Thoughts of gorging on French food must have helped those at Heathrow to while away the hours when queueing hopefully for a flight to Montpellier. Any memories they may have had of past pain and disasters from suffering an almost immediate attack of irritable bowel syndrome (IBS) after succumbing to the temptations of foie gras, cassoulet and creamy brie would have been driven from their minds.
Cramping pain, bloating and flatulence would have seemed as nothing when compared to the monotony of inching their way slowly to the check-in counter or the X-ray machines, and the awfulness of the sandwiches and crisps.
IBS won’t be the only fence for their gastrointestinal tract to clear when they finally arrive. Their sensitive guts will still have to win the annual battle with alien E. coli. There are usually a trillion bacteria happily milling around in a normal large intestine, but mix these with a few hundred thousand foreign E. coli from the grubby hands of a waiter, and the once calm pond soon becomes a turbulent whirlpool.
Up to a third of British people suffer from irritable bowel syndrome. IBS is a condition in which there is diarrhoea or constipation as well as pain and flatulence. No one can deny that emotional factors play a role in its causation, but too much talk of sexual, physical or emotional abuse in childhood — one of the fashionable aetiological factors blamed for it — and the doctor/patient relationship is unlikely to recover.
A sure way for a doctor to alienate a patient is to suggest that IBS is all in the mind. Food — even if it is rich and fatty — that would slide easily through the gastrointestinal tract if the diner is relaxed may cause mayhem if it is eaten at a business lunch, with a potential new partner, before an important engagement or when someone’s nerves are already at breaking point through tiredness, sleeplessness or queueing at Heathrow.
Advertisement
IBS is divided into two types: constipation-predominant and diarrhoea-predominant. Some patients suffer from both at different times. Whether there is constipation or diarrhoea, the pain is colicky.
The pain is such an important feature that, if a patient complains of painless diarrhoea, doctors should assume that the diagnosis is wrong and reinvestigate. Both doctor and patient are always worried that the symptoms of IBS are masking something more sinister.
Every patient with IBS must be well versed in the symptom changes that could denote some other disease that requires investigation. If the diarrhoea is repeatedly nocturnal, if there is any bleeding, weight loss, or even if the severity and position of the pain or the nature of the diarrhoea changes, they should consult their GP, as they should if there is any weight loss or a steady but unspectacular worsening of symptoms, even without any specific change in their character.
Sufferers should choose small portions of plain food, especially when eating in public, and go easy on the foie gras and brie, avoiding too much fruit, nuts, raisins and coffee. If there is any suggestion of milk or wheat intolerance, these should be taken sparingly.
Peter Whorwell, professor of gastroenterology at the University of Manchester, holds the belief — not taught generally for 30 years — that, whatever the type of IBS, a high-fibre diet is likely to make it worse.
Advertisement
Probiotics are a useful treatment provided they are, like Multibionta, of the type not destroyed by gastric acids. Taking Lomotil before a meal that is likely to precipitate IBS, or Buscopan up to three times a day, is permissible, as are small doses of tricyclic antidepressants taken once a day. Patients must be reassured that this is to reduce the activity of the gut nerves and not for their psychological effect.