(A Complete Guide to Colon Cleansing and Care)
by Dr.Hugh Cross MD
England. CT13 9DL
*Note to Readers
This page has one purpose only. To issue advice and
A SERIOUS WARNING.
There is absolutely no substitute for proper, informed and thorough medical care. No-one who is ill or has even the suspicion of being less than one hundred per cent fit should start on a training or unsupervised health programme. Any person who suspects or has symptoms of IBS should most certainly talk to his or her doctor,.. or another doctor elsewhere if confidentiality is in question. Expert help should always be sought either from the family physician or via him from a more highly qualified specialist if needed.
This book does not attempt to be a substitute for adequate professional medical care. No such substitute is possible.
The aim of the book is to provide information and guidance. It should be read as well as and alongside gaining access to full professional supervision.
If you have any symptoms of IBS or other condition then speak to your doctor.
YOU HAVE BEEN ADVISED.
This book is sold subject to the condition that it shall not, by way of trade or otherwise, be lent, re-sold, hired out or otherwise circulated without the publisher's prior consent in any form of binding or cover other than that in which it is published and without a similar condition including this condition being imposed upon the subsequent purchaser.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical and including photocopying, recording or any information storage or retrieval system without the prior permission of the publisher in writing.
Irritable Bowel Sydrome
Introduction: Facts, Figures and the Future
Section One: What is IBS?
Section Two: A Backward Glance
Section Three: IBS, - the Clinical Picture
Section Four: For the Technically Minded
Section Five: What's Causing It?
Section Six: What Will the Doctor Do?
Section Seven: What Can You Do?
Section Eight: Treat the Mind
Section Nine: The Magical Extras
Section Ten: The Summarised IBS Routine
Nutritional data, snacks and recipes
Sources and Bibliography
Facts, Figures and the Future
"IBS? What's that? Never heard of it."
"You know, IBS,.. Irritable Bowel Syndrome, - very common."
"Irritable Bowel Syndrome? With capital letters? You mean belly-aching and burping and all that?"
"Well, yes, that too. But as a recognisable condition, I mean."
"Oh really! No such thing. Just the latest medical fashion trend. I can't be bothered with things like that. I've got ill people to look after!"
That, verbatim, was the gist of a conversation overheard during coffee at a recent doctors' post-graduate seminar in Coventry. Any person who actually suffers from Irritable Bowel Syndrome could tell a very different story and would have a very different attitude. They know what it is all right. Nevertheless that short conversation tells us a lot about IBS, the prevalent attitude towards it, and the reason treatment has been so poor, hopes so often dashed and progress so slow,.. until now that is.
For now progress and help are within everyone's reach and treatment has never been better or easier. In fact, there is very good news all around for IBS sufferers. At last, it is possible to make this statement, - ‘Nowadays, a large proportion of IBS patients can be cured or controlled, the vast majority can be helped or improved and all can be beneficially treated.’
Just read on.
* * *
It's just as well there is now, at last, worthwhile therapy and help available because IBS has become one of the commonest disease conditions in western society. It is estimated that up to 20% of all adults suffer a lot of the time and 30% or more suffer at least some of the time. In addition to adults a lot of children and adolescents are also affected. It is of note that women IBS sufferers vastly outnumber men by a proportion of something like five to one.
The more the condition is recognised, and the more that patients feel able to talk about it, the more common we are discovering it to be. At the present time best guesses are that about one third of the adult population get at least some of the symptoms of IBS at least some of the time though many of them without becoming full scale, chronic sufferers. This is similar to the way many people get the odd, occasional symptoms of a cold,.. red eyes and sniffles perhaps, without always actually developing the whole picture of a full-blown streamer. For some, the picture is far worse, as about one in six of adults get IBS symptoms regularly, meaning much or all of their time.
Depending upon how one defines and diagnoses IBS, - and we shall come to that in the next section, - it is now realised that almost everyone gets some IBS symptoms some of the time. In other words, it is likely that practically everybody either has IBS, has had it, or will have it in the future to some degree or other. It is as common as that. Indeed, one group of experienced physicians has gone as far as to say that intermittent IBS symptoms are probably the norm in our society, - that it is those who never have it that are the odd ones!
