Gut Disorders

No two people have the same bowel movements – some people have movements at the same time every day, others more than once a day, some only a few times a week. The majority of people open their bowels between three times a day and three times a week and normal stools are usually solid. The term diarrhoea is used when stools are passed more than three times a day and when the stools become loose or watery. In acute diarrhoea, symptoms come on suddenly but usually clear up within 5-10 days. The most common cause of an attack of acute diarrhoea is an intestinal infection (gastroenteritis). Infants and young children are particularly susceptible to intestinal infections which are most commonly caused by a rotavirus. Acute diarrhoea can also be caused by food poisoning most commonly by the bacteria Salmonella and Campylobacter. These infections are passed on through contaminated food, such as poultry and eggs, or water; and sometimes by a person such as food handler who has the infection, but has no symptoms of that infection. People who travel a lot are also susceptible to intestinal infection, the most common cause being the bacterium, Escherichia coli. This organism releases enterotoxins in the gut, which produce intestinal secretion. And acute diarrhoea can sometimes occur during or after a course of antibiotics, as a result of a variety of drugs and alcohol, and is associated with attacks of acute anxiety. In the majority of cases acute diarrhoea can pass after a couple of days and may not need medical intervention.

Coeliac disease is caused by a sensitivity to the protein gluten (found in wheat, barley and rye), to the extent that gluten, if ingested, causes harm to the lining of the small intestine. The disease is thought to affect around 1% of people, but many will not experience symptoms – and so in a large proportion of people, the condition will remain undiagnosed. Symptoms of the condition can vary widely, but include: • diarrhoea, • vomiting, • weight loss • or a failure to gain weight, • abdominal pain • mouth ulcers. The best treatment for coeliac disease is simply to abstain from consuming any product containing gluten. Gluten is not an essential protein, and so, with a little planning, can simply be replaced in the diet. If you believe you may have coeliac disease, it is important to visit your doctor for a diagnosis. For further information, contact Coeliac UK – www.coeliac.co.uk

Constipation can be regarded as less of a condition in itself but more a symptom, manifesting itself as difficulty opening the bowels or passing stools. People diagnosed as constipated will generally open the bowels less than three times per week, feel the need to strain when opening the bowels, and/or pass hard or pellet-like stools. There are a number of factors that may increase the possibility of developing constipation – a diet lacking in fibre, fruit and vegetables; lack of exercise; a shift in lifestyle; and even ignoring the urge to pass stools;. Also being under or overweight and increased levels of stress may all be causal factors. Addressing these factors can often alleviate the problem. Whilst a very common complaint, constipation rarely causes long-term problems and can generally be treated quickly and effectively.

Crohn’s disease is a condition which causes inflammation in the gut and is one of two conditions referred to as inflammatory bowel disease (or IBD) the other one being Ulcerative Colitis. Crohn’s disease can lead to symptoms such as pain, diarrhoea, fatigue, loss of appetite and ulcers. Although any part of the gut can be affected, the condition most often manifests itself in the lower part of the gut (bottom of small intestine or top of large intestine). The disease is thought to affect 1 in 650 people, and usually starts between the ages of 15 and 40. The exact cause is unknown, although it is thought that there may be a genetic link, with one in five sufferers also having another family member with the disease. Men and women are affected equally and incidence has also been found to be higher in smokers. No specific link to diet has been discovered. Treatment and management of the condition focuses largely on reducing the inflammation in the intestine. This can sometimes be achieved through dietary or drug therapy, but in as many as 80% of cases, surgery is required to remove sections of the intestine. For more information, see www.crohnsandcolitis.org.uk

Diarrhoea is the passing of frequent, loose or watery stools. This may be accompanied by stomach cramps, which will generally be reduced after a stool is passed. There are two types of diarrhoea – acute (short-term) and chronic (long-term). Acute diarrhoea is most frequently caused by a virus or infection which may be spread person-to-person or by consuming contaminated food. It can also, more rarely, be brought on by stress, medication or excess alcohol consumption. Chronic diarrhoea is most commonly caused by Irritable Bowel Syndrome but can also be linked to Inflammatory Bowel Diseases, hormonal changes or certain medications. Acute diarrhoea will generally improve within a few days with an over-the-counter remedy, a high fluid intake and well-observed hygiene standards. If experiencing chronic diarrhoea (lasting for more than two weeks), it is vital to visit the doctor for a full diagnosis and treatment options.

Gallstones are actually crystals that form in bile within the body (usually in the gall bladder or bile duct). Bile is made in the liver, but is stored in a small ‘bag’ called the gall bladder. Bile is made of a number of different chemicals, and when it can no longer hold these chemicals in a liquid, gallstones begin to form. Gallstones can be as small as a grain of sand – or as large as a golf ball, but they most frequently contain cholesterol, a substance found in large amounts within bile. Gallstones are commoner in females and older people – but in many cases, they will go unnoticed and will cause no symptoms. They generally only tend to cause symptoms when they move from the gall bladder into the bile duct, at which point acute stomach pains will be felt. If gallstones are causing no problems, then they are best left alone; if however they cause repeated pain, they will generally be removed via keyhole surgery.

