Irritable Bowel Syndrome or IBS – this is a functional impairment intestines. For functional disorders characterized by the lack of laboratory evidence of the disease, although the patient feels unwell. The disease was described in the middle of the nineteenth century, but in those days it was called mucous colitis. Then the names changed many times and only by the end of the eighties of the twentieth century the term “irritable bowel syndrome“.
In total, the disease affects almost twenty-two million people on the planet, which is 20% of the population of mature age. Representatives of the weaker sex at the age of thirty to forty years are more susceptible to the disease. Unfortunately, the vast majority of patients do not even resort to the services of doctors, despite the fact that the disease not only affects the digestion of food, but also significantly reduces the quality of life of the patient. Patients decrease their sexual desire, their efficiency decreases, people stop enjoying life.
Mind and development of IBS
Stress was added to this list only at the beginning of the twenty-first century, and now it is considered almost the most important cause of the disease.
It is known that people with IBS are sick more often depressed, experiencing various fears (in particular, fear of getting cancer). In these patients, enhanced production of substances (endogenous opioids), which affect the activity of substances that trigger the process of digestion: the production of gastric juices, motor and secretory functions of the intestine.
It is noted that the most complex forms of IBS are observed in persons who have experienced situations on the verge of life and death, sexual abuse, physical abuse, as well as psyche deviations. Even the death of one of the parents in childhood or the divorce of the parents can subsequently cause the development of irritable bowel syndrome in an adult.
Who is at risk of getting sick?
- Representatives of the weaker sex suffer more from the disease during menstruation, since the symptoms are provoked by sex hormones, the number of which is increased during this period.
- According to some reports, the syndrome may be triggered by an acute intestinal infection.
- People suffering from chronic infectious and parasitic diseases of the digestive system are also at risk. Most often, IBS is combined with giardiasis, since giardia secrete substances that destroy the mucous membrane of the large intestine.
- Persons suffering from dysbiosis are also at risk. The intestines of such people are very sensitive to any small violations of microflora.
What is the function of the large intestine and what happens with IBS?
The length of the large intestine is normally about one and a half meters. The main task of this body is to absorb liquids and salts from semi-processed food masses, which are sent from the small intestine. During the day about two liters of fluid enter the colon. Here it can stagnate even for several days until complete absorption. Dehydrated fecal matter is evacuated from the body.
Contractions of the muscles of the colon push fecal masses towards the rectum. The strongest shocks occur several times a day.
In a number of individuals, the motor function is somewhat changed, which is the impetus for the development of the syndrome.
According to doctors, with this syndrome, pain is localized in the wall of the large intestine. In the tissues of this organ, there are many nerve endings that are sensitive to “stress hormones”, including adrenaline. The pain leads to an increase in intestinal motility, with increased gas formation, even a small bowel distension causes pain, since the receptors are already “excited”. The reaction to pain may be the opposite – that is, the patient becomes constipated. Both the small intestine and the large intestine are spasmed.
Signs of disease
The disease is chronic. Signs of it may appear after the age of twenty and with more or less intensity to pursue a person for life. In some people, the symptoms of IBS are completely gone.
According to the clinical picture, there are three types of irritable bowel syndrome:
- The main symptom is diarrhea,
- The main symptom is constipation.
- The main symptom is increased flatulence and epigastric pain.
At the same time, often in the same patient the symptoms can replace each other.
The most common symptom of the syndrome in all cases is an unpleasant sensation in the stomach, pain, and a change in the frequency of bowel movements. In addition, the quality of feces also changes. They can be either very solid or semi-fluid. In addition, patients note unsuccessful urge to defecate, a feeling of incomplete cleansing of the intestine, excessive attempts during bowel movements, the presence of mucus in the feces, excessive gas emissions.
Very often, IBS is associated with such illnesses as GERD (gastroesophageal reflux disease), muscle pain, migraine-like pain, manager syndrome, back pain, and depressed mood.
