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I.B.S.

IBS is a disorder of the gut in which the sufferer experiences abdominal pain, bloating or discomfort and a change in bowel habit, without an obvious cause. Some people can get mainly constipation and others mainly diarrhoea, whilst others alternate between the two.

IBS is called a syndrome because it involves different signs and symptoms which are all interrelated. IBS is a painful and often distressing condition which can seriously impact on the sufferer's quality of life. It is thought that women are about twice as likely as men to suffer from IBS and it is also more common in emotional and stressed people.

My Personal Experiences – Pips

I have suffered with I.B.S. for many years now. I'm not sure how it happened or "why me". It's become part of my life so I am learning to accept and live with it, though it's not always easy.

I have had a few tests, scans and an X-ray. At one point the doctor was convinced I was pregnant as I was so bloated but NO. It always came back to the I.B.S.

The worst thing about this syndrome is it's so very hard to diagnose. There is no specific test that really deciphers whether or not you have I.B.S. It is normally deciphered by the symptoms you are experiencing plus an elimination set of tests and sometimes you can think that no one is taking you seriously or indeed that you are making it all up.

Symptoms of IBS

Don't be alarmed as symptoms do vary from person to person. One, some or all of the following may be experienced by an IBS sufferer.

  • Abdominal pain
  • Abdominal spasm
  • Diarrhoea /Constipation and constant altering between the two
  • Rumbling noises and wind
  • Bloated stomach
  • Urgency – a need to rush and open the bowels
  • A feeling of incomplete emptying of the bowels
  • Incontinence if a toilet is not nearby
  • A sharp pain felt low down inside the rectum
  • Nausea, belching and vomiting.

Some other Non – Gastrointestinal features of it can be

  • Painful periods
  • Pain after sex for women
  • Pre menstrual tension.

Urinary symptoms

  • Frequency – Needing to urinate quite often
  • Urgency – Not being able to wait to urinate
  • Passing urine at night
  • Incomplete emptying of bladder.

Other Symptoms

  • Back pain
  • Headaches
  • Bad breath
  • Unpleasant taste in the mouth
  • Poor quality of sleep
  • Constant tiredness
  • Anxiety
  • Depression.

If you think some of this may sound like you. Go to your G.P and discuss with them the exact symptoms you are experiencing as an individual.

Diagnosis of IBS

There is not a one step diagnostic tool that will definitely decide whether you have IBS. It is usually diagnosed after other conditions are ruled out.

To help doctors in their diagnosis, the Rome II criteria was developed.

This is a list of common IBS symptoms, and also so-called 'red flag' symptoms which are not indicative of IBS and suggest that you may have another medical condition which needs investigating.

The Rome II Criteria

Irritable bowel syndrome can be diagnosed based on at least 12 weeks (which need not be consecutive) in the preceding 12 months, of abdominal discomfort or pain that has two out of three of these features:

  • Relieved with defecation; and/or onset associated with a change in frequency of stool; and/or onset associated with a change in form (appearance) of stool.
  • Symptoms that cumulatively support the diagnosis of IBS:
  • Abnormal stool frequency (may be defined as greater than three bowel movements per day and less than three bowel movements per week)
  • Abnormal stool form (lumpy/hard or loose/watery stool)
  • Abnormal stool passage (straining, urgency, or feeling of incomplete evacuation)
  • The passage of mucus
  • Bloating or feeling of abdominal distension.

Supportive symptoms of IBS:

  • Fewer than three bowel movements a week
  • More than three bowel movements a day
  • Hard or lumpy stools
  • Loose (mushy) or watery stools
  • Straining during a bowel movement
  • Urgency (having to rush to have a bowel movement)
  • Feeling of incomplete bowel movement
  • Passing mucus (white material) during a bowelmovement
  • Abdominal fullness, bloating, or swelling.

Red flag symptoms which are NOT typical of IBS:

  • Pain that often awakens/interferes with sleep
  • Diarrhoea that often awakens/interferes with sleep
  • Blood in your stool (visible or occult)
  • Weight loss
  • Fever
  • Abnormal physical examination.

These criteria are not definitive self diagnosis criteria but can help guide the diagnosis pathway. Tests that you might have pre diagnosis include a colonoscopy/barium enema where a small camera is inserted into the bowel under x-ray conditions and often an abdominal ultrasound as well.

These tests look for any visible signs of definite disease or illness. If you have IBS, most often no visible signs will be found at all and your doctor will then diagnose you from your symptoms alone.

Do keep in mind that just because nothing physical has been found, it does not mean that you have been exaggerating your symptoms or that they are not real or that you are being palmed off.

It's very normal to be worried about what this might mean for your future- there is no diagnosis – there is no definitive treatment – will you always suffer like this ?

