Uh-oh, it looks like your Internet Explorer is out of date.
For a better shopping experience, please upgrade now.
- Get it by Monday, January 29 , Order now and choose Expedited Delivery during checkout.
Irritable Bowel Syndrome (IBS) is an extremely common disorder affecting around 20% of the population of Western.
Understanding Irritable Bowel Syndrome offers you a comprehensive, review of what is known about IBS and its treatment. Written in easy-to-understand language by an IBS expert, the book contains numerous examples and real-life quotes from sufferers. Simon Darnley not only provides you with strategies for coping with this condition physically, he also deals with the psychological aspects of IBS to help you cope better mentally with the problem.
• Written in an easy-to-understand fashion by an expert in the subject
Contains numerous examples and real-life quotes from IBS sufferers
An invaluable guide for anyone suffering from IBS
Simon Darnley is a cognitive behavioural therapist (CBT) and researcher with over fifteen years' experience. For seven years he was a tutor in CBT at the Institute of Psychiatry in London and has recently completed a large research trial using cognitive behavioural therapy for IBS. He is also a part-time magician and comedian.
Read an Excerpt
Understanding Irritable Bowel Syndrome
By Simon Darnley Barbara Millar
John Wiley & SonsISBN: 0-470-84496-5
Chapter OneWhat is irritable bowel syndrome?
There is no simple test for irritable bowel syndrome. This chapter focuses on the symptoms that can lead to irritable bowel syndrome being diagnosed.
I am at a party making polite conversation with someone I've never met before; they ask what I do and I tell them I work in the field of IBS. Once the inevitable jokes are out of the way, I guarantee that they will either have it themselves or know someone who does. I've started to tell people I'm a train driver.
Here is Joanna's story. It's typical of the people I meet and treat with irritable bowel syndrome.
"Well I think it really started when I got 'Montezuma's revenge' on holiday in the Canary Islands about 6 years ago.
I was only 19 and it was my first real holiday without the parents. After that my bowel movements have never really returned to normal, I mean they are always fairly loose and runny, if you know what I mean!
But the thing I hate most is the bloating, I think I retain water really easily. Since then it comes and goes but I think overall it's getting worse.
It's embarrassing and often gets me down.
I did go to my doctor about 2 years ago and she did various blood tests but they could not find anything.
Lucy (a close friend) told me it might be a food allergy and so I cut out all wheat for a while but apart from losing acouple of pounds ... it didn't seem to help that much with the bloating or going to the toilet."
Joanna's story highlights many of the key features that make up irritable bowel syndrome (we will call it IBS from now on).
If you were to ask 100 specialists from 10 countries for a definition of IBS (say for the television programme Family Fortunes) you would find significant differences between them. Ask them again 10 years later and, as well as the differences between them, many answers will have changed. This is because we are still learning exactly what IBS is and how best to identify it. At present it is a condition identified by the symptoms. These symptoms include pain, bloating or discomfort in the abdomen and a mixture of diarrhoea and constipation. In IBS people will experience these symptoms but we have yet to find any disease or abnormality in the body to explain it.
We know IBS is very common. In industrialised countries it affects around one in six of us. That's about a dozen people in every street!
IBS will affect people in vastly different ways. Some people will only occasionally experience symptoms, while for others the pain, diarrhoea and constipation are so severe that it becomes distressing, and affects many areas of life. It is not life-threatening, but there are times it can feel like it!
What are the signs and symptoms of IBS?
Box 1: The four main symptoms of IBS.
1. Abdominal pains: stomach pains.
2. Bloating: stomach swelling or a feeling that your stomach is bloated.
There are four main symptoms of IBS, abdominal pain, diarrhoea, constipation and bloating. Other symptoms frequently found include mucus stools, increased wind, nausea and belching.
These symptoms can vary in frequency and intensity from person to person and within an individual person from day-to-day, and from month to month. Not knowing what will happen tomorrow is part of the frustrating nature of IBS:
"One day it's diarrhoea and the next I can't go at all, it's the stomach pain that's the worse thing."
"I can go to the loo up to 40 times in one day, the next day I may not go at all, it can really get me down."
"When I wake up I think, 'Will I have a fat day or a thin day?'"
Let's look at the symptoms in more detail.
1. Pain in the abdomen
For many people abdominal pains are the most unpleasant symptom. People describe the pain in different ways; it is frequently described as coming in spasms (spasmodic); it may be nagging, sharp, heavy or dull:
"I get waves of intense pain. It feels a bit like trapped wind."