There is an unfortunate tendency in some circles - rather like one of the doctors quoted in the first lines of this section - to regard all IBS symptoms as trivial and all the sufferers as unimportant because there is never any question of a life-threatening consequence. This is a bad judgement. IBS is not normally a dangerous diagnosis, - though we shall return to that point later. However, it most certainly can be a serious condition. It qualifies as serious because commonly it drastically reduces the happy and contented enjoyment of their lives for millions upon millions of people. The overall extent of the misery it causes is surely enormous. By any rational judgement that is serious. Very probably no one has died but huge numbers of individual human beings have had their lives made miserable to the point of job loss, broken homes, ruined life style, estrangements from family and, yes,.. even suicide. There are plenty of those. That too is serious. Indeed, how serious can you get?
So, unless absolutely driven to it as a last resort, let us have none of the usual medical advice, - claptrap like the 'have to learn to live with it' bit . Such a defeatist possibility must not be considered, let alone tolerated, until everyone's symptoms have been properly diagnosed and assessed then wholeheartedly attacked, brought under control, and reduced to the absolute minimum.
By reading and following this book, by understanding what you as the patient, or other patients, are up against, and by taking every methodical step, it is now possible to master this condition. By following the routines outlined later on in these pages, improvement, control and even cure can certainly be expected. There is no longer need to be despondent and downhearted.
Remember this, cure does exist, and help is at hand, - right here.
* * *
1. IBS affects vast numbers of people.
2. Some doctors don't take it seriously.
3. IBS is seldom dangerous, but often serious.
4. IBS can be treated, improved, controlled and, often, cured.
5. There is every reason for optimism.
What is IBS?
Los Angeles, the mis-named City of Angels, has lots of vaguely defined areas or sub-towns. There is no proper down-town, no proper city centre; suburbs run random into and around each other for endless miles. The result, as one wit described it, 'LA is a collection of freeway-connected towns trying hard to be a city.'
That is the way of it with IBS too. For IBS is a loose and variable collection of vaguely connected signs and symptoms trying to be a disease. So vague is it indeed, that plenty of authorities, while being familiar with the symptoms, do not recognise that they fit together to make a genuine, precisely-diagnosable disease at all.
So, one word at a time:-
Irritable: a condition of being easily stimulated, annoyed or angered, usually in the sense of unpleasantly; behaviour liable and able to result from external stimulation. In other words, irritable implies something that is easily disturbed in an unwelcome manner.
Bowel: this is the entirety of the food tube, - the parts of the alimentary tract, that start where the stomach ends. In other words it does not include the top three bits, - mouth, oesophagus and stomach, but it includes all the rest, - duodenum, small intestine (ileum and jejunum), large intestine (colon) and the rectum.
Syndrome: a collection of symptoms (features experienced and described by the patient) and signs (features discovered on examination) which, when occurring together, form a clinically recognisable picture different from any other and thereby comprising a separate, nameable disease entity.
It is over that first word that most argument centres. Some experts claim that the IBS bowel or certain parts of it, are not so much irritated by external factors, as normally existing normally in a high state of excitation - what we might call hyper-active. Yet others think that the bowel in IBS is the exact opposite, - being lazy and sluggish and thereby bringing troubles on itself by allowing undesirable bowel contents to remain in contact long enough to cause over-response or even damage. Yet others think it is not necessarily either of these but that the bowel is inadequately consistent, its unpredictable variability being responsible for the wide range of seemingly random symptom occurrence.
Finally, there is a large group who don't think the problem is in the bowel at all. While of course recognising that the symptoms manifest themselves in the bowel, they also recognise the close association of the bowel and its responses to the state of the individual's mind. They incline to think the bowel is merely responding with localised symptoms to what is, in fact, some form of cerebral/mental/emotional dysfunction.
From the latter has arisen the very important matter of whether this condition should really be known as IBS, or as IBS-2 or even MBS. The familiar Irritable Bowel Syndrome is IBS, - the general subject of this book. IBS-2 is the alternative of Irritable Brain Syndrome, and MBS, perhaps, a little unsympathetically goes further, - and calls the whole thing Miserable Brain Syndrome.
We shall discuss these highly relevant criteria later.
* * *
A Backward Glance
The history of IBS as a disease is quite informative. It did not appear significantly in the literature until about thirty years ago and it certainly was not the sort of thing that got mentioned in newspaper ads. Yet, clearly, a new disease doesn't suddenly appear and affect millions of people. Even AIDS and mad cow disease didn't do that, - both began gradually and grew steadily. IBS on the other hand seemed to doom vast numbers virtually overnight.
