Beating Problems of the Bowel

After the cough and cold, and pain relief departments, the next most frequented area in pharmacies is probably where we keep our products for 'bums and tums'.

Diarrhoea and constipation are always annoying and uncomfortable, but when they are long-lasting and associated with chronic conditions, they can also be quite distressing. Identification of the cause of bowel problems is an important first step in providing a treatment strategy. Medicine is sometimes required – often prescription medicines – but in any event it's also helpful to be able to provide information about non-pharmacological therapy, including dietary and stress management advice.

For instance, there is no effective medicine treatment for coeliac disease, but a simple adjustment to diet can mean a life completely free of symptoms.

Coeliac disease results from a permanent intestinal intolerance to gluten – the protein found in wheat, rye, barley and oats.

Coeliac disease affects the small intestine – the part of the digestive system responsible for absorbing nutrients; sufferers can become malnourished with deficiencies likely in iron, vitamin D, folate and zinc.

Consequences include osteoporosis, infertility and a small but real increased risk of some cancers.

Symptoms of coeliac disease are not always readily evident; when they do occur they can be vague and similar to (and therefore mistaken for) other bowel problems such as irritable bowel syndrome (IBS).

Certainly IBS is more common than coeliac disease. It, too, runs in families, but generally begins in early adulthood (children can suffer with coeliac disease) and affects more women than men. Symptoms of IBS can vary with sometimes diarrhoea and sometimes constipation predominating. Of course, the choice of medicine will depend on which symptoms are the most problematic and dietary modification is usually helpful as well.

Whilst coeliac disease can be treated successfully with a gluten-free diet and the symptoms of IBS often respond to a mix of medicine, avoidance of triggers and fibre intake adjustment, the conditions known collectively as inflammatory bowel disease – Crohn's disease and ulcerative colitis – can cause significant disability and require long-term therapy.

The main difference between these two diseases is that Crohn's disease may involve any part of the digestive tract from the foods, the skins of fruits and vegetables, nuts and seeds.

Foods containing resistant starch include unprocessed wholegrain cereals, seeds and nuts, under-ripe bananas, legumes, slightly undercooked ('al dente') pasta and cooked and cooled potato, rice and pasta. Resistant starch (as Hi-Maize) is added to some breakfast cereals and fibre supplement products.

Dietary fibre is also called 'roughage' or 'bulk'.

What is fibre?

Dietary fibre is a general term meaning the parts of foods from plants that are not digested or absorbed in the stomach or small intestine. Most dietary fibres are carbohydrates. Dietary fibre passes unchanged into the large intestine (colon), where bacteria at least partly break it down by fermentation. This fermentation may produce a lot of gas (wind) in the bowel.

There are several different types of dietary fibre including soluble fibre, insoluble fibre and resistant starch.

Good sources of soluble fibre include oats, barley, rye, fruits, and vegetables and legumes (e.g. beans, lentils).

Good sources of insoluble fibre include wheat bran, rice bran, and wholegrain.

Dietary fibre is necessary for good digestion and a healthy bowel. It also helps control weight, blood cholesterol levels and blood sugar levels and may protect against bowel cancer. Good sources of dietary fibre include wholegrain breads and cereals, fruits, vegetables, legumes, nuts and seeds.

Although IBS can be uncomfortable or upsetting, it does not damage the bowel and does not lead to other bowel diseases. It can affect anyone at any age, but often starts in late teenage years or early adulthood.

Signs and symptoms

IBS symptoms vary widely from person-to-person and include:

• pain or cramping in the abdomen, often relieved by passing wind or a bowel motion
• diarrhoea or constipation
• feeling as though the bowel has not emptied properly after passing a bowel motion
• feeling full or bloated
• passing a lot of wind
• mucus in bowel motions

IBS is a very common gastrointestinal (gut) disorder that results in abdominal pain and changes in bowel habits. The cause of IBS is unknown, but it seems to be related to an oversensitive digestive tract. Changes to diet and lifestyle and some medicines can help relieve IBS symptoms.

IBS can cause mainly constipation, mainly diarrhoea or alternating bouts of constipation and diarrhoea.

Most people have mild symptoms that come and go, but sometimes IBS symptoms can be severe and constant and interfere with daily activities.

IBS is more common in women than men and many women find their symptoms get worse during or around their menstrual period.

Causes

The exact cause of IBS is not known, but it may involve a change in the function of nerves and muscles in the gastrointestinal tract – from the mouth to the anus (although more commonly the small and/or large intestine) – whereas ulcerative colitis only affects the rectum and the colon.

Source: PSA Health Column 1485