IBS Constipation

IBS Constipation – Constipation as a symptom itself does not mean IBS. Basically the difference between simple constipation and constipation as a symptom of IBS hinges on whether or not there is any abdominal pain associated with the constipation. Many people suffer from constipation and have little if any pain and therefore do not fit the criteria for IBS.

Constipation is an important cause of IBS and it is important to recognise this in all its various forms. Constipation itself is difficult to define as the frequency of normal bowel movements can be in healthy patients from three times a day to 3 times per week. Constipation is the underlying cause of a great many cases of IBS. Therefore it is necessary to understand the causes of constipation to treat IBS successfully.

In normal digestion of food the nutrients are absorbed in the small intestine and waste residues then pass into the large intestines or they are fermented by helpful bacteria producing vitamins and fatty acids. Toxic chemicals are broken down and water is re-absorbed back into the body. Faeces are made up of bacteria, protein, fat, roughage, dead cells and water. Normal defecation involves a complex contraction of the diaphragm, abdominal wall and muscles in the wall of the bowel, collectively known as peristalsis.

Constipation has many causes meanly poor bowel habits such as straining, diet and lifestyle, sluggish bowel, weakened pelvic floor, underlying disease and medication such as painkillers and antacids. In many patients a high fibre diet is a suitable treatment, make sure to include the following foods. wholemeal bread, jacket potatoes, whole grain cereals, wholemeal pasta, beans, lentils, peas, fresh fruits, fresh vegetables, nuts and seeds. If a high fibre diet on its own is insufficient to relieve the constipation then there are treatments available to help things along.

• Laxatives – laxatives have been used to relieve compensation for thousands of years. Many modern laxatives were originally derived from herbs and plants. As a general rule the mildest possible laxatives should be used initially.
• Bulk forming agents – bulking agents work like reinforcing the natural physiology of the bowel. The increase the residue in the stool which draws more fluid thereby increasing the mass which in turn stimulates peristalsis, this means larger, softer and more easily passed stool.
• Osmotic agents – agents are retained within the gut drawing fluid into the bowel making the stool is larger than softer. Common agents include magnesium salts, lactulose, and polyethylene glycol.
• Stimulants – stimulants act on the muscles in the wall of the bowel causing them to contract. Many of them are herbal or natural laxatives such as Senna pod and rhubarb. All stimulant laxatives can also cause abdominal cramps so should only be taken on an occasional basis.
• Stool softeners – softeners such as liquid paraffin were once widely used but are no less popular. Today Docusate sodium is the most used softening agent.

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Anxiety and IBS

Many of us will swallow a little air with every mouthful of food that we eat. Air is normally easily absorbed from the stomach into the bloodstream and the lungs. Trouble can arise if we swallow too much air which then collects in the stomach and produces a number of ill effects. The stomach can become distended which in itself will cause discomfort. Air coming back up will lead to belching and occasionally acid reflux or vomiting. Some of the air can even leave the stomach and pass along the small intestine, this can cause pain by extending the guts and producing uncomfortable bloating. Eventually it will pass out through the anus causing embarrassing flatulence. This type of air swallowing has been shown to be a cause of IBS.

Excessive air swallowing can be due to a number of different reasons, such as heartburn, hernia, blocked nose and anxiety. Patients suffering from anxiety often develop an abnormal breathing pattern known as over breathing, hyperventilation or breathing patter and disorder (BPD). This abnormal breathing mostly involves the muscles of the upper chest and shallow breathing using the mouth. This increases the amount of air going down the gullet into the stomach and causes a range of abdominal symptoms. The natural breathing pattern is to breathe in through the nose and see that your stomach expands first with very little movement in the upper chest. This can be checked by sitting in front of a mirror and placing one hand is on your abdomen between the breast bone and naval, and the other hand on your breastbone just below the collarbones. When you take a deep breath the hand on your abdomen should move first and should also move a lot further than the hand on your chest which should move little if at all.

Many people small excessive air when they are speaking, particularly if they are excited and enjoying themselves. It is important to be aware of your breathing patterns when you are talking as some people gulp in a huge breath of air when starting to speak and then talk rapidly in long sentences. At the end of a sentence another huge gulp of air is taken. You should concentrate on speaking more slowly and on taking in sips of air during the sentence (in other words breathe at comma’s as as well as full stop’s!)

Although there are other causes of air swallowing such as acid reflux and blocked nose, anxiety is the number one cause. Hypnotherapy can be a surprisingly effective treatment for anxiety related IBS. As much as 87% of patients may experience benefits, with symptoms reduced by around half. It should be noted however that anxiety and air swallowing only represents approximately 20% of IBS cases.

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Malfermentation and IBS

The modern-day diets tend to contain lots of highly processed convenience foods that are often low in fibre. Fibre can be found in whole grains, bread, vegetables, pulses such as beans and lentils and peas, nuts, seeds and fruits. Fibre has an important role in absorbing fluid from the gut which produces soft stools that are easy to pass. Fibre also has other benefits such as reducing the absorption of cholesterol, reducing the risk of gallstones and helping to prevent piles.

We all there is little doubt that high fibre diets can be helpful for IBS sufferers, for some the high-fibre will create more wind, bloating and diarrhoea. The foods that tend to make wins and bloating words are dried fruits and nuts, baked beans and vegetables such as broccoli, cabbage or cauliflower. Fizzy drinks such as cola and beer can also increase wind.

Reducing bacterial activity in the bowel has been shown to help many patients. This was first realised when some patients found their IBS symptoms temporarily improved after a course of antibiotics prescribed for an infection. This suggests that bacteria in the gut can be a cause of IBS symptoms.

If you are an IBS sufferer there are basically two forms of diets that will help to reduce malfermentation. One is that all fibre diets and the other is the exclusion diet. The law fibre diets is probably the most straightforward diets for the treatment of IBS. For this reason it is normally the first diets recommended by doctors. The exclusion diets will help to find out whether you have any specific food intolerance is although it can be difficult to pinpoint the individual foods that are causing the problems. There are some foods that are more likely to be responsible for IBS symptoms than others, however the only be to decide which foods cause your symptoms is to test them individually. Before starting any diets always discuss it with your doctor. Common foods that have proven to be the source of the problems in many patients, including beef, potatoes, citrus fruits, wheat, daily products, fizzy drinks and yeasts.

Gluten is the protein found in meat and other cereals. Many people suffer from a gluten intolerance to various degrees (some patients may not even be aware of this intolerance). And in free diets will involve avoiding wheat, rye and barley, and all products containing them.

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