Of course that is not what really happened. IBS had always been there, but more as a loose collection of variable symptoms. No-one had connected them and deduced that here was a separate medical condition. Prior to the 1990's, doctors gave such similar symptomatic illnesses different names. 'Hyperactive colon' was one such. So was 'spastic colon.' Both names recognised the colon as the focal organ and increased activity as the cause. On the other side of the Atlantic the fashion was for titles with more jargon, - 'mobile bowel,' - and 'bowel awareness.' Most people, especially the sufferers, simply referred to IBS as 'tummy trouble.'
A major factor, earlier on, was that people who have IBS symptoms tend to be ashamed of them and not to talk much about them. It is a condition that attracts not so much sympathy as ridicule or frank disgust for the sufferer. Curiously, amongst the British in particular, much of the national sense of humour centres around bodily waste and the principal contents of main's drainage. Twenty years ago the popular TV comedians 'The Two Ronnies' performed a tediously lengthy sketch about people in the riotously funny predicament of having frequently to disturb their activities in order to hasten to the bathroom. Bowel disturbance remains a rich seam from which to dig out lower class humour for music-hall calibre jokes. Funny,.. or what? They are jokes that seldom amuse those troubled by IBS.
The fact of the matter is that whatever name is given to IBS symptoms they result in large numbers of ill patients. It must not be forgotten that the 'disease' of IBS is a very genuine illness. It results in hundreds of thousands of ill people, - of patients, - suffering varying degrees of misery and incapacity. These are people who are every bit as deserving of understanding and sympathy as someone with asthma or a broken leg. They are restricted in their lives, habits and employability. They consume large amounts of medication, suffer tiresome and unappealing diets, they trot back and forth to doctors and clinics, and they undergo often needless and usually fruitless surgical operations. Many spend days or even weeks and months scarcely able to leave their homes and in conditions where they are despised and spurned by potential friends even to the extent of alienating their very own loved ones. This is no matter to be made the butt of selfish, unfunny humour.
As with most things there is both good news and bad about IBS. The bad news is that it is vague enough to confuse methodical attempts to help, yet up to a third of the population gets or will get it sometime during life, - and when they do, most will not even seek help. That is a dismal picture.
The good news is that although it probably does not lead to anything else, (though we shall discuss that in more detail later), there is now a growing recognition of its problems and widespread nature. This means that there are huge profits to be made if and when a cure is discovered. Consequently, massive pharmaceutical research programmes are now in place to find a cure.
The best news of all is that IBS can already be cured in many cases and helped in almost all, - just by following the simple but effective programme explained later in this short book
* * *
IBS, - The Clinical Picture
Doctors don't like vague things. They like things cut and dried, - a particular disease, a certain diagnosis, a positive therapy. IBS is not like that. It is not, medically speaking, even a disease, but merely a collection of different symptoms, - a syndrome. It has no consistent obvious or known specific cause. It has no specific treatment. It has no single certain cure. When a patient with IBS is examined, there is very little, often nothing at all, to be found. When you look, there's nothing there, - nothing's wrong. Yet there it is despite the fact that there is no physical abnormality. The best way to summarise it is that IBS is a rag-bag of a diagnosis, - as if a dozen or so symptoms had been slung into a bag and labelled, - a series of vague, fleeting and varied pathological manifestations that somehow hang together, more or less, as a syndrome. If that makes it tough on the patient, it also makes it tough on those whose job it is to diagnose and treat it.
IBS affects both sexes, though predominantly the female, and all age groups though predominantly, the 40's to 60's. Its list of symptoms reads like an inventory from a misery factory. As well as less common symptoms, the first half a dozen or so on the following list are complained of by most if not all patients. In order of the frequency with which they are encountered in patients symptoms include,
1. Urgency to evacuate the bowels. This is usually associated with diarrhoea or loose motions and is often accompanied by explosive release of gases. Episodes often follow variable periods of constipation.
2. Nausea, indigestion/heartburn, loss of appetite, feeling dispirited and low. Symptoms are usually slight but may occasionally be severe.
3. Abdominal pain, sometimes vague and fleeting, but sometimes severe colic spasms of excruciating pain followed by easing for an interval before being repeated. As this is the result of the bowel muscles attempting to squeeze irritant or impacted contents along the tube and out of its way there is relief when the act is completed
4. Episodes of constipation.
5. Haemorrhoids (piles). These are swellings around the margin of the anal orifice. The entire area has a complex network, a plexus, of small veins draining blood back into the body. Sometimes, there is a genetic weakness in the elasticity of the vein walls. This makes them vulnerable to congestion and consequent swelling. Even when this weakness is not present, distension can be caused by the repeated straining to evacuate the bowels of uncomfortable and immobile faeces during periods of constipation. The haemorrhoids can distend further and further until they not only surround the anus, but start to hang, like clusters of small grapes, well down from the orifice. They are painful and can itch severely. They are also prone to bleeding and to secondary infection. Furthermore, they can adhere to clothing and the discomfort they cause during defaecation can be so severe as to make the patient afraid of the very act, - a reluctance that then worsens the symptoms of constipation.
