PATIENT INFORMATION

AUTHOR: PROFESSOR JOHN MURTAGH

Copyright of Professor John Murtagh and Australian Doctor. This patient handout may be photocopied or printed out by a doctor free of charge for patient information purposes.
Irritable bowel syndrome
What is an irritable bowel?
An irritable bowel which is also known
as an irritable colon or an irritable digestive
system is one that does not function in a
smooth, co-ordinated manner. This results in
colicky pain and disturbed bowel function.
What is the cause?
Although the cause of irritable bowel has
been the subject of considerable debate and
medical research, no clear-cut proven cause
has been found. What is known is that the
bowel is very sensitive in people with the
condition. The bowel is a muscular tube that
propels the food along in waves (called peri-
stalsis). This muscular action may become
overactive and cause spasms or tight contrac-
tions rather like a cramp in the leg muscles or
a stitch in the stomach.
It has always been considered that emo-
tional stress has been the main factor
involved, but there is no real proof to sup-
port this theory. However, people with it
sometimes say the problem is triggered by
stress.
Possible causes or aggravating factors are:

Infection of the bowel.

Food sensitivity, eg, spicy food.

Food allergy, eg, milk, cream.

Lack of bulk (fibre) in the diet.

Overuse of laxatives.

Pain-killing drugs and antibiotics.

Smoking.

Salicylates or related chemicals, such as

aspirin, food colourings and fresh pineapple.
What are the symptoms?
The main symptom is vague discomfort in
the abdomen in the centre or towards the
left extending to the pelvic area. The pain or
discomfort is usually relieved by passing wind
or by a bowel movement.
Loose or hard bowel motions may occur
and sometimes the motions will be like small,
hard pellets. You may also feel mildly nause-
ated, off your food, bloated or flatulent
(windy).
An international-based set of criteria sug-
gests that the diagnosis of irritable bowel syn-
drome is recurrent abdominal pain plus two or
more of the following:

Pain relieved by defaecation

Increased (or decreased) stools at the onset

of pain

Looser (or harder) stools at the onset of pain

Visible distention or bloating of the

abdomen

Passing mucus from the rectum

A sensation of incomplete emptying of the

bowel
There is considerable variation in degree
of symptoms, with some people having it to a
mild extent and others quite severe.
How common is irritable bowel?
It is very common and at least one person
in 100 visits their family doctor for treatment.
However, many do not seek treatment if the
problem is mild.
Some doctors say that it is very common,
with up to 30% of the population being
affected to some degree.
It can develop at any age but it usually
begins in the late teens or early 20s. It is twice
as likely to affect women as men.
What are the investigations?
There are no specific diagnostic tests for irri-
table bowel. However, your doctor will con-
duct a limited number of tests (often including
a colonoscopy) to make sure there is no serious
medical cause for your discomfort.
What are the risks?
The irritable bowel is harmless but it is
common for those with it to worry they have
bowel cancer.
It is usual to carry out tests to make sure
this is not the case. There is no cure and the
problem may come and go for years.
What is the treatment?
Self-help
Anyone with an irritable bowel should try
to work out the factors that make the symp-
toms worse. If you recognise stresses and
strains in your life, try to develop a more
relaxed lifestyle. Pleasant distractions are
good, especially as you may have to learn to
live with your problem.
Try to avoid foods that you can identify as
causing the problem. You may have to restrict
or cut out smoking and alcohol. A diet high in
fibre is advisable. Also follow a diet low in
dairy products and processed foods.
Medical help
Several prescribed drugs and herbal prepa-
rations have been promoted for the control of
this condition. Their effect has generally been
disappointing. Some people have found Colo-
fac to be effective but the results are variable. A
new drug called Zelmac for irritable bowel
syndrome in women has been released but fur-
ther clinical research is needed before its place
in treating the syndrome is fully established.
Main area of
abdominal pain
with radiation
to other areas
Bloating
Flatulence
Diarrhoea and/or
constipation