Irritable bowel syndrome is the modern name for a condition that was formerly known as spastic colon. It is the most common functional gastrointestinal disorder, and is present in up to 20 per cent of the general population in the UK, yet its diagnosis by simple means remains a dilemma. This, however is not a true figure, as many sufferers decide that their bloating is not a real problem, and therefore do not seek professional advice. If they were all to decide to consult their doctor or a consultant, this would place an impossible burden upon medical care facilities in the UK. IBS accounts for almost 50 per cent of outpatients seen by British gastroenterologists each week. The other costs of IBS are 270 THE NATURAL HEALTH BIBLE mainly in lost quality of life and the effect it has on social life and family health.
The occurrence of IBS almost exclusively in civilised nations, places it in the class of so called ‘civilised diseases’, stemming from its main causes which are dietary and lifestyle. A typical western diet, consisting largely of refined and adulterated food, over-consumption of one or two staple foods and hurried meals are just a few of the underlying causes of IBS. Epidemiologists often refer to IBS as an acquired disease to which food and environmental factors are the most likely contributing factors. If so, they are largely avoidable, yet the medical profession’s first response is not prevention but medication. For a diagnosis of irritable bowel syndrome to be made, a patient must have no underlying sinister symptoms, but be suffering with either constipation or diarrhoea or both, and abdominal pain and/or bloating and wind.
According to a large UK study published in 1965, a ‘normal’ bowel habit was considered to be anything from passing motions three times per day to three times per week. At the time 99 per cent of the population survey fell within these limits. It was also discovered that despite this many people still complained of diarrhoea or urgency, or constipation with stools difficult to pass. A further American survey some twenty years later revealed that 94 per cent had a stool frequency of between three times a day and three times per week. However, further questioning about a variety of bowel symptoms revealed that a total of 17 per cent had symptoms indicative of bowel dysfunction.
Surveys on precisely how common IBS is, vary from between 10 to 25 per cent. The most recent UK survey conducted on 2,000 adults from the Southampton area found that a total of 24 per cent of women and 19 per cent of men reported symptoms consistent with IBS. Many people who are troubled by it do not consult their general practitioner but muddle on alone. One wonders how the medical facilities would cope if everyone with IBS turned up for help!
• constipation – opening the bowels infrequently, or hard stools
• diarrhoea – loose rather than just frequent stools
• alternating diarrhoea and constipation
• abdominal discomfort or pain
• abdominal bloating
• excessive wind
• mucus or slime in the stool
• nausea and loss of appetite
• indigestion It is usual with IBS that patients will suffer with either diarrhoea or constipation, or a combination of the two, together with abdominal bloating and some discomfort or pain. These are the most common and typical symptoms.
• Age Many people develop IBS symptoms in young to middle age, although approximately 12 per cent of those with IBS did experience symptoms during their childhood.
• Operations It has been observed that approximately 10 per cent of women are more likely to suffer symptoms of IBS following an operation like a hysterectomy or surgery on the ovaries. These operations can leave internal scar tissue which is thought to be connected in some way to the onset of symptoms.
• Radiotherapy When the abdomen has been targeted by radiotherapy, scarring can occur which may then once again produce symptoms of IBS.
• Gynaecological problems The female reproductive organs have a very close relationship with the bowels. The womb, or uterus, is next to the end of the colon and a significant amount of the small bowel sits loosely coiled on top of the uterus. Many conditions relating to the uterus can release powerful chemicals which also influence the gut. A study by Dr Prior and colleagues on a sample of 200 women found that many of them noticed improvements in their bowel functions following a hysterectomy. Twenty-two per cent of his sample had IBS before surgery, and two-thirds reported improvement in their symptoms following the operation.
• Gastrointestinal infection Most of us have experienced a severe tummy upset whilst on holiday or after eating a take-away meal. Sudden onset of diarrhoea, sometimes accompanied by pain and fever, can either be caused by bacteria or by a virus. Usually it doesn’t last for more than a few days, but sometimes the gut never seems to feel the same again, and symptoms of IBS develop.
• Other bowel conditions Older people sometimes develop a condition called diverticulosis of the colon, when the weak walls of the colon begin to bulge, and this can sometimes cause symptoms of IBS as well. A lack of fibre may lie behind both conditions. Patients suffering with ulcerative colitis, a severe inflammation of the gut which causes diarrhoea and bleeding, may also experience symptoms of IBS, even when the colitis is controlled by drugs.
