Methods for treating irritable bowel syndrome. Features of the treatment of irritable bowel syndrome: symptoms, which doctor to contact, description of medications, diet, folk remedies IBS mixed version
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According to the working group of the World Health Organization (WHO), irritable bowel syndrome (IBS) is a functional bowel disorder in which abdominal pain is combined with disturbances in bowel function and bowel movements. The prevalence of IBS in the population is 14-48%.
In women, this pathology is observed 2-4 times more often than in men. Although the disease often begins in youth, the peak number of people seeking medical attention for this disease is between the ages of 35 and 50. Every year in the United States, the cost of diagnosis and visits to the doctor for IBS is $3 billion, and the cost of treatment is $2 billion. Patients with IBS have a significantly reduced ability to work, sleep disturbances, sexual activity, and other disorders that interfere with normal life.
Is IBS a mystery?
Until now, the true causes of IBS, unfortunately, have not been established. It is believed that IBS occurs due to motor and sensory disorders of the intestines. Disorders of the normal function of the central nervous system (CNS) play an important role in this.
Patients experience abnormal intestinal motility, disturbances in secretion processes in the intestines, and changes in visceral sensitivity. In IBS, both the small and large intestines exhibit increased reactivity in the form of intestinal spasms, slowing or accelerating motility to various irritants, including medications and even food.
E.P. Yakovenko et al. (1998) believes that in addition to the above factors, a disturbed microbial composition in the lumen of the small and large intestine plays a significant role in this disease.
The waste products of microorganisms maintain an irritated state of the intestines and contribute to disruption of the hydrolysis of sugars, fats, and proteins. Intraintestinal pH may decrease, causing inactivation of digestive enzymes and leading to relative enzyme deficiency.
At the same time, changes in intestinal sensitivity and motility can occur under the influence of the central nervous system, including its higher parts. Patients are prone to depression, anxiety, cancer phobia, and they often react more actively to stress.
Borderline neuropsychiatric disorders are found in 75% of patients with IBS. However, we can also assume an inverse relationship: such personality changes are not the cause, but the consequence of long-term disorders of the gastrointestinal tract (GIT).
Endogenous opioids (enkephalins, endorphins) and catecholamines are released both in the gastrointestinal tract and in the brain. They can influence through changes in the exchange of mediators (acetylcholine, serotonin, gastrin, etc.) on intestinal motility and secretion.
IBS is often considered as a psychosomatic disease in which stressful situations act as trigger factors with the subsequent inclusion of nervous, neuromuscular and hormonal chain reactions that determine the individual type of motor skills of a person.
Thus, in the pathogenesis of IBS, leading importance is given to the following factors: psychological, impaired motor skills and visceral sensitivity, changes in the chemical composition of intestinal contents.
How to recognize IBS
To diagnose this largely mysterious disease, the so-called Roman criteria are used.
The following symptoms persist or recur for at least 3 months.
Abdominal pain and/or discomfort that is relieved by bowel movements is dependent on changes in stool frequency or consistency.
A combination of two or more of the following symptoms that occur at least 25% of the time the patient experiences any complaints:
- change in stool frequency (more than 3 times a day or less than 3 times a week);
- change in stool consistency (fragmented, dense, liquid, watery);
- change in the act of defecation (the need for prolonged straining, urgent urges, a feeling of incomplete bowel movement);
- secretion of mucus during bowel movements;
- accumulation of gases in the intestines and a feeling of fullness in the abdomen.
The diagnosis of IBS is made by exclusion. A general blood test, a urine test, a stool test for occult blood, a scatological examination are carried out, daily fat loss in feces is determined, the microbiological composition of feces is determined, an ultrasound of the abdominal organs is performed, a colonoscopy, a gynecological examination, and for concomitant gastric dyspepsia - FGS.
It is advisable to consult the patient with a psychiatrist. In accordance with the recommendations of an international meeting of experts (Rome, 1998), IBS with pain and flatulence, IBS with diarrhea, and IBS with constipation are distinguished.
Principles of IBS treatment
The main condition for successful therapy is the establishment of a trusting relationship with the patient. He definitely needs to explain the functional nature of the disease, and also warn that manifestations of the syndrome can persist for many months and even years without progression; under the influence of treatment, symptoms may be weakened.
The patient's attention should be focused on the fact that the disease does not turn into cancer and that it is associated with hypersensitivity of the intestine to normal environmental factors. The duration of such a discussion with the patient should be at least 15 minutes.
Together with the patient, an individual plan of measures necessary to achieve remission of the disease, and possibly a complete cure, is drawn up.
It was not possible to prove the role of dietary nutrition in controlled trials, however, the influence of dietary factors on the nature of stool (diarrhea, constipation) seems to be quite significant. You should limit your intake of fatty and gas-forming foods, alcohol, caffeine, and sometimes excess fiber.
If you have constipation, you should still try to increase the amount of ballast substances - dietary fiber (DF) in the diet.
Sources of PV: cereals, root vegetables (beets, carrots, pumpkin), fruits, cereals (buckwheat, oatmeal). The most pronounced laxative effect is exerted by black bread, dried fruits, especially prunes, and dried apricots. Traditionally, for constipation, the amount of vegetables and fruits in the diet should be at least 500-700 g daily.
For bloating and pain, they should first be taken boiled, stewed and baked. As the pain subsides, a combination of raw and boiled, stewed, baked vegetables and fruits is individually selected. At the same time, it should be said that the opinion about the therapeutic effect of dietary fiber in IBS is ambiguous.
With constipation, defecation can be disrupted not only due to changes in the consistency of stool and slower motility of the entire colon, but also due to disorders in the coordination of contractions of the pelvic floor muscles.
For diarrhea, milk, raw vegetables and fruits are excluded; it is possible to use a small amount (100-200 g) of boiled or stewed carrots, zucchini, and baked apples. It is allowed to eat beef, chicken, rabbit, fish, eggs, fermented milk products, including cottage cheese, cheese, white bread, and cereals.
In case of severe diarrhea, wipe the food. As health improves, the quantity and composition of vegetables and fruits is determined by the patient individually.
Pharmacotherapy for IBS
Drug treatment of IBS is carried out in accordance with the recommendations for the diagnosis and treatment of IBS, approved at the V Russian Gastroenterological Week (Moscow, 1999).
Constipation and poor tolerance to products containing ballast substances (SB). Swelling laxatives are used: mucofalk - a preparation made from the shells of plantain seeds. It is able to retain water, thereby increasing the volume of the stool and making it soft.
Unlike other laxatives, these drugs do not irritate the intestines. Mucofalk is taken before breakfast (1-2 packets), washed down with a significant amount of water; if necessary, the drug is taken in the evening. For constipation resistant to mucofalk, it is combined with lactulose or cisapride.
Osmotic laxatives: lactulose, magnesium sulfate, magnesium citrate and hydroxide, forlax, etc.
Forlax forms hydrogen bonds with water molecules in the intestinal lumen, increases the amount of fluid in the chyme, stimulates mechanoreceptors, and improves intestinal motility.
The evacuation reflex is restored and the act of defecation is optimized (due to the normal volume and consistency of chyme). The drug is not absorbed or metabolized; it is taken 1-2 packets 1-2 times a day. The laxative effect develops 24-48 hours after administration.
Lactulose is taken 30 ml 1-2 times a day, magnesium sulfate - 10-30 g in 1/2 glass of water, magnesium citrate and hydroxide - 3-5 g per dose.
It is possible to use laxatives that soften stool: petroleum jelly, almond oil, liquid paraffin, although their laxative effect is somewhat less pronounced.
Laxatives are irritants (with an antiresorption-secretory mechanism of action): guttalax, bisacodyl, anthranoids. These drugs inhibit the absorption of water and electrolytes in the small and large intestines, thereby increasing the flow of water into the intestinal lumen.
