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posted by Alan Fraser - 14/09/2016 4:06:28 a.m.

B12 injections for fatigue is an interesting question. Firstly tiredness is the most commonly reported "non-bowel" symptom wiht irritable bowel syndrome. >90% report this symptom in surveys. The earn for this clear association is not known. This no easy answer to managing this symptom. The use of vitamins or B12 injections is a common approach but not supported by any evidence. Monthly injections is way more than the body requires even if there was a problem with B12 absorption. However there is also no harm and many people do report an improvement.

posted by Alan Fraser - 14/09/2016 4:01:53 a.m.

Pernicious anaemia is the result of longterm inflammation of the stomach which is caused by an auto-iuume process - that is the body forms antibodies against parts of the lining of the stomach. This process cannot be reversed - or least at present there is no safe, proven option. This means that there is a gradual thinning of the mucosa of the stomach - this leads to loss of ability to make stomach acid and loss of production of intrinsic factor - which is critical for absorption of B12. Therefore once diagnosed B12 replacement is lifelong. Oral B12 will be inadequate for most people and the most reliable way to maintain B12 in the body is by injection - an injection every 3 months is sufficient. The loss of stomach acid has minimal detrimental effect. The absorption of nutrients is just as good i.e despite common beliefs - acid is not essential for digestion

posted by Marita - 12/07/2016 12:00:49 p.m.

I have had IBS for many years (over 30) and although for many of those years I had severe diarrhea and cramps, I have now become very constipated and have cramps. I feel fatigued every day....is this part of IBS symptoms? I used to have vitamin B12 injections each year which helped greatly, but since moving to New Zealand the GP wont prescribe them? I now take Mg Lax capsules for constipation and they help somewhat. Is it okay to take them daily? Thank you for great website.

posted by Jane - 6/07/2016 3:42:32 p.m.

I have been diagnosed with pernicious anaemia. Am I correct that this is a result of end stage autoimmune gastritis? I have b12 injections once a month but would like to know a) Is there any scientific literature about healing AG? b) Would there be any benefit to having a scope to check the condition of my stomach? Thanks in advance.

posted by TE - 10/12/2015 12:28:32 p.m.

I have severe IBS and when I had a hydrogen breath test they said that it indicated 'borderline' bacterial overgrowth. I also have increasingly severe GORD symptoms which may warrant a PPI. Is suppressing acid with a PPI likely to exacerbate the bacterial overgrowth situation? The GORD is getting to the point where it doesn't look like I'll have much choice, but the last thing I want to do is make the my other symptoms worse.

posted by Alan Fraser - 19/06/2015 1:50:09 p.m.

Blood test for IBS. These are antibody tests showing a response to fragments of bacteria. The accuracy doesn't appear to be good enough to replace current testing and are unlikely to be widely available. Younger people can have the diagnosis made by symptoms alone and some simple blood tests (and if necessary a faecal calprotectin to check for inflammation). If older than 45 years it is much better to have a colonoscopy to exclude other disease. There are some advantages of having a colonoscopy at any age when considering IBS. The more confident the diagnosis the better the reassurance and consequently less anxiety leads to less symptoms. The bowel preparation also tends to improve symptoms for several months - perhaps by reducing bacterial load

posted by Alan Fraser - 19/06/2015 10:38:05 a.m.

Lump in the throat sensation. This is a difficult symptom to understand as all investigations are usually normal. Some investigators have considered that there is an association with acid reflux but most evidence suggests that there is no association. Often the onset is after a stressful life event and the symptoms last for several months then resolve without any treatment. So the situation may be frustrating but this is not a serious symptom.

posted by Alan Fraser - 19/06/2015 9:51:09 a.m.

Constipation after an operation is common. The process of unblocking can be frustrating. Once things are moving then Lax-sachets one daily will work well. However there will be a delay of 3-4 days if you are very blocked up. Suggest continuing with two Lax-sachets daily and be patient!! OR ask chemist for Picolax sachets - take one - wait 12 hours - if no effect take another sachet

posted by Linda - 7/06/2015 8:38:39 a.m.