There are many treatments available that will help you learn to manage your IBS and often it does disappear for long periods of time and sometimes forever.

Influencing factors

Some factors can influence the severity of the I.B.S. These are the main ones

  • Anxiety,
  • Nerves,
  • Stress,
  • Worry,
  • Certain foods,
  • Lack of exercise,
  • Insufficient sleep,
  • Poor diet,
  • Smoking
  • Alcohol.

Drug Treatments

Several drugs can be effective in quieting down the excessive bowel activity and relieving

Antispasmodic drugs such as Mebeverine can slow contractions in the bowel, which helps with diarrhoea and pain, and may help with bloating.

Effective antidiarrhoeal drugs such as loperamide and diphenoxylate can be used when necessary and to ease the feelings of urgency.

Antidepressants can sometimes help as some can change the way your gut muscles react and alter nerve responses from your gut. This is because 95% of all of our serotonin is in our bowels so the SSRI family of antidepressant is thought to be have some efficacy in IBS – the doses used in IBS tend to be lower than for depression.

Self Help Strategies And Complementary therapies

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 (a food diary this might help you to identify the foods that seem to trigger your symptoms). If you do find something, try avoiding those certain foods for a while to see if there's any improvement.

It can also be helpful to cut out spicy and fatty foods from the diet, as well as gas producing vegetables such as beans. It is an elimination diet that is recommended if you are badly affected suddenly as intolerances to food can develop quite quickly.

A healthy diet can also help considerably. It can be tempting, particularly if suffering from diarrhoea, to avoid foods containing fibre whereas in reality, eating the correct type of fibre maybe beneficial as in the case of the High Fibre / Low Irritant diet.

Many IBS sufferers find non-cereal fibre makes the problem worse.

Try the following diet from Charlie for four weeks, then gradually introduce food stuffs from the "avoid" list.

Foods Allowed Foods to Avoid
meat, fish, eggs, cheese, milk fatty meat, sausages, meat pie
natural yoghurt  
strained fruit yoghurt  
wholemeal bread  
wholegrain cereals muesli
potatoes (boiled/mashed) fried, roast and potato skins
tender vegetables (no stalks) ALL peas and beans
i.e. cauliflower, carrots, marrow celery, onions, leeks, peppers
lettuce hearts cucumber
tomatoes (de pipped and skinned)  
mushrooms  
fruit juice dried fruit
strained/stewed fruit raw fruit
tinned fruit (no pips/skins) ALL skins and pips of fruit
i.e. tinned peach in juice nuts, coconut
seedless jam ordinary jam / marmalade
shred less marmalade chutney / pickles
honey  
Plain biscuits Not containing nuts, fruit, coconut
plain sponge/Madeira cake fruit cake
wholemeal rice and pasta white rice and pasta
oatmeal and wholemeal flour white flour
strained soups chunky, onion and pea soup
seasonings, lemon juice, parsley bottled sauces

Also recommended if following this diet plan are drinking 8 glasses of fresh water, and a glass of fresh fruit juice.

It is quite likely that you will find this diet stricter than needed, as people vary in their tolerance of non cereal fibre. You may find that you are able to eat lots of things from the "banned" list without any ill effects as you gradually re-introduce them into your diet, whilst some things remain life long "no-no's" i.e. onions.

A typical daily meal plan could be as follows:

Breakfast unsweetened fruit juice, porridge, weatabix, wholemeal toast and honey

Mid morning tea, milk drink, fruit juice,digestive biscuit

Dinner lean meat, chicken, fish,boiled or mashed potatoes, or brown rice or wholemeal pasta with tender vegetables

Mid afternoon tea, fruit juice, spongecake

Tea eggs or cheese, boiled potatoes, tender vegetables, fresh salad from list, natural yoghurt

Bedtime milky drink, oatcake biscuit

It is very important to eat sensibly, and NOT get too "hung up" over food. Obsessing too much about food can in turn create anxiety, and lead to further attacks of IBS, for example "I haven't had my bowl of All bran today, I will get constipated". This is very likely to set off an anxiety attack, which in turn will lead to an IBS attack. Basically aim to eat a sensible balanced diet, and relax.