Due to this, the volume of intestinal contents increases and the time it takes to pass through the colon decreases. They also stimulate the contractile activity of the colon.
Guttalax is prescribed 5-15 drops, bisacodyl - 2-3 tablets per day or 1 rectal suppository. These two drugs are among the most prescribed, probably due to the predictability of their actions.
Antranoids: senna preparations, aloe, buckthorn bark, rhubarb root. Currently, they are prescribed less frequently, due to the fact that their use is accompanied by pain, especially at first. However, this is typical for all “irritants” in the first 3-6 doses. With long-term use of senna preparations, the formation of melanosis of the colon mucosa and damage to the intermuscular nerve plexus is possible.
Drugs that activate gastrointestinal motility: these drugs are classified as a separate group of prokinetics. They have a laxative effect and significantly reduce bloating. These include cisapride (Coordinax, Peristil), which is prescribed 3 times a day 15 minutes before meals and at night, or 20 mg 2 times a day.
Diarrhea. Drugs are prescribed that slow down the movement of contents through the intestines. First of all, it is loperamide (imodium, veroloperamide). Dosage regimen: 2-4 mg 1-2 times a day.
Astringents: calcium carbonate (1.5-3 g 1-3 times a day), aluminum hydroxide (1 g 1-2 times a day), smecta (1-2 packets 3-4 times a day).
IBS with pain syndrome
Antispasmodics:
- calcium channel blockers: spasmomen (40 mg 3 times a day) or dicetel (50 mg 3 times a day;
- anticholinergics: buscopan (10 mg 3 times a day);
- motor regulators: debridate (1-2 tablets 3 times a day).
The drug affects the enkephalinergic system of the intestine, as a result of which pain is reduced. Having an affinity for suppressive and excitation receptors, it has a stimulating effect in hypomotility and an antispasmodic effect in hyperkinesia.
Often, the pain syndrome is associated not so much with spasm (and antispasmodics in this case will be ineffective), but with distension of the intestine by gas, and therefore in some patients the pain disappears after the administration of drugs that reduce bloating.
Flatulence and flatulence often bother patients with IBS and as independent symptoms. The causes of excess gas accumulation in the intestines are complex. Excessive air swallowing plays an important role. This occurs when eating hastily, not chewing food enough, and talking while eating. A significant amount of gas is produced in the small and large intestines.
In the colon, gas is formed as a result of the enzymatic action of intestinal bacteria on organic substances that are not absorbed in the small intestine. More often these are carbohydrates that are not hydrolyzed by amylases, in which case CO2 is formed.
Hydrogen sulfide is a product of the transformation of amino acids by anaerobes. During the day, 20 liters of gas are formed in the intestines. It is mostly reabsorbed through the intestinal wall. Nitrogen and hydrogen sulfide are not absorbed and are excreted through the rectum. During the day, 600 ml of gases are released through the rectum; individual differences are possible within the range of 200-2000 ml.
The unpleasant odor of gases is associated with the presence of trace amounts of skatole, hydrogen sulfide, and mercaptan. They are formed in the large intestine as a result of the action of microflora on protein substrates undigested in the small intestine. Accumulating substances form foam in the intestines: a dispersed system consisting of gas bubbles and liquid. This system obeys the laws of surface tension.
The more the processes of normal digestion and absorption of food ingredients are disrupted, the more gases are formed and the conditions for the formation of stable foam are facilitated. Foam, covering the surface of the intestinal mucosa with a thin layer, complicates parietal digestion, reduces the activity of enzymes, and reduces the reabsorption of gases.
Patients with IBS most often have nutritional, dysbiotic, dynamic and psychogenic flatulence. Treatment is aimed at eliminating the causes of flatulence.
Adsorbents and defoamers are effective. This can be activated carbon, white clay, aluminum hydroxide, bismuth preparations. The best antifoam agent is simethicone (espumisan). It is a high molecular weight silicon-based polymer. It is prescribed 40 mg 3 times a day.
IBS with small intestinal bacterial overgrowth and colon dysbiosis. First, antibacterial drugs are prescribed: intetrix (1-2 caps. 3 times a day), or furazolidone (0.1 g 3 times a day), or ersefuril (1 cap. 3-4 times a day), or metronidazole (0. 25 g 3 times a day), sulgin (0.5 g 4 times a day), enterol 1-2 packets 2 times a day. One of these drugs is prescribed, as a rule, for 5-7 days, two consecutive courses of different drugs are possible.
Then you can prescribe a probiotic - a bacterial preparation: bifiform (1-2 caps. 2 times a day), or colibacterin, bifidum-bacterin, lactobacterin (5 biodoses 1-3 times a day immediately after meals for 2-6 weeks). At the same time, you can prescribe a prebiotic: hilak-forte (a product of the metabolism of normal microorganisms of the intestinal flora, 50-60 drops 3 times a day).
Against the background of intestinal dysbiosis, a relative deficiency of digestive enzymes may be observed. In this regard, enzyme preparations may be prescribed. For IBS with constipation, it is more advisable to prescribe enzyme preparations containing bile and/or hemicellulase: panzinorm, festal, digestal, enzistal, etc. They are prescribed 1 tablet. in the morning, 2 tablets. at lunch and 3 tablets. In the evening.
For IBS with diarrhea, enzymes containing pancreatin (pancitrate, Creon, lycrease, mezim-forte) are used. In general, for IBS with intestinal bacterial overgrowth syndrome, the following indicative treatment regimens are recommended:
- 1st week: ersefuril and/or metronidazole + enzyme preparation + drugs that normalize motor disorders;
- 2nd week: hilak-forte + bifi-form + enzyme preparation + drugs that normalize motor disorders;
- 3rd week: hilak-forte + bifi-form.
For depression, increased anxiety, asthenia, and cancerophobia, anxiolytics and antidepressants can be prescribed. As a rule, they are prescribed after consultation with a psychiatrist. The most effective are tricyclic antidepressants: amitriptyline (1-2 tablets), lerivon 1-2 tablets, or serotonin reuptake inhibitors: fluoxetine (Framex) - 40 mg/day.
In addition to relieving the actual symptoms of depression, they have a neuromodulatory and analgesic effect. Eglonil (25-50 mg 2 times a day) helps relieve severe autonomic disorders.
Despite a sufficient range of drugs used to treat IBS, the effectiveness of treatment is often assessed as insufficient. A search is underway for new treatments for this disease.
A great achievement is new enzyme preparations. One of them is pepphys. The effectiveness of the drug pepfiz (Ranbaxy Laboratories Ltd.) in patients with IBS was studied.
Pepfiz contains in 1 tablet: papain 84 mg, fungal diastase 30 mg, simethicone 27.5 mg and excipients - sodium bicarbonate, potassium bicarbonate, citric acid, fumaric acid, sodium saccharin, sodium carbonate, sodium lauryl sulfate, sunset yellow and orange dye flavoring
Pharmacological properties: digestive enzymes papain and fungal diastase facilitate digestion and absorption of proteins and carbohydrates in the body. Simethicone is an “defoamer” that reduces the amount of gas in the intestines.
Pepfiz is indicated for any disorders of the exocrine function of the pancreas (chronic pancreatitis), proximal parts of the small intestine and liver diseases, non-ulcer dyspepsia syndrome, flatulence, increased gas formation in the postoperative period, a feeling of fullness of the stomach or flatulence caused by unusual food, overeating, consumption alcohol, coffee, nicotine.
Dosage regimen: 1 tablet. 2-3 times a day after meals. Contents 1 table. before use, dissolve in 1/2 tbsp. water. No side effects were found for the drug. 1 tablet of pepfiz contains 419 mg of sodium, and therefore it should be prescribed with caution for hypertension, kidney and liver diseases. The drug is contraindicated in case of individual intolerance.
