Irritable Bowel Syndrome (IBS)
- The reasons
- Symptoms of irritable bowel syndrome
- Treatment of irritable bowel syndrome
- Diet for irritable bowel syndrome
- Life style correction
Irritable Bowel Syndrome (IBS) is a functional bowel disorder that manifests itself with various stool disorders and / or abdominal pains (in the abdomen) for at least 3 months.
According to the observations of corrosive doctors, up to 20% of adults suffer from signs of this syndrome, although it can make its debut in childhood. Women are particularly affected in countries with a high level of economy.
The origin of IBS and the exact mechanisms of its formation continue to be studied. To date, it is believed that the main role belongs to the psychosocial characteristics of patients and disorders of sensitivity and motor ability of the intestine. In such patients, an imbalance in the production of some active substances that affect the intestinal function (cholecystokinin, histamine, endorphins, bradykinin, serotonin, neurotensin, enkephalins, etc.) is detected.
To the development of this syndrome often predispose:
- frequent stress;
- physical or sexual abuse;
- intestinal infections;
- genetic predisposition.
Symptoms of irritable bowel syndrome
Patients with IBS have the following symptoms:
- pains of different intensity and duration:
- they almost never bother to sleep at night;
- the nature of pain varies from colic to arching pain;
- their location may also be different, but more often they are located in the lower abdomen or migrate from one part of the abdomen to another;
- pain provoked by psycho-emotional stress, physical - overstrain, may be associated with menstruation;
- after stool, pain is eliminated or, on the contrary, intensifies;
- may occur as a result of urgent urges;
- feces more than a mushy or liquid consistency;
- normal daily volume up to 200 g;
- sometimes the liquid stool is preceded by feces normal or even thick - consistency;
- emptying occurs mainly in the morning;
- perhaps the feeling that the emptying occurred is not complete;
- there is no chair at night;
- chronic stool delay for more than 2 days;
- regular but difficult stools;
- a small amount of fecal masses (less than 100 g) is possible with straining;
- sometimes after emptying there is a feeling of insufficient cleaning of the intestine;
- admissible impurity of mucus in the stool;
- abdominal distention (sometimes local), accompanied by rumbling and disappearing after intestinal emptying;
- psycho-emotional disorders (unstable mood, depression, hysteria, excessive fears and obsessive thoughts about their own health, aggressiveness, inadequate response to situations, etc.);
- manifestations from other organs and systems associated with their impaired visceral sensitivity (headaches, cold legs and hands, impaired potency, feeling of a lump in the throat, dysuria, nausea, chest pain, dissatisfaction with inhalation, etc.).
Some patients describe their feelings very emotionally, for a long time and in a colorful way, supporting them with photographs of bowel movements, diary entries and knowledge from medical or popular books or the Internet. But they, as a rule, lack mass loss, disturbing impurities in feces (pus, blood), temperature rise. Symptoms of IBS are rare for anyone when they debut suddenly and after the age of 50 years.
When making a diagnosis, clinicians often clarify the clinical version of the considered syndrome. There are the following options for IBS:
- with a predominance of pain;
- with a predominance of diarrhea;
- c predominance of constipation;
- mixed version.
Competent specialists in no case expose the diagnosis of this disease only to the clinical symptoms present in the patient. For its verification, a full-fledged and comprehensive laboratory-instrumental examination should be carried out, which will exclude all other causes of the existing intestinal disorder (celiac disease, Crohn's disease, diverticular disease, parasitic diseases, etc.).
The complex of necessary studies can be determined only by a doctor. This list may include:
- hemogram (all its parameters in IBS, as a rule, are normal, there is no anemia, elevated ESR, leukocytosis);
- biochemical tests (evaluation of pancreatic, liver enzymes, bile pigments of the blood eliminates the serious origin of pain and disorders of the chair: for example, pancreatitis );
- immunological studies (identification of specific antibodies and antigens are indicated to exclude celiac disease, ulcerative colitis, infectious diseases, Crohn's disease, food allergies, autoimmune pancreatitis, tumor markers, etc.);
- assessment of the hormonal status (it is advisable to assess the level of thyroid hormones, since stool disorders also occur during its pathology);
- feces microscopy (necessary for the detection of eggs or fragments of worms, Giardia cyst, pus, blood, disturbances in the absorption and digestion of food, indirect signs of allergies, all this is absent in IBS);
- assessment of fecal inflammatory markers (with IBS, fecal calprotectin and lactoferrin levels are within the normal range, an increase in these parameters indicates the presence of active inflammation in the intestinal mucosa of infectious or autoimmune origin);
- molecular genetic tests (able to detect viruses, bacteria, parasites, susceptibility to celiac disease, Crohn's disease);
- bacteriological crops (necessary to exclude infectious genesis of the disease, dysbiosis);