According to some studies, about sixty percent of patients with the syndrome are mentally unstable individuals with a predominance of anxiety.
Symptoms with prevalence of diarrhea
- Pain immediately after waking up in the morning. The intensity of the pain may be different, but the time of appearance is constant.
- Pain appears during eating, more often before lunch.
- Persistent diarrhea, a feeling of not definitive release of the intestines.
- Increased gas formation in the morning.
- Panic attacks and urges to defecate during difficult situations.
- Predisposition to dysbacteriosis.
- Discomfort when lying on the left side.
- Violation of urination.
- Migraine-like pains.
- Feeling of lack of oxygen.
- Sensation of a foreign object in the throat during swallowing.
- Sometimes predisposition to candidiasis.
Symptoms with constipation prevailing
- Difficulties with defecation in 25% of cases and more,
- Solid or pelted (sheep) feces in 25% of cases and more often
- Feeling of congestion during defecation in 25% or more of cases
- Hand help with bowel movement at 25% and more often or three times a week.
According to the Rome criteria (criteria adopted in 1988 by the International Group for the Study of Functional Pathology of the GIT) IBS is diagnosed if, in the absence of laboratory changes, the patient has experienced pain or discomfort in the stomach area for twelve months in a row that passes after a bowel movement. And also at least twice a week there is a combination of several of the following violations: mucus in the feces, bloating, a violation of the consistency of feces, difficulty with defecation.
When diagnosing a disease, especially in elderly patients, it is necessary to make sure that the symptoms are not caused by more serious diseases, such as intestinal cancer. In addition, it is necessary to ensure the absence of such diseases as Crohn’s disease, ulcerative colitis, intestinal infections, diverticular disease. Particular attention should be paid to such symptoms, which can indicate more complex diseases: weight loss, bleeding from the intestines, the appearance of symptoms of the disease in the dark, genetic predisposition to intestinal cancer, fever. If there is at least one of the above symptoms, the patient must undergo a full examination of the digestive organs.
In addition, when diagnosing, anal pathologies, mental disorders, diseases of the endocrine system, gynecological disorders, as well as the influence of drugs and some physiological conditions in women, should be excluded.
The diagnosis itself is divided into five stages.
First stage – preliminary diagnosis.
Second stage – the main symptom is determined and on its basis the form of the syndrome.
Third stage – the disease is differentiated from the above, and signs of anxiety are excluded.
Fourth stage – the “search” for organic disorders ends, the results of surveys, tests, analyzes are obtained.
Fifth stage – determination of the first stage of therapy for a month and a half or more. The effectiveness of this treatment confirms or refutes the diagnosis.
There are a number of tests that are used to diagnose, but they are quite complex and not every clinic can afford them.
If the patient complains of pain more, serial enterography, intestinal manometry, balloon-dilatation test are used.
If the main complaint is diarrhea, aspiration of the contents of the small intestine on the microflora, lactose tolerant test is used.
If the patient is most worried about constipation, an anorectal examination is prescribed, a radioisotope examination of the passage of fecal masses is indicated.
The most common diagnosis is “irritable bowel syndrome»Put the method of exclusion of other diseases. The most common disease that causes IBS is lactase deficiency or disaccharidase deficiency. The easiest way to identify this disease is to exclude from the diet products that include milk and its derivatives, as well as sorbitol for the digestion of which disaccharidase is needed.
In addition, when making a differential diagnosis, the food factor is excluded: food that irritates the intestines: fat, alcohol, coffee, food, contributing to the increased production of gases. In addition, some medications should be excluded: iron, potassium, antibiotics, laxatives, misoprostol, bile acids, and some others.
Before the first visit to the doctor
- It is necessary to state in writing all ailments, including directly and not related to digestion,
- A written list of all medicines, dietary supplements and vitamins that are taken, as well as how often and in what quantities, should be stated.
