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MEN IN THE BATHROOM: IRRITABLE BOWEL SYNDROME
A 35-year-old man consulted his doctor and complained that his bowels were interfering with his job. He had to go to the toilet so frequently and had so much gas and bloating that meetings had become an embarrassment. The strange thing was that this disruption only occurred during the day. At night he slept soundly. He also looked well and had not lost weight.
The man explained how he would have cramps and need to defecate two or three times in the morning, again in the afternoon and again in the evening. He often had a feeling of incomplete emptying and sometimes there was mucus in the bowl.
This disruption usually lasted for two or three weeks, disappeared for a month or two and then returned in the same pattern. He couldn’t relate its re-emergence to any particular event and said this had been continuing for years. Recent publicity about bowel cancer had prompted his visit to the gastroenterologist.
This man displayed typical symptoms of irritable bowel syndrome (IBS), which is such a common disorder that one in seven people in the community suffers from it. IBS is also known as spastic colon, mucous colitis or nervous bowel. It should not be confused with inflammatory bowel disease, which is more serious and can cause ulceration of the bowel wall.
The bowel is basically a muscular tube which stores and digests food. IBS is a disorder of the nerves of muscles of that tube. Despite being so common, many aspects of IBS remain unknown. However, it is known that IBS does not lead to cancer and does not require surgery. Symptoms particularly include cramping (often on the left side of the abdomen, but it may mimic heartburn or backache), bloating and an urgent need to move the bowels. The stool may be loose and watery, and might contain white mucus. Eating may make it worse and defecation or passing gas brings relief. There is no fever or bleeding and no obvious reason as to what might have brought this on.
Mysteriously, the diarrhoea may give way to constipation, but abdominal pains and a lot of gas may persist. The condition can correct itself and then return when least expected or wanted. For example, before an important occasion about which a man may really feel tense.
A feeling of incomplete emptying of the bowel, nausea and swelling of the stomach which increases throughout the day, fatigue and lethargy are also common symptoms.
In the vast majority of cases the cause is unknown. Most people who suffer from the disorder have an oversensitive bowel, but the factors which trigger the sensitivity are mostly unknown, although stress and diet may be important.
Stress can affect muscular contractions and bowel secretions. In some people the oversensitive bowel overreacts to normal stresses. In others, lifestyle choices expose them to more stress. In all cases, however, worrying about the cause of the symptoms can create a vicious circle, making the symptoms worse.
The impact of diet varies between people. In some, too little fibre or too much may provoke symptoms. Insufficient fibre is usually associated with constipation. Fatty foods can slow the movement of the food through the bowel and make bloating and constipation worse. Sugars in milk and beverages, sweets and some fruits may provoke diarrhoea.
A bout of gastroenteritis can trigger symptoms. The symptoms may persist or even begin long after the infection has cleared from the bowel.
IBS usually starts under the age of thirty-five. Up to half the consultations with gastroenterologists in Australia are for this condition. There is no diagnostic test for it. Diagnosis is usually made by taking a thorough history and by doing tests to exclude other diseases, such as bowel cancer.
It is not necessary to test everyone, but if, for example, a man over forty began experiencing the symptoms, tests would have to be done, especially if he had rectal bleeding, weight loss or nocturnal diarrhoea.
There is no universal treatment for IBS. Treatment is usually individualised and may include diet modification, stress management and medication.
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