4. Understanding Bowel Conditions

	IBS is a common functional bowel disorder characterised by four main symptoms: abdominal cramping, bloating, diarrhoea, and constipation. The organic cause of IBS is unknown, but trigger factors include diet, stress, emotional upset, female hormones and certain medications.

Constipation Diarrhoea Bloating Flatulence Abdominal pain, cramps & spasms Irritable Bowel Syndrome Haemorrhoids

Constipation

Constipation presents itself in the form of a symptom, or group of symptoms, which varies from person to person, making it difficult to define exactly. Often people worry about being constipated when they experience no bowel movements for only one day, but this can be perfectly natural for others. In some healthy people bowel movements occur just three times a week.

Generally, it is accepted that a person has constipation when they:

There are many malfunctions that can cause the symptoms of constipation, including problems that affect the muscles, the nerve supply, and alteration in colorectal anatomy or gut luminal contents. Links include medication, frailty and immobility (including that associated with surgery or terminal illness), pregnancy and habit (i.e. ignoring the call to stool).

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Diarrhoea

Diarrhoea can be defined as frequent discharge of watery faeces from the intestines. It has several causes, from minor reasons such as excessive consumption of food and drink, to more severe conditions such as infections or poisoning. This may result in dehydration and shock, and replacement of the fluids lost by the body is therefore a key feature of treatment.

Chronic diarrhoea (diarrhoea which persists or recurs over a prolonged duration) may be a sign of chronic illness, including Irritable Bowel Syndrome and inflammatory bowel disease. This diarrhoea usually presents itself as a porridge-like consistency, as opposed to a watery consistency associated with infections or food poisoning.

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Bloating

Bloating is when the abdomen feels full and tight. Patients may also complain of accompanying abdominal pain. The cause of bloating is usually due to relaxation of the abdominal muscles in an unconscious attempt to relieve discomfort. This often occurs in people with Irritable Bowel Syndrome. Bloating may also be caused by rich, fatty foods, food intolerance or overeating.

A more serious though more unusual cause may be the presence of ascites and tumours, such as those associated with ovarian cancer. It is important to be vigilant for ‘red flag’ symptoms, which are discussed later, and refer to a GP for further investigation if in any doubt.

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Flatulence

Flatulence is air in the intestine that is passed through the rectum. As a normal bodily function, passing wind is an important signal of normal bowel activity. It may also be caused by swallowing air when eating or drinking too fast. However, excessive air in the digestive tract may lead to abdominal discomfort that is often relieved by passing wind. Excessive wind can indicate the presence of IBS or an organic disease. In particular, patients experiencing a sudden occurrence of excessive wind, together with the onset of new symptoms, should be advised to consult a doctor.

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Abdominal pain, cramps & spasms

Abdominal pain, cramps & spasms can occur when there is a disruption to the digestion process. During normal digestion, smooth muscles in the gut undergo rhythmic, wave-like contractions in a process known as peristalsis. This action moves food along the digestive tract and is not normally strong enough to be felt. However, certain triggers can disrupt the usually gentle contractions, causing the muscles to spasm and cramp producing painful attacks of abdominal cramping. This can be provoked by a variety of physiological and psychological factors.

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Irritable Bowel Syndrome (IBS)

IBS is a common functional bowel disorder characterised by four main symptoms: abdominal cramping, bloating, diarrhoea, and constipation. However, people with IBS can also present with a wide range of non-gastrointestinal symptoms including gynaecological (painful periods, pain after sexual intercourse and premenstrual tension), urinary (frequent and urgent urination), musculoskeletal (back pain), and psychological symptoms (depression and anxiety).

The organic cause of IBS is unknown, but trigger factors include diet, stress, emotional upset, female hormones and certain medications.

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Haemorrhoids

Haemorrhoids (or piles) are the result of swelling and inflammation of veins in the rectum and anus often resulting in painful protrusions (prolapse). Although most people think haemorrhoids are abnormal, they are present in everyone. It is only when the haemorrhoids enlarge that they can cause problems, such as pain and irritation. The causes of haemorrhoids include genetic predisposition (family history of weakness in rectal vein walls and/or valves), straining during bowel movements, and too much pressure on the rectal veins due to poor posture or muscle tone. Obesity and a sedentary lifestyle may also contribute to the occurrence of haemorrhoids, especially for those with a genetic predisposition. Haemorrhoids are also common during pregnancy.

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