The gut is a complicated system that is susceptible to many uncomfortable conditions. Which lifestyle factors contribute to bowel problems and how can symptoms be controlled?

 

Many people experience constipation, diarrhoea, bloating or lower abdominal pain from time to time, yet these symptoms are often underestimated. According to digestive disorders charity Core, people with bowel disorders often suffer in silence. This may be partly down to feeling embarrassed, which stops them seeking the help they need.

But it can also be triggered by ignorance among the people around them, who have no idea of the pain and disability that digestive disorders can cause. Lifestyle choices are strongly associated with many bowelrelated symptoms. There’s evidence that stress, a lack of exercise and eating and drinking ‘unwisely’ over long periods of time may lead to bowel problems or make pre-existing ones worse.

“A healthy, balanced diet containing plenty of fruit and vegetables and some oily fish can generally be beneficial to the bowels,” says Professor Roger Jones, member of United European Gastroenterology (UEG)’s CRC Task Force. “Roughage (fibre) is also important in preventing constipation and diverticular disease [a condition that affects the large intestine]. Some people find that specific foods set off their bowel symptoms, but these foods vary from person to person.”

So which lifestyle factors can affect a person’s bowel symptoms? And which self help measures can they try before or alongside over-the-counter (OTC) remedies?

Constipation

A customer is likely to be constipated if they report a reduced frequency of bowel movements – typically less than three bowel movements in one week. Constipation affects people of all ages, but Professor Jones says it’s particularly common in older people, for various reasons.

“Their water intake may be the problem or they may have a poor diet, especially if they are eating preprepared foods,” he says. “Medication can also be a trigger. A lot of painkillers can lead to constipation, especially in older people, and some people are very sensitive to codeine, even in over-thecounter quantities. Antacids for upper gastrointestinal symptoms can cause constipation and some calcium antagonists and antidepressants can make constipation worse.”

In the UK, most people don’t eat enough fibre. So if pharmacy customers are constipated, they should be encouraged to increase their fibre intake before trying laxatives. Fibre makes stools bulkier and easier to pass. Good sources of fibre include pulses such as beans, chickpeas and lentils, as well as whole grain bread, rice and pasta, nuts and dried fruit.

Fluid intake is important too, as dehydration can make constipation worse. “Many people don’t get enough fluids,” says Dr Amanda Squire, dietitian and spokesperson for the British Dietetics Association. “Or if they do drink plenty, they focus more on fluids with a diuretic effect on the bowel, such as tea, coffee and cola. These tend to be high in caffeine too.”

Regular exercise or physical activity is an important part of constipation management. Exercise decreases the time it takes food to move through the large intestine, thereby limiting the amount of water absorbed from the faeces into the body. Hard, dry stools are more difficult to pass and can lead to straining and haemorrhoids. “Exercise keeps the bowel moving, which is why sedentary people are often constipated,” says Dr Nick Read, gastroenterologist, nutritionist, psychotherapist and chair of The IBS Network.

“Moderate exercise helps people work off stress and tension, which can otherwise cause sensitivity and irritability in the gut.” If lifestyle measures fail to work, bulk-forming laxatives are usually the next step. These work by helping the faeces to retain fluid, making them softer and less likely to dry out.

Wind and bloating

Flatulence and burping are often laughed about, but persistent wind and bloating can feel very uncomfortable. These symptoms are often associated with other bowel conditions, such as irritable bowel syndrome (IBS) and coeliac disease. When people swallow food, water or saliva, they also swallow small amounts of air, which collect in the digestive system.

Excessive flatulence may be caused by swallowing more air than usual or eating food that’s difficult to digest. “Rushing food and swallowing a lot of air can lead to burping and discomfort,” says Professor Jones. “Posture can be a problem with upper digestive system problems, such as reflux, but there’s no evidence that this affects the lower gut.” Taking regular exercise, drinking plenty of water and cutting out known trigger foods can often relieve the symptoms.

Culprit foods include fizzy drinks, sugar-free gum, beans, onions, broccoli, cabbage and cauliflower. If wind and bloating become a significant problem, customers can try over-the-counter remedies, including some dietary supplements, charcoal tablets and simeticone tablets. There is some evidence that peppermint tea may also help.

Irritable bowel syndrome

Irritable bowel syndrome (IBS) is thought to affect up to one in five people at some point in their life. The symptoms vary from person to person, but are usually worse after eating and tend to come and go. A change in diet may help to control mild IBS symptoms. “Everyone probably has IBS to some degree,” says Professor Jones.

“IBS is a complicated condition, or may even be a group of different conditions. Some people experience constipation, others have diarrhoea, while some develop mixed symptoms. There are patients who have functional IBS with normal investigations. There are also patients who develop IBS following a bowel infection; in these people, biopsies show inflammatory changes in their bowel. Patients have very different experiences of stimuli. Their symptoms may be made worse by stress or individual foods. In fact, food sensitivity is a common feature.”