About 20% of the world's population suffers from irritable bowel syndrome - IBS. The disease causes discomfort, reducing the quality of life, but due to the sensitivity of the problem, most patients do not seek medical help because they do not consider the syndrome to be a disease. Let's look at the symptoms of IBS in adults and how to treat this disease.
IBS: symptoms and treatment in adultsCauses of bowel irritation
The normal contraction and relaxation of the walls of the large and small intestines is called intestinal motility. The failure of these contractions, disruption of intestinal functionality, the appearance of discomfort in the abdominal area, pain for no apparent reason is called irritable bowel syndrome.
The main reason for the appearance of the pathology has not been identified - experts are still debating. Most are inclined to believe that chronic stress is to blame. Some patients note that unpleasant symptoms intensify during moments of emotional stress or after eating certain foods.
Potential factors for the development of IBS include:
- development of bacterial pathogenic microflora;
- alcohol abuse;
- overeating fatty foods – fat of any origin is a strong stimulator of intestinal motility;
- consumption of carbonated and gas-forming foods;
- lack or excess in the diet of dietary fiber - plant fiber;
- psycho-emotional stress.
There is a relationship with the patient’s hormonal status. In women during the menstrual cycle, when hormone levels are elevated, the symptoms are most pronounced. Some experts believe that it is the hormonal factor that explains the prevalence of IBS among women: 70% of patients are female.
Symptoms of irritable bowel
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Based on the type of disease, it is customary to classify IBS into three types:
- With a predominance of diarrhea (diarrhea), a frequent urge to defecate is characteristic, especially in the first half of the day. The urge often intensifies during times of psycho-emotional stress and fear. Pain in the lower abdomen, which decreases after going to the toilet.
Attention! People call these symptoms “bear disease.” These animals are known to be prone to involuntary defecation during times of stress or danger.
- A condition with predominant constipation - characterized by stool retention for more than 3 days. The feces become more dense and sheep-like. Sometimes there are traces of clear or white mucus in the stool. Aching pain in the abdomen. The patient has loss of appetite, nausea, heartburn.
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- The third stage of IBS is characterized by a predominance of abdominal pain, bloating and flatulence. There is frequent alternation of constipation and diarrhea.
Extraintestinal symptoms of IBS, which manifests itself in adult patients, include:
- gastroesophageal reflux - spontaneous reflux of stomach contents into the esophagus;
- chronic fatigue syndrome;
- fibromyalgia – symmetrical musculoskeletal pain;
- irritable bladder syndrome;
- dysfunction of the genitourinary system - decreased libido;
- headaches, dizziness;
- backache.
From 30 to 60% of patients experience psychopathological disorders: depression, anxiety, phobia. Patients are characterized by sudden changes in mood: hysteria, hypochondria, panic attacks.
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Diagnosing the pathology is problematic - many symptoms are similar to other diseases. The world's leading gastroenterologists have developed a diagnosis for IBS.
The diagnosis of IBS is made if unpleasant symptoms are observed more than 3 days a month over the past 3 months. The first symptoms should appear no earlier than 6 months ago. At least 2 signs are observed:
- pain symptoms and discomfort weaken or disappear altogether after defecation - going to the toilet;
- unpleasant and painful sensations appeared simultaneously with a change in stool frequency;
- a feeling of discomfort in the abdomen, pain appeared simultaneously with a change in the consistency (density) of stool.
When diagnosing irritable bowel syndrome, it is important to exclude the following pathologies:
To exclude these diseases, the attending physician prescribes the following studies:
- general and biochemical blood test;
- Kaprogram - laboratory study of human feces;
- sigmoidoscopy - examination of the rectal mucosa using a sigmoidoscope (a device consisting of a tube, a lighting device and an air supply device);
- irrigoscopy - a method of x-ray examination of the large intestine with the introduction of a radiopaque substance;
- biopsy – if indicated and there is suspicion of cancer.
If psychoemotional disorders are suspected, a visit to a neurologist and psychotherapist may be scheduled.
How to treat the syndrome
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Often the syndrome is caused by a complex of reasons, so it is not always possible to cure it. In addition, in pathophysiology - the science that studies the patterns of the occurrence of diseases, all the mechanisms causing the development of irritable bowel syndrome have not been fully established and there is no unambiguous treatment regimen.
Another obstacle to treating irritable bowel syndrome is that many patients simply do not treat IBS as a serious condition. After all, it does not pose an immediate threat to human life, and patients rarely seek medical help. Dysfunction of intestinal motility really only causes discomfort and reduces the patient’s standard of living and does not directly lead to complications and damage to the gastrointestinal tract tissues.
- haemorrhoids;
- anal fissures;
- paraproctitis, etc.
The psycho-emotional causes of the disease in adults should not be ignored: anxiety, depression. Left untreated, these conditions may contribute to the development of more serious psychological disorders.
Traditional medicine uses drug and non-drug methods to treat irritable bowel disease. The essence of therapy comes down to symptomatic treatment, which is prescribed based on the diagnosis.
Most adult patients choose self-treatment at home. To reduce unpleasant symptoms, it is enough to change your daily routine and normalize your diet. However, if these methods do not lead to positive results, it is recommended to resort to drug therapy.
Drugs to treat the syndrome
For the symptomatic treatment of the syndrome in adults, various groups of drugs are used:
- antispasmodics – suppress intestinal spasms. The effectiveness of the drugs decreases with long-term use. Medicines in this group are more effective than placebo. Recommended for abdominal pain, taken in a short course.
- Antidiarrheals – used for persistent diarrhea. The most common drug is Loperamide, under the trade name Imodium.
- laxatives – help relieve constipation;
- probiotics are non-pathogenic microorganisms that restore normal intestinal microflora and negatively affect pathogenic and conditionally pathogenic microorganisms;
- prebiotics are chemicals that have a beneficial effect on the stimulation and growth of normal intestinal microflora.
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If it is necessary to eliminate the mental causes of the development of the syndrome in adults, tranquilizers and antidepressants are prescribed.
Important! Attempts to independently select psychotropic drugs can lead to aggravation of neurological symptoms.
Daily routine and psychotherapy
In the treatment of IBS, an important point is the normalization of work and rest patterns. Adequate sleep for a person is the key to psychological health. The recommended 7-hour sleep helps get rid of many neurological causes of the syndrome: anxiety, depression, etc.
To improve intestinal motility, it is important to organize meals at a strictly designated time. The gastrointestinal tract has the ability to remember the time a person is accustomed to eating and prepares for it, producing the largest amount of gastric juice, which has a positive effect on the digestion process.
Psychotherapeutic methods of treatment are also used to treat the psychological factors of the disease. To reduce the patient's tension and anxiety levels, psychotherapy, hypnosis, and biofeedback methods are used. The effectiveness of the technique depends on how well the trusting contact between the doctor and the patient is established.
Prevention of the syndrome in adult patients
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The best prevention of the syndrome in adults is considered to be normalization of the diet. Patients are not recommended to consume foods that stimulate gas formation and indigestion:
- peas;
- legumes;
- potato;
- milk;
- carbonated drinks;
- alcohol;
- fatty foods.
Today there is no evidence that one should give up certain products - the “bans” are advisory in nature.
Attention! Excess and deficiency of plant fibers in the diet equally accompanies the appearance of symptoms of the syndrome.
Moderate exercise has a beneficial effect on digestion. Scientists from the University of Gettenberg experimentally managed to prove that in 50% of patients the symptoms of the syndrome decreased after short physical activity. To reduce the risk of unpleasant symptoms, it is enough to exercise for 30-60 minutes a day, 3-4 days a week.
