Irritable bowel syndrome
It is almost impossible to meet a person who would not be faced with the discomfort that occurs as a result of intestinal dysfunction. It could be such conditions of the digestive system that provoke constipation, diarrhea, colic, flatulence. In any case, it definitely affected the usual rhythm of life, disrupting it. The cause of the development of malfunctions in the intestines is not always bacterial agents that cause infections, or diseases of the digestive tract of an organic nature.
The available statistics unequivocally indicate that in 30% of cases, all disorders of the small and large intestines are due to functional disorders of their motor activity. These disorders in medicine are called a single term - irritable bowel syndrome.
Content:
- What is Irritable Bowel Syndrome?
- The causes of IBS
- IBS symptoms and signs
- Diagnosis of IBS
- Differential diagnosis of IBS
Treatment methods
- Diet
- If IBS is accompanied by diarrhea
- If IBS is accompanied by constipation
- For pain and cramps with IBS
- Antidepressants for IBS
- If IBS is accompanied by dysbiosis
- Alternative treatments
What is Irritable Bowel Syndrome?
Irritable bowel syndrome is a recurring stool disorder accompanied by painful sensations in the absence of other provoking reasons. Such reasons may be: fungal, bacterial or viral infection of the intestine, its immune inflammation, colonization by protozoa or helminths, the presence of a tumor, congenital anomalies of anatomical development. Moreover, all laboratory tests in a person should be normal, there should be no changes in blood and feces.
With regard to the issue of prevalence among the male and female population, women are more likely to suffer from this problem. They are prone to irritable bowel syndrome in 15-25% of cases, and men in 5-15% of cases. More often, these are people over the age of 20, the peak incidence among them falls on 35-50 years. Approximately 40% of people with characteristic complaints are in this age range.
Less than 40% of patients seek qualified help, of whom only 28% go with their problem to gastroenterologists, and 12% to therapists.
Irritable Bowel Syndrome Causes
It is impossible to designate any one reason why disorders in the functioning of the gastrointestinal tract develop. However, scientists have identified the most likely causes of irritable bowel syndrome, including:
-
Stress. It was found that intestinal problems of a corresponding nature most often occur against the background of instability and excessive excitability of the nervous system. Chronic stress is a particular danger in this regard. The same reason explains the fact that among the sick women are predominantly women, moreover, of young age.
Most often, a vicious circle is created: an unfavorable emotional background arises, it entails stress, stress contributes to irritation of the intestines, problems with the digestive system make a person fall into depression, because of this, other systems and organs suffer. Therefore, often in people suffering from irritable bowel syndrome, a neuropsychiatric doctor identifies various neuroses and personality disorders.
There is even such a joke among the representatives of medicine: instead of the term "irritable bowel syndrome", they use the term "irritable head syndrome". This is due to the fact that in parallel with disturbances in the digestive tract, there are problems with the central nervous system and autonomic regulation.
-
Violation of the motor activity of the intestines. The syndrome can be caused by impaired motor activity of the intestine, disruptions in the conduction between the intestinal muscles of nerve impulses, which causes the digestive organ to contract. In this case, it is not possible to detect any deviations in the functioning of the intestinal nervous apparatus or in the intestinal wall itself. Relaxations and contractions occurring with an indefinite frequency occur by themselves.
- Such people often suffer from a feeling of fullness and distension of the intestines, the threshold of their pain sensitivity is increased.
- You can also establish some relationship between hormonal fluctuations in the body and exacerbations of pathological symptoms. Often, women note that on the last and first day of the next menstrual cycle, they experience diarrhea, increased intestinal pain. Doctors attribute this to an increase in the concentration of prostaglandin E in the blood.
- An upset bowel can occur due to the inclusion of excessively fatty foods with a high calorie content on the menu. However, not only food, but also drinks can cause discomfort. The greatest danger in this regard is represented by: coffee and tea, alcohol and sweet carbonated water.
- Do not forget about the hereditary predisposition to such disorders. If irritable bowel syndrome has been diagnosed in a parent, it is more likely to bother children.
- Postponed intestinal infections can cause IBS. This is about 30% of all people with characteristic disorders.
- Lack of ballast substances that activate the production of digestive enzymes, as well as dysbiosis - all these conditions can act as the cause of irritable bowel syndrome.
Irritable Bowel Syndrome Symptoms and Signs
The symptoms of irritable bowel syndrome are very similar to those of common intestinal disorders.
There are several possible options for the course of pathology with characteristics characteristic of each of them:
-
Diarrhea-type irritable bowel syndrome. The urge to empty the bowels occurs either immediately after eating, or during the act of eating. A person can experience such discomfort several times throughout the day. Most often this happens in the morning or in the morning.
