensity from person to person and within an individual person from day to day, and from month to month.

Commonly reported experiences

  • · One day it’s diarrhoea and the next I can’t go at all, it’s the stomach pain that’s the worse thing
  • · I can go to the loo up to 40 times in one day, the next day I may not go at all, it can really get me down.
  • · When I wake up I think ‘will I have a fat day’ or ‘a thin day’

PAIN IN THE ABDOMEN

For many people abdominal/lower stomach pains are the most unpleasant symptom.  People describe the pain in different ways.  It is frequently reported  as coming in spasms, nagging, sharp, heavy or dull.

The pain could be in waves of intensity and feeling like trapped wind.  It can be felt anywhere in the abdominal area (just below the stomach) but is more frequent down the left hand side.  The severity of the pain is the one thing most likely to make people go to visit their doctor.  Abdominal pain is often but, not always relieved by passing a stool or wind.

BLOATING

Bloating or abdominal distension is common and although for most people it is not the most severe aspect of IBS, it can be a nuisance and embarrassing.

Generally mornings are  good but the abdomen may   gradually distend or bloat throughout the day.  By the evening it can become so bad that clothes such as jeans no longer fit.  Some people report  that eating will bring on the bloating, or may feel a specific food is responsible.

Abdominal bloating may increase the waist size up to 4 inches! and can be associated with discomfort, increased wind and rumbling noises.

DIARRHOEA

We have all had diarrhoea at some point in our lives, this is recognised as an attack/episode when we have the urge to  pass stools, which can be very strong and sometimes painful.

Some people will experience normal stools at the beginning of the day which may become very loose and watery and then regular stools for the rest of the day.

Others may experience an increased in frequency but do not pass watery stools instead they may pass more frequent solid stools.

CONSTIPATION

Constipation is passage of small amounts of hard, dry bowel movements usually fewer than 3 times a week.  People who are constipated may find it difficult or painful to have a bowel movement.  Other symptoms of constipation include feeling bloated, uncomfortable and sluggish.  Some people think they are constipated if they do not have a bowel movement every day but there is no right.

SYMPTOMS ASSOCIATED WITH IBS

Most people’s symptoms are so mild that they don’t bother to see a doctor about them.  However, some people can have symptoms that are more troublesome, especially abdominal cramps, bloating and diarrhoea.  People with severe IBS are usually affected by one symptom more than the others either pain, constipation or chronic diarrhoea.  The most common symptoms is abdominal pain which some people describe as aching and colicky.  The pain may be mild or severe and may be made either better or worse by opening the bowels passing wind or eating.  Pain may re occur at a particular time of the day often in the evening.  Women may find the fluctuation of pain relates to their menstrual cycle.

People with IBS often feel the urgent need to open their bowels especially after breakfast.  The stools may vary in consistency from hard and pellet like to loose and watery, or just small amounts of mucus.  Afterwards they may be a sense that the bowels have not been completely emptied.

Other symptoms include bloated abdomen, excess wind, nausea, vomiting and indigestion.  Some people also experience a sense of fullness.

DEFINING IBS

There is no definitive medical test that a doctor can give people to verify whether they have IBS.  A doctor will diagnose IBS based on the patient’s symptoms over a period of time.  The doctor will examine the person to rule out any other illnesses.

Nearly half the number of people with IBS will have symptoms before the age of 30.  Generally women are affected more than men.  The occurrence of IBS seems to decrease, as we get older.

IBS can become  a chronic condition, which means that once you get it, it is likely to stay with you for many years.  The symptoms will be in bouts sometimes minimal symptoms or no symptoms at all.

IBS is NOT harmful even though sometimes we may feel  it is.  IBS is uncomfortable, painful, and inconvenient and can cause a great deal of distress.  It does not lead to intestinal bleeding of the bowel or to a serious disease such as cancer, inflammatory bowel disease or Crohn’s Disease.

CAUSES AND EFFECTS OF IRRITABLE BOWEL SYNDROME

There are many possible causes and effects of IBS.  Some causes are psychological such as stress.  Many people complain that their doctors just don’t take their symptoms seriously and some GP’s go so far as to say that it is all in the mind.

WHAT WE EAT

Many people are aware that they are sensitive to certain foods and know that if they have too much of a particular food they will ‘suffer for it’ later on.  People with IBS may have food intolerances and their intestines become more sensitive.

