At least one in 12 of all GP visits are related to digestive symptoms. In most cases, symptoms are temporary and can be controlled by OTC medicines, lifestyle and dietary changes. Pharmacists and their staff play an essential role in helping people to avoid or manage lower GI problems and to seek help promptly for red flag symptoms.

Irritable bowel syndrome

Irritable bowel syndrome (IBS) is the commonest chronic GI disorder. Symptoms vary considerably between individuals and can include bloating, diarrhoea or constipation, abdominal discomfort, stool variation and nausea. In some patients, IBS can be associated with an irritable bladder.

IBS can affect anyone of any age but it is commonest in younger people up to the age of 30 and is twice as common in women than men. Before IBS is diagnosed, it is important to rule out other conditions such as coeliac disease.

Dr Anton Emmanuel, consultant gastroenterologist at University College Hospital and medical director of the gut and liver charity Core says: “There has been an increase in the prevalence of IBS in current times, most likely due to lifestyle and environmental factors, such as working long or peculiar hours, stretching ourselves too thin and trying to meet the demands of modern lifestyles.” IBS can also be triggered by a food intolerance, a bacterial infection or disruption of the gut bacteria following a course of antibiotics.

According to the IBS Network, one in six people develop IBS following gastroenteritis induced by infection with Campylobacter bacteria. Depending on the symptoms concerned, IBS can be managed through OTC and POM medication, such as antispasmodics, antidiarrhoeals, laxatives, prokinetics and antidepressants. Dietary changes, such as increasing soluble fibre and stress management, can also be effective.

Acute diarrhoea

Acute diarrhoea occurs when the gut lining becomes damaged by a bacterial or viral infection. Symptoms usually clear up within five to 10 days. Gastroenteritis is the commonest cause, followed by food poisoning.

Acute diarrhoea can also be caused by a course of antibiotics, while overindulgence in rich food or alcohol and anxiety are other triggers. Practising good basic hygiene is essential for reducing the risk of diarrhoea, especially when using the toilet or preparing food. Campylobacter is a common cause of acute diarrhoea which, in some cases, can lead to IBS, so care should always be taken when preparing and cooking chicken.

Travellers to countries where the standard of hygiene may be low should be advised to avoid tap water, ice, salads and undercooked food. Taking probiotics may help to reduce the chances of diarrhoea – for example, in travellers or after a course of antibiotics. A vaccine that helps protect children against rotavirus, a common cause of diarrhoea in children, is now part of the routine childhood vaccination schedule.

Dehydration is the main complication, so customers should keep their fluid levels up with oral rehydration therapy products, especially in the case of young children and the elderly. Loperamide can shorten an attack and is particularly useful in the event of a long journey or special occasion. Babies or children who have had six or more bouts of diarrhoea in the past 24 hours require immediate referral.

Other red flag symptoms in children include signs of dehydration, watery or bloody stools, persistent vomiting and a severe, persistent stomach ache. Adults should contact their doctor urgently with blood in the stools, black stools, or if they have recently been discharged from hospital or taken a course of antibiotics, or if symptoms have not cleared up within four days.

Constipation

According to NHS Choices, one in seven adults and one in three children will be suffering from constipation at any one time. Constipation arises when stools remain in the colon for too long, causing too much water to be absorbed back into the body. This may occur as a result of ignoring the urge to empty the bowel, a lack of dietary fibre, low fluid intake, anxiety or physical inactivity.

Constipation may also be a side-effect of some medicines and is also common in pregnancy due to the increase in progesterone, which acts as a muscle relaxant and slows the movement of waste. If lifestyle changes are ineffective, a bulk-forming laxative (e.g. ispaghula husk) or an osmotic laxative (e.g. lactulose) can be recommended to help the stools to retain fluid, making them softer and easier to pass. Alternatively, if the stools are soft but a person still has difficulty passing them, a stimulant laxative (e.g. senna) will help to encourage movement in the digestive tract.

Haemorrhoids

Haemorrhoids, also known as piles, are swellings that contain enlarged blood vessels that are found inside or around the bottom (the rectum and anus). Most haemorrhoids are mild and may even be asymptomatic. Symptoms include pruritus ani, bleeding after passing a stool and a lump hanging down outside the anus.

Bleeding from the back passage should always be investigated by a doctor. Most cases are thought to be caused by excessive straining on the toilet due to prolonged constipation often resulting from a lack of dietary fibre. Risk factors include obesity or overweight, pregnancy, a family history and being over the age of 45 years.

Haemorrhoids can often be avoided or treated using the same lifestyle factors as those to manage constipation. Swelling and discomfort may be relieved through the use of OTC creams, ointments or suppositories but these medicines should not be used for longer than five to seven days at a time as prolonged use can lead to sensitivity.

Flatulence

Most people pass wind five to 15 times a day on average, but excessive flatulence can cause distress and embarrassment. People who swallow large quantities of air, for example by eating or drinking too quickly, are most prone to flatulence. Chewing gum, smoking and badly fitting dentures can also cause people to swallow air.

Foods containing a high amount of unabsorbable carbohydrates, such as beans, broccoli, lentils and cauliflower, can also lead to flatulence. These foods cannot be digested by the intestine and so pass down into the colon to be broken down by bacteria, producing gas. Avoiding dietary triggers is the best way of managing flatulence, as well as increasing exercise and chewing food more slowly.

OTC products containing simethicone may help to provide relief by dispersing gas bubbles in the stomach. Probiotics may also provide relief by encouraging the growth of ‘friendly bacteria’ in the digestive tract.