- Diarrhea is often accompanied by emotional excitement, fear, anxiety. In the common people, you can hear such a term as bear disease, which characterizes a similar condition. The analogy is drawn with this forest dweller for a reason. It is he who reacts to danger or fear with an act of involuntary defecation. (read also: Symptoms, color and causes of diarrhea)
- Severe bloating, painful sensations localized in the right and left sides, as well as below the navel - these are the symptoms that accompany a sudden urge to empty the intestines. After visiting the restroom, the person experiences marked relief.
-
Constipation-like irritable bowel syndrome. Stool retention can be observed for more than 3 days. In this case, the person will also experience a feeling of bloating, pain in the characteristic area. Sometimes painful sensations proceed as colic, sometimes they are aching in nature. When the stool resolves, the pain dulls somewhat, but does not go away completely. The stool resembles the shape of sheep's feces with white or transparent mucous impurities.
Due to the prolonged inability to empty the intestines, a person suffers from appetite, heartburn or nausea may haunt him, and an unpleasant aftertaste appears in the mouth. (read also: Constipation - Causes, Symptoms and Treatment)
- Irritable bowel syndrome with alternating constipation and diarrhea. In this case, painful sensations come to the fore. Stool retention and diarrhea alternate.
To summarize, it can be noted that irritable bowel syndrome is accompanied by the following symptoms:
- Variability of stool disorder with a predominance of either constipation or diarrhea, or with their alternation.
- Abdominal pain that tends to improve after bowel movement.
- The resulting feeling of impossibility to contain feces.
- Flatulence, accompanied by severe bloating.
- Impurities of mucus in feces.
- A feeling of incomplete emptying of the intestines after going to the toilet.
Diagnosis of IBS
The diagnosis of irritable bowel syndrome is a certain challenge for doctors, since the indicators of blood and feces tests, X-ray examination and biopsy in humans remain within normal limits. Therefore, a conference was held in Rome at which the criteria for diagnosing irritable bowel syndrome were clearly defined.
Signs of this pathology are considered to be: pain and discomfort in the intestines for 3 days a month. The duration of the occurrence of such pain is six months or more. After the act of defecation, the person should feel relief. The change in the appearance of the stool and its shape should have occurred at the moment when the patient first noted painful sensations in himself.
Additional criteria that help clarify the diagnosis are:
- Acts of defecation are more frequent and occur more often 3 times in 24 hours, or reduced and occur less often 3 times in 7 days. That is, the person suffers from constipation or diarrhea.
- The stool changes shape: it becomes liquid with foam or hard and rough.
- Defecation is either difficult, or the urge cannot be contained.
At the same time, differential diagnosis is important, which makes it possible to distinguish between irritable bowel syndrome from other, more serious organ pathologies. That is why a patient with characteristic complaints should be sent for the following tests:
- General blood analysis;
- Blood chemistry;
- Coprogram;
- According to indications, undergo an irrigoscopy or sigmoidoscopy;
- If necessary, a biopsy of the intestinal wall is performed.
It has been established that most of the patients, namely 90% of people, after visiting a doctor and diagnosing IBS, independently cope with the symptoms of pathology and do not consider themselves sick. However, the remaining 10% of people recognize themselves as hopeless patients. They strive to undergo more and more new examinations, which do not reveal more or less serious diseases in them. Nevertheless, people are even more convinced that they have an extremely severe pathology and are often socially isolated for this reason.
Differential diagnosis of IBS
Problems with bowel movements and abdominal pain do not always indicate irritable bowel syndrome. Therefore, differential diagnosis is so important to establish the symptoms that are not typical for this syndrome.
Among them:
- Manifestation of a pathological condition in old age;
- Disease progression;
- The presence of acute symptoms, it is important to remember IBS - this is a chronic disease;
- Signs of intestinal disturbances occur at night;
- Discharge with blood impurities is observed from the anus;
- Diarrhea is painful;
- The feces contain fatty inclusions (steatorrhea);
- The body temperature rises;
- There is intolerance to gluten, lactose, fructose;
- Close relatives have been diagnosed with bowel cancer or other inflammation.
It is important to distinguish IBS from the following conditions to avoid misdiagnosis:
|
|
| Natural hormonal fluctuations in a woman's body |
|
| Gynecological diseases |
|
| Diseases of the intestines of organic origin |
|
| Gastrointestinal tumors of neuroendocrine origin |
|
| Endocrine etiology pathologies |
|
Treatment methods
The main task of treatment is to eliminate its negative symptoms that worsen the quality of human life. However, before resorting to conservative therapy, one should turn to the teachings of Academician Pavlov and recall his theory, which boils down to the fact that all diseases have their roots in disorders of the central nervous system. It is with regard to irritable bowel syndrome that his teachings are very relevant. Practical medicine has proven that various activities that are aimed at achieving the psychological comfort of an individual will have a positive effect on the condition of a person with IBS.