Haemorrhoids is a condition whereby blood vessels in the rectum and anus become inflamed. It is extremely common, and will be experienced by around 50% of people at some point in their lives. There are two types: internal haemorrhoids (which occur inside the rectum) and external haemorrhoids (which occur outside the anus). Symptoms include itching around and bleeding from the anus, as well as discomfort when opening bowels. The condition is brought on as a result of excessive pressure being placed on the blood vessels around the rectum – a common cause is excessive straining when passing stools. The condition is prevalent in pregnant women, due to increased abdominal pressure pushing down on the pelvic blood vessels. The obese are likely to suffer haemorrhoids for similar reasons. Treatment will generally take the form of dietary change (to increase fibre and therefore reduce straining), self-care (most usually sitting in a hot bath to reduce itchiness) and medications. There is a procedure called “banding” (essentially securing a band around the haemorrhoid to decrease blood supply) which is often used, and in extreme cases surgery to remove haemorrhoids.

When we eat or drink, food travels from down the oesophagus towards stomach. This should occur as a ‘one-way’ movement but reflux can occur when food or drink travels back up from the stomach and into the oesophagus. This is not the same as vomiting, which is a violent reaction, reflux can occur without people even realising. At the lower end of the oesophagus, there is a ring of muscle which is there to stop reflux. This generally works efficiently – when we eat or drink, the muscle relaxes but it then tightens up when we have finished. However, if the muscular ring gets too slack, reflux can occur. When symptoms do occur, these most commonly take the form of heartburn, a burning sensation in the chest. If reflux occurs repeatedly, it may lead to oesophagitis – inflammation of and damage to the lining of the oesophagus. In most cases, there seem to be no obvious causal factors leading to the slackening of the oesophagus’s muscular ring, although eating an excess of rich, fatty foods does seem to increase reflux. Treatment generally takes the form of medication – although lifestyle modifications can help too.

Indigestion can be harder to define than you might think, especially as it’s something that we can all experience from time to time – if we’ve had too much to eat or drink or rushed our food. Indigestion is best described as unpleasant or even painful sensations in the top of the abdomen or perhaps in the lower part of the chest, which usually come on after eating or drinking. Realistically, it is more a symptom but not a disease as such. Irritating and unpleasant and even a nuisance, indigestion is rarely serious. Even after medical investigations most people with indigestion don’t have an ulcer or more alarming problems. However if indigestion develops for the first time in mid or later life, you should contact your GP. Some people who have to take anti-inflammatory drugs for arthritis and similar conditions are at particular risk of getting both indigestion and a peptic ulcer, while an increasing number of people get indigestion because the acid in their stomach can reflux back up into their oesophagus (gullet). Less commonly, indigestion symptoms can be due to gallstones, disease of the pancreas, and rarely are caused by cancer in the stomach or oesophagus. But fortunately most people with indigestion don’t have any of these conditions: such patients are said to have ‘non-ulcer dyspepsia’.

Irritable Bowel Syndrome (IBS) is a medical term given to a collection of otherwise unexplained symptoms relating to a disturbance of the large bowel. At some point in their lives, about a third of the population will be affected and one in ten people seek advice from a GP. It can be both a painful and distressing condition and should be properly diagnosed by a medical professional. Symptoms of IBS can include: • Abdominal pain and spasms, often relieved by going to the toilet. • Diarrhoea, Constipation or an alternation between the two. • Bloating or swelling of the abdomen. • Rumbling noises and excessive passage of wind. • Urgency (An urgent need to visit the toilet). • Incontinence (If a toilet is not nearby). • Sharp pain felt low down inside the rectum. • Sensation of incomplete bowel movement. IBS is more frequently diagnosed in women compared with men, in young compared with old and in western countries compared with the developing world. It is commonly associated with emotional tension, is frequently triggered by life changes, difficult life situations or stressful life events. There is no cure for IBS and as symptoms can be different for people so too can the treatment to help alleviate symptoms. For some changes to diet can help while others take anti-spasmodic drugs. Some people have found benefit from complementary medicine such as acupuncture or homeopathy or taking probiotics. More information, advice and support available from www.theibsnetwork.org

Ulcerative colitis (UC) is a long-term condition which causes the colon to become inflamed and, with Crohn’s disease is an Inflammatory Bowel Disease. If the inflammation in the colon is severe, ulcers may develop – although it should be noted that this does not happen in every case. UC always affects the rectum (the part of the colon that lies just inside the anus), and sometimes inflammation is limited to this area only. In other people however, the entire colon (large intestine) is affected. The most common symptoms are abdominal pain, diarrhoea and bleeding from the back passage. The disease affects men and women equally, and symptoms are usually first experienced between the ages of 15 and 30. Despite extensive research, the cause of UC is still unknown – but it is thought that the condition is linked to the way in which the body responds to the mass of bacteria within the intestines. Treatment is usually by medication, although in extreme case surgery may be required. For more information, see www.crohnsandcolitis.org.uk