I have just come out of hospital after my first ever bout of constipation. I am vegetarian and have always eaten a high fibre diet and have been 'regular' at once a day every morning. Suddenly I only went a tiny amount over several days & over counter remedies did not work. I had a huge lump lower right abdomen, extreme pain. No food and enemas cleared me out but have to wait for colonoscopy. Hospital team no ideas of cause. Taking lax sachets, lots of water and fibre. Very bloated and still only a bowel motion pencil thin. Lump is back. Increasing to 2 sachets. Trying not to panic. Suggestions?

posted by MJ - 5/06/2015 11:03:05 a.m.

Hello. Your link to 'lump in the throat sensation' goes to your page on heartburn. I searched lump and found nothing. I have disphagia, achalasia and a distinct lump in the throat sensation. I have had a tyroid ultrasound, mamometry, barium swallow studies and ph studies. My GP has said that the ultra sound and x-ray were clear so there is nothing else to be done. But this still worries me because I am an x smoker of 40 pack years with COPD.

posted by Max Barwell - 22/05/2015 10:02:27 a.m.

Hi Alan, have you heard about the new blood tests for IBS, do you expect this would become available in NZ. http://health.usnews.com/health-news/health-wellness/articles/2015/05/21/new-blood-tests-diagnose-irritable-bowel-syndrome Thanks, Max.

posted by Alan Fraser - 1/05/2015 12:07:20 p.m.

Further comment re B12 injections. I note your concern is actually about the cobalt in the B12 injection. B12 has to have cobalt - it is part of the vitamin. Allergic reactions to B12 do occur - uncommon - the allergen is not always clear - unlikely to be the cobalt. In NZ there is only one type of preparation. Oral B12, even at high doses. will not work. Of course oral B12 also contains cobalt.

posted by Alan Fraser - 1/05/2015 11:55:05 a.m.

To Dawn. The combination of low B12, gastritis and positve parietal cell antibodies if enough to confirm the diagnosis of pernicious anaemia. YOu do not need to have the Schilling test you describe (that involves isotopes of cobalt). You simply now need to accept that you have to continue with 3 monthly injections of B12 - as there will be no (or minimal) absorption of oral B12

posted by Alan Fraser - 1/05/2015 11:52:26 a.m.

To SK. A normal colonoscopy is reassuring. A gastroscopy - view of the stomach - is also helpful to check for coeliac disease and take biopsies to check for lactose intolerance and also exclude gastritis and reflux. At 22 years it is far more likely to have IBS rather than any disease. There is an association between IBS and CFS. A clinic review will be helpful to see if any further investigations are warranted.

posted by Dawn S. - 24/04/2015 7:25:53 a.m.

Hello, I have auto immune atrophic gastritis and tested positive for anti parietal cells. I am very allergic to cobalt and unsure whether to continue with B12 injections because of this. I am aware that there might be no other alternative but I am worried about being injected with an allergen. Looking for an answer as to whether or not I should continue with this treatment. I had some sort of reaction to the three injections I did have but as I had high blood sugars as well can't be sure the reaction is just to the B12. Help please!

posted by SK - 4/03/2015 9:32:18 p.m.

Hi there, I'm 22 and have been dealing with bowel/stomach problems for years now and was diagonsed with IBS and CFS. I had a colonoscopy 2 years ago and it came back okay and it has became very severe since then. What are some other tests i can do to rule out other illness's? because i feel its so much more and i have been struggling severely with bowel and stomach problems, fatigue etc. Do you see patients or do we have to get referred?

posted by Alan Fraser - 13/02/2015 6:49:14 p.m.