- It would not be superfluous to visit the first consultation of a doctor in the company of a close relative or friend. This will help not to miss the important points of conversation with the doctor,
- You should grab a notebook with you and try to note in it the most important instructions of the doctor,
- All the questions that should be asked to the doctor should be stated in writing. The main questions are better to put on the first positions.
Such training will greatly facilitate the work of the doctor at the first consultation and increase its effectiveness.
Treatment of IBS
Treatment of IBS is only conservative and it is not an easy task. After all, the combination of symptoms in each patient is unique. Therefore, for each individual treatment program is developed.
The program always includes two stages: primary and basic. Treatment requires sufficient time and patience. The primary course is at least one and a half months.
Basic therapy lasts up to three months.
The choice of treatment is influenced by a combination of symptoms, their intensity, and the mental health of the patient and his habits.
The first task of the doctor is to convince the patient that he is not fatally ill, that his condition can be corrected. To do this, the doctor should also work as a psychoanalyst. It is very important for successful treatment to identify the factor provoking the violation of the bowels and try to completely eliminate it from the patient’s life. Since one of the main factors provoking a violation is a psychoemotional failure, it is necessary to help eliminate the causes of neurosis, which are often social, intra-family or social conflicts.
Very often, in the treatment of IBS, psychoanalysts and neuropathologists resort to the help of the patient in order to have a positive effect on the patient’s psyche simultaneously with the treatment of the body.
One of the most important moments in the treatment is the correction of the diet. Often this alone is enough to completely eliminate the symptoms of IBS.
In any form of the disease, a long course of probiotics is recommended (bifiform, bifidumbacterin, hilak-forte). Reception duration not less than 6 weeks.
Treatment of patients with a prevalence of flatulence and pain
With this form of the disease, only the elimination of pain often gives positive results and entails the elimination of bloating, constipation and diarrhea. The choice of drug remains for the attending physician.
The following groups of pain relievers are used:
one. Anticholinergic drugs
2 Cholecystokinin antagonists (loksiglumid),
3 Somatostatin and its analogues,
five. Myotropic antispasmodics (pinoverium bromide).
Most often of the listed groups of drugs used last: pinoveriuma bromide. Since the others either have many side effects or are not well understood.
Pinoverium bromide is administered 50 milligrams three times a day. In ninety percent of cases, this drug gives a good effect and relieves pain, as well as bloating.
Treatment of patients with a predominance of diarrhea
Diarrhea is one of the most unpleasant manifestations of IBS, which always reduces the quality of life and in some cases even interferes with work.
The drug of first choice in this disease is loperamide. For more than two decades, this tool has been used in medicine. Until now, no counterpart has been created for an equally short period of time and effectively eliminating diarrhea. Half of the patients noted the elimination of diarrhea after taking one pill. And almost ninety percent feel relief after 12 to 24 hours from the start of therapy. The mechanism of action of the drug is based on the inhibition of intestinal pulsation. The feces move more slowly through it, the liquid will have time to be absorbed into the intestinal walls and thereby the fecal masses reach a normal consistency. Under the action of this drug, the intestinal receptors become less sensitive to mechanical stress, so the pain decreases. Increases the tone of the anal circular muscles, thus eliminating the likelihood of spontaneous defecation.
In chronic form, an adult patient should begin treatment with two loperamide capsules (4 milligrams). Then you should take no more than 8 capsules per day. Defecation should occur no more than three times a day. If the consistency of faeces is satisfactory and the stool is not 12 hours, loperamide should be discontinued.
There is a lingual form of the drug, which is absorbed in the mouth. It is convenient to use when vomiting or problems with swallowing.
Loperamide-based products are very effective with a combination with simethicone – eliminating gases component.
If the stool is not too fast, the use of adsorbing substances – activated carbon, calcium carbonate is indicated. But the effect of these drugs can be expected only after three – five days.
