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Irritable bowel syndrome (IBS) – Causes, Symptoms, and Treatment

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Irritable bowel syndrome (IBS) is a chronic (lasting for at least three months) idiopathic gastrointestinal disease characterized by abdominal pain and bowel movement disorders, not caused by organic or biochemical changes.

1. Irritable Bowel Syndrome (IBS) – Causes

This short definition has the most important information about the Irritable bowel syndrome, which was once known as intestinal neurosis.

The intestinal hypersensitivity syndrome was described in 1892 as mucous colitis. The definition of irritable bowel syndrome was specified at the international meeting of experts in Rome in 1999.

Despite ongoing research, the primary cause of irritable bowel syndrome is unknown. Pathophysiological factors that may affect the occurrence of irritable bowel syndrome are:

  • Excessive growth of bacterial flora (SIBO) even in 84% of cases
  • Disorders of visceral sensation and motor function of the intestines
  • The increased motor response of the large intestine to some medicines (prostigmine), hormones (cholecystokinin) or food.
  • Changes in the psychological sphere (70-90% of patients with IBS have personality disorders, anxiety or depression).
  • Eating low-fat foods.
  • The presence of intestinal infection (e.g., dysentery) – these persons have been found to have an increased number of intestinal endocrine cells and their serotonin content. Infective irritable bowel syndrome affects 10 percent of patients and is usually diarrheal.
  • The role of the brain is not entirely clear – new research shows changes in activity in the areas of the cerebral cortex responsible for pain.

According to statistics, over 100 million people in North America and Europe suffer from irritable bowel syndrome. It is estimated that it is about 20-30 percent of the adult population. However, this is not a disease affecting only residents of highly developed countries – such as, in China, the incidence of irritable bowel syndrome is comparable to Western countries. About 75-80 percent of IBS are women.

2. Irritable bowel syndrome (IBS) – symptoms

The irritable bowel syndrome is extremely chronic and recurrent.

Depending on the symptoms of irritable bowel syndrome, several forms can be distinguished:

  1. Diarrheal.
  2. With dominant constipation (the so-called Colon spasticum),
  3. mixed.

It is quite interesting that stress situations trigger symptoms of intestinal hypersensitivity syndrome. The most common symptoms of the irritable bowel include:

  • Abdominal pain with an acute, systolic, harassing nature (usually abdominal and left hip). Typical features of abdominal pain which is a symptom of irritable bowel are: the pain increases after meals; the pain goes away after defecation or after flatulence
  • Diarrhea – in the case of irritable bowel, watery stools or semi-liquid stools are a symptom. It usually occurs after meals, mental stress and in the morning.
  • Constipation – is a symptom of irritable bowel in patients that don’t have diarrhea. The frequency of bowel movements is reduced, and the stool is compact and hard. After passing the stool, the feeling of incomplete bowel movement often arises. A common symptom of irritable bowel syndrome for diarrheal and constipated characters are skimpy bowel movements.
  • Abdominal distension – as it is known, it depends on the gas accumulating in the intestine, although its quantity does not have to be greater than in healthy people.
  • Stool with mucus.
  • Excess gases.
  • Nausea and vomiting.
  • Heartburn.
  • Other symptoms of irritable bowel syndrome include a headache, fatigue, menstrual disorders, pollakiuria, and so-called ” Stomach pouring.”

It may seem that with such a variety of symptoms characterizing the IBS by the physician should not be a problem, however, because intestinal hypersensitivity syndrome is a functional disorder and not an organic disorder most often patients with irritable bowel syndrome have abnormalities shown in medical examination.

3. Irritable bowel syndrome (IBS) – diagnosis

The diagnosis of irritable bowel syndrome should begin with the exclusion of such diseases as inflammatory and specific (infectious) intestinal inflammation, diverticulitis, diarrhea, abusing of laxatives, celiac disease, colorectal cancer, adenoma, endocrine tumors: gastrinoma, VIPoma, carcinoid, metabolic diseases: hyperthyroidism, diabetes, lactase deficiency.

As there is no change in the physical examination and medical tests, the diagnosis of irritable bowel syndrome is based on the fulfillment of the so-called Roman Criteria.

Based on the current Roman Criteria, irritable bowel syndrome can be diagnosed when there is pain or discomfort (i.e., a chronic sensation not referred to as pain) in the abdomen lasting at least three days a month for the last three months and accompanied by at least two of the three following symptoms:

  1. reduction of symptoms after defecation
  2. the onset of symptoms associated with a change in the frequency of bowel movements
  3. the onset of the discomfort associated with a change in the appearance of the stool.

