Health News and Information

There appear to be two distinct subgroups within IBS patients. The first group suffer from mild diarrhoea most of the time, often with pain, and sometimes with brief episodes of constipation. The second group suffer from constipation for some or most of the time, with bloating, and occasional bouts of mild diarrhoea. They may also suffer pain. For people in this second group, food sensitivity is unlikely to be at the root of their symptoms. For those with chronic diarrhoea – the first group – food sensitivity is worth investigating, especially if they have bloating and wind as well. Some studies have shown that as many as 70 per cent of IBS sufferers may be food-intolerant.

Alternative explanations for IBS are very thin on the ground. The most widely accepted theory is that the complaint is usually psychosomatic. Another theory suggests that lack of fibre in the diet is responsible. Although this idea is now largely discredited, extra bran and other bulk-forming agents are still prescribed for IBS, regardless of whether diarrhoea or constipation is the main symptom. The latter might be helped by this strategy, but not the former. Indeed, there is evidence that some people with IBS are made worse by eating bran, suggesting a sensitivity to wheat or other grains.

Exactly what goes wrong in IBS is far from clear. In many cases it may be that the muscles of the gut are contracting too much, or too little, or are simply un-synchronized. The muscles that control the bowel are smooth muscles, like those in the bladder and the bronchi (the tubes leading to the lungs). Some patients with IBS have to urinate frequently, and this can be a sign that smooth-muscle spasms are at the root of the symptoms, although frequent urination can also be a straightforward psychological problem.

What causes these spasms? It could be an effect of the sympathetic nerves, if IBS really is psychosomatic. Or it could be mediators released by mast cells (see p26) if there is a true allergic reaction. The term ‘asthma of the gut’ is sometimes used to describe this sort of reaction – in just the same way as there are spasms of the bronchial muscles, producing asthma, there could be spasmodic contractions of the smooth muscles of the gut, producing diarrhoea.

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As a means of survival you can also consider taking up the menopausal sport of jogging if you are already close to being fit and sure that you are not going to drop down dead as some men have through weak heart and over-exertion, and, if you are prepared to risk sprains, back trouble, strained muscles, dog bites and traffic accidents. Besides firming the body jogging strengthens the heart and lungs, but before starting out make sure you buy good quality jogging shoes with thick well-cushioned soles. Pounding the hard pavements severely taxes the resilience of forty-year-old joints and sinews. And start slowly. Jogging is not racing, it is a long run simply for the fitness and pleasure it gives.

Squash and tennis are good fitness sports most men have access to but many doctors regard swimming as the best exercise readily available because not only does every muscle in the body have to perform, the heart and lungs have to work rhythmically too as they build up the body into an essentially fit machine. (To swim as exercise means a minimum of twenty minutes at a good pace, rather than leisurely dipping, three times a week.) Golf, the archetypal middle-aged man’s sport, offers little exercise value unless you are carrying your own clubs.

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