- X-ray examinations (find characteristic changes in bowel tone, motor impairment, excess fluid secreted into the intestinal lumen, indirectly confirms the absence of inflammation, tumors, ulcers, constrictions, fistulas, intestinal obstruction of the diverticula - peculiar pockets of the intestinal wall):
- Review radiography of the entire abdominal cavity (to exclude the development of surgical pathology: perforation of the intestine, intestinal obstruction);
- enterography (X-ray examination of only the small intestine with contrast suspension);
- the passage of barium through the intestines (the study traces the passage of contrasting barium throughout the digestive tube);
- irrigoscopy (barium suspension is injected through the rectum, the study assesses the condition of the colon only);
- endoscopic examinations (visualize the mucous membrane of different parts of the digestive tube, motility disorders, most of them allow you to take tissue samples for histological analysis, endoscopic examination confirms the presence of erosive and ulcerative defects, benign and malignant tumors, narrowings, hemorrhages, inflammation, etc., with IBS, as a rule, there are only violations of intestinal motility):
- fibroesophagogastroscopy (excludes lesions of the duodenum, esophagus, different parts of the stomach, allows you to take biopsies from the zalukovic duodenum, necessary to exclude celiac disease or to test for lactase deficiency - enzymatic intolerance of milk);
- enteroscopy (endoscopic examination of an extremely small intestine, a time-consuming and difficult procedure for patients, biopsy sampling is possible);
- fibroilecolonoscopy (this study examines the state of the lowest part of the small intestine and assesses all parts of the colon, allows you to take the necessary biopsy specimens);
- endovideocapsule (endoscopic examination of the entire digestive tube, but biopsy sampling is technically impossible);
- histological analysis (excludes inflammatory and atrophic changes that are absent in IBS, signs of an allergic process, clarifies the type of tumors);
- Ultrasound (performed to exclude changes in the liver, biliary tract, spleen, pancreas, kidney, gallbladder);
- doplerography of vessels located in the abdominal cavity (to eliminate their narrowing);
- hydroMRT (a contrast study examines the state of the entire intestine and its surrounding structures, with IBS, there should be no inflammatory signs, thickening of the intestinal wall, enlarged lymph nodes, constrictions, fistulas, infiltrates, changes in the intestinal tissue);
- CT (there are special programs for examining the intestines - a virtual colonoscopy, although a biopsy is not technically possible, unfortunately).
Treatment of irritable bowel syndrome
Patients with IBS are treated for a long time and difficult. Sometimes doctors for years select the most optimal treatment methods for a particular situation. And they are not always medical.
Most patients do not need emergency or planned hospitalization. The decision on the composition and duration of the treatment program should be made individually for each patient with IBS, based on the characteristics of his psychoemotional and physical status, tolerance of drugs, nature of the accompanying pathology, age. The treatment is based on:
- diet therapy;
- life style changes;
- massage (abdomen or general, self-massage);
Diet for irritable bowel syndrome
The nature of the diet prescribed for the patient directly depends on the IBS variant. But all patients are advised to streamline their diet, to give up alcohol and individually poorly tolerated foods or products, to start keeping a food diary with fixing the time of consumption, the amount and type of food they eat.
In the presence of diarrhea, medical nutrition of patients should weaken the excessive motor activity of the unregulated intestine. Therefore, doctors strongly advise:
- give up cold foods, dishes and drinks;
- chop products when cooking (for example, make mashed potatoes from boiled vegetables);
- avoid fatty foods, as fats (especially animals) increase intestinal motility (lamb, goose, pork, fatty dairy products, red fish, fat, cream products, etc.);
- eliminate vegetables with a high content of essential oils (radish, garlic, onions, radishes, turnips, etc.) and mushrooms;
- limit fiber-rich foods (bran bread, popcorn, legumes, sea kale, prunes, barley, millet, etc.);
- be afraid of too salty and sweet drinks and dishes (pickles, syrups, honey, etc.);
- reduce the amount of caffeine-containing drinks.
The nutrition of such patients should consist of boiled, baked or stewed lean meat (turkey, veal, chicken, rabbit, beef), lean fish (bream, pike perch, hake, cod, pike, carp, etc.). For garnish or breakfast, you can eat crumbly cereal (semolina, rice, buckwheat), noodles, cereal puddings or vegetables (pumpkin, zucchini, potatoes, carrots, squash). The latter are boiled, baked or stewed. Juices, fruit drinks, jellies, souffles, mousses, marmalade, and marshmallows are made from berries and fruits. Eating fresh vegetables, berries, greens, or sweet fruits depends on their individual tolerance by the patient. Soups on skim fish or meat broth are allowed. Omelets and soft-boiled eggs, low-fat kefir, ryazhenka, milk, yogurt, cheese, cottage cheese and yogurts, doctor sausage, lean ham, cheesecakes, jam pies or boiled meat, dry biscuits are allowed.