Forecast
More than 90% of patients who sought medical help, after completing a course of treatment, normalizing their daily routine and correcting their diet, consider themselves healthy people. They have independently learned to cope with residual symptoms, if any, and lead a healthy lifestyle.
However, there are a number of people who, even after undergoing therapy, become fixated on the problem and claim that they are hopelessly ill. They constantly turn to different specialists and require further treatment measures. This condition does not relate to the patient’s physiological problems, but to psychological disorders.
Irritable bowel syndrome has different symptoms and causes, and different treatment methods. In most cases, by changing your usual lifestyle, it is possible to cure the syndrome without seeking medical help. However, if at home it was not possible to identify the pathogenesis - the cause of the syndrome, then it is recommended to consult a doctor.
Modern methods quite effectively relieve the symptoms of the syndrome and improve the patient’s quality of life. Ignoring the symptoms will aggravate the patient’s health condition and lead to unpredictable consequences.
The high prevalence of symptoms of irritable bowel syndrome in the population does not mean that all sufferers receive appropriate treatment. The symptoms of IBS (irritable bowel syndrome) are very unpleasant: there are functional disorders in the intestines, expressed in chronic discomfort, cramps and pain in the abdomen, and are accompanied by changes in the frequency of bowel movements and stool structure.
This pathology is a chronic intestinal disorder with disruption of its functioning without obvious reasons. This anomaly is accompanied by stool disorders, abdominal pain, discomfort, and inflammation or infectious lesions are not diagnosed. Psycho-emotional disorders are of great importance in the occurrence and development of the disease.
Irritable bowel syndrome is a condition where the bowel appears normal but does not function normally, this condition is biopsychosocial in nature.
Irritable bowel syndrome most often occurs in people over 20 years of age, about 40% of patients are people in the age group of 35-50 years. Although there are cases of anomaly occurring in adolescence or even childhood. Among women, 15-25% suffer from this pathology, among men – 5-18%.
Due to the fact that the symptoms do not seem dangerous, about 60% of those experiencing them do not consult a doctor, 12% consider it necessary to consult a therapist, 28% - to a gastroenterologist.
Causes of irritable bowel syndrome
Factors that contribute to the occurrence of irritable bowel syndrome are:
- malfunction of the nerve connections between the part of the brain that controls the proper functioning of the gastrointestinal tract and the intestines;
- motor impairment. Increased motility leads to diarrhea, slow motility causes constipation;
- dysbiosis Increased development of bacteria in the small intestine, which leads to diarrhea, flatulence, weight loss;
- lack of food rich in dietary fiber;
- incorrect diet. The predominance of spicy, fatty foods in the diet, large amounts of coffee and strong tea, and alcoholic drinks contribute to the occurrence of this syndrome;
- hereditary predisposition. The syndrome is more often observed in those whose parents had the same disorder;
- intestinal infections. Their presence provoked the occurrence of IBS in 30% of patients. Irritable bowel syndrome can also occur after treatment for infectious bowel diseases is completed. This type of irritable bowel syndrome is called post-infectious;
- frequent stress;
- sexual or physical violence.
Symptoms of Irritable Bowel Syndrome
The main signs of the syndrome are abdominal pain, stool disturbances and discomfort in the abdominal cavity. Spasm of different parts of the intestine is usually unstable and can change location on different days.
The most common symptoms in adults:
- alternating diarrhea or constipation;
- pain and cramps in the abdomen that go away after bowel movement;
- swelling and;
- increased gas formation (flatulence);
- frequent and sudden urge to defecate;
- feeling of fullness in the intestines, even after a bowel movement;
- discharge of mucus from the anus.
Signs of irritation may occur in a stressful situation or after eating. In women, signs of this syndrome may appear before or during menstruation.
The classification of the syndrome divides symptoms into three main types: with a predominance of pain, with a predominance of constipation, and diarrhea.
IBS | Symptoms |
---|---|
with constipation | frequent stool retention, which is replaced by normal bowel movements; pain that does not remain in one place, but dissipates, attacks are replaced by aching pain; bitterness occurs in the mouth, there may be nausea, flatulence. |
with diarrhea | increased urge to defecate during and after meals; pain after eating in the stomach, on the side slightly below the navel, in the lower back, which goes away after bowel movement; problems with urination |
mixed type with pain | spasmodic pain (sometimes aching or stabbing) in the abdomen, which disappears after a bowel movement, the pain is similar to intestinal colic; bowel disorder - alternating diarrhea and constipation; when you have the urge to defecate, you may feel that it is impossible to keep feces in the intestines; ; There is clear or white mucus in the stool during bowel movements. |
Symptoms of IBS appear after strong excitement, any emotional stress, or fear.
There may be a connection between irritable bowel syndrome and other functional disorders, for example, with autonomic asthenia syndrome, irritable bladder or stomach, neuroses and other conditions. Due to the fact that the disease occurs against the background of emotional turmoil, the characteristic symptoms include weakness, lower back pain, lethargy, heart pain, poor sleep, painful urination, migraine, impotence and others. Some pathologies (ulcerative colitis or Crohn's disease) can disguise themselves as this syndrome, so it is imperative to carry out a differential diagnosis.
The disease usually does not cause serious complications. Although the prognosis is favorable, this syndrome affects the patient’s quality of life, reducing his ability to work, disrupting sleep, rest, and sexual life.
Signs that should not be observed with the syndrome
When the following symptoms or signs are suspected of irritable bowel syndrome, this should alert you, as they are not typical for this syndrome:
- the disease began in old age;
- acute symptoms occur;
- loss of body weight, lack of appetite;
- diarrhea with pain, with the presence of steatorrhea (fat in the stool);
- intolerance to fructose, lactose or;
- heat;
- bowel cancer or inflammatory diseases in relatives.
Diagnosis of irritable bowel syndrome
To make a diagnosis, it is necessary to carry out the following examinations:
- general blood analysis. Anemia (occurs from hidden bleeding) and an increase in the level of white blood cells (the presence of inflammation) can be detected.
- stool occult blood test. Even bleeding invisible to the eye will show, and together with feces, increased fat loss indicates pancreatitis.
- analysis of thyroid hormones (to refute hyper- or hypothyroidism);
- gastroscopy and biopsy from the descending duodenum;
- Ultrasound of the intestine, abdominal ultrasound. They will show diseases of internal organs and neoplasms;
- radiography or contrast fluoroscopy with barium. It is used to obtain an image of the relief of the large intestine;
- colonoscopy and sigmoidoscopy;
- CT scan of the abdomen and pelvis. They help confirm or refute other causes of symptoms.
Differential diagnosis is required to separate this intestinal syndrome from other diseases, such as:
Intestinal disorders similar to this syndrome can be observed in some forms of diabetes mellitus, carcinoid syndrome, and thyrotoxicosis.
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Treatment
To eliminate flatulence, use cumin, anise, chamomile, and fennel.
An infusion of thorn leaves helps with constipation. For this, 1 tbsp. Pour boiling water (1 glass) over a spoonful of leaves, leave and take half a glass 3 times a day for about a week. Plantain seeds also help with constipation. Plantain seeds (2 dessert spoons) are soaked in 100 ml of water for half an hour and then eaten. You can take products based on buckthorn bark, fennel, licorice root, nettle, and chamomile.
For diarrhea, use an infusion of pomegranate peels. 1 tbsp. pour 250 ml of boiling water over a spoonful of crusts and leave until the water turns pink. You need to drink this infusion at once.
Prognosis for irritable bowel syndrome
The prognosis for the syndrome is favorable: there is no risk of developing severe complications and it does not reduce life expectancy. By applying a diet, adding physical activity to your life, and following the prescribed treatment, you can get noticeable positive changes in your well-being.
