Hospital of St John & St Elizabeth WHATISBOBO

All Categories » Gastrointestinal Problems » Bowel

Question Heading

My brother who is a diving instructor is taking me to do the pool work of an open water course on Saturday. He said that as I had intussusceptions (sorry for the spelling which is probably incorrect) when I was a baby that there might be a chance that I would need a medical before I could do the course. I had the operation when I was 6 months old and I am now 28. I have not had any intestinal problems since caused by the operation or otherwise.

I also have suffered from panic attacks after I had glandular fever when I was 18 and also 2 years ago whilst working in a very stressful job which I left. I have not suffered from anxiety or panic attacks for the last 2 years though. Do you think I need to have medical.

Answer Heading

The PADI medical has a real catch all statement on the form. “Do you have or have you ever had….” And one of the questions is about psychological problems. So you will have to answer YES to that. When you present the form to any dive shop after your bro’ has trained you, it may cause concern. So best to get your “Get out of jail free” card, otherwise known as the Fit to Dive cert. As all has been OK for a while, I am sure the anxiety will not be an issue. Unless of course, you are a total bag of nerves, and normal for you is half way between Norman Wisdom and a man about to be electrocuted.

The other issue, intussusceptions is not a problem now, but an interesting medical problem. That’s where your bowel slides into itself, like those odd water filled toys. The bowel then gets its’ blood supply cut off resulting in agonising pain, gangrene and death. Mainly babies get it and the classic sign is redcurrant jelly-like goo from the anus. A Munchausen’s-by-proxy favourite for parents with nothing to do after their lamb roast.

Question Heading

My wife is 51 years and normally in excellent health, she is certified AOW with some 60 dives to her credit. In May she underwent major surgery and was found with the following:

A 2.7 kg low malignancy Gastro-Intestinal Stromal Tumour (GIST) that was attached to a blood supply within her small bowel. They removed the tumour and are happy that it is all gone. She will need CT scans for the next five years to confirm this. She has been assessed as a moderate risk due to the tumour size but it was examined and found to be a low malignant tumour so the prognosis is good.

However as a result of the GIST they removed a large amount of her small bowel, she now has Short Bowel Syndrome (SBS) and is recovering from that. She does not have a Colostomy bag and her bowel is fully contained within the stomach. She is recovering well with the exception of wind and loose bowel movements but her consultant states that it early days and her bowels will adapt and settle down within about a year.

What we need to know is there any reason that she cannot dive with SBS. Her medication at this stage is:
Codeine 30 mg 4 times daily
Multi Vitamins once daily
and occasional pain relief such as Paracetamol (once or twice a week)

We are now working very gently on her fitness and have started walking and swimming to build her back up again.

Answer Heading

My 2 concerns here are the wind and the codeine. The problem with causing excess wind, due to SBS is that wind created in the bowel at depth, can expand on ascent, and cause pain and even rupture of the bowel.

Codeine, as we all know is an excellent pain killer, but it doesn’t half make you woozy and slow of thought. Not great if you are underwater and have to make quick clear decisions, especially if things go wrong. So I suggest that when she is off the codeine, and wind production is no more than the next person, then she will be fine to dive.

Question Heading

I was diagnosed with irritable bowel syndrome (IBS) recently. I've done a few open water dives and I find that I get really "gassy" during them. Afterwards my stomach feels bloated and I have to pass a lot of wind. Is this normal?

Answer Heading

Apparently a certain four letter “f-word” is one of the oldest in the English language. Chaucer describes one of his characters “letting fly a fart as loud as a thunder-clap” into the face of a rival in one of his Canterbury Tales, nearly blinding him. Nice. Unfortunately, production of some intestinal gas is an unavoidable part of digestion. A human can generate anything up to two litres of wind a day, although your average is nearer 600ml. Its major component is nitrogen, but sadly farting a lot does not reduce your DCI risk. The problem of course is that all this gas has to obey Boyle’s Law when diving, so it will expand and contract and generally cause maximum discomfort unless it is expelled, from either end of the gut. Some IBS sufferers do generate a lot of wind, and diving will therefore exacerbate the discomfort, but as long as there is “light at the end of the tunnel”, as it were, then the gas will escape and relief will ensue. The best advice I can give is simply to avoid anything “flatogenic” on a dive trip. The obvious culprits include beans, cabbages, onions, mushrooms etc., but also fizzy drinks and milk. With any luck you can then spare your cabin buddy a fragrant night on your first liveaboard.

HJE & WHATISBOBO