If a patient has diarrhea and mental disorders, not a long course of tricyclic antidepressants that partially alleviate abdominal pain is indicated.
Treatment of patients with a predominance of constipation
In the event that a change in nutrition has no effect, osmotic laxatives are prescribed: magnesia milk, lactulose, macrogol.
If these drugs are not effective, prokinetics are prescribed, in particular cisapride 5 to 10 milligrams three times – four times a day.
Do not take saline laxatives that cause pain.
If pain is combined with constipation, the use of anxiolytics and tricyclic antidepressants can intensify pain, constipation, and gas formation.
As an adjunct to medical treatment, physiotherapy exercises, hypnotherapy, and physiotherapy are indicated. Even schools and group classes for patients with IBS practice even abroad.
Irritable Bowel Syndrome in Children
According to some reports, 14% of school-age children from time to time develop symptoms typical of irritable bowel syndrome.
Although the disease is very widespread, its diagnosis is difficult. After all, the criteria for diagnosis are still not fully defined. A group of scientists from Institute of Pediatrics, Obstetrics and Gynecology at the Academy of Medical Sciences of Ukraine developed a method for determining IBS in children and adolescents.
First of all, the doctor in detail polls the sick baby. If the baby is still very small and cannot explain his feelings, parents should carefully watch him.
Symptoms that should alert parents:
- A child is capricious, often crying,
- Long sitting on the pot,
- He has an unstable defecation: now constipation, then diarrhea.
In the event that stomach pain or discomfort is combined with digestive disorders for six months or longer, and over the past 12 weeks, these symptoms are observed more than three times a month, the child is prescribed tests that exclude the likelihood of another disease (urine test, blood test, coprogram, bakprosev stool).
If there are signs of another disease (anxiety symptoms), the baby can be sent to the hospital for a thorough examination.
In the absence of signs of other diseases, the child is prescribed treatment that takes into account the specifics of his illness. At the end of the first course of treatment is determined by its effectiveness.
Treatment of IBS in children is based on the same principles as in adult patients. This is primarily the correction of nutrition and the use of medicines.
In case of exacerbation of pain and swelling, you should not give raw foods to the child (only boiled or stewed).
When diarrhea, food should be in a mushy semi-liquid form. It is necessary to refuse raw fruits and vegetables, milk.
Medicines for IBS in children
- Binding agents, sorption and enveloping: for example, smecta. If their use does not give action – loperamide. His children are not prescribed for a long time, only until the condition is relieved,
- Probiotics, prebiotics,
- Enzyme preparations: mezim, festal, pancreatin,
- If necessary, preparations for the correction of psycho-emotional state.
When combined form:
- Selective antispasmodics, for example, Duspatalin,
- Preparations for reducing gas formation, for example, simethicone,
- Probiotics and prebiotics,
- Enzyme preparations
- After the appointment of a doctor psychotherapeutic drugs.
A very important measure of the treatment of IBS in children is to strengthen the body. It is necessary to organize outdoor games, long walks in the fresh air.
Baby food needs to be organized clearly by the hour. Portions should not be large, the multiplicity – 5 – 6 times a day. After a night’s sleep, it is helpful to give your baby juice at room temperature. In order for the intestines to work clearly, you should follow the daily regimen.
Medical nutrition in IBS
The main requirement for the nutrition of the patient with irritable bowel syndrome is a good absorption of the products included in the diet. It should be made taking into account the tastes and habits of the patient, as well as the body’s response to products.
Diet for pain and constipation
The diet as a whole must match the diet. Number 3.
The diet should contain all the necessary nutrients: proteins, carbohydrates and lipids (preference to give vegetable). It is necessary to completely abandon food, which provokes fermentation and rotting processes in the intestines, as well as food with a large amount of extractive substances, essential oils and cholesterol. Increase the level of fiber, introducing more buckwheat, millet, barley. Nutritional value of the diet from 2500 to 2800 kcal. per day.