Crohn's disease affecting the anal area is a difficult problem. Infliximab has been a great advance for this problem and sometimes it can take up to 2 years to get a good result. Often there needs to be a combined approach with surgery - mainly to clear any pockets of infection and keep up fistula tracts for long enough to allow drainage of infected material. Antibiotics - often used for several weeks - is also helpful

posted by Urvashi - 22/10/2014 7:52:03 p.m.

I have been diagnosed with Crohns. I am on infliximab for the last 2 years. MRI shows anal fissures. I have swelling, extreme itching and sometimes clots around anal region. Botox done twice. But still I am with the same problems. Its hard to sleep at night due to itching. Please suggest what should I do.

posted by Alan Fraser - 3/09/2014 8:51:17 a.m.

Dear Elmein. Certainly a difficult problem. A rectal pacemaker may be an excellent option for you. This is specialized area and you will need advice from a Colorectal Unit in a large centre.

posted by Alan Fraser - 3/09/2014 8:46:52 a.m.

Dear Confused. Your question is very important and thoughtful. There has been a lot of publicity about the FODMAP diet for IBS and this has been very helpful for a lot of people. However the best results are seen where there is mainly diarrhoea with prominent bloating and wind. If constipation and pain are the main problems (maybe occasional diarrhoea) then the diet is less helpful. So sort of gentle approach to constipation is required that does not aggravate bloating, pain or lead to troublesome diarrhoea. There are several options - often trial and error to find something suitable

posted by Elmien Botha - 4/05/2014 9:39:22 p.m.

Good day, I recently saw a TV program about Gastric disaster operations; I then heard about a rectal pacemaker. I was born 42 year ago with cloaca anomalies. All my life, I had to take care about what I eat, since things as fruit-, milk and other acids as well as certain spices and starch could upset my stomach and I had NO BOWEL CONTROL and wear sanitary pads 24 hours a day. Throughout my life I used to live for long weekends as I can then eat lots of fruit to clean out my stomach, but the other days is always stressful and I lost my marriage because of the embarrassments I caused. I do have health-insurance with Southern Cross and do dream that I can have a normal life with the use of a rectal pacemaker, if possible…and maybe be able to have a relationship without the fear of an accident. I do hope to hear back from you if you are able to give me any news or advice? Kind regards Elmien

posted by Rick Fraser - 27/04/2014 10:06:18 p.m.

Hi again Dr Fraser, I am now on 25mg of mercaptopurine with 100mg of allopurinol. prior to a colonoscopy 3 weeks ago things were under control with 50mg of mercaptopurine only, but blood results showed underdosed. Things have not settled after the procedure which included 40 biopsies. Can a colonoscopy upset the ulcerative colitis? And, whats wrong with being 'underdosed' if symptoms are fine? My platelets came back to normal also on this 50mg 'underdose'. Now, I feel a bit seedy on this new combination. Thanks again, Rick.

posted by Confused - 15/04/2014 3:27:42 p.m.

Hi Alan. I started to experience constipation about 6 months ago & it has been getting progressively worse since then. I'm on the waiting list for a colonoscopy - my Dr thinks I might have IBS-constipation predominant but I don't have an official diagnosis yet. I am confused about the low FODMAPs diet for IBS. All constipation remedies seem to promote fiber + fluid to get things moving along but the low FODMAPs diet seems to promote the opposite. It seems like they're in contradiction with each other. Is the low FODMAPs diet mainly for people with IBS-diarrhea sub type or is it also useful for those with constipation? Are there any other 'natural' remedies that you can suggest for IBS-C? I've tried Movicol and MgLax but they just seem to make me retain water without being very effective in moving things along. I don't really want to rely on laxatives either. Thanks!

posted by Alan Fraser - 28/01/2014 12:33:19 p.m.

Slow transit constipation or constipation that has persisted since childhood can be a great challenge. The combination of Movicol (or now also as Lax-Sachets - an equivalent substitute) and MgLax has been really helpful for most people. Definitely a plus to be off stimulant laxatives if possible. Where this doesn't work it is important to completely clear the bowel with a colonoscopy washout solution such as Moviprep (2 litres taken over 1-2 days) then start again with maintenance Movicol and MgLax.

posted by frustrated - 30/12/2013 5:09:03 p.m.

