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Live Chat to Dr Anton Emmanuel about Irritable Bowel Syndrome |
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The Check Up live web chat about Irritable Bowel Syndrome is now finished. Thanks to everyone who sent in questions for our guest
Dr. Anton Emmanuel, Senior lecturer and Honorary Consultant in gastroenterology, St Mark’s Hospital, Middlesex.
We had a great response - there just wasn't time to answer them all. Read the full transcript below.
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Dr Anton Emmanuel: I strongly urge anyone who has gut symptoms that are new, or have worsened, to seek medical advice. Usually a GP can reassure you about the symptoms, but occasionally specialist referral is required to exclude a more worrying condition. Finally, the possible therapies for IBS are rapidly evolving and it is hoped that within the next few years specific interventions will be available for the commoner symptoms.
From David Roberts: What are the typical symptoms of IBS?
Dr Anton Emmanuel: Abdominal pain and bloating associated with alteration of bowel frequency (constipation or diarrhoea).
From Christine: What part does alcohol play in IBS?
Dr Anton Emmanuel: None!
From Gaynor: I want to ask whether the doctor and the presenter were suggesting that folk who take anti-depressents for anxiety are crazy. I know that the dosage is different/lower for sufferers of IBS - but still the tone was very negative towards anxiety sufferers.
Barbara Myers: Sorry for any misunderstanding. We were trying to convey exactly the opposite. That is, that anti-depressants are valuable treatments for IBS. The problem arises when doctors and patients think that prescribing and taking anti-depressants seems to suggest that the condition "is all in the mind". It is not.
Dr Anton Emmanuel: I could not agree more. Anti-depressants are the mainstay of treatment for severe IBS. The drug works at the level of the gut and has no negative psychiatric connotations.
From Douglas Bern: Pro-biotics are freely available in most health foods shops in this country, they are usually kept in the chill cabinet. My son who has gut dysbosis / yeast infection has responded very well to pro-biotics.
Dr Anton Emmanuel: The pro-biotics that are available at the moment in this country do not always have a high concentration of living bacteria in them. Studies are in advanced development to ensure that the high-dose pro-biotics, which are dealt with as medicines, will soon be available as prescribable drugs.
From Steve Leahy: I have been taking Fybogel x 2 per day now for 2 years. Is there a problem in long term use of fibre supplements for treatment of IBS?
Dr Anton Emmanuel:
There is no evidence that long-term fibre supplementation is harmful to gut function or general health.
From Helen Porter: The IBS aspect that causes me the most distress is flatulence - it's so embarrassing. I know I need to avoid some foods, eg onions, but these seem to vary from week to week. Any advice?
Dr Anton Emmanuel: Unfortunately dietary therapy is very hit and miss. If the problem you have is mostly with control of flatulence then bio-feedback may help improve flatus control. Some patients report that strong peppermint concentrate makes the flatus less offensive!
From Mike Cole: I think I've been suffering from IBS for about 3 years. I've managed to persuade my doctor to refer me to a gastro-enterologist, but until my appointment comes through are there any other things I can do to help alleviate my symptoms? I tend to suffer from severe diarrohea and stomach pains after eating, resulting in a visit to the the toilet about 2 hours after eating. I have tried Colpermine, but it tends to pass through me too quickly. Any suggestions?
Dr Anton Emmanuel: Urge to defaecate after meals is a very common symptom in a variety of gut conditions, not just IBS. Eating little and often can reduce the severity of this urge. There is no dietary alteration of proven benefit. Peppermint oil or peppermint tea may help reduce the amount of discomfort in a variety of gut conditions.
From Paul Kilby: I was diagnosed with IBS about 4 or 5 years ago. However, bleeding caused me to return to a doctor recently and I was diagnosed with IBD (inflammatory bowel disease). Does this mean that I had IBD all along, at first in a less potent form - or that I have actually "progressed" from IBS to IBD? My symptoms have always been bloating, gas, over active bowel as opposed to constipation and later bleeding from the bowel.
Dr Anton Emmanuel: IBS symptoms frequently co-exist in patients with IBD. It may be that your IBS pre-dates the inflammatory condition, but it is likely that the IBD began at the time your bleeding started. The occurence of rectal bleeding in a patient previously with IBS should raise concern and requires re-investigation. IBS and IBD are common conditions affecting 10 per cent and 0.5 per cent of the population respectively.
From James Harrison: I have been diagnosed with IBS. I think that it is definately stress related but sometime ago I had to have a course of antibiotics FLUCLOXACILLIN 500mg for an infection following a leg injury. The effect was on my bowels was amazing. My bowels felt and worked normal until I finshed the course. Any views on this please?
Dr Anton Emmanuel: The rationale for using pro-biotics is that they alter the bacterial environment in your colon, in a beneficial way. Anti-biotics may do exactly the same by selectively killing bacteria that are "harmful" to your bowel. Some patients report marked worsening after anit-biotics for analogous reasons if the drug kills the "helfpul" bacteria. The effect of these anti-biotics is usually short-lived and so cannot be recommended as long-term therapy for IBS.
From Stella: I have suffered IBS (also fibromyalgia and arthritis) for several years, and from time to time take a course of Colofac, which helps. For weeks at a time, I pass very narrow stools several times a day. Is this part of IBS? Also, I often have a bowel movement, only to feel I haven't finished very soon after. Again, is this part of IBS? I'd really like to know, as I'm nervous to approach my GP with yet more odd symptoms!
Dr Anton Emmanuel: Your symptoms are typical of an irritable rectum which is a frequent manifestation of IBS. The essence of treatment is to try to resist the recurrent urge to evacuate your bowel. Doing this will allow your rectum to expand more and with time lead to a reduction in the frequency of urge to void. Colofac may help reduce the contraction in the rectum and minimise these symptoms as an adjunct to the behaviour described above.
From Yvette: Please could the doctor say more about IBS and spine position/problems? I have chronic pain in my head and neck after a car accident 15 years ago.Β I have IBS, Irritable Bladder and hyperventilation.Β I've been told by physios these are all connected, but nobody can explain in what way.
Dr Anton Emmanuel: It may be that the IBS began after the trauma of what sounds like a major accident. There are theories that chronic spinal orthopaedic problems may result in reflex changes in abdominal wall musculature. This can be perceived as abdominal bloating and may alter bowel frequency. Interventional physiotherapy frequently improves such spinal pain and there is limited evidence that it may improve associated bowel symptoms.
From Ruth from Bedford: I have suffered from IBS for four years, It was brought on by an allergic reaction to the anti-malarial drug Larium.Β After a series of tests I have discovered that I can control the symptoms through anti depressants and by leaving out wheat and dairy.Β My question is, how long will this go on for?Β Will I have to cut out wheat and dairy for ever, or will I be able to eat normally and be pain free again one day?
Also why does IBS seem to be more common in the UK?
Dr Anton Emmanuel: It's not uncommon for the first symptoms of IBS to begin following a change of medication. Larium is a very potent anti-malarial which has a number of major and minor potential side-effects. It is certainly recognised as initiating symptoms such as yours.
Men suffering with IBS may experience symptoms for decades. My advice generally is that once you've got a regime that you're stable on, consider changing one aspect of it after two years of good health. If successful, continue gradually normalising your diet and discontinue medication.
Women are relatively more fortunate in that a significant proportion experience remission around the menopause.
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