The condition of patients with irritable bowel syndrome, the effectiveness of treatment and prognosis mainly depend on the severity of disorders of the nervous system. Overcoming conflicts that are the cause of neurosis in the patient is of decisive importance in recovery.
In most cases, drugs for the treatment of irritable bowel syndrome are selected based on its clinical picture. The main condition for successful treatment of IBS is effective cooperation between the patient and the doctor, modification of lifestyle and diet. Only if these measures have no effect should the patient begin taking medications for irritable bowel syndrome.
Drug groups
Drugs used for IBS can be divided into the following groups:
- anticholinergics;
- antidiarrheal drugs;
- antidepressants;
- laxatives that increase the volume of stool;
- serotonin receptor antagonists;
- chloride channel activators;
- guanylate cyclase agonists;
- probiotics.
The medicine for irritable bowel syndrome is selected based on the patient’s existing clinical picture, that is, it is symptomatic.
The most common means
Let's consider the indications for drugs from the groups listed above.
Anticholinergics
Medicines from this group have antispasmodic properties, that is, they inhibit contractions of intestinal smooth muscles. These medications help relieve the symptoms of abdominal cramps associated with irritable bowel syndrome.
Dicyclomine (Bentyl)
This drug directly relaxes the smooth muscles of the intestine without affecting the production of stomach acid. Its effect begins 1-2 hours after administration and lasts up to 4 hours. Dicyclomine is taken orally, usually 4 times a day before meals and at night.
To prevent side effects from developing, your doctor may prescribe this medication in small amounts at first and then gradually increase the dose. Antacids reduce the absorption of dicyclomine, so they cannot be taken at the same time as it.
If you take this medication to treat irritable bowel syndrome regularly and for a long period of time, if you suddenly stop taking it, you may experience a withdrawal syndrome that includes dizziness, sweating, and vomiting.
Other side effects that may occur when taking dicyclomine:
- dizziness (40%);
- dry mouth (33%);
- blurred vision (27%);
- drowsiness (9%);
- nervousness (6%);
- general weakness (7%).
Less common are bloating, confusion, paralysis of accommodation, delirium, dermatitis, erythema, fatigue, hallucinations, insomnia, malaise, palpitations, rashes, and syncope.
This treatment drug should not be used simultaneously with alcohol.
Dicyclomine is contraindicated in:
- allergies to it or other anticholinergics;
- angle-closure glaucoma;
- myasthenia gravis;
- massive bleeding;
- intestinal atony;
- toxic megacolon;
- heavy;
- esophagitis.
It is also not used in women who are breastfeeding or in children under 6 months of age.
Dicyclomine is prescribed with caution:
- patients with liver or kidney failure;
- patients with benign prostatic hyperplasia;
- people with congestive heart failure;
- for tachycardia due to heart failure or thyrotoxicosis, arterial hypertension, coronary heart disease, chronic obstructive pulmonary disease, mitral stenosis, brain damage;
- with tachyarrhythmia.
Hyoscyamine
This remedy is used to treat problems with the digestive tract, including irritable bowel syndrome, as well as various bladder conditions. Hyoscyamine reduces the production of stomach acid, slows down, and relaxes smooth muscles in many organs.
This drug should be taken strictly as prescribed by your doctor. Fast-acting tablets are taken 30-60 minutes before meals orally or sublingually at a dose of 125-250 mcg every 4 hours or as needed. Do not exceed the dose of 1.5 mg per day (12 tablets).
With extended-release tablets, you need to take 375-750 mcg of hyoscyamine twice a day. Also, do not exceed the dose of 1.5 mg in 24 hours (4 extended-release tablets).
Side effects include:
- dry mouth;
- urinary retention;
- blurred vision;
- tachycardia;
- mydriasis;
- increased intraocular pressure;
- loss of taste perception;
- headache;
- nervousness;
- drowsiness;
- weakness;
- nausea;
- vomiting;
- constipation;
- bloating and abdominal pain;
- diarrhea;
- allergic reactions, etc.
Taking Hyoscyamine for the treatment of irritable bowel syndrome is contraindicated in patients with an allergy to it, angle-closure glaucoma, myasthenia gravis, urinary tract obstruction, obstruction of the digestive tract (for example, pyloric stenosis), intestinal atony, unstable hemodynamics with bleeding, severe ulcerative colitis.
The drug should not be used by women who are breastfeeding.
Use hyoscyamine with caution if there is:
- congestive heart failure;
- coronary heart disease;
- chronic obstructive pulmonary disease;
- diaphragmatic hernia;
- reflux esophagitis;
- mitral stenosis;
- Down syndrome;
- autonomic neuropathy;
- hyperthyroidism;
- tachyarrhythmias.
Antiproliferative drugs
Antifertility medications used to treat irritable bowel syndrome slow down the passage of food and reduce the production of digestive juices.
Lomotil (diphenoxylate hydrochloride + atropine)
This combination medication helps reduce the frequency of bowel movements due to diarrhea by slowing bowel movements. Diphenoxylate is similar to narcotic pain relievers, but primarily affects the intestines. Atropine belongs to the class of anticholinergic drugs, which also slow intestinal motility and reduce the secretion of digestive juices.
Adults with irritable bowel syndrome and diarrhea are first prescribed to take Lomotil 2 tablets 4 times a day, and then gradually reduce the dose on an individual basis. For children aged 2 to 13 years, Lomotil is prescribed in the form of syrup in a dose calculated for their weight. Most often, relief from diarrhea occurs within the first 48 hours.
Side effects of this drug include:
- blurred vision;
- sedation;
- nausea and vomiting;
- discomfort and pain in the abdomen;
- dry mouth;
- exacerbation;
- bloating;
- constipation;
- loss of appetite;
- drowsiness;
- cardiopalmus;
- shortness of breath;
- nervousness and irritability.
Lomotil should not be prescribed to people with an allergy to diphenoxylate or atropine, intestinal obstruction, closed-angle glaucoma, myasthenia gravis, intestinal muscle weakness, diarrhea associated with pseudomembranous colitis or bacterial infection.
It is used with caution in the presence of renal and liver failure, ulcerative colitis.
It is one of the most commonly used antidiarrheal medications for the treatment of irritable bowel syndrome. It slows down peristalsis and reduces watery stool, relieving diarrhea.
For diarrhea in adults, Loperamide is first given in a starting dose of 4 mg (2 tablets), and then 2 mg (1 tablet) after each loose stool. Do not exceed a dose of 16 mg (8 tablets) per day. In children aged 2 to 6 years, it is recommended to use Loperamide in syrup form; the dose is selected by the doctor based on the severity of the disease and the child’s weight.
The drug is contraindicated in the presence of:
- allergies to Loperamide;
- bloody diarrhea;
- very high body temperature;
- infectious diarrhea;
- pseudomembranous colitis;
- constipation
They should not be used to treat children under 2 years of age.
Adverse reactions to Loperamide include:
- bloating;
- constipation;
- loss of appetite;
- nausea;
- dizziness;
- abdominal pain with nausea and vomiting;
- skin rash;
- drowsiness;
- dry mouth.
Antidepressants
Tricyclic antidepressants have an antidepressant and analgesic effect in irritable bowel syndrome, and therefore effectively eliminate the symptoms of this disease.
This drug provides an analgesic effect in the intestines in doses that are lower than those needed for antidepressant effects. Amitriptyline also lengthens the time it takes for food to pass through the intestines, reduces abdominal pain and stool frequency, and improves overall well-being. For irritable bowel syndrome, Amitriptyline is taken in tablets at a dose of 10-50 mg once a day before bedtime.
This drug is contraindicated in the presence of an allergy to it, in the acute period of myocardial infarction, during treatment with monoamine oxidase inhibitors during the previous 2 weeks, with glaucoma, and under the age of 12 years.
