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Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is extremely common, affecting as many as one in five people at some point in their lives.  There is no proven cure but certain lifestyle changes – such as avoiding trigger foods and finding ways to cope with stress more effectively – can help you to manage the symptoms better.

IBS is condition that affects the digestive system. It causes a range of symptoms including stomach cramps, bloating, diarrhoea and constipation. IBS is usually worse after eating and the condition tends to flare up and then subside, sometimes triggered by particular food or drink. It may not disappear completely and for some people it is a lifelong condition.

IBS should not be confused with IBD (inflammatory bowel disease), which is a long-term caused by inflammation of the gut. Although the exact cause of IBS is unknown, it is believed to be linked to gut sensitivity and problems digesting food. Stress is also believed to play a part.

In people with IBS, food either tends to move through your digestive system too quickly, which causes diarrhoea as the system does not have enough time to absorb water from the food, or it moves too slowly which causes constipation as too much water is absorbed making your stools hard and difficult to pass.

IBS may cause your body to become oversensitive to nerve signals from your digestive system, causing symptoms such as stomach cramps.  Intense emotional states such as stress or anxiety can cause chemical changes in your body, which may interfere with the workings of the digestive system.

Certain foods may trigger IBS symptoms;these will vary from person to person so if you have IBS it may be helpful to keep a food and symptom diary. Common triggers for IBS include:

  • Process, fried or fatty food
  • Caffeine
  • Chocolate
  • Alcohol
  • Fizzy drinks.

Anyone can be affected although women are twice as likely to suffer from IBS than men. The condition usually first develops between the ages of 20 and 30.

People who have had a significant episode of bowel infection, gastroenteritis or colitis may be more prone to developing IBS.

Once you have IBS, the condition may not completely go away although you may go for long periods without any or with relatively minor symptoms.

The most common treatment for IBS is to make changes to your diet or lifestyle and to understand what triggers your symptoms so you can avoid these triggers wherever possible.

Keeping a food and symptom diary may help you to recognise, which types of foods and drink make your symptoms worse or better. While your symptoms are active you should avoid these foods although you may not need to avoid them forever.

If you have IBS, it can be helpful to:

  • have regular smaller meals
  • cut back on caffeine
  • cut back on alcohol and fizzy drinks
  • avoid processed foods.

Depending on your symptoms you may need to modify the amount of fibre you eat. If you have diarrhoea you should cut down on insoluble fibre, which is found in:

  • bran
  • cereals
  • nuts and seeds (except golden linseeds)
  • wholegrain bread.

If you are experiencing constipation you may need to cut down on soluble fibre, which is found in:

  • fruit
  • root vegetables
  • oats
  • barley
  • golden linseeds
  • rye.

A low FODMAP diet may be recommended if you are experiencing persistent bloating. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These are carbohydrates that your digestive system might find it difficult to break down and absorb.

This means they can start to ferment in your gut, causing bloating. When you follow a low FODMAP diet, you restrict your intake of certain high FODMAP foods such as some fruit and vegetables, beans, wheat and milk. A dietician will help you to ensure you continue to eat a healthy balanced diet while following a low FODMAP.

Moderate intensity aerobic activity, such as fast walking or cycling, can help relieve IBS symptoms.

There are a number of ways of combatting stress including: relaxation techniques (meditation and breathing exercises) and physical activities such as Tai Chi or yoga.

In some cases, talking therapies such as cognitive behavioural therapy (CBT) or psychotherapy may help. Hypnotherapy is also used by some people with IBS.

Some people take probiotics to improve their digestive health. You need to take it for at least four weeks to see any effect.

Depending on your symptoms, you may be able to take medication to help.

  • For cramps – antispasmodics may help, buscopan or mebeverine
  • For constipation – laxatives
  • For diarrhoea – antimotility medication, loperamide.