Therefore, when the symptoms of this disease periodically arise, and the person himself is not able to cope with chronic stress, problems in society, or within the family, it is necessary to seek qualified help from a psychologist. When a phobia of bowel movement or somatized depression develops against the background of IBS, the help of a psychiatrist and a neuropathologist is mandatory.
When the condition is not aggravated, before resorting to medical correction, you can try to adhere to the following recommendations:
- Revise your lifestyle;
- Set up food;
- Exclude tobacco and alcoholic beverages;
- Physical activity should be daily, but feasible;
- Spend more time in the fresh air, just walking.
Such simple advice is quite capable of helping to cope with the imbalance of the nervous system and solve intestinal problems when they "grow" out of the head.
Diet
As for the transition to nutritional therapy for irritable bowel syndrome, it is not required. Nevertheless, certain rules should still be followed. First of all, you need to adjust the power supply. It should be fractional and take place in a calm atmosphere.
Depending on which symptomatology prevails in a person with irritable bowel syndrome, the following recommendations should be followed:
- With diarrhea, foods that stimulate intestinal motility should be excluded. These are all vegetables and fruits with coarse, indigestible fiber, as well as apples, plums, beets.
- With constipation, you should refuse fried and fatty foods.
- With increased gas production, you should not eat too much legumes, grapes, pastries, cabbage, nuts.
If a person knows about the presence of lactose intolerance, then milk should be excluded from the diet. It is successfully replaced by kefir, fermented baked milk, yogurt.
If you have celiac disease, then you must completely avoid foods containing gluten.
In addition, the consumption of carbonated drinks and chewing gum should be minimized. To normalize the intestinal microflora, Linex's course reception will help.
If IBS is accompanied by diarrhea
When the stool cannot be adjusted by more gentle methods, and the painful sensations are accompanied by diarrhea, it is necessary to resort to more radical methods of dealing with the pathology. However, you should not stop diarrhea on your own with drugs, since food infections often become its cause. Therefore, a gastroenterologist should prescribe drugs.
In addition, continuous medication for irritable bowel syndrome can be dangerous.
Drugs are prescribed exclusively for the period of exacerbation of this chronic disease:
- Up to three times a day before meals, you can take one tablet of Diphenoxylate or Loperamide (Loperamide, Lopedium, Diara, Imodium - the cost of these drugs is from 20 to 250 rubles). These funds help to slow down intestinal motility.
- To eliminate diarrhea, you can use Smecta.
- Astringent properties are possessed by decoctions of pomegranate peel, sweet cherry, alder and bird cherry fruits.
- Alosetron can help with diarrhea with irritable bowel syndrome.
- Sorbent preparations can be used, including: Polyphepan, Enterosgel, Polysorb, Filtrum STI.
If IBS is accompanied by constipation
- Allow to increase the volume of intestinal contents such drugs as: Naturolax, Mucofalk for 350 rubles, Ispagol - the price of 250 rubles, Metamucil, Fiberlex for 150 rubles, Solgar Psyllium for 1200 rubles. All these preparations are made on the basis of the flea plantain. With the addition of synthetic cellulose, kelp and agar, you can purchase products such as: Polycarbophil, Fibercon, Citrucel and Fiberal. The effect of taking them will last for 10 hours after the first dose.
- A popular remedy for relieving constipation is lactulose, a polyhydric alcohol. These are drugs such as: Normase, Portolac, Duphalac, Romfalak, Goodluck. They can be prescribed to people of any age, since they are not absorbed in the blood and allow you to cleanse the intestines with constipation.
- Preparations based on polyethylene glycol have a similar effect to lactulose. Their effect begins 3-6 hours after the first dose. These are such medicines as Macrogol, Forlax and Lavacol costing 200 rubles, Fortrans for 500 rubles, Relaxan, Osmogol, Transileg, as well as lactiol - Exportal.
- It is possible to take serotonin modulators: Prucaloprid and Tegaserod.
- Vaseline and vegetable oils also have a laxative effect. In addition, you can use Norgalax, sodium picosulfate (Slabilen in drops for 100 rubles, Slabikap, Gutassil, Guttalax in drops for 300 rubles, Laxigal for 350 rubles, Regulax Picosulfate for 150 rubles.
- In addition, mineral waters enriched with magnesium ions have a laxative effect. For example, this is Essentuki # 17.
