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Irritable Bowel Syndrome - IBS

 


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Condition
Irritable bowel syndrome, IBS
Class
Gastrointestinal
Description
Irritable bowel syndrome (IBS) is a chronic condition affecting the gut where pain is accompanied by a change in bowel habits and a bloated feeling. The condition affects people differently, some have diarrhoea, some have constipation, while in others bowel habits may alternate between diarrhoea and constipation.

IBS is an extremely common condition, estimated to affect about a third of people in the UK at some time during their lives, with 1 in 10 having symptoms that are sufficiently severe to need medical attention. IBS commonly starts between the ages of 15 and 40, but may occur at any age. Women are twice as likely to be affected as men.

Irritable bowel syndrome is sometimes called other names such as spastic colon. It should not be confused with inflammatory bowel disease (IBD) which is due to inflammation of the bowel. The bowel is not inflamed in IBS.

There is no link between IBS and bowel cancer.
Causes
The cause of IBS is not fully understood but sufferers are believed to have very sensitive bowels. It is this sensitivity that sets off reactions that causes the symptoms. If the bowel is overactive, the bowel contents pass more rapidly resulting in diarrhoea, whereas sluggish bowel activity causes constipation. Muscle spasm in the bowel causes discomfort and cramping pain.

It is not known why IBS sufferers have sensitive bowels, or what triggers bouts of IBS. In many cases, stress and worry may be the cause. Other things that may be responsible for triggering IBS are a highly-processed food diet, allergies to certain foods, presence of gas in the bowel, gastroenteritis, hormonal changes, a genetic link, even possibly a combination of any of these.
Symptoms
Symptoms vary greatly from person to person, but usually include pain, cramping, discomfort, a feeling of fullness or bloating, tummy rumbling, excess wind and a change or disruption of bowel habits. Changes in bowel habits can range from constipation to diarrhoea, or can alternate between the two. The number of times that someone goes to the toilet may increase or decrease, there may be a change in the texture of the stools and mucus may be passed. Many people notice that they also lack energy and do not sleep well.
Treatment
If diarrhoea is a problem, antidiarrhoeal drugs such as loperamide or diphenoxylate may help.

If constipation is a problem, increasing the amount of fruit and fibre in the diet may help. If changing diet does not work, laxatives such as lactulose, docusate sodium or macrogol should be used in preference to stimulant laxatives such as senna or bisacodyl. Spasm or pain can be relieved by antispasmodic agents such as alverine citrate, dicycloverine, hyoscine, mebeverine or peppermint oil.

Drugs that affect the activity of a chemical transmitter in the gut called serotonin have also been tried. Certain antidepressants called selective serotonin reuptake inhibitors eg fluoxetine and paroxetine, have been used to treat constipation related IBS.

Another drug called alosetron that opposes the effects of serotonin has been used for women with severe diarrhoea prominent IBS. However, because of potentially fatal side effects, alosetron is only available in America under very strictly controlled conditions. It is not available in the UK.
When to see your pharmacist
Many products for the relief of IBS can be obtained from your local pharmacy without the need for a prescription. It is important that you describe your symptoms fully to your pharmacist, indicating whether diarrhoea or constipation is the main symptom. Your pharmacist will ask you about your diet and whether you have noticed if your IBS occurs at certain times and not others.

You should also tell your pharmacist if you are taking any other medicine, have any other illnesses and whether you have noticed the presence of blood in your stools. Depending upon the symptoms, your pharmacist will recommend an antispasmodic, antidiarrhoeal or laxative and will offer advice about your diet. If your pharmacist suspects that your complaint may be something more serious, you will be advised to see your doctor.
When to see your doctor
See your doctor if you suspect that you have irritable bowel syndrome. Your doctor will examine you and take a note of your symptoms to decide if you have IBS. If other conditions are suspected, for example inflammatory bowel disease, your doctor may decide to perform further tests.

Seek immediate advice if there is any prolonged and unusual change in bowel habit, especially if you are over 40 years of age. Also, see your doctor urgently if there is blood in your stools, or you have unexpectedly lost weight.
Living with IBS
A well-balanced diet and regular meals will reduce symptoms. Foods that are high in fat often provoke symptoms and should be avoided. Rich or spicy foods can also cause attacks. Keep a diary of the foods that you eat and record the number of times that you go to the toilet, the type of motion that you pass and whether you have pain or any other symptoms. Sufferers are usually aware of particular foods that upset them but may not associate attacks with the more common trigger foods, such as dairy products, bread, cereals, onions and caffeinated drinks.

Some people benefit from increasing the fibre content in their diet by eating more cereals, fruit and vegetables, or by taking fibre supplements, which can be prescribed or purchased from a pharmacy. For other sufferers, actually reducing fibre intake can help relieve their symptoms. Probiotic foods have also been found to be of help. Try altering your diet, recording the food that you eat and your bowel habits, to determine what suits you best.

Stress and anxiety are also known to trigger IBS, so you may find that developing stress management strategies can be helpful. If anxiety or depression is a major part of the problem, talk to your doctor about the use of antidepressants or the use of counselling, psychotherapy, hypnotherapy or relaxation therapy.
Useful Tips
  • Stick to small, frequent meals and avoid large, irregular meals, which challenge the digestive system
  • Watch your diet and eating habits, too much or too little dietary fibre, too much fat, or a very rich/spicy diet may all upset the working of the bowel and trigger the symptoms of IBS
  • Alcohol, coffee, tea and smoking can all act as stimulants to the bowel and provoke an attack
  • Keep a diary of the foods that you eat and your bowel habits to identify those foods that may be causing IBS
Further information

Further information is available from Core, a UK charity established with the help and support of the British Society of Gastroenterologists that funds research into the entire range of gut, liver, intestinal and bowel illnesses.

www.corecharity.org.uk



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