Dr Margaret answers emailers’ embarrassing problems
in this monthly problem page.

Irritable bowel syndrome

Dear Dr Margaret
I certainly hope you can shed light on my problem. I get sudden attacks of diarrhoea. The attacks are not due to emotional upset. (Once it happened as we were on our way out to dinner, and I had to take off from a traffic light and cross several lanes to get to a public toilet – very quickly.) The attacks are not due to a parasite or other bug (I had ‘it’ analyzed). Sometimes I can tie it to something I have eaten (like burning after a Mexican dinner), but most of the time it just is. I have vegetables in my diet and a good amount of fibre, so I don’t think that is a cause. I understand my mother had this problem also. She never had colon cancer or any other diagnosed colon problem.

Obviously I cannot say with certainty what your problem is, but irritable bowel syndrome would be high on my list. It is certainly a very common condition (affecting 1 in 10 people). It is interesting that your mother had similar symptoms, because you are more than twice as likely to get irritable bowel syndrome if a close relative has it.

The term ‘irritable bowel syndrome’ covers various combinations of tummy symptoms. A common pattern is a sensation of distension and discomfort after food, often with wind and tummy rumbles. Constipation or diarrhoea or a combination of the two is another common pattern. The faeces may be pale and watery and may appear to contain mucus (but never blood), or they may have the consistency of toothpaste or resemble rabbit pellets. The almost explosive urgency that you describe is a very typical, and some people have pain in the abdomen beforehand, or a feeling of incomplete emptying afterwards.

You do not mention any discomfort, but many people with the syndrome do have abdominal pain. It can be anywhere in the abdomen, and may be gone after a few minutes or may last for hours.

All sorts of treatments have been tried, and a treatment that works for one person may be hopeless for someone else. For example, increasing fibre may help some people, but worsen the feelings of distension in others. Various ‘anti-spasmodic’ medications can relieve symptoms: ask your doctor or pharmacist for advice. In a very few people who have chronic, painless diarrhoea, a lactose-free diet may help.

Although irritable bowel is common, people with bowel symptoms should not assume it is the cause without talking to their doctor. If you have other symptoms as well as the gut symptoms (bleeding from the back passage or blood in the faeces, persistent tiredness, fever, arthritis, loss of weight, a lump in the abdomen, severe pain, worsening pain, diarrhoea in the night), or if you are over 40 when the symptoms start, you should see your doctor without delay.