IRRITABLE BOWEL SYNDROME and her solutions.
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| doctor. |
Source.
QIMP-14
Most of the people
are suffering from I.B.S. We describe at this site about this syndrome. Read
this post carefully.
.
What is I. B.S?
Discription:
Irritable bowel syndrome can be defined as a functional
bowel disorder
characterized by a
variable chronic or recurrent gastrointestinal symptoms
essentially associated with abdominal pain and altered bowel
habits. The
symptoms can not be explained by structural or biochemical
abnormalities. Usual
age incidence late teens to 40 years ; women are more
frequently affected than men.
Aetiology
As it is a
syndrome, a single cause is unlikely. On the otherhand no definite
or organic cause can be evaluated. Some
factors are believed to be associated
with the
aetiology of I.B.S 1. Psychosocial factors-about 50% patients are found to be associated
with this pro-
blems,such as
anxiety ,depression somatisation, neurosis, panic attacks, acute
sychologycal
stress etc.
2. Altered gastrointestinal motility
–some4 motility disorders are found but non is
diagnostic.
3. Abnormal visceral perception-
I.B.S may be associated with increased sensivity
to intestinal
distention.
4. Luminal factors-such as
following gastroenteritis, dietary intolerance e.g. wheat
,dairy products
etc.
Clinical
feature
Patients of I.B.S commonly present with –
1. Abdominal
pain referred to the left or right iliac fossa or to the
hypogastrium,
usually colicky cramping ,diffuse or localised and
rarely severe. It is generally
relieved by
defecation or with the passage of wind and is sometimes provoked by
food. Pain may be
associated with constipation the stools being hard pellet like &
accompanied by
mucous,but rectal bleeding does not occur. Tenderness is common
over the pelvic colon.
2. In I.B.S diarrhea
& alternate constipation is a common phenomenon. Diarrhea occurs
characteristically in the morning patient usually complaints of passes of
frequent small volume stools and a feeling incomplete emptying of the rectum. K
3.abdominal distension or bloating is very common .
4. Nausea, anorexia, tiredness and weakness occur. Vomiting
is common. But patients don’t loss weight.
5. Varying degrees of
anxiety or depression is present. Patient may also have other functional
complaints such as heartburn, chest pain, fatigue, urologic dysfunction, and
gynecologic problems.
Investigation:
In I.
B. S the finding of infestations are usually normal. So, it is of no value to
do a lot of tests. In most young patients diagnosis can confidently be made on clinical
presentations. But, older patient coming with abdominal pain or diarrhea must be investigated before diagnosing as
I.B.S. However, on most cases suspecting as I.B.S some routing and special
investigations are done to exclude any organic disease or gynecological
involvement.
Special
investigations:
- Ba- enema or colonoscopy-to exclude colorectal cancer or inflammatory bowel disease usually in patients of age over 40 years.
- Ultrasonography of abdominal and pelvic organs- to exclude any organic or gynaecological involvement.
- Radiological investigations.
- Test for lactose intolerance.
- Test for bile acide malabsorption.
Routine investigations:
- Complete blood count and ESR.
- Serological test.
- Serum albumin.
- Stool- Routine and occult blood test.
- Sigmoidoscopy.
Treatment:
1.Reassurance – inmost patients where symptoms are not
severe and stress- related, reassurance might be sufficient .
2.Patients with diarrhea –predominant:
(a) For pain diarrhea
– an ant cholinergic drug such as dicyclomine 10-20mg or mebeverine hydrochloride
135mg (1 tablet ) beore meals may help to control symptoms .
(b) Patient should avoid laxatives legumes and excessive
dietary fibre .
(c) If diarrhea persists loperamide2-8mg daily or codeine
phosphate 30-90mg daily or colestyramaine 1 sachet daily.
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