Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is a common digestive disorder which can cause troublesome and persistent symptoms. These vary greatly from person to person, but usually include cramping discomfort, a feeling of fullness or bloating, and a change or disruption of bowel habit. This can range from constipation (difficult or infrequent passage of a motion) to diarrhoea (frequent or loose motions and an urgent need to go), or can alternate between the two.
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The symptoms appear to be due to an increased sensitivity of the
bowel, which results in spasm of the bowel muscle. IBS is a disorder of
the way in which the bowel functions. For this reason, it is sometimes
referred to as a ‘functional bowel disorder’.
The irritable bowel syndrome is not:
* hereditary, although other members of the family may have similar
symptoms;
* food allergy, although some patients find they are intolerant of
particular foods;
* "all in the mind", even though test results may be normal;
* an infection, although it may have been triggered by an initial attack
of gastro-enteritis;
* bowel inflammation, as in the case of ulcerative colitis or Crohn’s
disease;
* caused by ulcers, gallstones, cancer or other more serious digestive
diseases, although some patients with these conditions may have some
symptoms in common with IBS at some stage.
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How common is it?
The irritable bowel syndrome is extremely common in developed countries.
More than half of all patients attending gastroenterology out-patient
clinics have IBS. A third of people in Britain have occasional symptoms
of IBS, and 1 in 10 have symptoms bad enough to require medical
attention. Women tend to seek medical attention for it more often than
men, but the prevalence in men and women is similar. IBS commonly starts
between 15 and 40 years of age, but may occur at any age.
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What are the symptoms of IBS?
The symptoms differ between patients and may vary from time to time, but
all patients will have at least some of these:
* Abdominal pain, which is often colicky in nature. It may be felt
anywhere in the abdomen, but is often low down on the left. Many
patients find their pain is worse when constipated, and it may be
relieved by opening the bowels or passing flatus (wind from the back
passage). In women there may be a pattern associated with their periods.
* Fullness and bloating, making clothes feel tight and uncomfortable and
sometimes associated with rumbling noises and flatulence (wind). The
abdomen may feel tender. Belching and passing wind through the back
passage can ease this. Nausea can occur but vomiting is not usually a
feature of IBS.
* Alteration in bowel habit, which may be constipation, diarrhoea or an
alternation between the two. Bowel habit varies enormously between
individuals, though most people have their own pattern. The change in
bowel habit may be in the frequency of action, the form of the motions,
or associated urgency (rushing to go). There may be some discomfort or
difficulty in opening the bowels. A sensation of incomplete emptying is
common. Ineffectual straining to pass a motion (tenesmus) and a sharp
pain felt low down inside the back passage (proctalgia fugax) are also
common. Incontinence can occasionally occur, causing great embarrassment
and anxiety.
Though some of these symptoms may be embarrassing or distressing, it is
important to tell the doctor about them. Worrying in silence may make
them feel even worse. Remember, they happen to a lot of people.
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What is the cause of irritable bowel syndrome?
The cause of IBS is not fully understood yet. Research has shown that
the bowel in IBS sufferers is more sensitive than usual and this
sensitivity sets off a reaction which causes the symptoms. Understanding
the normal muscle control in the bowel helps to explain what happens in
IBS.
The bowel is a muscular tube which propels food from mouth to anus,
allowing nutrients to be digested and absorbed along the way. The colon
(large bowel) links the small bowel to the rectum and anus (back
passage), and is the source of most of the symptoms of IBS. It acts as a
reservoir for the semi-liquid residue of the digestion of food, and
absorbs water and salts from this, leaving a more formed motion to be
passed. Regular muscular contractions propel the contents through the
colon. If the bowel is overactive, the contents pass more rapidly and
the patient gets diarrhoea, whereas sluggish activity causes
constipation. Muscle spasm in the bowel causes discomfort and cramping
pain. Eating a meal, or the presence of gas in the bowel, can trigger
contraction and spasm, causing symptoms.
Anxiety, depression and stress related pressures of life are commonly
associated with IBS. Feeling low may occur as a result of distressing
bowel symptoms, but in some it occurs spontaneously and seems to
aggravate the problem. Symptoms of IBS may increase stress because of
fears that there is some serious disease present.
The nature of the diet, eating habits and lifestyle also influence the
way the bowel functions. Too much, or too little, dietary fibre; too
much fat; or a very rich or 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. For some people, certain foods may have the same
effect. However, often there is no obvious precipitating factor.
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Are any investigations necessary?
