An Irritable Bowel

An irritable or sensitive bowel is a good example of a pain you can’t see. It looks normal at a laparoscopy or ultrasound but certainly doesn’t feel normal.

Bowel pain can be felt anywhere in the mid or low abdomen, sometimes more on the right side. When felt low in the abdomen it is easily confused with pain from pelvic muscles, the uterus, the bladder or endometriosis.

The most typical feature of bowel pain is that the pain gets better after wind or a bowel action has been passed, and there are usually other bowel symptoms, such as diarrhoea, constipation or bloating.

A food intolerance is different to a food allergy. If you are intolerant to a food, you may find that small amounts can be eaten without problems but larger amounts cause pain or irritable bowel symptoms. Some of the foods most likely to cause problems are a special group of carbohydrates, sometimes called FODMAP foods. Common foods that include large amounts of FODMAPs include:

While many of the foods we eat are absorbed quite quickly from the ‘small bowel’ (small intestine), FODMAP foods are digested slowly. While in the small bowel, they pull water into the bowel making the contents more liquid. The small amounts of FODMAP foods that reach the ‘large bowel’ (large intestine) are fermented by bacteria to form gas and irritating substances causing pain, diarrhoea, constipation or bloating. This isn’t a problem in most people. They pass wind from time to time but don’t have pain.

Some people absorb FODMAP foods even more slowly than usual. Even more water is pulled into the small bowel, and even more gas is made. If the bowel is otherwise healthy, they may make more wind than other people but still not have pain.

However, if the large bowel is sensitive (as it is in many people with pelvic pain), then eating these foods is likely to cause pain. The bowel doesn’t like the extra wind and water and let’s you know there is a problem by causing pain or bloating. Your bowels might vary from day to day – sometimes with diarrhoea, sometimes with constipation and sometimes with a mix of both.

This means that while your friends may be able to eat any food and feel fine, your bowel will be painful unless you are careful.

Should I just go ‘gluten-free’?

A gluten free diet is a special diet for people with Coeliac Disease. People with coeliac disease need to be on a strict ‘gluten free’ diet for the rest of their life.

People with an irritable bowel often feel much better on a ‘gluten free’ diet, because by cutting out gluten they are also cutting out wheat, a major FODMAP food. They do not have a problem with gluten and may be able to tolerate small amounts of wheat.

Before you change your diet, ask your doctor for a blood test that checks for coeliac disease. This test isn’t reliable if you have already cut out wheat from your diet, so it’s much easier to get it done first.

Are there other problem foods?

Yes, definitely, but everyone is different. You might have a problem with rich or fatty foods (cream, takeaway, animal fats), alcohol, coffee, fizzy drinks, and spicy food.

A low fat, low salt diet is good for everyone, but even more important if you have bowel problems.

If you find it all too hard to work out, a dietitian may be able to help.

We have been brought up to think that it’s important to have a bowel action every day. Actually, it’s OK to have a bowel action every couple of days or so, as long as it is soft and easy to pass when it happens.

It is easiest to open your bowels when the bowel motion is soft and your bowel is contracting strongly enough to pass it easily.

You can make the bowel action softer by:

• Drinking enough water
• Increasing the fibre in your diet
• Taking a fibre supplement such as sterculia (Normafibe^®). This supplement is useful as it causes less wind than most other supplements

You can increase bowel contractions by:

• Regular exercise, brisk walk every day
• Allowing unhurried time to go to the toilet after breakfast in the morning
• Avoiding medications such as codeine
• A herbal treatment such as slippery elm

But my constipation is really bad. Nothing works for me.

Some people have severe constipation, even when they do everything right. It is very unfair. They feel bloated and uncomfortable most of the time. If so, it is time to talk to your doctor, or maybe a gastroenterologist (bowel physician).

Doctors often think of bloating as an inconvenience rather than a major problem. This is because bloating rarely means a serious illness. The trouble is that bloating can make you feel uncomfortable and unattractive. It also makes any other pelvic pain worse.

Bloating can make your abdomen swell up and look big. Women often feel like this near period time, but it can happen in women or men after eating certain foods. Bloating can also make your abdomen feel big, even if you look normal.This is often due to a change in the way nerves work causing abnormal sensations such as bloating, and sensitivity to touch. You may find your clothes uncomfortable or dislike anyone touching your abdomen.

Before you do anything about bloating, you should see your doctor. Sometimes women feel bloated because they have an ovarian cyst. Your doctor can check this for you.

Once your doctor is sure there is no serious disease present, there is lots you can do to feel better:

• A low FODMAP diet helps most people with bloating
• A low dose of amitriptyline (5-25mg daily) can help the nerves work normally
• Peppermint oil capsules taken 3-4 times daily or peppermint tea
• Iberogast liquid 20 drops from  a chemist, drunk in warm water as tea 2-3 times daily

You’ll find lots more information on FODMAP foods and a low FODMAP app at the following link:

www.med.monash.edu/cecs/gastro/fodmap