IBS AND THE NERVOUS SYSTEM: FEAR OF NOT MAKING THE LAVATORY IN TIMEYour diarrhoea may be so bad that you are afraid to go out of the house, or only if you plan a route where you have access to a lavatory several times on the way. You are on the treadmill of fear- diarrhoea, fear-diarrhoea. If you are constantly sending fearful messages to the bowel, the diarrhoea will continue. You could take a diarrhoea mixture to give you more confidence for special occasions but the essential treatment is to change the message to the bowel – this is the only permanent treatment. You are the only one who can heal your nervous system and don’t be surprised if there are ups and downs, nature does not heal in a straight line. Help with this is on page 120 but you could also try delaying the call to stool. When you have the urge to go to the lavatory practise hanging on: even if you can only manage two seconds, keep trying and you will gradually gain more control. Stand or sit on a chair outside the lavatory, breathe slowly, tighten your buttocks and start to count on your fingers squeezing each one hard. You could do something similar when you are out too; count how many steps you can go past the lavatory before you double back.Since there is a good clean out in the mornings or several stools per day the amount of faeces on these panic visits is small. Although people with this problem are rarely incontinent outdoors it might make you feel safer if you protected yourself against the possibility. You could line your underpants or knickers with plastic and then cover that with tissue, kitchen roll, cotton wool or sanitary towels. Boots sell baby pants that are just a piece of plastic without elastic, or you could cut a plastic carrier bag to the shape you want. You may throw up your hands in horror and say you would rather stay indoors, but think about it; who but you would know? After all it is a temporary state, but when your nerves are better your diarrhoea will be a thing of the past. Get your mind out of your bowel and stop giving it all those negative commands: ‘I’ll never make the loo,’ ‘I can’t go out because of the diarrhoea,’ and so on.Vicky had been housebound with fear of incontinence outside for two years, then one day the person who normally collected her children from school rang to say she was delayed and could not make it in time. Vicky was panic-stricken but knew she would have to go. The school was only two streets away and she delayed leaving the house until the last minute. As she rushed out of the gate she turned her ankle on  the  step.  It was not until she was back home that she realized that she had not given her diarrhoea a thought; her bowel had had a rest from worrying messages because her thoughts were concentrated on the pain of her ankle.While the nerves of the internal organs are not normally under the control of the will you can train yourself to have some degree of control, and change the functioning of any organ of your body.*62\326\8*

A. When making the appointment, the patient is given instructions, and it is essential these be carried out exactly. Usually, not eating food or drinking fluids for a certain number of hours before the examination is recommended. Unless this is strictly adhered to, it could ruin the pictures, and so negate the value of the test. Sticking to the recommendations is essential.

Q. How does the barium come into the picture?

A. When you arrive for the test you will be given a glass of fluid which has been flavoured to mask the otherwise rather unpleasant taste of the barium. It doesn’t taste too bad, although many still complain. Really it is a small price to pay for a correct diagnosis. The barium enters the stomach, duodenum and bowel, and coats the lining with particles which accurately show their outline during the x-ray examination. The doctor may also give you a tablet to take which gives a feeling of fullness, but this is also important to make the pictures much clearer. It should not be burped up.

Q. Is the examination painful?

A. Fortunately, it does not hurt, for you cannot feel the x-rays going through the body. You will be placed in numerous positions, usually lying on an examination table which isn’t too comfy. You may be tilted from a standing to lying position, and turned this way and that, on one side then the other, and asked to hold your breath whilst he pushes his buttons. The tummy might be pressed.

You may be given an injection to ease down stomach movements. This may make you see double for a short time, and is worth knowing about beforehand, for it is better to have somebody present to drive you home later in case there are temporary difficulties.

Q. Does it take very long?

A. The whole examination takes about 10 to 15 minutes. You are awake the whole time, and will probably be given verbal instructions to follow. Try and co-operate as much as possible for this helps the radiologist arrive at a correct diagnosis. In some offices you may be able to see what is going on, for television screens are now widely used, and you can actually see your own inside in glorious black-and-white (sorry, no colour yet) on the screen. The doctor usually takes a series of pictures which will demonstrate the ulcer in various positions. Also, if there is any other pathology present, such as a hiatus hernia, or growth — hopefully not, but one may be present in the stomach, often with few if any symptoms.

Q. How does the patient feel afterwards?

A. After the examination there are very few if any unpleasant effects. Occasionally the injection (if given) may cause blurring of the vision for a while, but this soon passes off. Constipation is common for a day or two due to the barium, and a laxative may be recommended. A mild one is best, or bran with breakfast for several days, or prunes, or raisins and figs can often do a better job than artificial medications. Today, there is a swing away from laxatives.

Q. Are these examinations safe for pregnant women?

A. Today, great care is taken to avoid x-rays as far as possible during pregnancy, for it is believed the rays may be harmful to the developing baby. So, this diagnostic test may be delayed until after the baby is born, unless it is urgent. In any case, with women in the reproductive age groups, the ‘Ten Day Rule’ is now widely applied.

This says that x-rays are carried out only in the ten day interval immediately following the start of a normal menstrual period.

During this time the woman is not likely to be pregnant, for ovulation has not occurred. After this interval of course, ovulation and possible pregnancy is a chance, and is a risk better avoided. This of course applies to women who are not taking active contraceptive measures. In any case, efforts to avoid exposure of the reproductive organs may be made.

Q. Are x-rays always accurate, and do they always diagnose ulcers or are they sometimes missed? I have heard all kinds of stories.

A. One must remember that x-rays are only shadows, and despite the skill of the radiologist and his experience, ulcers may be missed. It is claimed that these examinations will correctly pick up 70-80% of peptic ulcers. Some claim the figure is higher, some lower. If it is a definite ‘positive’, then the ulcer is certainly present. If it is ‘negative’, and symptoms are present, then an error is possible. The doctors always do their best, but some cases are very difficult, especially if the ulcer is small and very shallow.

Q. What happens after this examination?

A. The results are delivered back to your doctor, and in due course you contact him again, and he goes over the results in detail. If you have an ulcer, treatment will follow.

Q. What about the other form of investigation you mentioned?

A. Endoscopy today is very widely carried out, and some doctors prefer this to start with, eliminating the x-rays. On the other hand, some doctors prefer it as an adjunct and have both performed. In my opinion, as x-rays are known to have possible harmful effects in some people, and are inadvisable in pregnant women, the endoscope is often quicker, more accurate and a better form of investigation.

*10\61\2*