This suggests that the food intolerances are a result of IBS and not the cause. As already stated constipation can be a symptom of IBS,  lack of fibre in your diet may cause constipation.

Studies have shown that stress may effect bowel patterns, leading to abdominal pain and bloating.  This does not mean that IBS is a psychological disorder.

HOW CAN I BE SURE I DON’T HAVE A MORE SERIOUS BOWEL CONDITION

While IBS may cause distress and discomfort it does differ from a serious disease such as cancer of the bowel .  Initially  many of the symptoms seem to be the same as cancer and many people worry that their symptoms mean they have a more serious problem.

Ask yourself the following questions:

1. Do the symptoms usually come and go over hours or days?

2. Do the symptoms vary from time to time? For example sometimes do you have diarrhoea/constipation sometimes the pain will vary in its position or vary depending on your mood and amount of stress going on in your life?

3. Do you find if you are busy many of the symptoms reduce?  Again if the answer is yes to these questions, then it is more likely you have IBS.

4. Do the pains or bloating ease off when you open your bowels or do you have feelings you still want to pass a stool even if you have just been?

Once again, if the answer is yes to this question, then it is more likely to be IBS.

Many people with IBS also suffer from a wide variety of symptoms not associated with the bowel.  Women with IBS seem to have more digestive problems than men.  Tiredness, backache and gynaecological symptoms are also common.

Lower abdominal pain in IBS can frequently be confused with other gynaecological problems.  Nearly 50% of women who are seeing a gynaecologist for lower abdominal pain also suffer from IBS.  If you have IBS you are nearly three times more likely to have a hysterectomy than  women who do not have IBS.  This often means that many women undergo a wide variety of gynaecological test, treatments or surgery which may be unnecessary.

THE SOCIAL EFFECTS OF IRRITABLE BOWEL SYNDROME

Some people are afraid to go too far away from home or work and  the toilet in case they experience pain or diarrhoea.

CONSULTING YOUR GP

Make a list of answers to these questions in preparation for when you visit your doctor, it is important to tell him everything.

IF YOU HAVE PAIN

Is the pain in the same place or does it move around ?

How often do have pain and how long does it last?

What happens to the pain when you open your bowels?

BLOATING

How often do you experience bloating and how long does it last?

DIARRHOEA AND CONSTIPATION

How many times do you open your bowels on a good/bad day?

When you go to toilet, do you feel as if you have not completely emptied your bowels?

Have you ever felt the need to go but couldn’t?

Is the diarrhoea constant?

Have you noticed blood in your stools?

Have you lost a significant amount of weight lately?

AT YOUR APPOINTMENT

Make sure you listen and understand what the doctor is saying. The doctor may carry out some test, a process in diagnosing IBS.  It is very common for a doctor to take a blood test this is usually to check for anaemia.  Other test includes possibly a Sigmoidoscopy. Colonoscopy and barium enemas.

DIET

Make sure your diet is nourishing and well balanced.  Do not follow any diet that restricts your intake of essential nutrients. Some people benefit from eating bran, others avoid white flour and sugar, others find that restricting coffee, tea and alcohol helps.

Some people with IBS find that eating a large meal may result in severe abdominal pain or an urgent desire to go to the toilet.  Eating several smaller meals during the day, rather than three large ones, may help to reduce the symptoms.

The most difficult foods for the body to digest are fats and animal products.  So many people find it helpful to keep their meals low in fat and increase the carbohydrate content adding more bread, pasta, rice, fruit, vegetables and cereals.  Citrus foods especially those that are not fresh are also avoided by some people.

Avoid fried foods, spicy foods and beans as they aggravate IBS.

Below is a list of food to eat and food not to eat.

 

FOOD  WHICH MAY REDUCE SYMPTOMS

Wholegrain bread

Rice

Pasta

Plenty of fresh fruit

White meat

Fish

Drink peppermint tea

Cereals

FOOD WHICH MAY INCREASE SYMPTOMS

Cheese– may eat in small amounts

Milk

Chocolate

Butter – may eat in small amounts

Caffeine – may eat in small amounts

Red meat

Fried foods

Cabbage

Alcohol

Oils

Poultry skin

Eggs

REMEMBER TRY TO EAT LITTLE AND OFTEN

MEDICAL TREATMENTS

Medication may be prescribed to treat moderate to severe pain, diarrhoea or constipation that does not respond to home treatment.