If you have previously suffered from IBS it is helpful to know which kinds of food and drink trigger your symptoms so you can avoid them. Regular relaxation techniques can also help to avoid stress, which can lead to IBS symptoms.

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Diverticular Disease and Diverticulitis

Diverticular disease and diverticulitis are  conditions affecting the large intestine (colon). Diverticulae are small out pouches or pockets that form in weak areas in the wall of the colon. Diverticulitis is inflammation or infection of the diverticulae.

The symptoms of diverticular disease include:

  • Lower abdominal pain, usually on left-hand side and intermittent
  • Pain or bloating that is worse after eating. It may be eased by passing stools or wind.
  • Change in bowel habits.

Most individuals with diverticula disease (diverticulosis) will not experience any symptoms) and be identified coincidentally at colonoscopy or CT scan.

Diverticulitis

One in four people with diverticula disease will develop diverticulitis. The symptoms of diverticulitis are similar to those for diverticular disease or IBS.  The pain of diverticulitis however is more severe and constant usually lasting at least 3 days, is often associated with a fever and change in bowel habit.

Bleeding

Small blood vessels in a diverticulum can rupture, this results in altered blood mixed in with the stool this is usually self-limiting, it can be large enough to result in just the passage of blood and a drop in blood pressure.

Perforation

A diverticulum can rupture causing sudden onset of pain and sepsis, if this occurs you need urgent admission to hospital. The perforation can sometimes be treated with intravenous antibiotics alone if it is locally sealed off. The leaking gas and faeces however usually spreads through the entire abdominal cavity, an urgent operation is required to remove the section of colon with the perforation and washout the contamination before life threatening complications develop.

Stricture

The section of the colon affected by diverticular disease can narrow (stricture), this is caused by repeated episodes of inflammation causing dense fibrotic scar tissue. Initially the stricture causes bloating and ‘grippy’ (colicky) abdominal pain but eventually can cause complete blockage in the bowel.

It is believed that diverticula may develop as a result of not eating enough fibre. This is because fibre makes your stool softer and larger so your intestines need to use less pressure to force it out of your body. If your stool is hard, it can create weak spots in the o layer of muscle in your colon. The inner layer of the colon can then squeeze through these weak spots, creating a diverticulum.

Diverticulitis occurs when the diverticulae become infected.

Diverticula are extremely common in people over 70. The risk of developing diverticular disease is increased by a range of different factors, including:

  • smoking
  • being overweight
  • having a close relative with the condition
  • a low fibre diet.

Diverticular disease does not require treatment.

A high fibre diet can slow progression of diverticular disease You are advised to eat at least five portions of fruit and vegetables a day, as well as wholegrain bread, pasta, high fibre cereals and brown rice. Avoid eating nuts, seeds and corn if you have diverticular disease as these could block the diverticula and cause infection.

Infection causing diverticulitis should be treated with antibiotics, oral antibiotics at home may be adequate however admission to hospital for intra venous antibiotics is often required. If repeated attacks of diverticulitis occur an elective operation may be indicated to remove the affected section of bowel, the advantage of an elective operation is that the bowel can be joined back together and a stoma is less likely, an emergency operation always requires a stoma.

Bleeding requires hospital assessment for a blood transfusion and antibiotics. The bleeding is nearly always self-limiting but does sometimes require interventional radiology or an operation. The interventional radiological procedure involves a special catheter being passed via a groin artery to deliver micro coils to block off the small vessel next to the bleeding diverticulum. An operation removes the bleeding section of colon.

A perforation can sometimes be treated with intravenous antibiotics alone if it is locally sealed off.
The leaking gas and faeces however usually spreads through the entire abdominal cavity, an urgent operation is required to remove the section of colon with the perforation and washout the contamination before life threatening complications develop.

A stricture (narrowing) in the colon if only minor can be manged with a low fibre diet and stool softening laxatives to reduce the pain and bloating that occurs. A more significant stricture requires an operation to remove the narrowed section of colon.

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