The aim of the diagnostic procedure is primarily the exclusion of the organic cause of the problem. The set of tests serves this purpose. These include morphology, ESR, blood biochemistry, general urine test, hydrogen test, feces test for the presence of parasites and latent blood, stool bacteriological and rectoscopy or fibrosigmoidoscopy.

Also, depending on the patient’s clinical status and family history, a lactose tolerance test or a 2-week trial with a lactose-free diet, colonoscopy, or ultrasound or computed tomography of the abdominal cavity is performed.

Irritable bowel syndrome is therefore diagnosed by symptoms and the exclusion of organic diseases.

4. Irritable bowel syndrome (IBS) – treatment

Irritable bowel syndrome as of today cannot be permanently cured, but you can control its symptoms. For this to be possible, you must follow a diet, avoid/deal with stress and use proper symptomatic drugs. Drugs should be chosen by a gastroenterologist, depending on the form:

  • In the diarrhea form, loperamide, diphenoxylate, cholestyramine may be used.
  • Constipation can be treated with bran and lactulose.
  • Patients with flatulence may use simethicone or dimethicone.
  • For postprandial pain, oxyfenonium bromide and hyoscine may be used.
  • If the pain is chronic, it is worth considering the use of amitriptyline or paroxetine – antidepressant drugs that can significantly reduce your discomfort.
  • In case of increased anxiety, your doctor may recommend benzodiazepines.

In addition to these drugs, some natural remedies for IBS are also very effective:

  • Iberis amara, which has prokinetic and anti-inflammatory properties. It’s also protecting the mucous membrane of the gastrointestinal tract.
  • Angelica root with spasmolytic and appetite enhancing effects.
  • Chamomile flower with spasmolytic, anti-inflammatory, carminative, antibacterial and antiulcer activity.
  • Cumin, which has a spasmolytic, carminative and antibacterial effect.
  • A milk thistle fruit that protects the liver and has an antiseptic effect.
  • Lemon balm leaf with calming and carminative effect.
  • Peppermint leaf that works spasmolytic, antiemetic, anti-fermentation and anesthetic.
  • Celandine herb with spasmolytic and anti-inflammatory effects.
  • Licorice root that has spasmolytic, anti-inflammatory and protective effects on the intestinal mucosa.

Diet in the irritable bowel syndrome

In the irritable bowel syndrome, diet is the most important thing. During treatment of the irritable bowel syndrome, the diet and portion size plays a very important role. A diet in the irritable bowel syndrome with heavy meals may worsen symptoms. Diet in the irritable bowel syndrome consists primarily of eating smaller portions of food and eating more often. It is also crucial to eat things that are easy to digest.

The food should be varied and rich in vegetable fibers. In patients with irritable bowel syndrome with diarrhea and abdominal pain, bran consumption is recommended. Instead of bran, patients can take methylcellulose bulking agents. Avoid foods having a lot of carbohydrates and foods that can cause bloating: beans, sprouts, brussels sprouts. It is recommended to avoid drinking coffee and alcohol.

As mentioned, the irritable bowel syndrome is a psychosomatic disease that sometimes remains in close relation to the patient’s mental state. Therefore, in addition to the antidepressants mentioned above (also sometimes used in anxiety therapy), psychotherapy applies.

This method should be used when the pharmacological treatment of irritable bowel syndrome is not effective. The most effective form of psychotherapy in the irritable bowel syndrome remains cognitive-behavioral therapy.

As the primary cause of irritable bowel syndrome is unknown, we do not yet know how to prevent it. However, every patient can learn how to prevent the symptoms of irritable bowel syndrome. A sizable proportion of patients with irritable bowel syndrome can control the disease by carefully seeing to potential factors that cause irritable bowel syndrome.

This can be achieved relatively easily: by running a personal diary of the irritable bowel syndrome, where you must write everything that you eat and drink for a few weeks, and other circumstances and events. The record should be compared with the occurrence of symptoms of irritable bowel syndrome. You can then decide what foods, drinks or events precede the onset of symptoms.

5. Irritable bowel syndrome (IBS) – prognosis

Unfortunately, the irritable bowel syndrome as of today is not curable. In the majority of patients with irritable bowel syndrome, the symptoms persistently recur. The positive fact is that despite the considerable discomfort and poor quality of life, irritable bowel syndrome has a mild course and never leads to cachexia or other profound consequences.

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