For pain and cramps with IBS
- Preparations from the antifoam group: Espumisan, Zeolat, Polysilan, Dimethicone. They contribute to the destruction of gas bubbles, which often lead to painful sensations.
- Debridat, as well as calcium channel blockers such as Dicetel and Spasmomen, are capable of regulating motor skills and reducing pain.
- In addition to the standard means to relieve spasm - No-shpy and Drotavern, anticholiergic drugs can be prescribed for IBS, such as Darifenacin, Hyoscyamine and Zamifenacin.
Antidepressants for IBS
It is no secret that irritable bowel syndrome is often an expression of psychological problems. However, even when everything is in order with the psyche, the syndrome itself can lead to neurological disorders. Moreover, this can happen even with the most balanced person. In this regard, doctors are increasingly prescribing tricyclic antidepressants for such patients.
Drugs of this group help to normalize the process of transmission of impulses through neurons from the spinal cord and brain to the intestine, and also reduce a person's susceptibility to pain. As a result, stool disturbance and pain are eliminated, since uneven bowel contractions either completely disappear or significantly decrease.
- Doxepin, Amitriptyline, Nortriptyline, Imipramine and Trimipramine are considered to be the gold standard for the treatment of IBS with antidepressants.
- Modern practical medicine indicates that the following drugs will be most effective for psychosomatic disorders: Pyrazidol, Befol, Fenelzin, Moclobemide.
If IBS is accompanied by dysbiosis
If, against the background of irritable bowel syndrome, the patient is diagnosed with dysbiosis, then this greatly aggravates the course of the pathology, increasing the discomfort. The pain is more intense, and the bloating and stool upset increase. Therefore, it is necessary to get rid of dysbiosis without fail.
To suppress the vital activity of pathogenic bacteria, use:
- Seven-day course of nitrofurans: Enterofuril, Furazolidone, Stop-diarrhea.
- With an unburdened course of dysbiosis, nitrofurans can be replaced with probiotics that have antibacterial activity. It can be: Bactisuptil, Enterol or individually selected bacteriophages.
- Perhaps the appointment of fluoroquinolones, for example, Cefloxacin or Ciprofloxacin, or Metronidazole, Trichopol. An antiseptic intestinal agent is also used - Intetrix, or an antimicrobial drug - Rifaximin (Alfa-normix).
The therapy should be supplemented with enterosorbents, such as: Enterosgel, Filtrum, Lactofiltrum.
When the course aimed at suppressing pathogenic microorganisms is completed, it is necessary to use drugs to normalize its own intestinal microflora. Show the greatest efficiency: Permadophilus, Linex, Bifidumbacterin, Normoflorin, Bifikol. They must be taken throughout the month.
In addition, doctors prescribe drugs that create favorable conditions for the reproduction and vital activity of beneficial microorganisms in the intestine. It could be Hilak-forte and Lactulose.
Alternative treatments
Since the pathology is due to transient functional disorders, the use of alternative methods of treatment is quite justified. In addition, there are such traditional medicines that were used to eliminate disturbances in the work of the intestines long before the appearance of the term IBS itself. However, as in traditional medicine, it is necessary to use folk remedies prudently and observe the measure.
-
Medicinal plants. There are several herbs that can help with irritable bowel syndrome:
- Peppermint oil can help relieve spasms when used in an aroma lamp.
- Oak bark, chamomile decoction have long been known for their astringent properties. Fennel seeds, dill water, caraway seeds, valerian root, mint, chamomile and anise drops will help relieve soreness.
- Burnet, Potentilla root, plantain, serpentine, sage leaves, blueberries, walnuts - all these gifts of nature help to eliminate diarrhea.
- Physiotherapy. Exercise can help normalize bowel function. It is better if the classes are held outdoors. This has a beneficial effect on the central nervous system, which means it helps to eliminate the symptoms of IBS. Yoga, Pilates, brisk walking and cycling can be effective. In Sweden, at the University of Gettenberg, special experiments were carried out, which made it possible to establish that even 30 minutes of moderate physical activity a day helped to reduce the symptoms of IBS in 50% of patients. You need to do it up to 5 times a week.
- Mediation practices. You can calm the nervous system with yoga. They are sometimes a great alternative to taking antidepressants. However, it is important that the patient himself can tune in to achieve the result. It is better if the classes are held in groups. Summing up, we can conclude that for the treatment of irritable bowel syndrome, drugs are not so important as adherence to a measured lifestyle, as well as belief in complete recovery, which is quite real.
The author of the article: Gorshenina Elena Ivanovna | Gastroenterologist
Education: Diploma in the specialty "General Medicine" received at the Russian State Medical University named after N. I. Pirogova (2005). Postgraduate studies in the specialty "Gastroenterology" - educational and scientific medical center.
