Thursday 20 June 2019

A sudden sensitive gut and dealing with smelly feet

Ask the GP...

Irritable bowl syndrome (IBS)
Irritable bowl syndrome (IBS)

Nina Byrnes

Advice from our GP on how to manage irritable bowel syndrome (IBS) and how to tackle smelly feet.

Q. Over the past year or two, I have noticed intermittent bouts of digestive problems - sometimes I have very loose, watery bowel movements in the morning, and other times I get constipated and might not go to the bathroom for a couple of days. The latter doesn't bother me, it is just something I have started noticing. I am in my 40s and have a fairly good diet, but I do indulge in biscuits and chocolate most evenings. Is this something I should get checked out? What do you think it could mean? It doesn't really bother me but it is a change I have noticed in the past year.

Dr Nina replies: Irritable bowel syndrome (IBS) is a collection of symptoms which are due to altered function of the gut. It is thought to affect between 5pc and 20pc of the population.

It can occur at any age but is most commonly diagnosed in those under the age of 50 and is two times more common in women than in men. Symptoms include abdominal pain, bloating, and altered bowel habits causing either constipation or diarrhoea. These can occur for days, weeks, months or years. It may flare and settle at different times. Importantly IBS symptoms don't usually occur during the night or disturb sleep.

IBS isn't caused by stress, but can get worse in times of anxiety and stress. In women, hormones may have some effect and a flare may occur premenstrually. Bloating and passage of mucus can occur. It is important to note that weight loss, fever, blood in the bowel motions and persistent pain are not features of IBS, and if these are present you should attend a doctor. In IBS gut investigations are usually normal.

It is felt that those with IBS may have a gut that is more sensitive and works more quickly or slowly than it should. A lot of the symptoms are due to spasm occurring along the bowel leading to a trapping of wind and change in the movement of stool through the bowel and the absorption of fluids.

IBS cannot be cured but needs to be managed. Keeping a diary will not only help you track your symptoms, but may also help you identify some triggers. If you are able to identify a type of food that causes a flare in you then it makes sense to reduce or avoid this but blanket exclusion diets have not been proven to be of any benefit. It is important to have enough fibre in your diet to bulk up stool and encourage its movement through the bowel. If you are increasing fibre, do it slowly as sudden changes can make symptoms worse.

In recent years the low FODMAP diet has gained some popularity. FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. It is based on the theory that certain carbohydrates when broken down to these compounds in the gut can draw fluid into it and cause fermentation, which leads poor digestion, wind and bloating. The initial phase of the diet is quite restrictive, as all high FODMAP foods are eliminated. They are then slowly reintroduced one at a time and a person can then identify their own personal sensitivities.

Other options to help reduce symptoms include: managing stress and anxiety, and using medication during flares if required. Medication prescribed usually involves combining drugs that encourage gastric emptying (reduce bloating), bulk up stool and reduce spasm in the bowels.

Peppermint can also be helpful. Aloe vera has not been proven to be of benefit. Some find alternative therapies such as acupuncture and yoga helpful, although again their benefit is not proven.

IBS tends to ease with age, it does not damage the gut, there is no underlying disease in the bowel and it is not associated with an increased risk of cancer.

Is there anything I can do about smelly feet?

The odour of smelly feet is largely caused but the build up of bacteria and fungus due the moisture and heat that occur when feet sweat. Care for smelly feet starts with basic hygiene. Wash the feet at least once a day using an antibacterial soap. Soaking feet for up to 20 minutes daily will also help. Once the feet have been washed, dry them fully and carefully. Applying an anti-athlete’s foot powder or spray will help prevent the build up of fungus as the day goes on.

If sweating is a particular problem, spraying with antiperspirant may help. There are sprays specifically for feet but the under arm ones work also. Keep nails short and clean as bacteria and fungus can build up here too.

The best way to keep feet odour-free is to keep them cool, so going barefoot or wearing flip-flops or sandals when possible is a good idea. When you do have to wear shoes, pay attention to what you put on. Never go sock-free. Feet sweat more and then all the bacteria, dead skin and fungus, just stays in your shoes causing more odour build up. Socks should be made from cotton and may need to be changed more than once daily. 

Shoes should be made from breathable material, such as leather. Sharing footwear should be avoided. It is a good idea to alternate between pairs of shoes. Between wearings open the shoes up and leave in a dry, well-ventilated environment, allowing each one to dry out before wearing it again. Using anti-infective powders or sprays in your shoe may help reduce odours. It is possible to buy shoe inserts that will help shoes dry, but there are some simple home remedies.

A simple home remedy is to put some kitty litter in the leg of a pair of ladies’ nylon tights and put this inside the shoe. It’ll help dry them and remove any odour. Baking soda inserts may also help.

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