It can be felt anywhere in the abdominal area (just below the stomach) but is more frequent down the left-hand side. The severity of this pain is the one thing most likely to drive people into seeing a doctor. Some people will describe them as 'stomach pains' even though these pains tend to occur in the abdomen:
"Sometimes I'm in so much pain that I can't even sit on the toilet."
"It feels like I have been cut in two."
"I can cope with the diarrhoea, but the pain wears me down."
People may worry about what the pain may mean:
"The cramps can be so bad it can't just be IBS, it must be something more serious."
But other people will not experience pain but rather a 'discomfort':
"It's not that painful, but it is a nagging feeling."
Some women have found that the pains are worse prior to and during menstruation:
"I just know it's going to be worse with my periods."
Abdominal pain is often but not always relieved by passing a stool or passing wind.
Bloating or abdominal distension is common and, although for most people it is not the most severe aspect of IBS, it can be embarrassing and a nuisance:
"My stomach sticks out so far that it looks like I'm pregnant. It is so embarrassing."
"I spend most of my time in tracksuits to cover it up."
"My boyfriend wants to go out all the time and I have to make excuses as I don't want to go out when I'm bloated."
"It makes me feel ugly."
"I swear sometimes I can see it growing."
When people have been asked about bloating, they describe a very similar pattern. People find that the mornings are generally good but their abdomens will gradually distend or bloat throughout the day. By the evenings the bloating can become so bad that tight clothes such as jeans no longer fit.
Some people also find that eating will bring on the bloating:
"I know eating at lunchtime will bring on the bloating, so if I have to go out in the evening I will skip lunch altogether."
Others swear that specific foods are responsible:
"I know it sounds weird but fruit, especially bananas, seems to make the bloating worse."
Some doctors were unsure whether the bloating was a 'real symptom' and there was an increase in waist size or whether it was a subjective feeling in that people felt tightness but there was no actual waist expansion. It has now been demonstrated that bloating is associated with an increase in waist size and that this would gradually increase throughout the day, sometimes up to 4 inches!
Abdominal bloating is associated with discomfort, increased wind (flatulence) and rumbling noises (borborygmi):
"I try and avoid meetings at work-I worry that I will pass wind, it really smells bad, it would be so embarrassing."
"If I relax the wind can be really disgusting ... I avoid sex wherever possible."
We have all had diarrhoea at some point in our lives. When our stools are very runny, mushy or watery we know we have diarrhoea. Its one of those words which, along with constipation, everyone understands but is hard to define.
"I thought the world had exploded out of my bottom."
This is recognised as an episode/attack or bout of diarrhoea. Commonly, but not necessarily exclusively, this attack of diarrhoea will be associated with wanting to use the toilet immediately and more frequently than normal. The urge to go can be very strong and sometimes painful:
"I knew I had to go and I had to go then!"
"There was no warning, I just had to drop everything and go!"
"The feeling was overwhelming, I was so worried I would not make it [to the toilet]."
Some people will experience normal stools at the beginning of the day followed by very loose watery stools, and then regular stools for the rest of the day:
"I can have what I call normal and runny stools in a matter of hours!"
Others will experience an increased bout of going to the toilet but do not pass watery stools; instead they may pass frequent solid stools:
"I go up to 15 times in a morning, but each time I will pass a fairly solid stool."
This is not diarrhoea. It is still a very common symptom in IBS but different to diarrhoea as the stools are not watery. Some experts have named this phenomenon 'pseudodiarrhoea'.
As we have seen with diarrhoea, constipation can be difficult to define but most people will understand what it is:
"I pass very small rabbit poos."
"I only go about once or twice a week if I'm lucky, and even then it's very hard and lumpy."
The main features are small hard lumpy stools and infrequent defecation.
But we know some people have always tended to pass infrequent hard lumpy stools and do not see themselves as constipated; for them that is normal. It may be that they are constipated but they do not know they are and manage to live their lives quite happily without suffering any other symptoms.
In IBS, constipation is often associated with straining, or a feeling you want to go but can't:
"I will sit and strain for up to 30 minutes sometimes. If I'm lucky I'll pass a small amount."
"I often feel I want to go quite desperately, but when I try and go nothing comes out."
"It can be very difficult to go!"
Some people have tried to define constipation as occurring when people go less than three times a week. Generally this is a reasonable guide, but it's not definitive. Some people who may go three times one week and four times the next are very likely to still suffer from constipation.