Hi Dr Alan, I have been experiencing constipation for the past 3 years or so and have finally been diagnosed with a slow transit of colon. My Dr put me on movicol and mg lax (as suggested by your page) and this worked for a while (a couple of months) but is no longer effective. I am hesitant to use stimulant laxatives as I know that this can cause a dependence and will only make the problem worse long term. Is there anything else that you can suggest that I do?

posted by Alan Fraser - 23/12/2013 10:32:10 a.m.

To Rick and comments re treatment of ulcerative colitis. Difficult situation but still some good options available. It seems likely that azathiopine is causing side-effects - 6-mercaptopurine may be tolerated better and methotrexate is another option. Putting up with symptoms may be acceptable for a short while but soon the low quality of life will become intolerable. There is a greater risk of a serious relapse leading to hospital admission. Herbal treatment generally disappointing Boswellia has some possible benefits but has not been well studied - unlikely to - bring you into remission. Entocort is not usually effective in the long-term and not approved for ulcerative colitis treatment in NZ. Systemic effect only 10% that of Prednisone but could have a negative effect on bones if used at high dose for long periods of time.

posted by Alan Fraser - 23/12/2013 10:24:21 a.m.

To "Recovering" - a difficult problem - the combination of MgLax and Movicol is usually enough. At this point I usually recommend a colonoscopy - sometimes the complete bowel clear-out is effective and then maintenance osmotic laxatives will work. Colonic transit study can define the severity of the problem

posted by Alan Fraser - 23/12/2013 10:21:26 a.m.

Lots of good comments - hard to keep up!! Microscopic colitis is not as common as ulcerative colitis but is certainly being diagnosed more commonly now with more colonoscopies with biopsies taken when required. There is no association with irritable bowel syndrome but it is common to fix the inflammatory part with treatment like Entocort leaving the pre-existing IBS (irritable bowel) part. The main approach will be dietary exclusions as per the "Diet and IBS" section

posted by Ksren - 27/11/2013 10:49:30 a.m.

Indeed. My gastro told me that microscopic colitis is as common as other forms of IBD - ulcerative colitis, Crohn's etc but until recently much underdiagnosed. I have been fortunate in my response to budesonide and am currently in remission....but left with IBS problems (definitely very different to colitis symptons) which I am finding much more difficult to settle. Do you know if onset of IBS (I suppose not surprising) is common with microscopic colitis? And if it's likely to settle? I never had any bowel problems at all until the last year - and to think I never realised how lucky I was

posted by Linda - 26/11/2013 10:33:14 p.m.

YOUR INFORMATIVE NEW ZEALAND WEB SITE IS MUCH APPRECIATED. THANK YOU DR FRASER.

posted by Recovering - 23/11/2013 4:38:50 p.m.

Hi Alan, what a great website! Mr Dr put me on to it and I have found it very useful. I do have a question for you though: I am 27 and have been in recovery for anorexia for 7 months now. I abused stimulant laxatives for a little while (about 12 months) but haven't touched them since starting recovery. I have found that I now suffer from constipation and bloating (which is only the result of the constipation). I have tried increasing fiber and fluid in my diet but this has had minimal effect and has made the bloating worse. I also tried using a combination of Mg Lax and Movicol which worked for a while but is now no longer effective. Is there anything else I can use to help alleviate these issues? I have stopped taking the osmotic laxatives and now every time I return to them they just make me retain water without helping me to pass anything. I am finding it very hard to continue with my recovery because of these problems. Your advice would me much appreciated

posted by Shrivathsa - 22/11/2013 3:47:34 a.m.

