Tuesday 20 August 2019

Dear Dr Nina: 'I've been having stomach problems for the last year'

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Photo posed

Nina Byrnes

I am a 38-year-old woman. I have suffered from stomach pain, alternating diarrhoea and constipation and flatulence for the last year. Previous to that I never had any kind of stomach ailment.

I have a healthy diet - and have tried the fodmap diet, kept a food and symptom diary, and tried other suggestions from my GP, but nothing affects the symptoms. I feel like my GP is not taking me seriously, and he has hinted that I could be suffering from stress or other psychological factors. I find this incredibly offensive. I really feel like there is something wrong. How can I get tested for bowel cancer and other diseases?

Dr Nina replies: I can see that you are very frustrated with your symptoms, but your GP may in fact be giving you good advice. Your symptoms are quite typical of irritable bowel syndrome. 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, and it is suggested that it has only been diagnosed in about 5pc to 7pc of those who suffer.

IBS can occur at any age but is most commonly diagnosed in those under the age of 50 and is 1.5 to 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. In women, hormones may have some affect and a flare may occur premenstrually. Bloating and passage of mucus can occur. The symptoms can be very concerning to those affected. Cancer is often the biggest worry. Weight loss, fever, blood in the bowel motions and persistent pain should cause concern, as they are not features of IBS. If these are present, then referral for further tests is warranted.

If there is a family history of bowel disease such as inflammatory bowel disease or bowel cancer then further tests may also be recommended. The majority of cases of IBS can be diagnosed on symptoms alone. Gut investigations are usually normal in those with IBS.

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.

Research also suggests that brain hormones may play a role. Psychological stress can make symptoms worse. When trying to work out the cause of bowel symptoms, a mood and food diary can be of great assistance. If symptoms are triggered by certain foods, anxiety or stress, then IBS is the most likely cause.

If the triggers and cause aren't very clear, then some tests can be arranged. Bloods tests can rule out inflammation, signs of blood loss or coeliac disease. If any concerning symptoms are present then a colonoscopy will be recommended. This is usually a straightforward day-case procedure but it is important to note that no surgical investigation is without risk, so it should only be ordered when genuinely required. An abdominal ultrasound can rule out gallstones, which may mimic some symptoms of IBS.

In recent years the fodmap diet - short chain carbohydrates that are poorly absorbed in the small intestine - has gained some popularity. It must be frustrating this hasn't worked for you, but it doesn't work for all.

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 reduce bloating, bulk up stool and reduce spasm in the bowels.

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