• Drugs Some pain-killing drugs can cause symptoms of IBS, either shortly after they are taken, or several months later. Antibiotics, certainly if taken in the long-term, can cause diarrhoea as a side-effect which may set up IBS-type symptoms in some. This seems to be due to 272 THE NATURAL HEALTH BIBLE a build up of Candida albicans, the organism responsible for thrush. This is often self-limiting and passes off, but for some it persists. Sometimes supplements of iron or multi-vitamins and minerals containing iron can irritate the gut also and produce symptoms of IBS.
• Stress There is now plenty of evidence to show that stress can worsen symptoms of IBS. The stress factors affect the muscles in the gut and can cause them to go into spasm, rendering the bowel inefficient, and causing pain. Chronic sufferers of IBS sometimes suffer with anxiety and depression as their symptoms remain unresolved, which produces a vicious circle.
• A change of diet Food intolerances sometimes develop after a period of eating substantial quantities of the same food, or when new foods which are hard to digest are introduced. Further information on this subject can be found in the information on Food Allergies (see page 58).
• Nothing Strangely, it seems that symptoms of IBS occur out of the blue with no single precipitating factor. Perhaps a subtle combination of circumstances may be the underlying cause or perhaps there may be genetic factors at play.
Twenty years ago, it used to be fashionable in medical circles to investigate patients complaining with symptoms of IBS, with a view to diagnosing a stomach or duodenal ulcer, gall stones, digestive problems or problems with the colon, or large bowel, particularly diverticulosis. IBS was a diagnosis made by the doctor when nothing else could be found. This meant that patients were often subjected to numerous tests including blood tests and x-rays, that were unnecessary. This was frustrating for patient and doctor alike.
Times have fortunately changed. It has become recognised that IBS is often the diagnosis for young to middle-aged patients, with abdominal pain or disturbance of bowel function. There are no tests to verify the diagnosis of IBS, it is often made on a balance of probabilities. It is important to be screened by your doctor to eliminate the possibility of any sinister underlying cause to your symptoms.
• Follow an exclusion diet outlined in the Menu for Irritable Bowel Syndrome on page 472. An exclusion diet involves avoiding all commonly allergenic foods for a set period of time, then reintroducing them one by one. The most frequently implicated foods are wheat, dairy, eggs and citrus foods.
• Take a probiotic supplement which provide a standardised dose of the healthy bacteria Lactobacillus acidophillus and bifido bacteria. Eating live yoghurt might also be helpful, but supplements ensure a more precise dose. Most probiotics require refrigeration, but some do not have special storage requirements.
• If you are constipated add 1–2 tbsp of organic golden linseeds to your wheat-free breakfast cereal daily. They can be crushed and soaked in water or milk (soya or rice ‘milk’) for maximum efficiency. Crushing and soaking them reduces the risk of any associated discomfort such as bloating. Refer to the chapter on constipation for more information.
• Take supplements of magnesium amino acid chelate to improve bowel function if your are constipated. Magnesium works by relaxing the smooth muscles of the gut. The WNAS recommend taking it ‘to gut tolerance’ which means that too much can result in loose stools. Monitor and adjust your dose accordingly.
• Aloe vera is a good adjunct to a specific dietary and supplement programme. Aloe vera is used primarily to heal the digestive tract. Be aware of cheap inferior brands on the market, and choose one from a reputable manufacturer. Aloe vera is available in liquid or gel form.
• Take some digestive enzymes. These function to mimic the natural enzymes secreted by the pancreas and stomach. Sometimes these are lacking in patients with IBS, especially those who suffer with chronic bloating and a feeling of fullness soon after eating, even small quantities. They shouldn’t be taken in the long term as the body might lose its ability to produce these enzymes naturally.
• Charcoal tablets are quite a good standby for the immediate relief of bloating and discomfort. However do not take daily or at the same time as nutritional supplements because the charcoal can actually inhibit the absorption of nutrients.
Creative visualisation is a wonderfully simple and most enjoyable method of relaxation, that requires little or no training. It is perfect for those who haven’t had the time to learn how to practice yoga or meditation. We advise patients to lie flat on the floor, with a cushion beneath the head. Bend your knees and place your feet flat on the floor, so that you are in what is called ‘The Alexander position’ after the founder of the Alexander Technique. Next, close your eyes, take some slow steady breaths, and consciously relax your face, your fingers and your toes. When you feel comfortable, whilst still breathing slowly and steadily, you simply visualise any fantasy you fancy, from a world cruise to a good night out! The trick is to keep your mind on the trip in question. It seems to be an acquired skill, and one that you may have to work at. If you have a very busy mind, you may need to have a pen and paper handy at first, in order to download your thoughts. You need to do this for fifteen or twenty minutes per day, and then gently come back to reality, rolling over on to your side prior to standing. Some patients feel so relaxed doing their creative visualisation, that they fall asleep!