Irritable Bowel Syndrome (IBS)
- Symptoms of irritable bowel syndrome
- Treatment of irritable bowel syndrome
- Diet in irritable bowel syndrome
- Correction of life style
Irritable bowel syndrome (IBS) is a functional intestinal disorder, manifested by various disorders of the stool and / or abdominal pain (in the abdomen) for at least 3 months.
According to observations of corrosive doctors, up to 20% of adults suffer from signs of this syndrome, although it can debut in childhood. Women are especially affected in countries with a high level of economy.
The origin of IBS and the exact mechanisms of its formation continue to be studied. By now, 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 development of some active substances that affect the functioning of the intestine (cholecystokinin, histamine, endorphins, bradykinin, serotonin, neurotensin, enkephalins, etc.) is revealed.
The development of this syndrome is often predisposed:
- Frequent stress;
- Physical or sexual violence;
- Intestinal infections;
- Genetic predisposition.
Symptoms of irritable bowel syndrome
In patients with IBS, the following symptoms are observed:
Pain of varying intensity and duration:
- They almost never disturb at night when falling asleep;
- By the nature of the pain range from colic to erupting pain;
- Their location may also be different, but more often they are localized in - the lower abdomen or migrate from one part of the abdomen to another;
- Pains are provoked by psychoemotional stresses, physical - overexertion, can be associated with menstruation;
- After a stool, pains are eliminated or, conversely, intensified;
- Can occur as a result of urgent urges;
- Feces are more often mushy or liquid in consistency;
- A normal daily volume of up to 200 g;
- Sometimes a stool is preceded by stool of usual or even dense - consistency;
- Emptying occurs mainly in the morning;
- Perhaps the feeling that the occurred emptying is not complete enough;
- At night there is no chair;
- Chronic stool retention for more than 2 days;
- Regular, but obstructed stool;
- A small volume of feces (less than 100 g) with straining is possible;
- Sometimes after emptying there is a feeling of insufficient purification of the intestine;
- Admixture of mucus in the stool;
- bloating (sometimes local), accompanied by rumbling and disappearing after intestinal emptying;
- psychoemotional disorders (unstable mood, depression, hysteroid, excessive fears and obsessive thoughts about one's own health, aggressiveness, inadequate response to situations, etc.);
- manifestations on the part of other organs and systems associated with their impaired visceral sensitivity (headaches, cold feet and hands, potency disorders, lumpy feeling in the throat, urination disorders, nausea, chest pains, dissatisfaction with inspiration, etc.).
Some patients describe their feelings very emotionally, long and colorfully, supporting them with photos of excrements, diary entries and knowledge, picked up from medical or popular books or the Internet. But they, as a rule, lack mass loss, disturbing admixtures in feces (pus, blood), rise in temperature. Symptoms of IBS are rare in anyone when they make their debut abruptly and at the age of 50.
When making a diagnosis, clinicians often specify the clinical variant of the syndrome under consideration. The following variants of IBS are distinguished:
- With prevalence of pain syndrome;
- With prevalence of diarrhea;
- C predominance of constipation;
- Mixed version.
Competent specialists in no case do not diagnose this disease only on the clinical symptoms present in the patient. To verify it, a complete and comprehensive laboratory and 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.).
