IRRITABLE BOWEL SYNDROME AND OTHER COMMON CAUSES OF DIARRHOEA

Introduction

A change from the pattern of normal stools to more frequent, loose watery bowel movements is normally referred to as diarrhoea. Symptoms normally disappear in a few days, but sometimes diarrhoea lasts for weeks or more, in which case it can be an indication of a more serious disease. It is important to talk to your doctor if the condition lasts more than a few days,or if your stools contain blood, mucus, or more undigested foods than usual.

Signs

Food passes from the small intestine, where nutrients are taken into the body, into the large intestine where fluid is absorbed before the waste moves into the lower bowel. If the normal digestive and absorptive process is disturbed, often due to infection or inflammation in the intestine or occasionally food allergy, the large intestine cannot cope with the increased volumes of fluid,and so less is absorbed. Also, increased activity of the large intestine can result in cramping abdominal pain. Thus "true" diarrhoea is not only associated with more frequent stools but with stools of increased volume.

Diarrhoea can be triggered off by many different factors, icluding infection, over-indulgence (including alcohol), stress, and cations. In some cases, it is a symptom of more serious illnesses.

Treatment

Anyone with diarrhoea should drink plenty of fluid. Bottled water is safest, especially when abroad. If the sufferer is young, old, or weak, an oral rehydration treatment should be taken to replace the fluid, salts and minerals that are lost with each bowel movement.

Try and rest. Bed rest is not always practical, but wherever possible stay at home or in your hotel until the symptoms subside. If the diarrhoea persists for more than a few days, you must go to a doctor.

Keep lmodium at hand. lmodium contains loperamide which has been widely prescribed by doctors for years to treat diarrhoea quickly and easily. lmodium slows down the action of the gut, which may also help relieve stomach cramps and the feeling of urgency. It can stop diarrhoea in under one hour for some people. 1modium should not be used by children under the age of twelve. A doctor should be consulted if the diarrhoea persists for longer than twenty-four hours. As with all medicines, always read the label.

Common causes of diarrhoea
Irritable bowel syndrome

It is estimated that one in every five people will be affected by irritable bowel syndrome (IBS) at some time in their life. The symptoms at mildest can be a nuisance and, in more severe cases, very distressing, leading to over 80,000 hospital referrals each year. IBS is a disorder affecting the muscular walls of the bowel and therefore the movement of the gut. In the past it has been called "mucous colitis" or "spastic colon".

Symptoms

There are a number of symptoms associated with IBS. These may vary from person to person, or from time to time, However, the most common symptoms are:

• abdominal pain, frequently gripy, which is relieved by passing wind or a bowel movement
• bloating and distension of the abdomen, often accompanied by rumbling noises
• increased bowel frequency, diarrhoea, constipation or alternating bouts of both
• small, pebble or ribbon-like stools
• rectal discomfort

There are many other symptoms associated with the disorder such as:

• nausea
• poor appetite
• tenderness of the abdomen
• headaches
• backache
• occasional incontinence

There may also be symptoms of increased frequency of passing urine and pelvic discomfort during sexual intercourse (dyspareunia).

Causes

IBS can be provoked by a number of factors. It is not, however, an infection, hereditary disease, or the result of bowel inflammation. Experts differ, but generally it is agreed that IBS may be triggered by:

• lack of dietary fibre
• stress
• anxiety or depression
• food intolerance
• an intestinal infection (for example, food poisoning)

People frequently suffer from constipation, abdominal pains, wind, and diarrhoea. If however, any of these symptoms persist for more than a few days, or are accompanied by any of the following symptoms, then you should go and see your doctor:

• weight loss
• lethargy and extreme pallor, which could suggest anaemia
• passing blood
• black stools

Your doctor will decide whether the symptoms require further investigation immediately. He may suggest further tests if you do not respond to a course of treatment. Remember, although IBS is uncomfortable, it is not a serious disease.

Treatment

Treatments vary according to the individual symptoms. Abdominal pain and bowel spasm usually responds to anti-spasmodic drugs. Constipation is relieved by bulk laxatives that provide fibre and stimulate the bowel muscles. Also, oil of peppermint soothes the lower bowel.

Anti-diarrhoea drugs slow down the action of the gut. Anti-depressants are usually prescribed for anxiety and depression, while stress is often treated with psychotherapy and hypnotherapy.

Self-help

There are a number of ways in which you can help relieve the symptoms of IBS. In many cases, a change of diet or reduction in stress can lead to total relief.