If persistent constipation prevails in patients, then their diet should:
- optimize your drinking regime (at least 2 liters of tea, juice, jelly, coffee, water, etc. should be drunk per day);
- drink not only warm but also cold drinks (for example, start the morning with drinking cold water);
- avoid rubbing food while cooking;
- eat more often (every hit of even a small amount of food in the stomach reflexively causes activation of the colon movements);
- do not give up weak coffee (this drink stimulates gut motility);
- eat more fresh fruits, vegetables and other products with a high quota of fiber (legumes, pearl barley, kelp, bakery products with whole grains and bran, dried fruits, etc.);
- beware of vegetables with essential oils (radishes, turnips, garlic, onions, etc.) and mushrooms;
- drink freshly squeezed fruit or vegetable juices (the organic acids contained in them increase the mobility of the intestines);
- in the absence of contraindications, salty foods, sugary drinks (sugar syrup, water with honey, etc.), creamy or milk caramel, which act as natural laxatives, are permitted;
- refuse fatty (especially fried) meat and fish, as the refractory fats of these products, although they stimulate motility, but the carcinogenic substances released during frying with constipation are longer in contact with the intestinal mucosa and can provoke its malignant degeneration.
Patients are allowed boiled, stewed or baked meat and fish dishes (preferably a piece), low-fat fish or meat soups with vegetables and cereals, vegetable and cereal side dishes. It is better to limit the rice, semolina and pasta. Omelets and soft-boiled eggs (hard-boiled eggs increase constipation), fresh dairy products (one-day kefir is especially shown), mild cheese, ham without fat, soaked herring, black caviar are allowed.
Life style correction
For patients with IBS, it is extremely important to establish a calm emotional atmosphere in the surrounding working, family and home environment. In the midst of clinical manifestations, it is better for them to avoid traveling or business trips, since they need proper nutrition, a regular visit to the toilet in the morning in a relaxed atmosphere and the absence of psycho-traumatic situations.
The choice of means of drug support depends on the symptoms of IBS in a particular patient. Medical complex may include:
- antispasmodics, eliminating pain, if it is caused by intestinal hyper tone (drotaverin, pinaveria bromide, mebeverin, etc.);
- M-cholinolytics, reducing spasm and having some anti-inhibitory effect (Buscopan, Belloid, Platyphylline, Riabal, Metacin, etc.);
- prokinetics - regulators of intestinal motility (metoclopramide, trimedate, tegaserod, itoprid, alosetron, debridate, etc.);
- protivaponosnye means
- means that weaken intestinal motility (loperamide, reacek, nufenoxol);
- drugs, condensing feces (desmol, calcium carbonate, etc.);
- sorbents (filtrum, smecta, enterosgel, lignosorb, polysorb, etc.);
- Bile acid excretion agents (polyphepan, bilignin, etc.);
- antraglycosides (preparations of senna, cofranil, ramil, regulac, tisasen, etc., can be addictive);
- oils (castroric, petroleum jelly, etc.);
- derivatives of diphenylmethane (bisacodyl, isafenin, etc.);
- salt (Karlovy Vary salt, salts of magnesium sulfate, sodium sulfate, etc.);
- means of increasing the amount of feces and accelerating its transit (bran, - mukofalk, laminaria, MCC, etc.);
- lactulose (normase, dufalak, lactusan, etc.);
- laxative suppositories (calciolax, ferrolax, glycerin, etc.);
- psychotropic (amitriptyline, paroxetine, attarax, grandaxine, phenazepam, azafen, elenium, valerian, motherwort, etc.);
- carminative (disflatil, pepfiz, espumizan, sub-simplex, etc.).
In patients with IBS, physiotherapy can help normalize the bowel tone: eliminate spasticity or atony.
The elimination of intestinal spasms helps to eliminate pain and constipation, if they are associated with excessive tone. For this purpose, paraffin and ozokerite applications, electrophoresis with papaverine, magnesium salts, platyfillin, diathermy, inductothermia, UHF, mud applications, acupuncture, coniferous baths, aeroionotherapy, are used.
Constipation caused by the weakening of intestinal motility is treated by electrophoresis with calcium chloride or prozerin, faradization, ultrasound, ultraviolet irradiation, diadynamic currents, contrast baths, and acupuncture.
Many patients and doctors neglect physical exercises. Meanwhile, physiotherapy helps:
- restore impaired intestinal regulation;
- improve metabolic processes;
- eliminate constipation;
- stabilize the nervous system;
- have a general tonic effect.
Patients are made up of whole sets of exercises for the body (turns, bends), abdominals (bends, leg lifts, etc.). In addition, respiratory gymnastics are recommended (including exercises to stimulate diaphragmatic breathing), rhythmic squeezing and unclenching of the anal (anus) sphincter. A good effect has a systematic walking, outdoor sports, swimming, jogging.
For patients with constipation of psychogenic origin, a special technique has been developed - Trussault-Bergman's gymnastics, combining breathing exercises with voluntary movements (protrusion-retracting) of the abdominal wall and straining.
Наличие СРК абсолютно никак не влияет на продолжительность жизни. Вероятность возникновения онкологических недугов у пациентов с СРК не отличается от риска появления данных болезней у здоровых людей. Заболевание годами не прогрессирует, но его течение хроническое с периодическим возобновлением имеющейся симптоматики. Но добиться полнейшего и окончательного исчезновения заболевания или продолжительной стабильной ремиссии удается лишь у трети таких пациентов.
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