IBS has such a broad spectrum of symptoms that people write to us every day worried that they may have something more serious. Doctors are often too busy to see all the patients with IBS who might need reassurance. At The IBS Network, we see our role in providing reliable information that can help people understand their own condition so that they only seek medical help when they really need to. Below are some of the symptoms people worry about.
My symptoms wake me up at night. Should I be worried? I have already had extensive investigations and have no serious disease.
Medical students were (and probably still are) taught that symptoms of IBS do not wake them at night. This may be because it was assumed that IBS was related to emotional tension as relayed through the autonomic nervous system and that the brainstem and autonomic nervous system and the bowels close down at night. These assumptions are only half truths. Mild colonic inflammation and depletion of the microbiome both occur in IBS and may impair the ability of the colon to salvage the effluent from the small intestine. This is particularly so if small bowel transit is so rapid as to impair absorption of bile acid and fats, which would irritate the colon, stimulate peristalsis and wake you up with an urge to go. Your tests have all been negative. I would try eating less bulky and fatty meals a bit earlier in the evening and see iff that makes a difference.
During a flare up of my symptoms, I often get a fever yet my doctor tells me that you don’t get fevers with IBS. So should I be worried?
Medical teaching would say that you don’t get a fever with IBS because it is not an infection or an immune disorder. This may have to be revised in the light of new information on the involvement of the microbiome and the gut immune system in IBS. Depletion of the microbiome can occur in IBS and this may cause an increased permeability (leaky gut) and allow bacteria and bacterial products to penetrate the lining of the gut, causing inflammation not only in the gut but also in the lover and other sites. The combined effect of bacterial products and cytokine transmitters from white blood cells can act on the thermoregulatory centres in the brain stem and raise body temperature. Also trauma can dysregulate the brain stem centres directly and increase body temperature. But since mercury thermometers have been withdrawn, few people take their body temperature any more. So symptoms of trembling and sweating may not actually be signs of fever, but effects of nervousness and anxiety, which also tend to bring on attacks of IBS.
Is loss of blood from the rectum always due to something more serious?
Not necessarily. The commonest cause of rectal bleeding is haemorrhoids or piles and these may not always be obvious. Bleeding from piles tends to be bright red and splatter around the lavatory pan as you strain to pass a stool. Nevertheless, your GP or gastroenterologist cannot assume that haemorrhoids is always the cause and if the bleeding persists, should always refer you for a colonoscopy since cancer and colitis also cause rectal bleeding.
Can I lose weight with IBS?
Yes, of course. People with IBS can often experience pain as soon as they eat and this may make them disinclined to eat; a condition I have referred to as anorexia dolorosa. Eating disorders are frequently associated with IBS. Patients with anorexia nervosa are often constipated – nothing in, nothing out. Also, some of the diets for IBS may cause people to lose weight. Most causes of weight loss in IBS are due to the IBS but doctors cannot assume that is the case. Weight less is a symptom of cancer and of inflammatory bowel disease as well as endocrine disorders such as thyrotoxicosis and diabetes so it is important that these conditions are excluded.
Medicine is an inexact science that should rely more on prudence and common sense than on strict control. Common diseases occur commonly and anything serious tends to ‘show its hand’ pretty soon. Watchful inactivity is often a wise counsel as long as doctors can see their patients frequently, but the sheer numbers of appointments often means that doctors reach for the investigation forms and prescription pads without being able to see how things develop. Bearing in mind the enormous numbers of people with IBS and the limitations of health service resources, we at The IBS Network take the view that people with IBS should be empowered to understand and manage their own disease with the help of their health care professional when necessary but this requires knowledge of the symptoms they need they need to take seriously and request investigations for.
For information on all aspects of IBS, do click on our IBS Self Care Plan .
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