AREAS OF EXPERTISE

Functional Bowel disorder

A functional gastrointestinal disorder comprises symptoms arising in the mid or lower gastrointestinal tract that are not attributable to anatomic or biochemical defects. The symptoms include abdominal pain, early satiety, nausea, bloating, distention, and various symptoms of disordered defecation. The three most common functional bowel disorders are irritable bowel syndrome (IBS), constipation, and functional dyspepsia.

Irritable bowel syndrome (IBS)

IBS, the most common functional bowel disorder, is characterized by chronic or recurrent symptoms of lower abdominal pain related to bowel movements, change in bowel habit (diarrhoea, constipation, or alternating), a sense of incomplete rectal evacuation, passage of mucus with stool, and abdominal bloating and distention.

Functional dyspepsia

Functional dyspepsia is characterized by chronic or recurrent pain or discomfort centered in the upper abdomen. Unlike IBS, symptoms are not related to the process of defecation. There is no evidence of organic disease or structural or biochemical abnormality.

 

What is constipation?

Constipation is where you have one or more of the following:

• Stools that are hard, painful and difficult to pass, causing you to strain harder than usual when going to the toilet
• Emptying your bowels less often than is normal for you.
• Feelings of ‘bloating’, discomfort or even pain in the lower part of your belly.

Constipation is very common in the UK, with up to four in 10 people affected. It is normal to be embarrassed to talk about constipation, but there are many ways to treat it and if treated it has no long-term effects on health in most people.

How often should I be emptying my bowels?

What is normal for one person is not necessarily normal for another. Some people may empty their bowels three times a day, whilst for others once every three days may be normal. If you are emptying your bowels less often than you normally do, then you may be constipated.

Why are healthy bowel motions important?

Maintaining your own regular bowel motions is important for preventing the complications that constipation can bring. If you do not treat your constipation and it continues for a long time, you may develop haemorrhoids (dilated blood vessels around your anus from straining too hard) or faecal impaction (stools so hard that they collect in your rectum and cannot be passed)

What causes constipation?

There are many causes of constipation. The common ones include:

• not eating enough fibre or drinking enough water
• not getting enough exercise
• resisting the urge to empty your bowels
• some medications such as codeine (a painkiller) and iron tablets
• Some illnesses 

 

How is constipation treated?

The first treatment for constipation is to change the food you eat and increase the amount of water you drink in a day (see below). Exercise helps treat constipation by using gravity to help the food along the gut. 

If the above do not work, your doctor may prescribe laxatives.

Faecal impaction may be treated by your doctor inserting a gloved finger into the rectum and manually breaking the stool up so that it can be passed.

 

How can I prevent constipation?

As with most medical conditions, prevention is better than cure. The key to preventing constipation is eating the right kinds of food and drinking enough water to keep your stools bulky and soft enough to pass through your gut easily. Use the tick boxes to check off the measures you have taken to prevent constipation:

• Switch to wholegrain bread, aiming for five slices a day.
• Increase your fruit and vegetable intake to at least five portions a day.
• Drink plenty (around two litres) of water per day. If your urine is pale and straw-coloured, you are probably getting enough water.
• Try switching to wholegrain pasta and rice.
• Try including prunes; prune juice, nuts and beans in your daily routine.

 

What is bowel incontinence?

Bowel incontinence occurs when you are unable to voluntarily control bowel movements, leading to leakage from the back passage. This very common condition can be upsetting; however there are a wide variety of treatments available to help.
  

What causes bowel incontinence?

Bowel incontinence is not a single disease in itself; it has a wide variety of causes. The main ones are as follows:

• general loss of control: dementia, alzheimer’s  
• nerve damage: stroke, diabetes, spinal cord injuries, multiple sclerosis (a disease of the nervous system) problems with the rectum itself: diarrhoea, constipation and rectal cancer
• problems with muscles: childbirth, previous surgery, radiation therapy

Many of these conditions are more common in the elderly, although bowel incontinence itself is not a normal part of ageing.

This condition is more common in women than men because it can develop as a complication of childbirth.

 

What are the symptoms of bowel incontinence?
 

A sudden urge to go to open your bowels and not being able to reach the lavatory in time (urge incontinence).

The passing of stool without knowing it (passive soiling).

Passing stool inadvertently while passing wind.

Symptoms may be experienced differently by different people and are not necessarily present all of the time. Some of the associated symptoms include:
 

• inability to control bladder function
• stomach pain and irritation
• bloating
• stomach cramps
• constipation
• chronic diarrhoea (may be due to underlying conditions such as ulcerative colitis or Crohn’s disease)

 

How is bowel incontinence diagnosed?

Your GP will normally be able to make the diagnosis after you tell him/her your symptoms.

To investigate the cause your doctor may insert a gloved finger into your rectum to check for impacted stools and test the power of the anal sphincter muscles.

 

What other tests might be useful?

• Endoscopy: using a small camera to check for abnormalities in the structure of the rectum and colon.
• Anorectal manometry: using a pressure monitor to check the strength of the muscles that control the bowels.
• Nerve tests: to check that the nerves that normally control the bowels are working properly.
• An ultrasound scan: to see if there is any damage to the sphincter muscles

 

What treatments are available?

• Dietary changes: will vary according to whether diarrhoea or constipation is the main underlying problem.
• Medications: laxatives would be used to speed up bowel motions in constipation while different medications such as loperamide are used to slow down bowel motions if needed.
• Pads: absorbent pads that prevent visible soiling.
• Anal plug: when inserted into the rectum can stop soiling.
• Pelvic floor exercises: physiotherapists can take you through a variety of exercises designed to strengthen the muscles that control bowel outflow.
• Bowel retraining: can help people with nerve damage to self-regulate their own bowel motions.
• Surgery: there are a wide variety of surgical techniques that can be utilised in different ways depending on the underlying cause.

 

As a rule the least invasive and most agreeable solution will be considered first. Bowel incontinence is not uncommon and treatment is widely available.