Amitriptyline should be used with caution if:
- cardiovascular diseases;
- diabetes mellitus;
- renal and liver failure;
- thyroid dysfunction;
- convulsive seizures;
- benign prostatic hyperplasia;
- urinary retention;
- weakening of peristalsis.
When treating irritable bowel syndrome, the drug passes into breast milk, so breastfeeding should be avoided while taking it.
Side effects of amitriptyline may include:
- constipation or diarrhea;
- nausea and vomiting;
- changes in appetite and weight;
- more frequent urination;
- rash, itching;
- swelling of the mammary glands;
- decreased libido and impotence;
- dizziness;
- weakness;
- temperature increase.
Under no circumstances should you take Amitriptyline and alcohol at the same time.
Antibiotics
Antibacterial agents may be used in the treatment of irritable bowel syndrome to prevent the overgrowth of intestinal bacteria.
Rifaximin
This is a semi-synthetic antibiotic that inhibits protein synthesis in bacteria and their growth. Most often, Rifaximin is prescribed for IBS in the presence of diarrhea. As a rule, it is used at a dose of 550 mg every 8 hours for 14 days.
Rifaximin is contraindicated if you are allergic to it. Side effects include flatulence, headaches, tenesmus, abdominal pain, nausea, constipation, fever, vomiting, allergic reactions, itching, rash.
Laxatives that increase stool volume
These drugs consist of hydrophilic polysaccharides and celluloses, which swell in the intestinal fluid, forming a gel that facilitates the passage of intestinal contents and stimulates peristalsis. They may relieve symptoms of constipation and diarrhea.
Methylcellulose
This synthetic drug is prescribed for irritable bowel syndrome to provide a mild laxative effect. Take 2 capsules up to 6 times a day, making sure to take each dose with a glass of water.
Methylcellulose should not be used for:
- allergies to it;
- intestinal obstruction;
- symptoms of appendicitis or acute abdomen;
- the presence of ulcers in the digestive tract;
- fecal matter;
- dysphagia;
- bleeding from the rectum.
Side effects of this drug include flatulence and excessive bowel movements.
Plantain seeds
Psyllium seed preparations stimulate stool by forming a gel-like liquid and promoting peristalsis. They are available in the form of powder or granules, which are in bags. These drugs are taken in a dose of 2.5-7.5 g, diluted in a glass of water, until reaching 30 g per day.
Contraindications include allergies, intestinal obstruction, symptoms of appendicitis or acute abdomen, ulcers in the digestive tract, fecal impaction, dysphagia and rectal bleeding.
Side effects include abdominal cramps, flatulence, and constipation.
Serotonin receptor antagonists
Of this group of medications, Alosetron is used for irritable bowel syndrome. The drug is used only in women with IBS that manifests as severe diarrhea and does not respond to standard treatment.
Initially, 0.5 mg is prescribed orally every 12 hours for 4 weeks, then, if well tolerated, the dose is increased to 1 mg every 12 hours.
The drug is contraindicated if there is:
- allergies;
- rectal bleeding;
- constipation;
- ischemic colitis;
- intestinal obstruction;
- intestinal perforation;
- Crohn's disease;
- ulcerative colitis;
- severe liver failure.
Side effects include:
- constipation;
- abdominal pain;
- nausea;
- headache;
- fatigue;
- intestinal distension;
- flatulence;
- haemorrhoids;
- urinary tract infections;
- ischemic colitis;
- anxiety;
- bone pain.
Chloride channel activators
The drugs increase the amount of fluid in the intestines, which stimulates bowel movements. They are prescribed for IBS with constipation.
Lubiprostone
The drug is used for irritable bowel syndrome with constipation only in women over 18 years of age. Lubiprostone is prescribed at a dose of 8 mcg orally every 8 hours.
It is contraindicated for allergies and mechanical intestinal obstruction. Side effects include nausea, vomiting, diarrhea, swelling, chest discomfort, fatigue, dizziness, flatulence, dyspepsia, dry mouth, abdominal pain.
Guanylate cyclase agonists
The drugs increase the secretion of fluid into the intestinal lumen and speed up the passage of food.
Linaclotide
Used to treat irritable bowel syndrome with constipation in adults, it helps increase the volume of intestinal contents by increasing fluid secretion. This facilitates the passage of contents through the intestines and also relieves pain and discomfort in the abdomen.
Linaklotide is taken at a dose of 290 mcg once a day on an empty stomach 30 minutes before the first meal.
The drug is contraindicated in the presence of an allergy to it, in children under 6 years of age, or mechanical intestinal obstruction. Older children (from 6 to 17 years old) should also refrain from using Linaclotide, since there is not enough information about its safety.
Side effects include diarrhea, abdominal pain, flatulence, headaches, sinusitis, fecal incontinence, fatigue, vomiting.
Probiotics
These are products that contain so-called friendly bacteria, restoring the natural balance of intestinal microflora. Some patients report that taking probiotics regularly helps relieve IBS symptoms, but these claims lack scientific evidence.
If a person with irritable bowel syndrome decides to take probiotics, they will need to be treated with them for at least 4 weeks.
Enterogermina
This drug consists of spores of the microorganism Bacillus clausii, which is part of the normal intestinal microflora, which can be useful in its restoration. As a rule, Enterozermina is taken orally, 1 bottle 2-3 times a day.
Contraindications include allergies to the drug, children under 1 month of age. When treated with Enterozermina, side effects rarely develop; allergic reactions such as urticaria and skin rash may occur.
Treatment with folk remedies and diet
Treatment of irritable bowel syndrome with medications is recommended to be combined with folk remedies and diet.
The diet is selected based on the dominant symptoms. The patient needs to keep a diary and note the foods consumed in it and record the symptoms of the disease. This will help you identify the food that triggers your IBS flare-up so you can avoid it.
If IBS is combined with constipation, increasing the amount of soluble fiber in the diet, which is found in fruits, root vegetables (carrots, potatoes), oats, barley, and rye, can help. On the contrary, for diarrhea it is better to eat foods high in insoluble fiber - whole grains, bran, nuts and seeds.
If a patient is bothered by persistent bloating, limiting the intake of foods containing oligosaccharides, disaccharides, monosaccharides and polyols may help. These substances are quickly absorbed in the intestines, which is accompanied by the release of large amounts of gases. Such products include regular, leafy, Chinese, cauliflower and Brussels sprouts, broccoli, peas, chickpeas, lentils, and beans.
Patients often give preference to folk remedies to combat irritable bowel syndrome. This can be done, but first you need to consult a doctor, since some of the ingredients used in this treatment may interact with the medications a person is taking.
Like drug treatment, the use of traditional medicine for IBS depends on the symptoms of the disease:
- Peppermint infusion helps with frequent abdominal cramps. To prepare it, pour 2 tablespoons of dry leaves into a glass of boiling water and leave for 20 minutes. The infusion can be used instead of tea.
- Dill infusion can help with bloating. To prepare it, pour a tablespoon of herb or dill seed into 500 ml of boiling water and leave for 2 hours. Drink 100-150 ml three times a day before meals.
- For diarrhea, an infusion of pomegranate peels is sometimes used. Pour 250 ml of boiling water over a tablespoon of dry peels and leave until pink. Should be consumed at once.
- Psyllium seeds can help with constipation. To do this, 2 dessert spoons of seeds need to be soaked in 100 ml of water for 30 minutes, after which they need to be eaten.
In addition, exercise is beneficial for patients with IBS - it helps relieve depression and stress, and stimulates the normal functioning of the digestive tract.
Irritable bowel syndrome is a common condition. This diagnosis is made if no other causes of the existing symptoms of digestive disorders can be found. Before treating irritable bowel syndrome with medications, you should try to eliminate its symptoms through diet and exercise.
