In this article, we will describe in more detail one of the most common causes of bloating, and that is irritable bowel syndrome (IBS).
What is important to note is that Irritable bowel syndrome is a FUNCTIONAL bowel disorder manifested by cramps and abdominal pain and diarrhea, and/or constipation in the absence of organic, specific pathology.
The colon (colon) is affected, and despite severe problems, IBS does not lead to permanent damage to the intestine.
Back in 1892, Osler described patients with abdominal problems (cramps, diarrhea, constipation, mucus in the stool) and named the condition MUCOUS COLITIS. He noticed an association of this type of colitis with various mental disorders.
Traditionally, the diagnosis of irritable bowel syndrome is declared when all other diagnoses are ruled out. There is no definite structural problem, so IBS is still a CLINICAL DIAGNOSIS.
Manning identified 6 criteria for diagnosing IBS:
- Abdominal cramps accompanied by more frequent stools
- Abdominal cramps followed by diarrhea
- Reduction of pain after bowel emptying
- Abdominal bloating
- The feeling of incomplete bowel emptying
- Mucus in the stool
In 2006, the criteria for diagnosis were revised, and patients were required to have discomfort for at least 3 days a month, for at least 3 months with 2 of the above symptoms.
IBS’s variants: 1) Irritable bowel syndrome with predominantly diarrheal stools 2) Irritable bowel syndrome with constipation 3) IBS with a combination of diarrhea and constipation 4) Irritable bowel syndrome in which periods of constipation and diarrhea alternate.
Irritable bowel syndrome causes
There are several theories about the cause of IBS: from changes in colon motility, “hypersensitivity” of receptors in the gut to stimuli, and many others.
People who suffer from irritable bowel syndrome feel normal motility and peristalsis in the intestines. More often suffer from depressive and anxiety disorders and may also have frequent urination, urge to urinate, and nocturnal urination.
In recent years, the possibility of microscopic inflammation of the intestine has also been discussed: a smaller number of patients have an increased number of lymphocytes in the colon’s mucosa.
The theory of bacterial growth in the small intestine is also popular, so probiotic and antibiotic therapy is recommended in some cases.
Incidence of IBS
One in 5 Americans has irritable bowel syndrome problems, with a minority coming in for a checkup. Some studies say that in the world, at least 10-20 percent of people have problems related to IBS, with 20-50% of gastroenterological consultations falling on this diagnosis.
It is more common in women (although men are more affected in India: 70-80% of patients are men) before 35. Digestive problems that appear for the FIRST time after 40 need to be treated in more detail and the organic cause excluded.
Symptoms of irritable bowel syndrome
Abdominal cramps and pain
- Feeling bloated/bloated
- Increased gas/wind generation
- Mucus in the stool
- Changes in stool: constipation/constipation, diarrhea accompanied by cramps, pain
- People with Irritable bowel syndrome have more frequent and decreased libido, fibromyalgia, PMS, dyspeptic symptoms (heartburn, acid), frequent urination unrelated to the urinary tract’s inflammation.
«ALARM SYMPTOMS» (additional processing required: do not support the diagnosis of irritable bowel syndrome)
- Problems occur in people older than 50 years
- Nocturnal ailments that wake up from sleep
- Weight loss and appetite
- Diarrhea stools without cramps
- Fatty stools
- Bleeding from the colon
- Progression of symptoms
Treatment and diagnosis of IBS
VERY DETAILED And medical history and examination are key in the diagnosis of IBS
Laboratory tests: complete blood count, liver tests (AST, ALT; GGT; AP, bilirubin), electrolytes (Na, K, calcium), TSH (thyroid hormone), sedimentation, CRP, blood sugar
Examination of stool for occult blood (hemoccult)
Examination of the stool for parasites, bacteria, antigen on Giardia lamblia (parasite) and testing for Clostridium difficile if infection with these organisms is suspected
In some cases, it is necessary to exclude lactose intolerance (exhalation test) and fructose (fruit sugar), and celiac disease (blood antibodies).
In case of suspicion of an organic disorder based on laboratory tests, further processing may include:
X-ray of the stomach and small intestine passage: this excludes tumors and small bowel obstruction, inflammatory and inflammatory bowel disease
Irigography / colonoscopy: examinations of the colon
CT of the abdomen concerning the pancreas
Consultation with a gastroenterologist and possibly a psychiatrist or psychologist
Medical students and specialists in internal medicine must go through the “solving” of differential diagnoses. What does that mean? This means that certain symptoms can result from various diseases and conditions, and then, based on the symptoms, clinical examination, history, laboratory findings, we conclude which disease/condition it is.
The differential diagnosis of IBS is long: inflammatory bowel disease (ulcerative colitis, Crohn’s disease), ischemia, endometriosis, acute intermittent porphyria, various tumors of the digestive tract, celiac disease, hypothyroidism, food allergies, parasite infections, elevated blood calcium, lead intoxication, anxiety, and disorders.
- Adequate hydration (DRINK WATER), especially in people with dominant constipation
- Avoid caffeine, green beans, and dairy products; if lactose intolerance is suspected: you can not consume milk for 7-14 days and see if there is an improvement in symptoms.
- Avoid fatty foods. Eat regularly.
- Regular exercise: there are muscles in the gut that can be “trained”: 30 minutes of exercise a day with 10 or so abs can help reduce constipation by speeding up peristalsis
Foods with many leftovers are generally recommended, but be careful with those who tend to swell and inflate: try for yourself what is best for you!
Medications for Irritable bowel syndrome
Regular fiber intake can help with constipation. Lactulose can be tried daily with plenty of fluids.
Anticholinergics: Mebeverine helps with cramps but can worsen constipation
Loperamide: may be helpful in diarrhea. Long-term use is not recommended
Antidepressants: since IBS often goes hand in hand with various anxiety disorders, depression, nervousness, serotonin blockers, and tricyclic antidepressants (imipramine, amitriptyline). Patients’ resistance to taking this therapy is understandable, but my answer and recommendation are: “you have nothing to lose but difficulties!” If you do not feel better or have side effects, you can always stop the therapy », there is no addiction or habit, unlike benzodiazepines, which are consumed regularly.
Psychotherapy, biofeedback, meditation, relaxation exercises …
Specific drugs for IBS
ALOSETRON: is an antagonist of serotonin receptors in the gut. When it first came on the market, it was withdrawn due to several side effects, so it can now only be prescribed by specialist gastroenterologists.
LUBIPROSTONE: is approved in the treatment of women over the age of 18 who suffer from IBS with the dominant symptom of constipation: it increases fluid production in the intestines and thus facilitates emptying.
Herbal preparations: peppermint is an antispasmodic (relaxes the smooth muscles of the intestine) and can reduce discomfort in the short term
Probiotics: “good bacteria” normally present in the intestines and yogurt and various dietary supplements. Some research shows that people with irritable bowel syndrome are deficient in “good bacteria,” and taking probiotics regularly can reduce IBS symptoms: But there are no definitive studies to support this.
Biofeedback, relaxation techniques, massage, meditation can help reduce stress.
Learn as much as you can about your condition: the more you know about your disease, your body, and the available treatment methods, the better for you: you have control over the disease, not it over you !!