The 10 Most commonly asked questions:

1. People always talk about ‘normal’ bowel habits. What constitutes ‘normal’?
2. I always seem to be constipated. How can I cure this?
3. How do I know if I have IBS?
4. I get a lot of wind. Why?
5. Is bleeding always serious?
6. Are piles and haemorrhoids the same thing, and can you really get them from sitting on wet grass, cold steps or hot radiators?
7. I’m worried I have bowel cancer as it runs in my family. What should I do?
8. Is Crohn’s disease contagious?
9. Are there any precautions one can take to prevent ‘holiday tummy’?
10. My child complains of ‘tummy ache’. What should I do?

1) People always talk about ‘normal’ bowel habits. What constitutes ‘normal’?

Bowel habits are an individual thing. Some people go twice a day, while others may go only every other day. Generally, anything between three times a day and three times a week is considered ‘normal’, although there are perfectly healthy people whose toilet habits fall outside even this broad range. ‘Normal’ is what is normal for you and not anyone else. Judge it by your own daily habits. You can often also tell if you’re bowel habits are ‘normal’ by looking at your faeces (‘poo’) – if they are watery and unformed, this is usually because you have diarrhoea, and if they are hard and pellet-like, and difficult to pass without straining, then this is a sure sign of constipation. A ‘good’ stool is soft, just formed (sausage-like) and tends to float on the surface of the water.

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2) I always seem to be constipated. How can I cure this?

Constipation is not a disease, but simply a sign that our intestines are having trouble getting rid of compacted waste in our bowels. The majority of cases of constipation are caused by simple problems like dehydration, changes in routine (like travelling), ignoring the body’s ‘urge to go’ and even things like iron supplements and certain common medicines (like those containing codeine). Chronic constipation can lead to piles forming, and eventually it can contribute to problems like diverticulosis, so it should always be addressed.

There are several things you can do to relieve chronic constipation:
a) Drink more fluids. Aim for an intake of at least 2 litres (4 pints) of water daily. Watch you intake of tea and coffee as they may make constipation worse.
b) Eating high-fibre foods as part of your everyday diet is an easy way of alleviating chronic constipation (although some people who suffer from IBS may find that fibre can aggravate their symptoms). However, always increase your fibre intake slowly(especially with beans and pulses) as a rapid change can give you wind and abdominal discomfort, although this normally lessens as your guts get used to the change in diet. The recommended amount of dietary fibre is 20-35 grams daily.
c) Choose wholemeal or fibre-enriched pastas, brown rice and unrefined flour.
d) Eat more fruit and vegetables
e) Bran is easy to add to baked goods like muffins, and cereals
f) Flaxseed is a good source of soluble and insoluble fibre (3 grams per tablespoon), and it also contains healthy omega-3 fatty acids. Sprinkle it over salads and cereals or yoghurt to give a nutty taste.
g) Dried apricots, desiccated coconut, dried peaches and toasted almonds are all convenient, high-fibre snacks.
h) Eat regularly – the gut responds best when fed little and often. And try to have your main meal at lunchtime rather than dinner, to give it more time to digest properly during the afternoon.
i) Exercise: take your intestines for a walk – they will love it! An exercised body always functions more effectively than an underactive one, and exercise is a good way of helping relieve constipation
j) Don’t ignore the Urge – when your body signals that it wants to pay a visit to the bathroom – let it. If you constantly ignore these natural urges, your bowels will cease to signal properly, which further accentuates the problem. You can always ‘retrain’ your bowels by sitting on the toilet for a few minutes at the same time each day, but never for longer than about 5-10 minutes, and never strain if nothing is happening.
k) Avoid laxatives – although they’re helpful every once in a while, laxatives, especially stimulant ones, can lead to dependency, which is not healthy for the bowels and can cause unwelcome changes in the bowel if used for many years.
l) Herbal help: Laxatives – herbal or otherwise – are no long-term solution to constipation, but there are several herbs with mild purgative properties that can be used occasionally. Senna is the best known, but others include cascara, frangula, and yellow dock. Aloes, dandelion, liquorice, and rhubarb root also possess laxative properties. Ispaghula husk is an excellent natural bulking agent, which helps the body move waste food through the large intestine more easily. It should always be taken with lots of water.

