Spastic Colon

Patients with spastic colon experience pain, often acute and piercing, in the lower abdomen slightly above the genitalia. This can pass quickly, the onset of pain being associated with the passage of looser than normal stools, abdominal distension (bloating), an unsatisfactory bowel habit (defaecating then immediately feeling the need to go again) and mucus in the stool. Sometimes, as described earlier, there is a frequency of bowel action while at other times patients are constipated. Spastic colon is a debilitating and often chronic condition.

Main Symptoms:

Visible abdominal distention (bloating)
Pain relieved by bowel action
More frequent stools with onset of pain
Rectal passing of mucus
Sensation of incomplete evacuation

In our experience, pain in this, the commonest variant of IBS, is likely to be due to abnormalities of contractility or motility of the colon and smooth muscle relaxants or antispasmodics are often effective.

Examples are:

Mebeverine hydrochloride (eg Colofac)
Merbentyl
Peppermint oil eg Equilon herbal,Colpermin.

Each of these drugs has a different mode of action so it follows that one preparation may be more effective for one individual patient at any one time. Experience indicates that treatment should be taken regularly for defined periods. Some will require treatment for longer periods than others. In the diarrhoea predominant Spastic Colon Syndrome variant, bowel frequency can be reduced by prescribing loperamide (e.g. Imodium) usually at quite low doses, but again on a regular basis. In the constipation predominant form, Movicol, an osmotic cathartic agent can be prescribed initially but the mainstay of management is dietary in which the patient is advised to ingest adequate amounts of fibre in the diet, balanced correctly between soluble and insoluble forms and combined with an adequate fluid intake. At our clinic, we prefer Movicol to other laxatives as it does not promote bowel evacuation by abnormally stimulating muscle contraction (stimulatory laxatives e.g. senna). Movicol works by drawing increased amounts of fluid into the colon from the small or middle intestine, softening the stool and stimulating normal motility. Unlike lactulose it is not broken down to gas after completing its action and therefore does not cause bloating, discomfort and flatulence. In addition to patients with constipation predominant IBS improving their intakes of dietary fibre, all patients with the Spastic Colon Syndrome variant of IBS should be advised to eat regularly and not to eat large rich meals -by 'rich' we mean fatty since fat is the component of food that causes the release from the gut lining of a chemical messenger or hormone called cholecystokinin (CCK). CCK promotes contraction of the muscles of the colon and will make symptoms considerably worse.

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Main Variants Of IBS - Spastic Colon