Irritable Bowel Syndrome (IBS) Symptoms Treatment

Irritable Bowel Syndrome (IBS)

Irritable Bowel Syndrome (IBs) is a gastrointes­tinal disorder without any structural pathology, characterized by pain in abdomen, and consti­pation and diarrhea.

  • Irritable bowel syndrome (IBS) is a gastrointestinal syndrome characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause.
  • May be characterized as diarrhea-predominant or constipation-predominant; or may alternate between diarrhea and constipation.
  • Synonym(s): Spastic colon; Irritable colon
  • A condition marked by abdominal pain (often relieved by the passage of stool or gas); disturbances of evacuation (constipation, diarrhea, or alternating episodes of both); bloating and abdominal distention; and the passage of mucus in stools.

Dairrhea

Irritable Bowel Syndrome (IBS) Symptoms Treatment

Constipation

Rome II Criteria for Diagnosis of IBS

  • Patient should have 12 weeks of abdominal pain in the past 12 months.
  • Pain is relieved by defecation (passing stools). Onset of disease (pain) is with decrease in stool frequency and form.
  • May be characterized as diarrhea-predominant or constipation-predominant;
  • or may alternate between diarrhea and constipation.
  • Synonym(s): Spastic colon; Irritable colon

Clinical Features Symptoms OF IBS —

  • · Occurs in’ young patients <45 years. May occur in middle aged and elderly.
  • · More common,in women.
  • · There is abdominal pain and constipation, diar­rhea, or both.
  • · Diarrhea is usually painless.
  • · Pain occurs in hypogastrium, right side, left side, or in the epigastrium.
  • · It may be cramp-like or mild.
  • Mucus in stools
  • Constipation
  • Bloating
  • Diarrhea
  • Abdominal distention
  • May be characterized as diarrhea-predominant or constipation-predominant;
  • or may alternate between diarrhea and constipation.
  • Synonym(s): Spastic colon; Irritable colon
  • · There is no malnutrition.
  • · Pain occurs during waking hours.
  • · Pain is increased by eating and emotional stress.
  • · Pain is relieved by passage of stools.
  • · Pain may be related with menstruation in women.
  • · Constipation may be continuous and painful.

Other Symptoms of IBS —

  • Feelings of incomplete evacuation
  • Abnormal stool form
  • Nausea, vomiting (rarely)
  • · Stools are hard.
  • · In patients with diarrhea, stool is small in quan­tity.
  • There may be mucus in stools so it is also called mucus colitis.
  • There is no bleeding or malabsorption.
  • There is abdominal distension and flatulence due to gas.
  • There is belching, heart burn, nausea, vomiting, dyspepsia.
  • IBS exists with other functional disorders like non-cardiac chest pain.
  • IBS has a strong relationship with stress and emotional upsets.
Risk Factors
  • Other family members with similar GI disorder
  • History of childhood sexual abuse
  • Sexual or domestic abuse in women
  • Depression
  • Can occur after an infectious colitis

Imaging

  • Abdominal CT scan or abdominal ultrasound to evaluate pain is generally normal.
  • Small-bowel series or video capsule endoscopy to rule out Crohn disease of small intestine may be considered, and will also be normal.
  • Sitzmarker study may be used to evaluate colon transit in patients with constipation.

Lab Findings

  • Diarrhea-predominant: ESR, CBC, tissue transglutaminase, TSH, and stool for ova and parasites
  • Constipation-predominant: CBC, TSH, electrolytes
  • Abdominal pain: LFTs and amylase

IBS Treatment

  • Reassurance
  • Irritable Bowel Syndrome (IBS) TREATMENT
  • Avoid coffee, legumes (peas), cabbage and any food which causes symptoms.
  • High-fiber diet like bran is good for both consti­pation and diarrhea.
  • Fiber is given as psyllium.
  • Antispasmodics – anticholinergic drugs to relieve pain is given 30 minutes before meals.
  • Belladonna alkaloids, dicyclomine, are used as antispasmodics.
  • Antidiarrheal agents – codine, diphenoxylate. Antidepressants – paroxetine, citalopram, tricy­die antidrepressants like desipramine.
  • Antiflatulents – Simethicone, antacids, activated charcoal.
  • Avoid chewing gum? carbonated drinks, artificial sweeteners, cabbage, peas.
  • Serotonin-receptor antagonists.

List of drugs used in IBS for various abdominal disorders —

Symptom Drug Dose
Diarrhea Loperamide 2–4 mg when necessary/maximum 12 g/d
Cholestyramine resin 4 g with meals
Constipation Psyllium husk 3–4 g bid with meals, then adjust
Methylcellulose 2 g bid with meals, then adjust
Calcium polycarbophil 1 g qd to qid
Lactulose syrup 10–20 g bid
70% sorbitol 15 mL bid
Polyethylene glycol 3350 17 g in 250 mL water qd
Lubiprostone (Amitiza) 24 mg bid
Magnesium hydroxide 30–60 mL qd
Abdominal pain Smooth-muscle relaxant qd to qid ac
Tricyclic antidepressants Start 25–50 mg hs, then adjust
Selective serotonin reuptake inhibitors Begin small dose, increase as needed

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