Useful video about the treatment of irritable bowel syndrome
Irritable bowel syndrome (IBS) is a chronic, often recurrent type of intestinal pathology, manifested in the form of discomfort, pain, bloating and changes in stool, in the absence of any organic causes.
ICD-10 K58 ICD-9 564.1 DiseasesDB 30638 MedlinePlus 000246 eMedicine med/1190 MeSH D043183 Leave a request and within a few minutes we will find you a trusted doctor and help you make an appointment with him. Or select a doctor yourself by clicking on the “Find a Doctor” button.
Causes
The physiological causes that can cause irritable bowel syndrome have not been established. Laboratory, histological and x-ray studies were unable to reveal structural abnormalities in IBS.
Most often, both short-term and permanent nutritional disorders lead to the formation of irritable bowel syndrome:
- irrational consumption of fatty, heavy foods;
- abuse of caffeine, alcohol, carbonated drinks;
- binge eating;
- consumption of foods that can cause gas formation or indigestion (raw and lightly salted fish, legumes);
- lack of the required amount of fiber in the diet.
Irritable bowel syndrome during pregnancy occurs due to changes in the blood supply to the entire digestive tract and the pressure exerted by the growing uterus. Pregnant women can provoke IBS by abusing various sweets, fruits, and vegetables that contribute to the appearance of gas.
Causes in children
Children are often susceptible to IBS due to the intestines being unprepared to process “adult” heavy foods. An unbalanced diet makes the situation worse. The lack of dietary fiber in it, the abundance of coarse fiber, and a large number of fried foods can not only increase the symptoms in the patient, but also give impetus to the development of IBS in a healthy person. Due to the increased sensitivity of the colon in children to certain types of fruits (apples, pears, pears, plums), eating them in large quantities can trigger the development of irritable bowel syndrome.
In addition to nutrition, young children and infants are susceptible to irritable bowel syndrome due to neurogenic disorders that depend on the internal regulation of the digestive organ. Various changes in the process of intestinal motility are also common. In addition, during ultrasound examinations, spasticity of the colon and deviations in fecal transit are often detected in children.
Causes of IBS in adults
In addition to poor nutrition, the following factors can lead to irritable bowel syndrome:
- stress, nervous disorders, emotional instability, worries;
- poor nutrition;
- genetic predisposition;
- lack of fiber in the diet;
- hormonal disorders;
- various diseases affecting the functioning of the gastrointestinal tract.
The leading place in the list of causes of IBS after poor nutrition and diseases of internal organs is stress and emotional tension. The etiology of irritable bowel syndrome directly depends on psychological health, since various disorders (panic, irritability) provoke increased reproduction of substances responsible for the speed of digestion. Moreover, the more severe the stress or psychological trauma, the more severe the symptoms of IBS will be.
Symptoms and signs
Disorders in the intestines can be temporary, caused by an unbalanced diet or food poisoning, or permanent, indicating serious illness. Such symptoms may indicate irritable bowel syndrome, which in medicine is considered a fairly serious diagnosis. Temporary signs of instability of the digestive system can be distinguished from IBS by the following symptoms.
Main symptoms
IBS can manifest as:
- problems with stool (diarrhea, constipation, passing gas);
- discomfort, spasms and pain in the abdominal area of various locations (in one or several places at the same time), decreasing after defecation and increasing after eating;
- bloating of the abdominal cavity (the abdomen increases in size during the day, increasing in size towards the evening);
- the appearance of mucus in the stool.
Other signs of IBS
In addition to abdominal symptoms of the disease, IBS can manifest itself in extraintestinal symptoms. Among them:
- frequent headaches;
- high fatigue, loss of strength;
- sleep disorders, insomnia;
- lack or deterioration of appetite;
- a slight increase in temperature (within subfebrile - up to 37.5);
- signs of arrhythmia, rapid pulse;
- feeling of lack of air or suffocation;
- weight loss due to loss of appetite or psychological reasons for the development of IBS;
- violation of skin pigmentation and its nutrition (manifests in the form of peeling, dryness, formation of redness, age spots, change in color of the epidermis).
What should you be wary of?
Symptoms of irritable bowel syndrome may also indicate many other serious diseases hiding under the guise of IBS. They can be distinguished from this disease by the following signs that are not characteristic of it:
- the disease began in old age - IBS typically manifests itself earlier in childhood or young adulthood;
- constant acute pain - irritable bowel syndrome is chronic, most often the pain is dull, aching in nature, subsides after bowel movement. Constant and prolonged pain indicates another disease;
- increasing severity of the disease;
- nocturnal symptoms – with IBS, most often discomfort and the urge to defecate appear in the morning and daytime hours;
- a sharp decrease in body weight, if it is not facilitated by loss of appetite;
- bleeding from the anus;
- diarrhea with acute pain;
- seals in the anus;
- the appearance of a large amount of fat in the stool, not related to nutrition (steatorrhea);
- increased body temperature, fever or prolonged low-grade fever (up to 37.5 degrees);
- lactose, gluten or fructose intolerance;
- signs of dehydration;
- anemia;
- swelling of the abdomen;
- cancer and inflammatory bowel diseases in relatives.
Such symptoms cannot be ignored, since they indicate more serious illnesses than IBS. Ignoring them and attempting self-medication can lead to the diagnosis being made at an advanced stage, which poses a serious danger to the patient.
Classification
Unpleasant symptoms in the pathology of irritable bowel syndrome appear in combination or individually. The disease can take one of the following forms:
- IBS with pronounced diarrhea or impaired bowel movements towards relief (infrequent loose stools);
- irritable bowel syndrome with constipation;
- IBS without changes in stool, but with pronounced pain, cramping, bloating or gas formation in the intestines;
- IBS disease with variable stool (when, depending on certain conditions, diarrhea is replaced by constipation and vice versa).
The first variant of irritable bowel syndrome is the most common; it is characterized by the manifestation of a pronounced urge to defecate almost immediately after eating. The amount of need for bowel movements in this case increases greatly. It is also possible for urges to form due to emotional tension, stress, anxiety or excitement. With this kind of IBS, they are preceded by an acute unpleasant sensation in the lower abdomen and lateral intestines, which completely disappears after relief.
The second variant of IBS manifests itself in the form of constipation for up to 2-3 days, during which pain occurs inside the abdomen, intestinal colic or aching pain. With IBS, appetite decreases, heartburn appears, an unpleasant taste on the tongue, and a slight feeling of nausea may occur (usually without the urge to vomit). The stool becomes dense and may contain mucus.
In the third variant, irritable bowel syndrome occurs without a pronounced disturbance of stool, it remains normal or the number of urges slightly increases, but the shape and density of stool do not change. At the same time, unpleasant signs of IBS bother the patient. This may include pain and cramping in the lower abdomen and sides, bloating in the abdominal area, and the passage of gas.
The fourth option for the development of IBS includes all possible signs. Stool disorders alternate depending on various factors, with spastic, stabbing, sharp or aching pain in the abdomen, flatulence, and mucus formation. Also, such patients are often bothered by an anxious feeling of having to visit the toilet again immediately after bowel movement.
Diagnostics
Irritable bowel syndrome is classified as a functional disorder. There are no special types of research to make a diagnosis, since the disease does not affect the internal organs of a person in any way and does not provoke the development of pathologies. If it is suspected, the doctor prescribes a differential diagnosis to rule out other ailments that have the same symptoms. If no other pathologies are identified, a diagnosis is made and symptomatic treatment of IBS is prescribed.