- Grain or bran bread, rye bread,
- Fresh dairy products, cottage cheese and sour cream,
- Vegetable and cream oils,
- Fish and meat cooked in different ways
- Boiled hard boiled eggs,
- The above cereals,
- Raw fruits and vegetables,
- Jam, honey, compote,
- Sauces and seasonings.
- Chocolate, cocoa, coffee, strong tea,
- A porridge,
- Cream soups,
Food is preferably not very hot.
When deterioration in food should be more protein and completely abandon animal fat, as well as food that is not tolerated by the body of the patient. It is forbidden to use prunes, beets, honey, carrots, raw vegetables and fruits that have a laxative effect.
Those who suffer from increased gas formation should abandon peas, beans, beans, cabbage, reduce the amount of grape and apple juice, nuts, bananas, beer, raisins in the diet. Increased gas formation can be caused by sorbitol, which is sometimes included in medicines and dietary foods, as well as fructose, the source of which are berries and fruits. Eating should be from 4 to 6 times a day. Before bed, it is advisable not to gorge.
Those persons who do not tolerate milk and dairy products (lactase deficiency), should abandon these products completely or minimize their share in the diet.
When exacerbating the disease should follow the diet table №46.
- Three-day fermented milk products, fresh curd,
- Butter restrict,
- Eggs limit
- Decoction of oats and rice
- Meat in small quantities,
- Salt, sugar and sweets in small quantities.
- Spices, pickles, seasonings, spicy dishes,
- Fruits vegetables,
- Rye bread,
- Fresh dairy products, milk,
- Fatty meat and fish,
- Cold drinks,
Food and drinks should be eaten hot.
Often, patients with IBS are generally afraid to eat something and try to cut as much as possible the range of products. But it’s not right. On the contrary, the diet should be as varied as possible, taking into account the peculiarities of the work of the digestive tract of each patient. Since the lack of certain substances, such as magnesium, zinc, omega-3 and omega-6 fatty acids, leads to a deterioration of the intestinal mucosa.
There is a lot of controversy in the scientific world about how to use plant fiber in medical nutrition. Those studies that have been carried out so far give rather contradictory results. But in one the doctors are united: in the diet of patients with IBS with constipation there should be an abundance of coarse fiber, which increases peristalsis. And in the diet of people suffering from diarrhea, on the contrary, there should be a lot of water-soluble fiber (pectin).
For constipation, it is recommended to add bran, pumpkin, beets, cabbage, carrots, sea kale, mushrooms, apples, oatmeal and buckwheat into the diet. Dietary fibers in the intestine create favorable conditions for the reproduction of beneficial microflora and the production of microbial butyric and propionic acids favorable for the intestinal mucosa.
How else to alleviate the condition of IBS?
one. Eat well on schedule, do not rush, chew food very carefully.
2 Make friends with sports and physical education. This will reduce the manifestations of the disease, improve the emotional state.
3 The act of defecation should take place when the body requires it. You should not try to force yourself to defecate by force, just as it is harmful to postpone this event if there is a need.
four. In the process of defecation should not strain too much. Everything should be calm and natural. Hurry here is also not needed.
five. It is advisable to keep a food diary. This will help to identify foods that cause deterioration and eliminate them from the diet. In the food diary should be recorded absolutely everything eaten per day. At the same time it is necessary to record in the diary and the deterioration or the appearance of symptoms of the disease. You can visit the advice of a nutritionist who will help you to prepare a diet.
6 When IBS, it is desirable to avoid surgical interventions, if there is such a possibility. According to some data, patients with IBS are more likely to be prescribed surgery to remove the gallbladder or appendix, which could have been avoided.
Plants that are used in the treatment of irritable bowel syndrome most often:
For constipation: licorice root, buckthorn bark, fennel seeds, aniseed and cumin seeds, nettle, yarrow, watch, chamomile.
