The new British disease

EVERY nationality has its bodily obsession. When Italians feel under the weather they moan about their fegato ingrossato ("bloated liver"). Germans worry when their blood pressure hovers below the normal mark, while the Chinese are obsessed with balancing "heat" and "damp". Americans meanwhile keep a watchful eye on their immune system. But the British are fascinated by their bowels, and never more so than now. Health sections in bookshops are groaning under the weight of advice on how to achieve a healthy gut, more and more research is being done on bowel diseases and drug companies are rushing to produce over-the-counter treatments for Irritable Bowel Syndrome.

New syndromes are coined daily, each with its own neat set of inititals. Irritable Bowel Syndrome (IBS) itself can be sub-divided into spastic colon, functional diarrhoea and something called foregut motility disorder, which affects the upper gut. Then there is recurrent abdominal pain (RAP) and performance anxiety diarrhoea (PAD) - basically stage fright.

IBS is very common. Some studies suggest one in five people will suffer from some sort of digestive disturbance which could be diagnosed as IBS; others put the figure as high as one in three. At least seven million Britons regularly have IBS symptoms - a cacophony of alternating diarrhoea, flatulence, bloating, constipation and wind - and it is twice as common in women as in men.

Dr Glyn Hudson, a counselling psychologist who works in a general practice in Bristol, says that nine times out of 10, IBS is caused by stress. It is literally a gut reaction to the Nineties. "The increase in stress since the recession has been tremendous and, as a consequence, there has been a massive increase in IBS - particularly among teachers, people working in banking and insurance and manual workers. It's like a 20th-century plague."

For the British, a smooth-working bowel has always been synonymous with good health. Generations of boys forged in the smithies of public schools learned that a thundering performance on the field and in the lavatory was the secret of a happy life. Regularity has become entwined with contentment and thousands become depressed when they don't "perform" at least once a day. Yet a "normal" bowel movement can be anything from three times a week to three times a day. In an effort to attain the once-a-day goal, one in five Britons takes laxatives, and we consume 20 million laxatives a year. A survey carried out by the Eating Disorders Association revealed that nearly three-quarters of its members were abusing laxatives. Many cases of IBS are brought on by laxative abuse.

Some gastroenterologists are beginning to realise that IBS and other bowel ailments for which there is no organic cause are largely psychosomatic. Dr Ken Heaton, a gastroenterologist at Bristol Royal Infirmary and a leading researcher in the field, maintains that diet is a factor in only one-third of IBS cases. "There are always psychological problems. A lot of people find it difficult to express their emotions in normal ways, and tend to express those emotions through their guts," says Dr Heaton. "These are the most difficult people to help because they don't recognise they have any emotional problems and are very cross if you suggest there might be an emotional factor. The fact is that everyone has emotions and some people express them in one way and some in another. I'm sure some people do it through their intestines."

In other words, the famed British stiff upper lip may be at the heart of the problem. One recent study confirmed what many introverts suspected - that the more extrovert you are and the better your self-image, the greater the stool weight. Patients with IBS are perceived by the medical profession as tense, unhappy people, more anxious and depressed than their fellow human beings. Numerous studies have backed this up. Four out of 10 people who go to hospital with IBS symptoms also have symptoms of anxiety and depression. Their neurosis isn't helped by a largely indifferent medical profession. In a questionnaire sent out by a self-help group, the IBS Network, to 148 of its members, over one-quarter felt that their GP did not understand their IBS problems and was not sympathetic to them. Many sufferers felt their complaints were not taken seriously.

The attitude of doctors is easy to understand. They can help organic bowel disease, such as cancer, but with IBS they are at a loss. Dr Kenneth B. Klein, former Professor of Medicine at the Univer-sity of North Carolina School of Medicine and currently a Wellcome Research Fellow in Britain, carried out a comprehensive study seven years ago of all the treatments used in IBS. He came to the conclusion that there was no evidence that any of the drugs worked at all.

"Biologically, IBS is uninteresting because it's nebulous," concurs David Windgate, professor of gastrointestinal science at the London Hospital Medical College. "There are no interesting tests, no distinct blood results. It's about talking to people, and if you are not interested in talking to people you are not interested in treating people with IBS. But all patients want is to be listened to - even if there is no cure."

Reminiscences of childhood potty training can be frightening. An acquaintance remembers being smacked when he didn't perform; another recalls her grandmother pressing soap in and around her anus during a bout of constipation. As a toddler she lined up her dolls on potties and berated them for not going to the lavatory. It is hardly surprising that bowels loom large in adult life when things go wrong. Professor Nick Read, a gastroenterologist at the Northern General Hospital, Sheffield, who for three years has worked in a psychotherapeutic manner with patients with gut disorders, maintains that many bowel problems originate in childhood. Prof Read practises "bowel- directed psychotherapy" and says that his success rate is nearly 100 per cent. "The gut is singled out for these sort of conditions, more so than other parts of the body," he says.

"If we think back to babyhood the infant reacts to conflict and makes his or her presence known on the world through eating, behaviour or defecation. In some of the people with severe IBS there is something seriously wrong at a very early stage, so they are expressing quite primitive feelings throughout the gut." Our fascination with our bowels and our quest for a clean, well-behaved gut has lead to the rise of detox diets, colonic irrigation, pills and powders to "restore" the gut flora, complementary therapists who specialise in bowel disorder and diets that supposedly "flush away" toxins.

Michael Johnson, 37, has had IBS for seven years and says he has what he calls "constarrhoea" - alternating constipation and diarrhoea. He has spent thousands of pounds on alternative therapies, but with little success. "I've tried acupuncture, which I found very restful; herbalism, which did no good at all; and massage, which did help, but I couldn't afford pounds 30 a week. I had some luck with homeopathy, and for a week it was normal. The joy was indescribable. It was a crushing disappointment when the good effects weren't sustained. You get sceptical about trying the next thing."

Despite the time and effort we spend on our bowels, the muesli and slices of bread thick enough to lag a loft with, our daily stool output is a mere 120 grammes per person per day, compared with the 400 grammes produced by Ugandan villagers. Doubtless, they don't agonise about bowel movements; they just get on with the job.

8 The Troubled Gut by Barbara Rowlands is published by Hodder Headline at pounds 6.99