6. Blood in the stools (faeces) can result not only from bleeding piles but from blood oozing from internal piles or from inflamed areas of bowel lining higher up the alimentary canal. Although the amounts are not normally great they can alarm the patient out of all proportion as undiagnosed bleeding always brings with it the fear of 'something worse leaking up inside.'
7. Another frequent complaint, often though not always associated with obvious bleeding, is the fear of cancer. It is widely publicised that cancer of the bowel is one of the more common varieties nowadays. The appearance of symptoms like pain, nausea and disturbed bowel habit are also publicised as typical symptoms of it. Small wonder that IBS sufferers, who anyway tend to be of the apprehensive type, start to fear the worst.
8. Embarrassment. Our society being as it is, many IBS symptoms are a source of shame to sufferers. Loud bowel noises, passing wind, obvious discomfort, impaired appetite and the frequent need to excuse oneself from company to visit the toilet, - though natural enough are liable to incur sympathy, inconvenience or even mirth in others, none of which are welcome to the sufferer. The embarrassment is such they many stay away from company and even stay mostly at home scarcely daring to venture far away because of the joint effects of the symptoms and the shame they incur.
Commonly it is this same embarrassment that results in patients failing to attend their doctor. Most have undergone self-treatment with generally poor results. A large proportion have then sought the help of a local pharmacist or, more commonly, one in another town or area for fear of anyone local discovering their plight. Statistics show that the majority of patients do not attend the doctor for a long time, some up to five years later, as a result of mixed feelings of shame and a wish not to bother the doctor for something as trivial as an upset tummy. Sadly, all too many get little better relief from professional medication than they did from their own.
In addition to the above symptoms which are almost universal, there are others, less frequent and often more vague, but nonetheless troublesome:-
9. Although there is usually a long-term lack of relish for food, the patient may experience sudden bursts of great hunger interspersed with periods when the tummy feels bloated and over-full even though it is not. This is usually due to gas (flatus) either swallowed with the food or produced by the fermenting or inadequate digestion of bowel contents. Some foods including pulses (peas, beans etc.) and those of high fibre content are particularly liable to cause this. The gas causes 'tummy rumbles' correctly called borborygmi, which may be loud enough to be heard in the next room. Releasing the pent-up gas by burping, at either end of the alimentary canal, can release loud reports and offensive odours. Other people naturally notice.
As a result of gas pressure on other areas, the patient's need to go to the toilet, or at least to feel as if they should, is further exaggerated and is a further embarrassment when there is a need to 'go' during meetings, mealtimes or intimate occasions. Furthermore, gas under pressure can squeeze other nearby organs. Pressure on the urinary bladder (see below) can make the need to urinate more frequent and more urgent. Kidney pressure may cause pain and some bleeding into the urine. Pressure directly on the stomach by simulating fullness further reduces appetite. Pressure on the diaphragm causes breathlessness. It is not possible to exclude the effects of pressure on even more remote organs, - blood vessels, endocrine glands, the heart and the liver.
10. Back pains. Explanation for this is obscure, - 'related inflammation', 'referred pain' and other such phrases simply conceal the fact that no-one knows why back pain so often accompanies IBS. Yet a large proportion of sufferers say that discomfort, mainly in the lower back, is, for them, a major feature.
11. Frequency. Over-often need to pass urine, commonly in only small amounts, is a symptom many complain of but, curiously, may not realise to be associated with the bowel symptoms proper. It is generally regarded as a consequence of excess bowel gas compressing the pressure-sensitive trigone area of the bladder thus exaggerating the need to evacuate.
12. Oral symptoms. Many patients complain of bad breath, - often an indication of stomach disturbances like indigestion. Others find themselves prone to painful ulcers in the mouth which entire cavity can become inflamed and tender. The tongue may swell and become cracked and tender, as can the lips. Mouth washes and oral hygiene are only partially corrective, probably as the cause lies elsewhere.
13. Shortage of breath or uncomfortable breathing. This too the patient often fails to recognise as part of the picture, fearing that it is another serious condition.