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3) How do I know if I have IBS?

Firstly, whether you think you have IBS or not, don’t rely on books, web pages or any other written source to make your diagnosis: always see your physician, and let him diagnose IBS for you.
The reason this is so important is because many of the symptoms that are associated with IBS can also be symptoms of other digestive problems, and some – like bowel cancer – are serious. So have all doubt removed, by having yourself checked properly.

Some symptoms are typical of IBS, and although they can vary greatly from person to person, they include:
a) Abdominal cramping
b) Feelings of ‘fullness’ or bloating
c) Unaccustomed changes in the bowel habit like irregularity or alternating between constipation and (painless) diarrhoea, or a predominance of (painless) diarrhoea and constipation
d) Wind
e) Nausea
f) Feelings of urgency (rushing to go to the toilet)
g) Pain in the back passage
h) Ineffective straining, or feelings or inadequate emptying of the bowel
i) Occasionally, pain on sexual intercourse in some women

Bleeding is never associated with IBS (unless you are also suffering from piles, for example) so if you have any blood loss when you visit the bathroom, seek medical attention as soon as possible.

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4) I get a lot of wind. Why?

Believe it or not, there are many things that can cause us to have problems with wind – and not all of them are that obvious. Did you know, for example, that badly fitted dentures could cause wind? Or that smoking can, too?
There are two major ways in which we produce gas. Firstly, we swallow air when we eat. Some people swallow more than others and certain foods (for example, fizzy drinks) also contribute to this. Some people swallow air as a nervous reaction – called ‘aerophagy’ – and this can cause quite severe wind problems from both ends. Secondly, wind is a by-product of food digestion. Fats and proteins cause little gas, but carbohydrates (vegetables, beans, pulses, fruit, whole grains), sugars, dairy products and foods that contain sorbitol (often found in sugar-free items) all produce gas as they are digested. Lactose intolerance can also cause a lot of uncomfortable wind.

Some of the things you can do to reduce wind include:
a) Eat and drink more slowly, and don’t gulp your food. You’ll swallow less air this way.
b) Identify and cut out foods that seem to give you wind – onions, baked beans, whole grains and fructose are common culprits.
c) Avoid chewing gum and sucking hard sweets as they make you swallow more air.
d) Cut down on smoking, which also makes people swallow air.
e) If you’re a denture-wearer, have them checked to make sure they fit properly. Badly fitted dentures can cause many problems, and air-swallowing is one of them.
f) Try ‘anti-gas’ preparations that contain simethicone – e.g. Rennie Deflatine, Maalox and Mylanta II can help. Also, products containing activated charcoal can help reduce colon wind.
g) Celery seeds are a good herbal remedy for wind, so is fresh dill tea (simply brewed in boiling water and strained before drinking) and peppermint oil.
h) If all else fails…. it may sound like a joke but it isn’t – you can buy special airtight underwear (Under-Ease) from the US that contains a replaceable charcoal filter designed to remove the unsociable smells associated with troublesome and persistent wind. Visit www.under-tec.com for details.

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5) Is bleeding always serious?

Bleeding, although it may be alarming, doesn’t necessarily mean that there is a serious problem. It is actually a fairly common complaint, affecting over 15 per cent of us at some point or other in our lives.