Anti depressants may improve IBS symptoms, even in people who do not have depression.

In, most cases the choice of medication is based on a person’s most troublesome symptom.

If the symptom is constipation then a fibre medication may be prescribed or  bran supplements.  Some brands of supplements may be Fybogel, Isogel and Regulan.

The pain of IBS has been thought to be related to spasm of the colon muscles, this may give you the symptoms of bloating, wind and abdominal discomfort, by prescribing antispasmodics which vary from direct smooth muscle relaxants or preparations of peppermint oil and a range of drugs known as Anticholinergics. These drugs reduce abdominal pain and may be helpful when pain follows a meal.  Peppermint oil/tea relaxes the intestine and often relieves discomfort.

Many general pain killers such as Paracetemol, codeine and Distalgesic have a constipating action so therefore these are best only used when needed.

Diarrhoea can be treated safely, drugs such as Lopermide (Imodium) may restore a sense of control and allow more socialization.  Many of these drugs though may lead to constipation.  Imodium slows down the passage of waste through your digestive system and increases absorption of water.

Wind can be difficult to treat.  Look at your diet and avoid or reduce the  intake of gas-forming foods such as  beans and fatty foods.

COGNITIVE BEHAVIOUR THERAPY (CBT)

This is a form of psychotherapy in which the therapist and client work together to find and learn ways to cope with problems and to help people to live their lives in the way they want to.  The CBT Therapist’s aim is not to cure IBS, there will still be symptoms.  Treatment does not focus on the cause or onset of IBS.  The focus of CBT is your behaviour, thoughts and feelings that surround the IBS. By improving these the psychological symptoms of IBS may reduce.

CBT CASE STUDY

An example of how the way a person thinks, act and feels can intensify and maintain IBS

Tricia has an important meeting with her boss in the morning that causes some anxiety. (feelings and thoughts).

She knows that these sorts of situations often cause her IBS to flare up, and cause more diarrhoea and bloating than usual.

She is further concerned that her diarrhoea will cause her to leave the meeting early and that she may inadvertently pass wind causing great embarrassment. (Thought).

She decided to call in sick to work with diarrhoea. (Behaviour)

She then feels guilty and depressed about the effect of her IBS on her life. (Feelings and thoughts).

Tricia thinks that maybe she should give up her job if she can’t manage the meetings. (Behaviour and thoughts).

From the example we can see how the role of a person’s thoughts, feelings and behaviours will affect how they respond to the symptoms.  This in turn will affect many aspects of their daily life.  If a  person experiences a particularly nasty bout of symptoms, this can cause them to focus on the symptoms much more becoming hypersensitive to them which then increases the impact and frequency of the IBS symptoms.

THE PROCESS OF CBT

CBT is structured so that it is possible to be clear about what is happening and where the treatment is going.  The therapist outlines what is involved in the treatment, identifying the treatment techniques and working towards these in a graded fashion.  The client is expected to play an active and important part in treatment.  What the person does between the sessions – working on various issues- is just as important as what happens in the session.  Ideally they should learn to become their own therapist.

Treatment is usually short-term, around six to eight sessions for IBS is usually enough.  At this time the client is expected to understand the treatment techniques well enough to continue treatment themselves (if necessary).  For CBT to work, the person must understand the principles behind the therapy, the therapy is unlikely to be successful otherwise.

CBT has already been found to be a safe and effective treatment for many disorders such as anxiety and depression and in the last few years there have been an increasing number of studies showing that CBT can be effective for IBS.

Irritable bowel syndrome is difficult to live with it has many difficult and worrying symptoms but luckily for most people they will come and go.  There are many things still to be discovered about IBS.  It is not known if some people’s bowels are more sensitive than others.  IBS cannot harm you and is unlikely to get much worse.  Understanding IBS is the first step to beating it.  It is known that many things can make IBS worse, for example stress or certain foods, and that drugs and other therapies may help manage the problem.  Unfortunately no one has yet found a cure for IBS.  Accepting that you have IBS and coming to terms with it is the first step to beating it.

IBS can if you let it affect all areas of your life.  The second step to beating IBS is not to let it stop you from having a good and enjoyable life.  Remember, it is ok to have IBS, it is nothing to be ashamed or to apologise for.