Rumbling In The Tummy!! Irritable Bowel Syndrome
QUITE familiar. Isn't it ? The fellow whose intestine is at war with itself and makes so much noise while sitting by you!! And who seeks the toilet every ten minutes or so!!. As expected, such persons are also anxious and appear to be in distress. Welcome to the world of "Irritable Bowel Syndrome".
What is Irritable Bowel Syndrome (IBS)?
This is a disorder of the digestive system, the intestine (that part of the digestive system responsible for digestion of food, among other things). It is characterized by a feeling of being bloated up with air; abdominal pains, abdominal discomfort. It also manifests with diarrhoea and constipation, sometimes alternating with each other. Many times, it comes up in episodes with respites in-between.
What are the causes of IBS?
The definite cause is unknown but like in many conditions in Medicine, there are often as many suggestions as there are experts!!
One thing is apparent; there is a derangement in the communication between the brain and the intestine!! This 'communication gap' involves the hormones, the immune system and chemicals transmitting message in the brain (neurotransmitters). It appears that the loss of balance among these elements results in abnormal muscle contractions or spasms (muscle pulls). These 'muscle pulls' are painful and may either speed passage of stools -diarrhoea or slow it down -constipation.
Persons with IBS have an unusually sensitive intestine. They will develop painful intestinal spasms from these possible factors:
(a) Eating, especially certain foods
(b) Stress - Don't we have plenty of that in Nigeria.!
(c) Trapped gas causing bloating - try beans!!
(d) Hormone changes, especially in women during menstruation.
(e) Certain medications, especially antibiotics like erythromycin
(f) Genetics - 'Its all in the stars.' Some persons in certain families just have a propensity for IBS.
How is IBS classified ?
Mild- most people see IBS as nuisance value. The symptoms do not disrupt their lives. They may be worried that they have cancer and may need to see a physician-Gastroenterologist, for assurance.
Moderate- these have more bothersome symptoms that occasionally disrupt work, school, social and other activities. Each episode may be related to stress, physical exertion, certain foods or medications.
Severe- these will manifest with intensive abdominal pain, urge to pass stools, extreme bloating of the tummy and generally feeling uncomfortable
What are the complaints ?
Abdominal pain, discomfort, constipation, diarrhoea, bloating, mucus in stools and a feeling of inadequate emptying of the bowels.
How is it diagnosed?
Most times, the presenting complaints by the sufferer and physical examination are sufficient to clinch the diagnosis. However, other conditions that present likewise need to be excluded.
If seen in younger persons, there may be no need for extensive testing. If however seen in older persons, 50 years and above, there is a crying need for extensive tests to exclude cancer. Tests such as stool tests to look out for worms may be requested. Other tests such as sigmoidoscopy will look into the lower intestines. Barium studies which outlins the intestines by means of radio-opaque dye may be useful in excluding other causes of prolonged diarrhoea or constipation.
Other tests may include Colonoscopy (which allows a doctor to look at the lining of the entire large intestines), thyroid function tests.
How long will I suffer from IBS?
Symptoms may persist for a longtime, unfortunately. The good news is that it does not shorten your life or cause cancer.
The pattern varies from person to person. Some have it on and off for years. Many are free of symptoms for months and then, it starts again possibly due to stress or dietary indiscretion.
Symptoms do improve over years and may stop completely in certain persons.
When should I consult a doctor?
(a) When, in spite of treatment, your symptoms do not improve.
(b) When your complaints are more than usual.
(c) When symptoms wake you from sleep.
(d) If you become rather more tired
(e) Unexplained weight loss.
(f) Decreased appetite.
(g) Presence of blood in your stool.
(h) Abdominal pain that is not relieved when you fart or pass stool.
What is the treatment?
Unfortunately, despite the array of treatments, no single treatment works for everyone. So also, there is no cure and the condition can only be managed. It is important you consult a specialist in the treatment of diseases of the intestines called GASTROENTEROLOGIST.
The person affected should avoid precipitating factors by:
(a) Limiting caffeine as in coffee and those energy drinks.
(b) Limit fatty foods such as fast foods, suya and milk.
(c) Limit fruits and artificial sweeteners.
(d) Increase fibre in your food as this relieves constipation.
(e) Avoid beans, cabbage, milk, ice cream and such foods that bloat up your tummy.
You should also engage in regular exercises such as jogging, brisk walking (be mindful of the 'okadas', '419ers', ritual killers and executive beggars).
You should also quit smoking and avoid foods that trigger an attack.
Stress management and psycho therapy are useful in certain persons.
Medications are useful but not necessarily compulsory. These include - 'Imodium' for diarrhoea: Zelnorin for constipation. Others are anti-anxiety drugs such as Paroxetine. Other useful drugs are anti-depressants (not that you are necessarily depressed) therefore it does help!! Anti-anxiety drugs such as Valium, Lexotan are also useful. So also medications called anti-cholinergics
The choice of drug is better left to your gastroenterologist.
What non- drug treatments are available?
Psychotherapy and behavioural therapy
Hypnosis
Relaxation, meditation
Yoga
Biofeedback
Any need for surgery?
Usually, NO.