Dear Sir, We are final year engineering students from NIE,mysore,India. As a part of final year curriculum we are implementing a project in image enhancement area. In this regard we are using wireless endoscopy images which can be enhanced for a better view and diagnosis. As these images are hard to get here we were hoping that you can help us out in procuring these images. You can verify this request from our project guide Dr. Rohini Nagapadma whose contact details are included below. Please help us in this regard,. And We assure you that we don't misuse the images in any manner. Regards, Shrivathsa Udupa Project Guide: Dr Rohini Nagapadma,

posted by Rick Fraser - 2/11/2013 11:57:35 p.m.

Hi Dr Fraser, I have been on Azathioprine for Ulcerative Colitis for 2 months now (100 mg )No side effects until the last 7 days where I feel extremely sick and lie around all night and have no dinner. It seems to get worse each night, and had a night off taking it and felt fine. I may abandon it and try some natural therapies like Boswellia. Can't take prednisone because of bone density. Tend to battle on with symptoms, can go 6 times a day and carry on with life, including tramping, however specialist not impressed when I put up with symptoms and not seek help. Asacol does not stop flare up for me but may help prevent it coming back if under control. Never tried Entocort, does that effect the bones? Thanks.

posted by Diana Wattie - 3/10/2013 1:46:58 p.m.

I have had a malignant polyp removed and at a recent colonoscopy, performed by you, I have more polyps one a tubular adenoma. I have a family history of colon cancer. I have 2 Children in their early to mid 40's, at what age should they be checked?

posted by Alan Fraser - 20/07/2013 7:01:30 a.m.

Diarrhoea is common with coeliac disease but is not required for the diagnosis. The severe problem with constipation that you describe cannot be explained by coeliac disease.

posted by Alan Fraser - 20/07/2013 6:59:38 a.m.

Microscopic colitis is supposed to be uncommon but not on this comments page!! There is no consensus on diet except that some people do respond to a gluten-free diet. Entocort works very well but sometimes does need to be continued for longer than 2-3 months - usually 1-2 caps per day works as maintenance and the risk of steroid side-effects is low (particularly at one capsule per day)

posted by Mackenzie - 20/05/2013 7:58:23 p.m.

I was diagnosed with coeliac disease in November 2009 by a blood test - I suffered constipation rather than diarrhoea. In September 2009 my bowel completely shut down, landing me in the ICU on a ventilator. In August 2010 I was hospitalised with constipated with constipation and low blood sugar. I hadn't eaten for many days due to the abdominal pain. The constipation is continuing and getting worse despite taking Movicol. Should I be concerned that I have another disorder?

posted by Karen2 - 16/05/2013 10:06:28 a.m.

Hi. I am another 55 year old woman just diagnosed with collagenous colitis and also on a tapered course of Entocort for 2 months. I had a great response to Entocort for diarrhoea within about 10 days, and graduslly started introducing additional foods back into my diet. For the last 2 weeks, although the bowel motions have been fine, I have suffered from terrible bloating and explosive wind in the evenings (sometimes a bit messy) - but only on week days! Do you know what this might be in your experience? My gastroenterologist was surprised and suggested that I should have kept to the low residue diet longer but that maybe I am eating too much wheat and could try cutting back on that - I am already finding it really hard to maintain my weight and if bread and pasta have to go I am not sure whatvI will do! Do you have any experiences of anything similar or suggestions thst might help? How long do you typically recommend maintaining low residue diet once the Entocort hss kicked i

posted by Alan Fraser - 22/04/2013 1:19:46 p.m.

Microscopic colitis an uncommon condition but is being diagnosed more often now as colonoscopy and biopsies becomes a more common investigation for diarrhoea. The cause is unknown and treatment is a matter of trialling different medications. Entocort the most active medication. Relapse is common but repeat treatments are reasonable hoping eventually for spontaneous resolution - mean duration of disease about 3 years. Continuing with loperamide can be helpful to reduce diarrhoea. Asacol is another useful option

posted by Karen - 13/04/2013 11:49:02 p.m.

