Life Doctor

"DID A rectal washout ... a Mr Slack said that no bowel movements should be strained and that I should have bran every day." Kenneth Williams described his bowel movements daily in his diary. He was extreme, but we are all concerned with malfunctioning motions. It's a guaranteed winner topic at parties.

"DID A rectal washout ... a Mr Slack said that no bowel movements should be strained and that I should have bran every day." Kenneth Williams described his bowel movements daily in his diary. He was extreme, but we are all concerned with malfunctioning motions. It's a guaranteed winner topic at parties.

Bowel fans will be pleased that there is new consensus on Irritable Bowel Syndrome (IBS). An international team of gut experts last month created the "Rome Criteria", which defined the problem as "abdominal pain associated with a change in bowel habits". Six attacks a year and you are a sufferer: fewer and you are just a whinger.

Thirteen to 15 per cent of the population suffers from IBS. The incidence of the disease is not increasing but we are complaining more. At the Royal Society of Medicine's Diet, Gut Function & Health conference last week, IBS was high on the agenda.

Gastro-enterologist Dr Ken Heaton, retired honorary senior research fellow at the University of Bristol, gave a paper that said (among other things) that contrary to popular thinking, some cases of IBS could be caused by too much fibre.

Poor old fibre. Fifteen years ago it was huge, blamed for coronary heart disease, diabetes, obesity and more. But of all the allegations, only bowel cancer remains linked to not getting enough All Bran.

Gail, 32, found her stomach problems cleared up when she stopped eating healthily. "I used to have constipation for a week, then a week of diarrhoea. My doctor advised me to eat more fibre. I was eating muesli, grapes, nuts and greens by the ton. And it was getting worse. Only when I went to be investigated at the hospital did anyone suggest that I might be eating too much fibre. I started filling up on bulky, fatty stuff instead, meat, cheese, creamy pasta - all the foods I thought would constipate me and in a few weeks I was loads better."

I know how she feels. At one stage during the fibre mania I worried that I shouldn't be eating white-shelled eggs. But now it seems we don't have to choose wholemeal pasta and brown rice after all - Dr Heaton says that all "rice and pasta have a structure that stays in a lumpy form", so white's all right. Bread, however, is still better brown.

Changes in bowel behaviour are normal, and the reasons are numerous - emotion, for example, definitely comes into it (as anyone who has failed to revise for an exam will know). "Fibre is not the most important determinant of bowel behaviour," says Dr Heaton. "A study I did found that fibre intake was a very weak determinant of transit time."

Dr Heaton is a world expert in this area but he is modest about his success. "It was easy pickings - it's an extraordinarily under-researched area. Processing stools in a laboratory does not appeal to everyone." He has produced a seven-point "Stool Form Scale" (available in seven languages) which ranges from "1, separate hard lumps, painful" to "7, watery, no solid pieces" with number 4 as the optimum. Basically if you are producing "1s" you need more fibre, if "7s" you need a Immodium.

Dealing with IBS

1. Slow down your lifestyle.

2. Adopt a philosophical approach to the world and the problem.

3. Get up at a regular time and give your bowels time to work before leaving the house.

4. Take regular exercise.

5. If your are a type 7 (as shown above), try bulking agents like ispaghula husk.

6. If you are a type 1 (as shown above), eat more fibre, fresh fruit and vegetables.