IBS management depends on the symptoms experienced. First-line OTC products include anti-spasmodics for abdominal pain, bulk-forming laxatives for constipation and anti-motility medicines for diarrhoea. Prescribed low-dose antidepressants can help to reduce more severe abdominal pain and cramping.

If customers have IBS-like symptoms but haven’t yet been diagnosed, it’s important that they see a GP. A study published in the December 2014 issue of the UEG Journal revealed that 10 per cent of people with inflammatory bowel disease (IBD) are misdiagnosed with IBS and in three per cent of cases, the misdiagnosis can persist for five or more years. Stress or anxiety may aggravate IBS in some people. For this reason, relaxation techniques, gentle activities such as yoga or Pilates and talking therapies may help to control the symptoms.

“Stress is important with not just IBS, but inflammatory bowel disease too,” says Dr Read. “IBS is often triggered by a traumatic event, such as a car accident, relationship problems or bereavement. Even if people feel resilient and carry on, any underlying stress has to come out somehow – usually in the gut. It’s important to take regular breaks, eat with friends and have time by yourself each day to reduce a flare up. Some people benefit from hypnotherapy, psychotherapy, behavioural therapy, mindfulness and some complementary therapies.”

Research has shown that the bacteria living naturally in the gut play an important role in human health and disease. Everyone’s bacteria are unique to him or her, and small changes in this finely balanced community can influence susceptibility to illnesses such as IBS, cancer, heart disease and obesity. Probiotics – ‘friendly bacteria’ – and prebiotics (food for these bacteria) are supposed to restore the natural gut flora balance.

“The microbiome is an interesting area,” says Dr Read. “From a scientific point of view, the gut can influence whether people are, for example, overweight or develop diabetes. The microbiome can be depleted in people with IBS. But the evidence on whether this can be put right with probiotics is still not that good.”

 

Coeliac disease

Coeliac disease is one of the few bowel disorders that is associated with food choices. In this serious autoimmune disease, the body’s immune system damages the lining of the small bowel when affected people eat gluten, a protein found in wheat, barley and rye. The only treatment is a strict gluten-free diet for life.

Left untreated, coeliac disease can lead to a number of complications, including osteoporosis and, in rare cases, even small bowel cancer. One in 100 people in the UK are known to have coeliac disease, with the prevalence rising to one in 10 for close family members. However, statistics show that only 24 per cent of those with the condition are diagnosed.

To help fast-track diagnosis, Coeliac UK recently launched its online assessment tool on a dedicated website. The charity’s two-year ‘Is it coeliac disease?’ campaign will highlight the most common symptoms of coeliac disease and prompt people experiencing these symptoms to seek help. “Doctors are failing to diagnose many cases of coeliac disease,” says Professor Jones.

“This is often because they don’t think of the condition when a patient comes into the surgery with common troublesome symptoms, such as diarrhoea, abdominal discomfort and weight loss. A doctor will rule out potentially serious conditions such as inflammatory bowel disease or cancer and then send the patient away. Sometimes a doctor will do a blood test for coeliac disease, but if patients are not absorbing proteins well, the blood test may show up as negative. It’s therefore important that patients are referred for all coeliac disease tests if there is any chance that this could be the diagnosis.”

Bowel cancer

Most bowel symptoms settle down with a few lifestyle changes and suitable OTC products. A persistent or severe change in bowel habits or symptoms should be taken seriously, as this may indicate a serious condition such as inflammatory bowel disease or bowel cancer. “Many people in the UK have a stiff upper lip when it comes to their bowel health,” says Professor Jones.

“Even when they have alarm symptoms, they may not go to the doctor. Younger people are at risk of bowel cancer as well as older people, so it’s important to take bowel symptoms seriously whatever their age.” Lifestyle choices such as drinking less alcohol, eating a high fibre diet, being a non-smoker, keeping to a healthy weight and being active can all help prevent bowel cancer from developing. Every year, over 41,500 people are diagnosed with bowel cancer and around 16,000 people die of the disease.

Early diagnosis is vital. If diagnosed at the earliest stage, bowel cancer can be treated successfully, with nine out of 10 people surviving for more than five years. Pharmacies play an important role in raising the awareness of bowel cancer. According to Nick Bason, head of policy and communications for Bowel Cancer UK, pharmacy staff are often the first point of contact for customers in the pharmacy.

Red flag symptoms for bowel cancer include bleeding from the bottom and/or blood in the faeces, a change in normal bowel habits lasting three weeks or more, extreme tiredness for no obvious reason, unexplained weight loss and/or a pain or lump in the abdomen. “Our advice is that if anyone is experiencing one or several of these symptoms, they should visit their GP,” says Nick. “Above all, bleeding from the bottom or blood mixed in with poo is not normal and the customer should be encouraged to go and see their GP.”

Many people in the UK have a stiff upper lip when it comes to their bowel health