A complex of necessary research can only be determined by a doctor. This list may include:
- Hemogram (all its parameters in IBS, as a rule, normal, no anemia, elevation of ESR, leukocytosis);
- Biochemical tests (evaluation of pancreatic, hepatic enzymes, bile pigments of blood allows you to exclude the serious origin of pain and stool disorders: for example, pancreatitis );
- Immunological studies (determination of specific antibodies and antigens are indicated for the exclusion of celiac disease, ulcerative colitis, infectious diseases, Crohn's disease, food allergy, autoimmune pancreatitis, oncomarkers, etc.);
- Evaluation of the hormonal status (it is advisable to assess the level of thyroid hormones, since stool disorders also occur with its pathology);
- Microscopy of feces (necessary for the detection of eggs or fragments of worms, cysts of lamblia, pus, blood, malabsorption and digestion of food, indirect signs of allergy, all this is absent in IBS);
- Assessment of fecal markers of inflammation (with IBS levels of fecal calprotectin and lactoferrin are within the norm, an increase in these parameters indicates the presence of active inflammation in the intestinal mucosa of an infectious or autoimmune origin);
- Molecular genetic analysis (able to detect viruses, bacteria, parasites, predisposition to celiac disease, Crohn's disease);
- Bacteriological crops (necessary to exclude the infectious genesis of the disease, dysbiosis);
- X-ray examinations (show changes in intestine tone characteristic of IBS, motor disorders, excess secretion of secreted into the intestinal lumen, indirectly confirms the absence of inflammation, tumors, ulcers, constrictions, fistula, intestinal obstruction of diverticula - peculiar pockets consisting of the intestinal wall):
- survey 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 small intestine with contrasting suspension);
- Passage of barium in the intestine (the study traces the passage of contrasting barium throughout the digestive tube);
- Irrigoscopy (barium suspension is introduced through the rectum, the study estimates the state of only the large intestine);
- Endoscopic examinations (visualize the mucosa of different parts of the digestive tube, motor 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 neoplasms, constrictions, 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 biopsy samples from the zygomatic duodenum necessary to exclude celiac disease or sample for lactase deficiency - enzymatic intolerance to milk);
- Enteroscopy (endoscopic examination of the extremely small intestine, time-consuming and complicated procedure for patients, biopsy can be taken);
- Fibroileocolonoscopy (this study studies the state of the lowest part of the small intestine and evaluates all parts of the colon, allows you to take necessary biopsies);
- endovideo capsule (endoscopic examination of the entire digestive tube, but the collection of biopsies is technically impossible);
- Histological analysis (excludes inflammatory and atrophic changes, absent in IBS, signs of allergic process, specifies the type of tumors);
- Ultrasound (performed to exclude changes in the liver, biliary tract, spleen, pancreas, kidney, gallbladder);
- Dopplerography of vessels located in the abdominal cavity (to exclude their narrowing);
- HydroMRT (contrast study studies the condition of the entire gut and surrounding structures, with IBS there should be no inflammatory signs, thickening of the intestinal wall, enlarged lymph nodes, narrowing, fistula, infiltrates, changes in the intestinal tissue);
- CT scans (there are special programs for examination of the intestine - virtual colonoscopy, although biopsy sampling, unfortunately, is technically impossible).
Treatment of irritable bowel syndrome
Patients with IBS are treated long and hard. Sometimes doctors choose the most appropriate treatment methods for years. And they are not always medicamentous.
Most patients do not need emergency or planned hospitalization. The decision on the composition and duration of the treatment program should be taken individually for each patient with IBS, based on the characteristics of his psycho-emotional and physical status, the tolerability of medications, the nature of the concomitant pathology, age. At the heart of the treatment are:
- Diet therapy;
- Changes in lifestyle;
- Massage (abdominal or general, self-massage);
Diet in irritable bowel syndrome
The nature of the diet prescribed to the patient directly depends on the variant of IBS. But all patients are advised to regulate their diet, give up alcohol and individually poorly tolerated dishes or foods, start keeping a diary with fixation of the time of consumption, the amount and type of food they eat.
In the presence of diarrhea, the nutritional diet of patients should reduce the excessive motor activity of the dysregulated intestine. Therefore, doctors are strongly advised:
- To refuse from cold food, food and drinks;
- Grind the products when they are cooked (for example, from boiled vegetables to make a mash);
- Avoid fatty foods, since 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, radish, turnip, etc.) and mushrooms;
- Limit fiber-rich foods (bread with bran, popcorn, legumes, sea kale, prunes, pearl barley, millet, etc.);
- To be afraid of too salty and sweet drinks and dishes (pickles, syrups, honey, etc.);
- Reduce the amount of caffeine-containing beverages.