Hi Dr Fraser, I'm a 55 year old woman just been diagnosed with collagenous colitis after biopsy review from colonoscopy. I have been prescribed a tapered 2 month course of Entocort - but from looking at the web, it seems that although this is likely to give me relief (how long will it take to work!! I am still taking loperamide some mornings) I will most likely have a relapse at the end - what is your experience ? I also wondered if I should be following any special diet - prior to diagnosis, I was avoiding very high fibre food and coffee but eating pretty normally aside from that. People seem to try all kinds of exclusion diets, but my specialist just told me to take it easy for a couple of weeks until Entocort kicks in and then introduce normal food gradually. Why are fruits with pips such an issue ? I love strawberries! Thanks Karen

posted by Alan Fraser - 13/03/2013 1:49:14 p.m.

Response to Frank: Aching joints is unlikely to be a side effect of Azathioprine and more likely to be related directly to the colitis. Usually the better the control of the colitis then the joints are more settled.

posted by Alan Fraser - 13/03/2013 1:46:34 p.m.

Response to Karen: No supplemental vitamins should be required with exclusion diet for IBS. The bloating part of symptom is often improved but constipation needs some gentle treatment - best option with IBS is magnesium capsules. I recommend MgLax Good Health (1-2 caps daily). Other laxatives can cause more symptoms. Fibre and lactulose cause bloating and Senna, Laxsol, Dulcolax cause abdominal pain and aggravate erratic bowel habit

posted by Alan Fraser - 13/03/2013 1:41:59 p.m.

Thanks for positive comments about the website. Apologizes for not adding regular comments

posted by Selina Cotterell - 12/03/2013 10:17:44 a.m.

Hi Do you reccommend any good GP in hamilton to deal with IBS issues I haven't had any sucess

posted by azlan - 16/11/2012 12:36:46 a.m.

Dear Dr.. My wife got a chrohns since 1997 and on our final checkup last week, my wife was identified got extreme crohns disease as the disease was affecting the vagina area'(fistula).. Before this, she was been treat with infliximab but no positive reactionas result. By next week, my doctor advice us on humira treatmrnt. My question is; is it necessary for surgery as advice by my doctor? Is there any treatment you can advice? Thank..

posted by Karen - 30/10/2012 2:04:49 p.m.

Dear Alan Fraser, Several questions: 1. Do you think it is advisable to take oral vitamins, and in particular magnesium and vit C while going through the exclusion diet process? I used to eat a lot of fresh fruit and vegsbut of course am not doing it now. 2. Is there any evidence that Irritable Bowel Syndrome eventually rights itself, ie the bowel develops healthy organism to digest a variety of foods and hopefully constipation ceases? Would really like to know. I can say that cutting out the not allowed foods stops the bloating and much of the discomfort but not the constipation. Looking forward to your responses. Regards Karen

posted by Frank Forand - 9/08/2012 1:46:42 p.m.

Hi Dr. Fraser, I am on 150mg Azathioprine for ulcerative colitis. It has been four months with no bad side effects. I just started getting mild aching joints and muscles. Regular blood tests all o.k. I don't want to go off of the Aza. because it is the only med. that has worked for me. Is the aching joints a sign of permanent damage or could I stay on the Aza. if I can tolerate the aches. Any information will be appreciated. Thankyou Frank Forand

posted by Frank Forand - 9/08/2012 1:08:45 p.m.

Thank-you very much for this website Dr. Fraser. It has been very helpful for me with ulcerative colitis. I do have a question and will post it soon. Thanks again Frank

posted by Jude Wicks - 19/07/2012 1:16:48 p.m.

Alan, My daughter in London has been advised by the clinic she's attending for the treatment of Ulcertive Colitis to take the ProBiotic VSL#3 but it's extremely expensive and not subsidised. She's already undergone a two month course of Predinose earlier this year but the Colitis shows signs of another flare up. Any recommendations?

posted by Jackie Procter - 2/07/2012 11:26:11 p.m.

Excellent website, useful and informative. Thank you for providing this service.

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