From diarrhea: Potentilla root, burnet root, serpentine root, blueberries, mint, plantain, walnut leaves, sage leaves.
From intestinal spasms: mint, chamomile, fennel seeds, valerian root, cumin seeds, calamus root, anise seeds.
From increased gas formation: mint, chamomile, valerian, anise seeds, fennel, cumin, oregano.
one. Against pain and bloating: peppermint in the form of tea. In addition, you can use the inside of the capsule with the oil preparation of mint or spice up fresh food.
2 To eliminate inflammation from the intestinal walls, to relax the muscles, use a decoction of equal parts of chamomile, peppermint, dioscorea, hydraestis and althea. You can use it up to 4 times per day.
3 For flatulence: add cinnamon and ginger to food.
four. Plantain seeds are shown against constipation. Take one tablespoon, pour 200 ml of cold water, hold for 30 minutes. Drink half a tablespoon to prevent constipation.
five. For diarrhea: mix in equal amounts (2 drops) peppermint oil, tea tree, geranium, sandalwood. Dilute with almond oil (30 ml) and do a belly massage. Movement in a circle. Also rub the lower back.
6 Take three parts of the plantain, nettle, two parts of sage, dried bread and St. John’s wort, and one part of mint and yarrow. Mix everything well, brew one teaspoon of the collection with 200 ml of boiling water, hold for half an hour, pass through a sieve and use a quarter cup three times a day for a quarter of an hour before meals. You can use the drug and microclysters. The volume of fluid for one enema – 50 ml.
7 For constipation: take one tablespoon of flax seeds, pour 100 ml of boiling water, stir for a quarter of an hour and pass through a sieve. You need to consume a thick liquid in two tablespoons three to four times a day. In the case of persistent constipation should be used infusion 1 tsp. seed 200 ml of boiling water every day before bedtime. You can grind dry seeds in a mortar and add a little water overnight, use 400 ml of water in the morning.
eight. Take equal parts of chamomile, buckthorn bark and mint, one tablespoon of the collection to brew 200 ml of boiling water, hold on a water bath for a quarter of an hour, let stand until it cools and strain on gauze. Drink 50 ml twice a day on an empty stomach.
9. In equal parts: mint, cumin and fennel seeds, valerian, chamomile. Cook and take as in the previous recipe.
ten. Take 20 grams. flowers of calendula and linden, 10 gr. flowers of cornflower, sage and birch leaf. Brew and take as in the previous recipe.
eleven. Take 30 grams. calamus root, ten grams of wormwood, dill seeds and yarrow. Cook as previously.
12. For diarrhea: remove the peel and internal partitions from one medium grenade, chop finely, pour 1 l. boiling water, give a little stand and use instead of drinks.
13. With diarrhea: carrot juice. It should be consumed with pulp 100 – 200 ml on an empty stomach. Reception duration is not longer than a week. Juice must be squeezed immediately before use.
14. With vomiting and nausea, pain in the intestines and stomach, potato juice is effective. Drink immediately after preparation.
15. Constipation, heartburn, pain and vomiting is shown consuming cabbage juice. It should be consumed slightly warmed by 200 ml four times a day, forty-five minutes before the meal. The duration of therapy is from twenty to forty days.
Prevention of IBS
- Power regulation,
- Compilation and execution of the daily routine,
- Physical exercise,
- Normalization of psycho-emotional state,
- Correction of endocrine function.
IBS differs from other diseases in that, despite the uncomfortable condition, the syndrome is not dangerous for life and cannot cause serious complications, such as bleeding or necrosis of the intestinal mucosa.
However, ignoring the symptoms will increase their intensity.
We must not forget about the psychological aspect of this disease. After all, the constant discomfort in the stomach, the need to run and look for a toilet at any time is a reality for patients with IBS. All this significantly affects the quality of life, personal and professional relationships.
Patients with irritable bowel syndrome with prevalence of obstinate constipation may develop coprostasis.