The alternative therapies available which may help include

  • Peppermint oil capsules
  • Aloe vera juice
  • Actimel /Yakult one a day drink
  • acidophilus supplements
  • Colloidal minerals
  • Bulking agents such as Fibrogel
  • Charcoal capsules can provide relief from the bloating
  • Essiac
  • Calcium for the diarrhoea IBS
  • Hypnosis and self hypnosis
  • Exercise, going for a walk, a cycle or using the gym
  • Relaxing exercise such as yoga, Tai'chi combined with meditation can bring enormous relief if used regularly
  • Relaxation and breathing exercises will help calm you and your digestive system.
  • Reiki
  • Aromatherapy oils can help. (fennel or peppermint diluted into a carrier oil). Either in a bath or massaged onto the stomach area. (Contraindicated if pregnant or nursing a baby)
  • Therapists who can help in specific ways include Homeopaths, Chinese herbal medicine clinics and acupuncturists

CBT from Charlie

In the same way that Cognitive Behavioural Therapy is used to treat sufferers of anxiety and panic attacks, sufferers of IBS can also take some cognitive steps to improving their condition. It is very common for sufferers of IBS to lose regular bowel habits. However, it is possible to retrain the bowel and gain relief from either constipation of diarrhoea.

To deal with constipation: establish a routine of using the toilet at the same time each day. Make use of the gastro-colonic reflex and try "sitting" after a meal when a bowel motion is more likely. Take some reading matter, or put on the radio, and be prepared to wait. Do not strain, do persevere, and within several weeks of establishing a ritual, you should have been able to re-train your bowel and be able to pass a normal motion at a similar time each day.

A similar training exercise can also be used to counter act diarrhoea. Frequent bowels motions in particular in response to anxiety often lead to looser and more frequent motions. Wait a few minutes after the first initial moment of pain or urgency. Repeat this waiting period over a few days, gradually increasing the length of time between initial sensations and using the toilet. Once on the toilet wait for a further 30 seconds before allowing your body to empty, thus proving control over your bowels. Again, this will take several weeks before the effects of re-training are felt.

It is also very useful to challenge the anxiety associated with IBS, and for this it is necessary to keep a diary just like in overcoming anxiety and panic.

Write a list of all things that you avoid/do not enjoy doing as a result of suffering from IBS.

Put them in order of severity, with the least "scary" thing at the top and the most worrying situation at the bottom.

An example of this may be using the toilet before leaving the house. A challenge to this would be to leave the house and take short walk around the block without using the toilet first.

Keep working down the list, taking on new challenges and repeating old ones. If you experience any panic whilst doing any challenge it is advisable to confront the issue for a minimum of one hour. It is incredibly unlikely that an anxiety attack will last longer than 45 minutes, thus ensuring that your exposure lasts longer than the attack.

Breathing exercises and muscle relaxation exercises are extremely beneficial in these situations.

Occasionally IBS may return. This may be for a multitude of reasons, it could correspond with a stressful period of your life, or even happen as a result of a weekend of self indulgence – too much wine and rich food.

If you find your symptoms returning DO NOT panic. Resume the exercises which helped you last, and do not start avoiding situations again.

Further Information

There three books that are personally recommended

Title:Irritable Bowel Syndrome and Diverticulosis
Publisher:Thorsons Jun 21, 1999
Author:Shirley Trickett Buy from Amazon
ISBN 10:0722538618
ISBN 13:978-0722538616

Title:Good Gut Healing
Publisher:Piatkus Books Dec 18, 2003
Author:Kathryn Marsden Buy from Amazon
ISBN 10:0749924489
ISBN 13:978-0749924485

Title:Understanding Irritable Bowel Syndrome
Publisher:Family Doctor Publications Ltd Jan 1, 2005
Author:Dr Karen Moriarty Buy from Amazon
ISBN 10:1898205612
ISBN 13:978-1898205616

 

Websites

http://digestive.niddk.nih.gov/ddiseases/pubs/ibs

http://www.irritable-bowel-syndrome-cure.org/index.php

For those extra severe days

Being prepared is essential to learning to manage IBS under difficult circumstances such as returning to work. It is a potentially embarrassing problem so the more you can feel in control the better and less anxiety provoking it will be should you be caught short.

www.whennaturecalls.com do a great travel loo bag. Odourless and in biodegradable gel. Great to know you have and therefore will never need.

Also useful is a bag with big ziplok bags or a couple of plastic bags, wet wipes, spare set of clothes, a relaxation CD, rescue remedy, lavender oil, peppermint capsules, loperimide and a map with all the motorway services marked.

As there have been quite a few posts recently from people who are having a horrid time with IBS and feeling very anxious about it, I thought it might be useful to post a few pertinent excerpts from a book I have.

The book is called 'Overcoming Irritable Bowel Syndrome' by Jonathan M. Berkowitz M.D. You can buy the book from Amazon and it has a wealth of information, both in terms of explaining why your body feels as it does and ways to overcome it. I haven't gone into huge amounts of detail here, due to copyright, but perhaps it will lead you to reading the book.

– At least 20% of the population have IBS and it is the second most frequent reason for missing work (in the US).

– There are 4 types: Abdominal Pain-Predominant, diarrhoea-predominant, constipation-predominant, and constipation/diarrhoea pre-dominant.