14. Irregular pulse. The normal, resting pulse rate is not only steady at somewhere around the 70 per minute mark, but is also regular. In young people inhaling and exhaling deeply and slowly, can cause slight fluctuations but even these are gradual. Furthermore, they are regularly irregular. Gas pressure from the abdomen and compressing the heart from below can cause irregular irregularities. When noticed by the apprehensive IBS patient, they can prove most alarming and are commonly a reason for the patient first seeking medical advice.
15. Depression and anxiety. The emotional aspects of IBS will be discussed at length later. It is hard to say in any instance whether the state of mind of being mentally depressed or over anxious causes or is associated with the causes of IBS, or whether the IBS symptoms, in turn, make the sufferer depressed and anxious. Probably both factors combine to operate as a vicious circle.
16. Faecal incontinence. This is not a frequent symptom but is one which is disastrous for the patient if it occurs. Particularly during periods when the stools are very loose and liquid sudden physical movements like coughing or hurrying upstairs, can result in small amounts of faecal material being forced involuntarily to escape sphincter control. The social consequences need not be dwelt upon.
17. Agitation. With dubious bowel control, wind, pain and the whole variety of IBS symptoms it is no surprise that the patient finds it hard to relax and be calm for any length of time. They often report continuous restlessness and, along with that, a repeatedly disturbed concentration and impaired memory recall.
18. Fluid retention, basically a matter of excess water and electrolytes being held in the tissues, can contribute to the bloated, over-full feeling. There is noticeable weight gain, fingers may swell, joints become difficult to flex, and there is a general feeling of overall bodily 'puffiness.' Women who tend to get similar symptoms especially pre-menstrually seem to suffer most and this may be due to hormonal fluctuation again possibly associated with raised abdominal pressure. Some confirmation may be indicated as a number of women also complain of menopause-like 'hot-flushes' during and soon after eating.
19. Skin rashes, commonly of an irritating nature, are reported by some patients. These can occur in small, localised patches, mainly on the hands, feet and face, or can be more generalised. Some patients describe itching that is severe enough to disturb sleep patterns.
20. Fatigue. It is difficult to apportion blame for it but many patients experience fatigue of a degree they do not find commensurate with their life style. Some say they can drop asleep repeatedly, so tired do they feel, yet are restive and have their sleep repeatedly interrupted.
21. Faintness. Often occurring in episodes over a few hours or days some patients experience 'sinking' feelings or sensations of weakness and giddiness. These are often associated with perspiring or even voluminous sweating. Feelings of nausea and a draining of colour from the complexion at the same time suggest that these are the unpleasant results of a 'vagus' nerve syndrome. Save for the possibility of falling during a fainting spell these episodes feel unpleasant but are actually not dangerous.
22. Reduced libido. The diminished sex drive and lowered levels of achievement of sexual satisfaction reported by so many IBS sufferers may have a variety of causes. To start with, the potential social embarrassments already mentioned can acquire amplified levels of significance during intimate physical encounters. The general feeling of low grade health and continuously feeling below par adds to this, as does the fact that a high proportion of patients already tend to be of a sensitive and easily upset emotional nature. Associated hormonal factors have also not yet been excluded.
* * *
For the technically minded
Do you really want to know about the anatomy and physiology of the condition? If so, read on. If not, this is the place to skip forward to the sections on causes and cures. However, although as the English writer Pope pointed out, '.. a little learning is a dangerous thing,' none at all might be even worse. In other words, if a little knowledge is dangerous, where is the man who has enough to be out of danger?
The human body is no less remarkable than those of other fascinating creatures. Man, taken in the round, we believe to be the highest or most superior species so far evolved on earth. Not only is he physically evolved to a spectacular degree of perfection for his niche in the environment, but he is mentally evolved far, far beyond any other known creature. Indeed, his mental powers and the technology that resulted from them has enabled him to enlarge his niche then to spread to and colonise almost every kind of environment. It has proved immensely advantageous to man as a species.
But there has been a downside too. Man's physical evolution from the primitive man-like apes of the distant past has been a continuous and successful process but also and very, very slow process. Hundreds or thousand of years have elapsed while the refinements that comprise modern man, Homo sapiens sapiens, became developed and welded into the present, still-changing picture. For man's physical evolution is still going on; and it is still going on as slowly as ever.
However, some ten thousand years or so ago man's progressing mind led him into experimentation with groups, societies, hunting methods, fire and
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