A doctor may suspect IBS if the patient complains of:
- bloating, frequent passing of gas;
- a feeling of pain and stinging in the lower and sides of the abdomen, which precedes the urge to defecate (with normal bowel movements) and disappears after it;
- the appearance of unpleasant and painful sensations in the intestines accompanying constipation or diarrhea;
- changes in bowel movements (a feeling of fullness in the intestines after emptying, an increase in the number of visits to the toilet per day, a strong urge to defecate when it is impossible to tolerate, and others);
- the presence of impurities visible to the eye, mucus in the feces;
The disease is characterized by a periodic change between chronic and acute conditions, therefore, to establish an accurate diagnosis, the doctor needs to know that:
- the manifestation of these changes occurs in connection with some events in the patient’s life;
- symptoms appear against the background of stressful situations, depression, agitation;
- pain and the urge to defecate occur when eating or immediately after eating;
- there are other symptoms associated with other organs and systems;
- there are unpleasant sensations when palpating the abdomen.
If there is one or more of the described complaints, the doctor may prescribe the following tests:
- general blood analysis. This is done to identify deviations from the norm, which makes it possible to notice an increase in the number of leukocytes as a sign of inflammation, as well as anemia, as an indicator of possible hidden bleeding;
- blood chemistry. Determines some diseases of internal organs (liver, pancreas, etc. in order to exclude them from the list of possible causes);
- blood for celiac disease. Allows you to exclude a serious disease of the gastrointestinal tract, leading to functional disorders in it and entailing the development of prolonged diarrhea, which is also characteristic of IBS.
- stool occult blood test. Determine the presence or absence of hidden intestinal bleeding;
- microscopic examination of stool and scatology. Detects various changes in feces, allows you to determine the presence of an inflammatory or infectious process. In this way, the underlying disease is determined;
- abdominal ultrasound and intestinal ultrasound can detect many serious diseases of internal organs, including some neoplasms;
- colonoscopy and sigmoidoscopy (instrumental examinations). Prescribed for suspected tumors, inflammatory bowel diseases, developmental anomalies, diverticula;
- CT, MRI. Studies are prescribed if there is a suspicion of intestinal obstruction, acute appendicitis, the presence of fecal stones or oncology.
If none of the other possible diagnoses are confirmed, the patient is diagnosed with IBS and treated.
Treatment
IBS therapy, especially medication, is carried out under the supervision of a doctor. It depends on each specific case and is based on the individual symptoms manifested by the patient, since the course of the disease may vary among patients. Regular treatment of irritable bowel symptoms with medications, prebiotics, and physical therapy can completely get you “on your feet” and get rid of the disease.
Symptomatic treatment
Treatment of IBS with drugs is a method prescribed by a doctor to eliminate the main symptoms (bloating, pain, bowel movements, etc.). Usually a regimen of drugs with different properties is prescribed.
- Antispasmodics. Relieves muscle spasms, thereby reducing the intensity of most manifestations of the disease in irritable bowel syndrome. Most often, doctors prescribe Mebeverine, Duspatolin, Niaspam, and Sparex. The dosage and number of applications are prescribed to patients individually. These antispasmodic medications often contain peppermint oil, which can cause side effects such as heartburn and a burning sensation in the anal area. Treatment of IBS during pregnancy with these drugs is not approved.
- Laxatives. They allow you to quickly eliminate constipation and reduce the density of stool in case of IBS. Such drugs increase the amount of fluid, diluting the intestinal contents to a soft state. They should be consumed with plenty of water, since most medications of this action contain fiber, which swells in the feces. Using laxatives before bed is not recommended. Irritable bowel syndrome can be treated with drugs: Duffalac, Frutolax, Guttalax, Regulax and others.
- Antidiarrheals. This type of medication is suitable for the treatment of IBS with diarrhea; they affect intestinal motility, which allows you to increase the time between the urge to defecate. They help compact the structure of feces, bringing it to normal volume, smoothly bringing it back to normal. Most medications with antidiarrheal effects have side effects (intestinal muscle spasms, dizziness, bloating, drowsiness, and others) and are contraindicated in pregnant women. IBS with diarrhea can be cured with the help of drugs: Trimedat, Loperamide, Imodium and others.
Stress management
If the causes of the onset or exacerbation of IBS symptoms are stress, psychological stress, fatigue or depression, then, along with symptomatic treatment, the following groups of medications are prescribed to reduce the impact of the psychological factor on the body:
- Antidepressants. Prescribed if a connection has been identified between exacerbation of IBS (irritable bowel syndrome) and stressful situations, worries and other emotional changes.
- Sedatives. They are used for short-term combating acute attacks of panic, anxiety, and overexcitement.
In addition to medications, the following types of psychological treatment can help cope with various types of emotional instability and weakness that lead to exacerbation of IBS:
- psychotherapy;
- hypnosis;
- cognitive behavioral therapy;
- other psychological methods (meditation, relaxation therapy)
These treatment methods give the greatest effect in combination with some other methods of treating IBS (diet, symptomatic treatment, folk remedies)
Diet
The motto of a patient with irritable bowel syndrome is proper, balanced nutrition and an active lifestyle. Portions should be small, and the meals themselves should be divided into 5 times. Junk food is completely excluded, and prebiotics are added to the diet. If symptoms of bloating and gas appear, cabbage, legumes, apples, grapes and other gas-forming foods should be removed from the diet. In case of lactose intolerance, the consumption of milk and foods containing it is limited.
Treatment of constipation is carried out by introducing dietary fiber, fiber and products containing them into the diet. For IBS diarrhea, rice must be added to the diet, and raw fruits and vegetables are completely prohibited. The menu must include:
- diluted cranberry juices, compotes, tea;
- poultry broths;
- pasta;
- boiled or baked vegetables: potatoes, carrots, tomatoes;
- porridge, first courses.
Alternative Treatment
Symptomatic treatment of IBS can be done with non-drug medications. Traditional methods can reduce most signs of the disease.
With nausea, vomiting and intestinal colic, freshly squeezed potato juice helps. A decoction of a mixture of peppermint, chamomile, hydrastis, marshmallow, and dioscorea will help relieve inflammation of the walls in IBS and relax tense intestinal muscles. Cabbage juice is universal for heartburn, vomiting, abdominal pain and constipation.
Help with intestinal pain, flatulence, and bloating in IBS:
- peppermint decoction;
- ginger;
- cinnamon;
- a decoction of a mixture of mint, buckthorn bark, and chamomile flowers;
- infusion of caraway seeds, mint, valerian, fennel and chamomile;
- a decoction of calendula flowers, linden, cornflower, birch leaves, sage;
- infusion of wormwood leaves, dill seeds and yarrow.
To help with constipation:
- decoction of plantain seeds;
- flax seed mood;
- decoction of prunes and dried apricots.
Help with diarrhea due to IBS:
- massage with a mixture of peppermint, geranium, tea tree, sandalwood and almond oils;
- a decoction of plantain, nettle leaves, dried wort, sage and St. John's wort;
- infusion of the peel and internal partitions of ripe pomegranate;
- freshly squeezed carrot juice with pulp;
- thick rice water.
When stressed, it is good to use herbal infusions or a mixture of herbs:
- valerian root;
- motherwort grass;
- St. John's wort;
- oregano;
- peppermint leaves;
- series;
- chamomile;
- Melissa;
- Blooming Sally;
- elecampane.
Treatment of IBS in children
Diagnosis of irritable bowel syndrome in young children is significantly difficult, since patients cannot yet formulate their complaints. Hematuria syndrome due to intestinal diseases significantly complicates the situation in childhood, so treatment of IBS symptoms cannot be delayed.
Parents should be alert to the following signs:
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- the child has become more capricious, restless, and cries often;
- time spent on the potty increased;
- Problems with stool have appeared (the child poops while crying or cannot poop at all, visits to the potty have become more frequent, diarrhea has developed).
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