Bleeding happens for many reasons. The delicate lining of our stomach and intestines is highly vascular – this means that millions of small blood vessels are extremely close to the surface in order for our blood to absorb the nutrients we need as food progresses through the gut. Anything that upsets this lining is likely to cause bleeding. Helicobacter pylori, the bacterium that is now known to cause the majority of stomach and duodenal ulcers, irritates the gut lining and makes it bleed. (Evan an excess of alcohol can irritate the delicate lining and cause tiny blood vessels to rupture, spilling blood into the digestive tract.) Simply treated problems like haemorrhoids are the most common cause of bleeding, although proctitis, polyps, anal fistulas, anal fissures and rectal prolapses can also cause it. The most serious causes of bleeding from the back passage include intussusception (in children), Diverticulitis, ulcerative colitis Crohn’s disease, bowel cancer and anal cancer.

A doctor must always check bleeding. However, it is usually caused by a minor problem, so don’t let any signs of bleeding send you into an uncontrolled panic.

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6) Are piles and haemorrhoids the same thing, and can you really get them from sitting on wet grass, cold steps or hot radiators?

‘Haemorrhoids’ is the medical term, and ‘piles’ is an everyday expression for the same thing. Piles form when veins in the soft tissue around the anus and inside the rectum become swollen. ‘External’ haemorrhoids form in the outer anal area, while ‘internal’ haemorrhoids are located inside the body, in the inner section of the anus and the rectum. Sometimes internal piles may protrude out of the anus; these are called ‘prolapsed’ or ‘prolapsing’ haemorrhoids. Piles never turn into cancer.

The old wives’ tale about getting piles by sitting on wet, cold or hot surfaces is false. This is good news if parking your backside on wet lawns or cold, concrete steps is your thing. So what can really cause piles?
a) Constipation. Straining to pass a hard stool can lead to excessive pressure on the blood vessels in the rectum, which predisposes them towards developing into piles
b) Pregnancy, where there is increasing and constant weight from a growing baby, can also cause piles to form.
c) Standing for extended periods of time, and being overweight are also contributory factors in the development of haemorrhoids.

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7) I’m worried I have bowel cancer as it runs in my family. What should I do?

Any disorder that carries a genetic element is always likely to pop up in successive generations of a family, and scientists know that certain genes may place some people at greater risk of developing colorectal cancers. They are also two rare hereditary disorders, Familial Adenomatous Polyposis (FAP) and Hereditary Non-Polyposis Colorectal Cancer (HNPCC). If these conditions run in your family, there is a high risk of developing bowel cancer, although together these two conditions account for less than 5 per cent of all large bowel cancers. And if one of your relatives does (or did) have FAP or HNPCC, the chances are that your family know about this, and are already being screened, and preventative measures taken.

Regardless, if bowel cancer has cropped up in your family before, you must always make sure your doctor knows. Firstly, they can double-check to confirm that you aren’t being affected by a rare condition like FAP. Secondly, they can make sure you’re being screened for bowel cancer – because bowel cancer is one of the most easily and successfully treated of all cancers, providing it’s caught early.

There are things you can do for yourself to lower your chances of developing bowel cancer, whether it runs in your family or not. Eat healthily, choosing a high-fibre diet with plenty of fruit and vegetables. Avoid a diet high in fat, especially saturated animal fats. Lose weight, and take regular exercise. Quit smoking and don’t drink too much alcohol.

Avoid using blue bleach blocks in your toilets, which can mask any sign of blood on the stools, and make sure you look in the loo whenever you pass a stool. Don’t be coy, and visit your doctor if you have any unexplained symptoms – whether bleeding, alternating constipation or diarrhoea, or an unexplained change in bowel habit that persists for more than 2 weeks, feelings of incomplete emptying of the bowel, unexplained anaemia, tiredness or loss of appetite.

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8) Is Crohn’s disease contagious?

Crohn’s disease is an inflammatory bowel disorder that is often grouped along with ulcerative colitis (UC). These two conditions are generally grouped together under the ‘inflammatory’ umbrella because they share similar symptoms. But scientists don’t yet know what causes either of these conditions, and it may well be that their causes turn out to be quite different. Neither Crohn’s disease nor UC are ‘contagious’ as such.