– Symptoms tend to undergo a period of remission and exacerbation, often in response to predicatable factors such as stress/anxiety or a known irritant (e.g. wheat).

– 25-50% of people with IBS experience nausea and heartburn as symptoms. Indigestion and acid reflux are also common.

– Many people with IBS also experience urinary problems.

– People with IBS have been shown to have lower thresholds for bowel pain, which could relate to how the brain processes information about activity in the bowel.

– Abdominal pain is nearly always present and can range from mild to severe. It may be partially or completely resolved by defecation, only to come back later in the day. Bloating may also accompany the pain.

– Abdominal pain is sometimes caused by eating, and relieved by going to the loo.

– Pain can be dull, crampy and widespread, but also sharp and knifelike. It is not uncommon to have pain in multiple sites of the abdomen. It may radiate to the lower back.

– The lower abdomen is often affected in terms of pain, esp. the left side.

– Some people experience pain in the upper left abdomen or quadrant, which they may also feel in their chest. This is caused by gas and known as 'Splenic flexure syndrome'. The splenic flexure is part of the colon near the spleen and gas accumuates there as it sits high in the abdomen.

– One trick to relieve pain in the upper left quadrant is to lie flat on your back and rasie your buttocks so they are higher than your abdomen. This way the gas rises naturally and travels to the rectum.

– The bowel is hugely responsive to emotional and psychological factors. IBS can be a learned condition to stress, with the intestines becoming sensitised. This is why CBT and hynotherapy can help ease IBS.

– The rapid bowel transit in some people with IBS decreases the time the body has to absorb gas, leaving more gas in the bowel (and more smelly!).

– Another source of gas comes from swallowing air. Known as aerophagia, this mechanism plays a more significant role in people with anxiety, who tend to swallow more air. Hyperventilation is another factor in increased gas.

– People with IBS suffer bloating, or the perception of bloating, often as they are 'gassy'.

– Many people also pass small amount of stool, with whitish or clear mucus.

– Constipation is one of the most common medical complaints, amongst the general population. IBS patients tend to have constipation for days or weeks, followed by a bout of diarrhoea. Most cases are caused by inadequate fibre intake.

– For more than 90% of people, there is no identifiable reason for their constipation, and most of these will respond to increased fibre and water and taking exercise.

– Constipated stoods are 'ribbon-like', 'pencil-thin', hard, or marble like. There will be a feeling of incompletion.

– The longer the constipation goes on for, the more abdominal pain you will experience.

– Most people feel the urge to defecate after breakfast and other meals.

– IBS patients with diarrhoea will often need to defecate urgently after eating, often lots of gas is passed too.

– It is unclear whether fibre works well for IBS-diarrhoea. For a minority of people it slows down the gut, but for many it exacerbates the problem. There are howevere different types of fibre – soluble vs. insoluble.

– The Brain-Gut model shows that many people with IBS have autonomic nervous system dysfunction similar to those found in people with anxiety and depression. These systems stimulate each other, creating a vicious cycle of IBS, anxiety, and depression.

– Oestrogen and hormones can impact on IBS symptoms, as can periods.

– The pathways that control the bowels are also related to psychological disturbances – leading to a learned response.

– One study showed that 77% of people surveyed had a psychiatric disorder just before or coinciding with their first IBS episode. It has been observed that IBS patients tend to have more concerns about their health (e.g. think they have cancer). These concerns have a dramatic effect on IBS symptoms and the likelihood of a poor treatment outcome.

– However, it is not fair to say that IBS is purely psychological. IBS can initially start up after an infection, such as food poisoning or a virus.

– Food allergies and intolerances can be partly to blame, in around 16-33% of cases. The most common offenders are alcohol, milk, eggs, caffeine, wheat, sorbitol, fatty foods, corn, sulfites and gas producing veg such as broccoli, sprouts, cabbage, cauliflower, onions. Smoking is also a culprit.

– The only way to ascertain intolerances is to eliminate foods, keep a diary of what you eat and the symptoms, and reintroduce foods slowly one by one to see what happens.

– If you identify a culprit food, do not be surprised that you experience IBS symptoms if you continue to eat it.

– It's worth bearing in mind that some foods are blamed, but are not necessarily the culprit. When patients are told they have unwittingly eaten a food they believe they are intolerant to, they consequently show symptoms of IBS – despite not having been given the food in reality.

– Certain vitmains and minerals, such as folic acid, Vitamin A, calcium, zinc, vitamin c, probiotics can all potentially help.

– Acupuncture, CBT, Biofeedback and hypnotherapy have been shown to be very good for IBS. Exercise is also very important.

– Prescription meds can also help.