In IBS constipation can be mixed up with the other symptoms:
"I can pass small painful stools in the morning and then normal ones in the evening!"
Some people with IBS may pass small, hard, lumpy stools several times a day and believe they have diarrhoea, where in fact they will have constipation.
Symptoms associated with IBS
1. Mucus stools
The passage of mucus with stools is a fairly common symptom in IBS. People who experience this will describe slimy or watery stools:
"It's like jelly but not quite set!"
It tends to occur more often in patients who experience more constipation and sometimes the mucus stools can be misinterpreted as runny, diarrhoea-type stools.
2. A feeling of incomplete evacuation
"Take yesterday, I had just passed a large stool and yet it still felt there was something left to come out!"
"Most days I feel I should go, even if I have been recently ... But when I try nothing comes out."
"It's a feeling like you want to go to the toilet but you can't, it feels trapped in my guts!"
This feeling is common in IBS. Doctors call it a 'feeling of incomplete evacuation'. This sensation is a very common symptom associated with IBS. It often leads to a constant awareness of the rectal area and excessive straining:
"I seem to be constantly aware that my bowel is never empty."
"I will strain for up to 30 minutes every time I go." "I can feel it's there, I strain for ages but I can't pass anything."
It should not be confused with tenesmus which is a painful and violent urge to pass a stool. This rarely occurs in IBS
3. Urgency and incontinence
I'm sure we have all experienced an urgent sense that we have to go to the toilet immediately. With IBS this is a regular feature, along with diarrhoea. Although many people worry they will not make it in time and become incontinent, our research has found this is, thankfully, rare. However, another study suggested that 16 per cent of IBS sufferers have experienced bowel incontinence at some time or another.
The average woman will passes wind 12 times per day, and the average man will pass wind 18 times per day. People with IBS frequently pass more wind than the average person, have more awareness of it and will worry more about the embarrassment it may cause:
"When I have a bout of IBS, my wind can be disgusting, I really worry about letting one go in front of people at work. I have called in sick if it's too bad."
"I don't like it when I relax in company as I know I am more likely to break wind."
5. Nausea, vomiting and belching
Nausea is an uncomfortable feeling in the stomach that is usually accompanied by the urge to vomit. Although not common in IBS, some people do experience these symptoms as part of their IBS.
Box 2. Symptoms frequently associated with IBS.
Feeling that you still need to go even after you have just been: feeling of incomplete evacuation.
Straining to go to the toilet. Wind.
Urgency and incontinence.
People with IBS can also have other symptoms not related to the bowels. These include: nausea, belching, vomiting, feeling full after eating only a small meals, tiredness, problems with passing water (urinating) and pain during intercourse.
We have described many of the symptoms that make up IBS, but how do doctors then diagnose the problem? If you were expecting to find a clear definition of IBS in this section you may be disappointed. We have already said there is no definitive medical test that a doctor can give people to verify whether they have IBS. This makes IBS a clinical diagnosis. The doctor will make a diagnosis based on the symptoms a patient has over a period of time. He or she will check the person does not have any symptoms that would indicate other illnesses and only proceed with the diagnosis once these have been ruled out. For example, in younger people a doctor would want to rule out the possibility of inflammatory bowel disease, and in older people (50+) he or she would want to check for the possibility of colorectal cancer (see Chapter 2 on seeing a doctor). Only after checking this out would the doctor then make a diagnosis of IBS. It can sometimes be difficult to recognise and doctors and patients can be uncertain whether they actually have it or not. Symptoms usually fluctuate and may not occur for months or even years, or the person may find it hard to describe all their symptoms.
Over the years experts have worked to develop and refine criteria that will help makeit easier to diagnose IBS. Having a recognisable set of criteria in diagnosing IBS has many advantages. Diagnoses can be transferable to other health professionals and insurance companies, ensuring some consistency between all those working in the field around the world.
The first attempt at developing specific criteria for IBS was published in 1978. Researchers at Bristol derived the Manning criteria (named after the main researcher) from symptoms reported by patients with abdominal pain who attended a hospital gastroenterology department.
Excerpted from Understanding Irritable Bowel Syndrome by Simon Darnley Barbara Millar Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
About the Authors.
1. What is Irritable Bowel Syndrome?
2. Causes and Effects of IBS.
4. Medical Treatments.
5. Psychological Treatments.
6. Other Alternative Treatments.
7. Jargon Busting.