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Patient
Advice and Information
Irritable Bowel
Syndrome
by Dr Panayiotopoulos, Consultant Vascular and General Surgeon
Essex.
1.
What do we mean by irritable bowel syndrome?
The IBS is a troublesome, common disorder that
represents mostly a
functional abnormality or a motility disorder of
the bowel rather than a true disease.
It is characterized by an increased sensitivity of the bowel
resulting in spasm of the bowel muscle. In almost all cases there
are no anatomic findings in the various tests performed and quite
often the diagnosis is put by exclusion
criteria.
However, it is a true condition, rather an “all in the mind”
problem, even though test results are normal. It is not an allergy,
an inflammation, an infection or a hereditary problem.
2.
How common is it?
It is extremely
common in western or developed countries,
affecting about one third of patients seeking help in a
gastroenterology clinic. Affects slightly more often women and
usually starts in mid-life [30-40s].
3.
What are the symptoms of IBS?
They vary from person to person and from time to
time, but usually include
cramping discomfort,
fullness, bloating and
change in the bowel habit,
ranging from constipation to diarrhea or alternate between these
two. Fullness and
bloating make
the cloths feel tight and are associated with
flatulence
[wind].
Most people
feel an urgency
[rushing to go] to open their bowels and there may be a discomfort
or difficulty in opening the bowels. A sensation of incomplete
emptying is common.
Tenesmus
[ineffectual straining to pass a motion] and
proctalgia fugax
[sharp pain felt inside the low back passage] are also common during
the exacerbations.
 4.
What causes IBS?
Although we do not fully
understand the cause of the condition, it seems that modern life
is the cause of it, with lack of exercise [which is related to
normal and more frequent bowel motions], stress, anxiety and
depression [interfere with nerve controlled bowel motility],
improper diet [too much or too less fibre, too much fat and spicy
food], dietary habits [one meal per day], plus alcohol, coffee, tea
etc, resulting in alterations in bowel motility.
5.
Are there any investigations needed?
It is important to exclude the
presence of more serious bowel conditions, including cancer and
diverticulosis [a pouch that develops in the wall of the bowel.
However, patients with diverticulosis may experience episodic pain,
constipation and diarrhea, but these are associated to the motility
disorder rather than the diverticulae.
Bowel cancer can
cause similar symptoms, but as the peak incidence of cancer is the 6th
decade, these tests are needed only in more elder patients. In many
young patients the doctor may diagnose the condition based on just
the history and the physical examination.
. Barium enema.
The bowel looks more tightened, like string and quite often has
diverticulae.
 
. Sigmoidoscopy
[examination of the last 15-30cm of the bowel] and colonoscopy
[examination of the whole large bowel] with a special telescope, if
an organic condition[i.e. diverticulosis] is discovered.
6.
What is the treatment of irritable
bowel syndrome?
It is important to understand that IBS, although
troublesome, does not lead to serious complications. Understanding
the condition, the mechanism of symptoms and close observation to
what seems to be triggering them, may help the patient to avoid
things that seem to provoke the attacks.
Advice on diet, eating habits and lifestyle with a
well balanced healthy diet, regular small meals will usually reduce
symptoms. Although few patients are benefited by an increase in diet
fibre, most are helped by a reduction in fibre intake, such as
fruits, vegetables and cereal. Food rich in fat and spicy food
should be avoided, while regular exercise after a meal is also
beneficial.
In the majority of the cases reassurance,
understanding of the condition and symptomatic relief [treating
constipation, diarrhea, spasmodic pain, stress and anxiety] is all
that is needed. However, the answer to the question “is there a
cure?” is probably not, as the sufferer has to become doctor of
himself, has to change his life style, his attitude and his approach
to modern life, including eating habits and society initiated
stresses.
-
 What is
diverticulosis?
A
diverticulum is a small pouch on the wall of the bowel,
representing a herniation [prolapse] of the bowel mucosa [lining]
through the wall of the bowel. The presence of diverticulae forms
the condition called diverticulosis. It is an acquired
condition and affects mostly the left side of the large bowel
[sigmoid colon]. It is also an extremely common condition, seen in
35% of adults by the age of 65 years. By 75 years, 70% of
adults are affected.
-
What causes
divericulosis?
A variety of factors are involved,
both genetic [inherited] and acquired.
.
Genetic factors.
There is no absolute genetic inheritance but some families have a
high incidence.
.
Environmental factors.
High fat and low fibre diet
.
Chronic constipation,
as it increases the intraluminal
pressure.
.
Age.
-
 What symptoms
does diverticulosis cause?
Diverticulosis probably remains
asymptomatic in about 80% of the patients and is discovered
incidentally on
. Barium enema
or
.
Sigmoidoscopy
[examination of the last 15-30cm of the bowel] and colonoscopy
[examination of the whole large bowel]
with a special telescope, if it is discovered at all.
The symptoms
are actually complications –bleeding and diverticulitis-.
However, patients with diverticulosis may experience episodic pain,
constipation and diarrhea, but these are associated to motility
disorder rather than the divericulae. The risk of developing these
serious complications is about 10-20%.
7.
What is diverticulitis?
Diverticulitis is the result of
inflammation around the diverticulum, either from small
perforation or infection. Is the commonest complication of
diverticulosis. Most patients will present with temperature and pain
on the left loin.
Although in most of the cases the symptoms settle
with expectant treatment, there is a considerable risk of serious
complications, including perforation and peritonitis, bowel
obstruction and abscess or fistulae formation.
8. What is the treatment for
diverticulitis?
+
Non-operative treatment with analgesics, antibiotics and intravenous
fluids is employed in all patients initially. In the majority of
patients there is substantial clinical improvement in 24-48 hours.
+
Patients with severe symptoms or acute complications should be
operated upon urgently. In such a case it is more likely that the
affected bowel will be removed but the proximal end will be
exteriorised as a colostomy. The latter is reversed at a second
stage.
+
Patients with complications that do not need urgent surgery [like
fistulae or abscesses] are better operated on an elective basis.
The indications for elective bowel resection are:
-
Recurrent
diverticulitis
-
Persistent
diverticulitis with pain mass, dysuria, etc
-
Age under 50 years
-
Stricture
-
Inability to exclude
carcinoma.
About 25% of patients that are hospitalized for
diverticulitis, will require surgical treatment. The affected
side of the bowel is removed and the two ends may be joined
together. In emergency cases a colostomy may be formed, joining the
two ends at a later stage.
9.
What is the risk of recurrence following an acute attack?
Diverticulitis recurs in one third of the
medically treated patients. Recurrence rate following surgery
is 3-7% while the risk of surgery is 2-4%.
Although you have to increase your dietary fiber, it
is not known if this measure prevents recurrences.
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Please note:
A written referral from a general practitioner is helpful but is not essentially required in order to make an appointment to see a consultant specialist. |