However, one theory believes Crohn’s disease to be caused by a cousin of the tuberculosis germ - a bacteria called Mycobacterium paratuberculosis, which infects sheep and cattle, and which causes Johne’s disease – an illness that leads to diarrhoea and other symptoms in these animals that are very similar to Crohn’s disease in humans. It is believed that the germ, which is very hardy, is shed onto farmland through the faeces of infected cattle, and may seep into the groundwater and possibly even milk supplies through faecal contamination.

There is no evidence, however, to support any belief that Crohn’s disease (or indeed UC) can be spread between people.

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9) Are there any precautions one can take to prevent ‘holiday tummy’?

One of the best ways to prevent catching a bout of traveller’s diarrhoea is to avoid foods and drinks that may be contaminated. Unfortunately, food that is contaminated by bacteria or parasites won’t necessarily look, smell or taste ‘bad’, so you have to carefully judge the situations and conditions that the food is served or presented under.

a) Never drink untreated water in areas where parasitic or bacterial infections are endemic – always avoid tap water and don’t even use it to brush your teeth.
b) Only drink bottled water that you have opened yourself, and avoid ice cubes, which may have been made using tap water.
c) Street sellers are occasionally unscrupulous, selling ‘pirated’ bottled water. Stick to known brands with intact seals.
d) Fizzy (canned or bottled) drinks are normally safe. Open them yourself.
e) Disinfectants like iodine and water purifying tablets are normally very effective, although not necessarily if the water looks cloudy. Iodine resin water purifiers filter and purify fresh water from all sources
f) Be scrupulous about washing your hands before eating and after going to the bathroom.
g) Don’t accept ‘street’ food or eat where the hygiene is suspect.
h) Avoid undercooked or raw meat, fish or shellfish
i) Avoid unpasteurised dairy foods
j) Avoid eating salads and always peel fruit or vegetables that are eaten raw.

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10) My child complains of ‘tummy ache’. What should I do?

Children can get ‘tummy ache’ for all sorts of reasons from eating too many candies to appendicitis, and because they are little, they often don’t explain themselves very clearly, either. One little girl used to tell her mother she had a ‘headache in my tummy’ when she was feeling sick, and my eldest daughter used to say ‘it stings’ when she meant ‘it aches’.

The fear of ignoring a serious problem is every parent’s nightmare, but most parents also dread the thought of going to the doctor unnecessarily, too. It’s a difficult dilemma.
‘Tummy aches’ can occur in children because of many things. Common colds often cause tummy aches, perhaps because of the increase in mucus that is swallowed by (especially) young children who are too young to know how to blow their noses properly. They can also be caused by threadworms, appendicitis, upsets caused by food intolerance or allergy, and a host of other problems.

Parents are always advised to take a child immediately to their doctor if:
a) An infant has diarrhoea and vomiting that lasts more than 4-6 hours
b) Your child has a high fever (temperature) – this can lead to convulsions if not brought under control
c) There is abdominal pain, especially if it accompanied by diarrhoea, constipation or vomiting
d) Your baby or child goes unusually quiet, floppy, lethargic, drowsy (unable to rouse) or ‘glassy-eyed’
e) You are worried that your child may be suffering from a serious illness (like meningitis) –urgent treatment can prevent potentially fatal complications setting in.

The good news is that mums (and dads) are normally equipped with a good gut instinct regarding their baby’s welfare. We’ve all heard stories about a parent’s insistence that something was really wrong with their child leading to the child’s life being saved. (for instance...)

Use your intuition. You know your child best and you know when their behaviour or demeanour is not right. If you are concerned, always take your child to your doctor. It is far better to be labelled a worrier than it is to see your child on life support, and any doctor would rather examine a child unnecessarily than know that a parent didn’t seek help soon enough.

"A splendidly detailed book... it will be a life saver for a great many people" Claire Rayner

"An invaluable book for anyone with a bowel or digestive problem" Prof. R. John Nicholls, FRCS

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