Investigations are important to exclude other more serious bowel
disorders that can produce similar symptoms to those of IBS. The history
of the symptoms and a physical examination will help to establish the
diagnosis. In many young patients, the doctor may diagnose with a few
initial investigations and treat the disorder. In older patients who
develop new digestive symptoms, the doctor will do more extensive
investigations to exclude other bowel disorders. Laboratory tests,
x-rays and endoscopy (internal examination with an instrument) may be
done to exclude other digestive disease. The response to a trial of
treatment may help to establish the diagnosis. If some of the symptoms
are not typical, such as weight loss or blood in the motions, full
investigation is essential.
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What treatment is available?
Although the irritable bowel syndrome may produce troublesome symptoms,
it does not lead to serious complications. It is important to know and
understand this. An explanation of the disorder and how symptoms are
produced helps to relieve anxiety and allows the patient to cope better
with the symptoms. If attacks are infrequent or mild, this insight may
be sufficient. Reassurance that more serious or progressive disorders
are not present is also important. A knowledge of what provokes an
attack may help individuals control their symptoms more effectively and
prevent attacks, or at least help them to cope better.
Advice on diet, eating habits and lifestyle helps many IBS sufferers. A
well-balanced ‘healthy’ diet, taken as regular meals, will reduce
symptoms. Some patients benefit from increasing the fibre content of the
diet and others may be helped by reduction in fibre intake. Important
foods containing fibre are cereals, fruit and vegetables. Fibre
supplements prepared from plants can be prescribed or obtained from the
chemist, but these should not be used without first discussing the
symptoms with a doctor.
Foods which are high in fat often provoke symptoms and should be
avoided. Rich or spicy foods can also cause attacks. People usually are
aware of particular foods which upset them, but may not associate
attacks with common foods such as dairy products, bread and cereals,
which can trigger symptoms. Large, infrequent meals challenge the
digestion much more than small, frequent ones, which often help to
reduce symptoms.
Patients who relate their symptoms to stress or anxiety usually benefit
from a better understanding of the condition. Sometimes counselling in
stress management is helpful. Others with more severe symptoms may
benefit from hypnotherapy. If anxiety or depression are a major part of
the problem, psychotherapy may help. Treatment with an antidepressant
may also reduce symptoms.
Antispasmodic drugs help some patients, but response is variable.
Constipation may require additional laxative treatment under medical
supervision. Diarrhoea can also be controlled, particularly if it is
limiting activity, mobility and lifestyle.
In many cases, reassurance, explanation and symptomatic treatment are
all that is required and regular medication is not necessary.
Products to help control IBS are widely available from the pharmacist,
however, the use of digestive enzymes for its treatment would be the
best for most sufferers. Fatty and spicy foods and dairy products may
all trigger or increase the symptoms of IBS. The most probable and
logical reason is because these food remain in the digestive system
untouched and undigested for the bacteria in the large intestine to
break down and digest. This results in fermentation leading to cramps,
flatulence, abdominal pain, bloating, wind and diarrhoea. Enzymes are
normally found in the digestive tract but IBS sufferers may have a
reduced amount of them to fully digest the food. Supplementing the
digestive system with enzymes is beneficial and this may help in
complete or near complete eradication of symptoms. Lipozyme is the
product enzyme that breaks down fats. Ideal for those who have symptoms
triggered by oily and fatty foods. Prolactazyme is for those who feel
weak after digesting dairy products. Spectrumzyme, Polyzyme and
Digestaid are cocktails of enzymes to breakdown fats, proteins, starch
and carbohydrates. Carbozyme is for those whose symptoms are triggered
by the intake of carbohydrates. You find more information in the
products page. All these products are shipped to all parts of the world
and sell at 10% less.
Digestrin is a product that claims to treat IBS. The company that makes
it, Selmedica, are so confident that they offer a money back guarantee
for a year! This product is available to residents of the US, UK and all
others where FedEx fly. Digestrin comes in 3 different packages. There
is nothing to loose so you may as well try it. If you live in the US a
free phone number is provided for any questions you may want to ask,
however, I kindly ask you to place the order on line and not over the
phone. This helps your order to be tracked and for this you would be
helping me in continuing with the development of this web site.
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Is there a cure?
Despite considerable research, the cause of irritable bowel syndrome
remains in-completely understood and there is, as yet, no cure. It is
well established that the symptoms of IBS are due to the way in which
the bowel functions, rather than any specific disease of the bowel. With
new research methods, which the Digestive Disorders Foundation is
supporting, it is becoming possible to monitor the functioning of the
bowel and to understand it better. It is hoped that this will provide
more specific and effective treatments for the troublesome symptoms of
this common condition. Fortunately, most patients’ symptoms are
reasonably controlled most of the time by the treatments outlined. For
some, the symptoms often resolve on their own with time. However, there
is a continuing need to sustain further research into IBS, to help
relieve the symptoms for sufferers and to advance our understanding of
the functioning of the bowel.
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