About one third of all sufferers benefit from increasing the fibre content of their diet. This is most helpful in patients in whom constipation is the major symptom. This involves eating plenty of brown bread, brown rice, fruit, vegetables, and muesli or high-bran cereals. If wind is a particular problem, and the high fibre diet does not improve the symptoms, as your doctor or a dietician for advice.

Try increasing your liquid intake, especially on waking or between meals. Give yourself plenty of time to eat your food - a skipped breakfast or snatched sandwich at lunchtime may aggravate the problem. Eat smaller meals regularly.

Stress, caused by trying to pack too much into the day, pressure at work, or personal crisis is estimated to be a major contributor to bowel disorder. The first step in combating stress is to learn recognise that you are stressed and take the appropriate action. Either cut down on your workload, face up to problems and taking positive action to help solve them, or simply ensure that you set aside a certain amount of time each day to sit down and relax.

Sitting all day, especially in tight clothing can restrict abdominal muscles. Try walking or cycling to work and allow yourself ten minutes each day to run through a simple stretching and relaxing exercise routine. More structured exercise such as aerobics, jogging, and swimming provides additional relaxing effects, and often helps to alleviate miserable feelings.

Regular use of non-fibre laxatives can cause problems if used without medical supervision. A high-fibre diet or the use of a bulking agent should be sufficient to stimulate the bowels to work normally.

Gentle massage of the abdomen in a circular clockwise motion can help relieve pain and release wind.

Other causes of diarrhoea

Eating rich spicy foods, too much fibre, or large amounts of sorbitol (artificial sweetener) can irritate the lining of the gut and result in diarrhoea.

Avoid eating large quantities of rich or spiced foods, especially if you are not used to them. Choose smaller portions and combine them with something blander such as rice, bread, pasta, or plain potatoes.

Some types of drink can affect the body, leading to diarrhoea. These include alcohol (especially in excess), drinks containing a high proportion of hops (such as stout and real ale), fruit juice, (especially those containing pulp), squash, and canned drinks containing high quantities of sugar or artificial sweetener (sorbitol).

Avoid drinking large quantities of cold liquids very quickly. Never drink alcohol on an empty stomach and alternate, if possible, with water. Switch to brands of soft drinks with a low sugar content.

Nervous diarrhoea

Stress or a bout of anxiety can result in short periods of diarrhoea. Learn to recognise when you are under stress and take action to combat it (as outlined above).

"Travellers" diarrhoea

Diarrhoea is extremely common when travelling abroad, and can be caused by a combination of poor hygiene, contaminated food or water, a change in diet, and excessive alcohol.

Be scrupulous about personal hygiene. Anything that you touch could be contaminated with bacteria that can lead to diarrhoea, so wash your hands frequently.

Avoid drinking local water, and remember to cut out ice as well. Use bottled water to clean your teeth if you are in especially high risk areas where sanitation is poor.

Choose food carefully. Shellfish and seafood can be especially suspect. Always ensure that food is freshly prepared and avoid items (such as cakes) that have been on open display, and reheated foods, especially poultry. Never eat unpeeled fruit and vegetables.

Viral diarrhoea

There are numerous viruses that affect the gut. They often cause cramping abdominal pain, nausea, and vomiting. See a doctor as soon as possible if the symptoms last longer than twenty-four hours, especially if the sufferer is young, old, or very weak.

Bacterial diarrhoea

There are a variety of bacteria which result in food poisoning. These are most frequently found in untreated water, undercooked meat, poultry and fish, foods left for periods of time at room temperature, reheated foods and unpasteurised milk. It is especially important never to drink unpasteurised milk from any animal when abroad.

To avoid bacterial infection:

• keep everything in the kitchen clean
• keep cold foods cold and hot foods hot
• cook foods thoroughly and refrigerate leftovers promptly
• do not reheat chilled foods more than once
• keep pets away from foods
• shop carefully and check expiry dates
• when buying food or eating out, check that the premises are clean and the staff are well groomed with clean aprons, hands and hair; see how the food is stored and ensure that the staff do not directly handle the food

Visit your doctor if you suspect you might have a bacterial infection,, as some infections can be more serious than others.

Other causes

Diarrhoea can also be caused by certain medications, parasites or more serious illnesses such as ulcerative colitis, Crohn's Disease and some forms of intestinal cancer. It is important, therefore, to visit your doctor if the symptoms continue. For further information, contact:
IBS Network
St John House
Hither Green Hospital
Hither Green
London
SE13 6RU

or:
British Digestive Foundation
PO Box 251
Edgeware
Middlesex
HA8 6HG