I need a loo nearby!

Dr Margaret answers users' embarrassing problems in this problem page feature (new problems every 2 weeks).

For the past 2 years I have had a really embarrassing problem. I suddenly have to rush to empty my bowels without any warning. It can happen anywhere and any time. It’s got to the point where I’m afraid to travel anywhere in case there’s no loo. I never go on the London Underground because there are no loos. It’s awful to lose control over your bowels at my age - I’m only 29. Is there anything I can do, without having to discuss it with my GP?

Dr Margaret replies
It’s most likely that you have irritable bowel syndrome (IBS), particularly if you also have tummy pain. IBS causes a wide range of symptoms. Almost everyone with IBS has some abdominal pain, often relieved by defecation. Many people have the urgent need to defecate that you describe. A ‘morning rush’ is common - you have to defecate urgently several times on rising and after breakfast, and then the bowels settle for the rest of the day. The faeces may be loose with the texture of toothpaste, or normal or pellety. Some people have constipation, or a feeling that they cannot empty their bowel completely. A sense of abdominal bloating is also very common, and often gets worse throughout the day. There are some simple measures that you can take to try to alleviate your symptoms, but you should also see your doctor, as some other conditions can produce similar symptoms. Read on for a full answer to this problem.

What is IBS?
Normally, the muscles in the wall of the gut contract rhythmically, pushing food and then faeces along (food in the upper part of the gut, faeces in the lower part as you get nearer to the rectum). In IBS, these contractions tend to be excessive and also irregular.

People with IBS are also more sensitive to feelings from the gut. Normally, the brain is not very aware of what is happening in our intestines, unless there is something wrong (such as an infection or excessive wind). In people with IBS, the brain seems to be oversensitive to normal signals from the nerves in the wall of the gut. This doesn’t mean that IBS is in the imagination - it is more likely to be an imbalance of the chemicals involved in signalling between nerve cells.

Food and IBS
IBS is not a food allergy, but some foods may trigger symptoms. Try keeping a food diary for a few weeks to see if spicy or fatty foods or any particular fruit or vegetable (such as onions, cabbage, grapes, plums) make it worse for you. But don’t make any really drastic alterations to your diet without consulting your GP, or you could end up with a dietary deficiency as well as IBS.

Fibre in the diet has pros and cons for people with IBS. In general, a diet high in fibre from fruit and vegetables helps to stabilize the gut. On the other hand, many IBS suffers find that it worsens wind and discomfort, particularly if they add extra wheat bran. Peppermint tea can help ease wind or pain. Canadian expert Dr Grant Thompson points out that how you eat may be as important as what you eat: ‘Coffee for breakfast, nothing for lunch and high-stress gorging at dinnertime exaggerate the gut’s already-sensitive reflexes. In addition, not allowing enough time for defecation inhibits a healthy gut rhythm’.

Why you should see your doctor
Although IBS is the most likely diagnosis (because you’re under 45 and have had the symptoms for some time) you should talk to your GP. There are two reasons.

Firstly, your doctor will want to rule out more serious conditions such as Crohn’s disease, ulcerative colitis or coeliac disease that can have similar effects. So you will be asked about additional symptoms, such as loss of weight, anaemia, bleeding from the back passage; these might indicate a more serious problem.

Secondly, although there is no simple cure for IBS, your GP can give you more detailed advice about diet and lifestyle, and perhaps prescribe anti-spasmodic medication.

Ask your doctor about hypnotherapy; it’s one of the best treatments, but is not yet widely available. It probably works by reducing stress and anxiety and re-educating the brain pathways that are over-responding to stimuli from the nerves in the wall of the gut. Antidepressant drugs may be helpful because they affect neurotransmitter chemicals in the gut.

Overcoming your embarrassment
You’re not alone in being reluctant to talk to your doctor. Last year a survey by the private health care company BUPA showed that although 86% of people would consult if they had bowel symptoms, 43% said they would be embarrassed to talk about their symptoms in detail. And the under-35s were twice as embarrassed as the over 55s. In fact, you shouldn’t be shy because IBS is incredibly common, so your GP will be very used to the problem. About 10% of all GP consultations are about gut problems, and a quarter of these are IBS. Almost half the patients seeing specialist gastroenterologists in hospital clinics have IBS, and in the USA it accounts for about 3.5 million visits to physicians every year.

Helping yourself
Try cutting out caffeine, alcohol and smoking. You have probably noticed the problem is worse when you are anxious or stressed. In normal people, anxiety makes the stomach churn, but in IBS it can provoke violent diarrhoea. Avoiding stress is easier said than done, but your public library should have books on relaxation and reducing stress. Regular exercise is also beneficial.

Further information
The Digestive Disorders Foundation has a leaflet on IBS.
Send a stamped addressed envelope to PO Box 251, Edgeware, Middx HA8 6HG, UK or go to www.digestivedisorders.org.uk/leaflets/ibs.html

The IBS Network provides practical information about living with IBS.
Send a stamped addressed envelope and a £1 coin as a donation to Northern General Hospital, Sheffield, S5 7AU
phone the Helpline on 01543 492192 (6 pm - 8pm)
or go to www.IBSnetwork.org.uk

The IBS Self Help Group has a helpful website
go to www.ibsgroup.org/

Any more questions?
Do you have any more questions about

April 9, 2001

If so, please e-mail them to info@healthpress.co.uk within the next couple of weeks. I cannot send an individual reply, but I will try to answer them here.

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