As a practicing Consultant Gastroenterologist, by far the commonest condition that I see in my out-patient clinics, is IBS
The patients are usually are at their wit’s end by the time they get to see me, having harassed their GPs into submission to make the ‘second opinion’ referral.
A syndrome is a cluster of medical symptoms and signs that when put together form the diagnosis. With IBS sufferers the main complaints are of bloating (doctor I feel 6 months pregnant!), wind (I can’t go out for a meal because it is too embarrassing for my family!), excess mucus production (I can’t believe I have to still wear pads at my age!) and diarrhoea or constipation or both (doctor I don’t know whether I am coming or going!).
IBS sufferers may also get bad heartburn, back ache, urinary frequency and symptoms in women are often worse during or around menstruation. Symptoms usually start in the late teens or following an episode of gastroenteritis and there is a strong association with stress and anxiety.
Any new symptoms in an older patient however, should be investigated as there are potentially more serious causes.
The bottom line with IBS sufferers however is, ‘THERE IS NOTHING WRONG WITH THE BOWEL!’
Because of the above, IBS can be tricky to treat. How do you ‘treat’ a normal bowel or stress and anxiety…?
Bloating and diarrhoea can be helped by antispasmodics such as mebeverine or mint derivatives such as colpermin. Heartburn can be controlled with anti-acid medication. Constipation can be managed by high fibre (although this may make the bloating worse!).
I tend to immediately refer patients to my very clever dietitian colleagues for dietary exclusion which can be dramatically helpful. I do also occasionally treat with low dose tricyclic antidepressants which can also help with the bloating. Sometimes acupuncture, hypnotherapy and psychotherapy may be needed but sadly there is no panacea.
So IBS is no fun for anybody. Certainly no fun for the patients, their GPs, or for me as a so-called ‘specialist’, as I frequently feel inadequate in being able to help them.
Written by Dr M J Webberley – consultant gastroenterologist