Understanding Pain and IBS

What causes pain?

Apart from those people whose main symptom is repeated painless diarrhoea, most people with irritable bowel syndrome complain of pain. In spite of this is a tests show that there is no structural abnormality of the intestines. So what causes the pain?

Pain is often a sign that you’re doing something that may damage your body – for example, picking up a hot saucepan handle – or it may remind you that you have already have damage from a burn or a bruise and that your body needs time to heal. Throughout the body, there are sensitive nerves which, when stimulated or irritated, send messages to the brain that are perceived as pain. Pain is primarily a protective mechanism, alerting you that something is wrong. It is often this that makes you consult a doctor – and once the cause is dealt with the pain has served its purpose.

Pain is described as acute when it has come on recently (and often suddenly) and chronic if you have had it for some considerable time length of time.

Types of abdominal pain

Doctors often find it difficult to distinguish between pain caused by a structural abnormality or disease (organic pain) and pain that does not appear to result from any identifiable structural changes or disease processes (functional pain).

Functional pain

The term functional pain comes from the idea that the pain is the result of changes in the function of part of the body. Functional pain can be just as severe and disabling as organic pain – for example, women may describe their attacks of functional pain related to irritable bowel syndrome as worse than that of childbirth.

Most people with irritable bowel syndrome experience functional abdominal pain caused by disturbed bowel action. The term functional abdominal pain covers pain originating from any site within the abdominal cavity, including the gastrointestinal tract. Women seem to experience it more than men, particularly around the time of the menopause, when hormonal changes influence muscle activity in the intestines.

Is the pain organic or functional?

Even an experienced doctor may sometimes find it difficult to tell whether your pain is organic or functional. Nevertheless, it is important that the distinction is made, to avoid any possibility of an organic disease (such as a bowel tumour) being wrongly diagnosed as a functional disorder (for example, as IBS).

The problem for the doctor is to distinguish the two types of pain without subjecting you to a series of tests that may be intensive, often uncomfortable, occasionally dangerous and usually expensive. Such tests are not needed for someone with non- organic, functional pain

On the other hand, doctors have to take care not to dismiss too quickly someone who may have an organic cause for their pain. Throughout the remainder of these articles – it is explained how doctors use guidelines to help them choose the right approach.

What triggers abdominal pain?

Abdominal organs are usually insensitive to many stimuli that would be very painful if applied to your skin. Cutting – tearing or crushing of the gut, for example, does not result in pain.

However, the nerve endings of pain fibres in the muscular walls of the gut are sensitive to stretching or tension. This means that excessive distension or tight contractions (spasm) in the gut wall will trigger pain.

Visceral and referred pain

There are two types of abdominal pain that can occur in irritable bowel syndrome. One is visceral pain (pain from internal organs of the abdomen and intestines). The other is referred pain, which is felt in a different part of the body to the part that triggers the pain.

Visceral pain

Visceral pain is felt in the abdomen as a result of some stimulus within the gut itself. The pain is usually dull and focused mostly somewhere along a line down the middle of the abdomen (the midline). It may be higher up lower down – depending on where the nerve supply to the affected organ originates.

When volunteers took part in experiments in which a balloon was used to distend different parts of the gut, the pain was felt in the midline of the abdomen. In addition:

  • Pain arising from distension of the oesophagus was perceived behind the sternum (breastbone).
  • Pain from stimulation of the duodenum (the first part of the small intestines) was felt in the solar plexus (between the lower ribs in the midline).
  • Pain from the lower part of the small intestines (jejunum and ileum) was felt around the navel.
  • Pain resulting from distension of the colon was felt in the midline of the lower abdomen.

In the studies there was no mention of pain caused by balloons being felt anywhere outside the abdominal area. These findings correspond closely with the pattern of abdominal pain experienced by people with organic diseases. The distribution of pain felt by people with functional abdominal pain, however, is much less clear-cut and often unusual compared with the abdominal pain experienced by people with organic diseases.

Referred pain

Referred pain is felt in an area that may be some distance away from the area where it is actually being caused. This happens when the brain interprets signals from one part of the body is coming from another area. It does this when another area is supplied by the same nerve pathways as the organ involved. One example is pain caused by gallstones which is often felt between the shoulder blades.

Referred pain may be felt in skin or deeper tissues, but is usually confined to one particular area. Sometimes, the skin covering the painful region becomes unusually sensitive, and the underlying muscles may feel tender or painful.

Types of pain in irritable bowel syndrome

Pain is a signal that something is wrong. There are many different terms to describe it. Those most often used in irritable bowel syndrome are described below.

  • Acute: short lasting
  • Chronic: long-term
  • Functional: caused by abnormal functioning
  • Organic: the result of disease Visceral: felt in the abdomen
  • Referred: felt somewhere other than the source of pain.

Pain threshold

The pain threshold the pain threshold is the level of tolerance at which someone perceives discomfort as pain. Some people have a low pain threshold and can tolerate less discomfort than others with a high pain threshold.

Your pain threshold is a subjective factor which can vary from time to time. It depends on the circumstances, your mood, the real or assumed cause of the pain, and many other influences.

Common myths about chronic pain

“If they can’t find a reason for my pain it must be all in my head!”

Sometimes the pain of cause of pain is not clear – but the pain is still very real. Fortunately there is a lot that you can do to help yourself live with the pain, even if you do not know the cause.

“Maybe if I ignore the pain it will just go away?”

No! Some effort and learning are necessary to manage pain effectively.

“Perhaps I’m suffering with this pain because I’m a bad person?”

Long lasting (chronic) pain isn’t a punishment for your past. But the things that you do and the way that you behave have any important effect on your self- esteem and the way that you feel.

“There are drugs that can cure pain.”

Drugs can be effective in relieving pain. No drugs cure pain permanently.

“Some people pretend to have pain as an excuse not to go to work or to get sympathy.”

A few people may fake pain, but most sufferers of chronic pain only want relief.

“My doctors don’t care; otherwise they would do something about my pain.”

Your doctors will do everything that they can to assist you and relieved your pain. If they are not completely successful, it is not because they don’t care.

What can influence the severity of irritable bowel’s and symptoms?

Various factors can play a part in determining the severity of the symptoms of irritable bowel syndrome; some relate to the illness itself, others to individual circumstances.

These include:

Your personality

  • Psychological factors
  • Worry about your illness
  • Impaired ability to express emotions
  • Stress levels
  • Depression, anxiety or panic attacks

The form that your condition takes

  • Chronic (long lasting) or intermittent
  • Unusual symptoms
  • Symptoms poorly controlled

Your circumstances

  • Poor social circumstances
  • Attitudes of relatives and friends
  • Sexual abuse as a child
  • Work and personal satisfaction
  • Economic gains from having an illness
  • Medical investigation and treatment

Key points

  • Pain is a subjective sensation felt when nervous impulses from a tissue or organ are transmitted to the brain
  • Pain may be acute (sudden onset) or chronic) long term)
  • Pain may be organic or functional; most people with IBS get functional abdominal pain
  • Pain may be felt in the abdomen (visceral) or somewhere on related (referred)
  • Your pain threshold is influenced by your circumstances, mood, the real or assumed cause of the pain, and many other factors.