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.). Garnish or breakfast can be eaten with crumbly porridges (semolina, rice, buckwheat), vermicelli, puddings from cereals or vegetables (pumpkin, zucchini, potatoes, carrots, squash). The latter boil, bake or extinguish. From berries and fruit prepare juices, fruit drinks, kissels, soufflé, mousses, marmalade, marshmallows. The consumption of fresh vegetables, berries, greens or sweet fruits depends on the individual patient's tolerance. Soups with skimmed fish or meat broth are allowed. Omelettes and soft-boiled eggs are allowed, low-fat kefir, fermented milk, milk, curdled milk, cheese, cottage cheese and yoghurt, doctor's sausage, lean ham, cheesecake, pies with jam or boiled meat, dry biscuits.
If the patients are dominated by persistent constipation, then their diet should:
- Optimize your drinking regimen (at least 2 liters of tea, juices, kissels, coffee, water, etc.) should be drunk a day;
- Drink not only warm, but also chilled drinks (for example, to start the morning with drinking cold water);
- Avoid wiping food when cooking;
- More often there is (every hit of even a small amount of food in the stomach reflex causes activation of the movements of the colon);
- Do not give up weak coffee (this drink stimulates the motility of the intestine);
- Eat more fresh fruits, vegetables and other products with a high fiber quota (beans, pearl barley, kelp, baked goods with whole grains and bran, dried fruit, etc.);
- Beware of vegetables with essential oils (radish, turnip, garlic, onion, etc.) and mushrooms;
- To drink freshly squeezed fruit or vegetable juices (the organic acids contained in them strengthen the motor capacity of the intestine);
- In the absence of contraindications, salty meals, sweet drinks (sugar syrup, water with honey, etc.), cream or milk caramel, which act as natural laxatives, are allowed;
- Give up fatty (especially roasted) meat and fish, as the refractory fats of these products, although they stimulate motor skills, but the carcinogens released during frying with constipation last longer contact with the intestinal mucosa and are capable of provoking 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 rice, semolina and pasta. Omelettes and soft-boiled eggs are allowed (hard-boiled eggs strengthen constipation), fresh dairy products (especially one-day kefir), raw cheese, ham without fat, soaked herring, black caviar.
Correction of life style
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, they should avoid traveling or traveling, since proper nutrition, regular toilet rides in the mornings in a calm environment and the absence of psychotraumatic situations are necessary.
The choice of medications depends on the symptomatology of IBS in a particular patient. The treatment complex can include:
- Antispasmodics, eliminating pain, if it is caused by intestinal hypertension (drotaverin, pinaveria bromide, mebeverin, etc.);
- M-holinolitiki, reduce spasm and have some opposing effect (buscopan, belloid, platyphylline, riabal, metacin, etc.);
- Prokinetics - regulators of intestinal motility (metoclopramide, trimedate, tegaserod, itopride, alosetron, debrideate, etc.);
- Opposing means:
- drugs that weaken intestinal motility (loperamide, reisek, nufenoxol);
- medicines that condense feces (desmol, calcium carbonate, etc.);
- sorbents (filter, smect, enterosgel, lignosorb, polysorb, etc.);
- means for excretion of bile acids (polyphepan, bilignin, etc.);
- Anthraglycosides (preparations of senna, cofranil, rhamnil, regulax, tisasen, etc., can cause addiction);
- oils (castor, vaseline, etc.);
- Derivatives of diphenylmethane (bisacodyl, isafenin, etc.);
- Salt (Karlovy Vary salt, magnesium sulphate salts, sodium sulfate, etc.);
- Means that increase the volume of stool and accelerate its transit (bran, - mukofalk, laminarid, MCC, etc.);
- lactulose (normase, dyufaklak, laktusan, etc.);
- laxative candles (calciolax, ferrolaks, glycerol, etc.);
- Psychotropic (amitriptyline, paroxetine, attaraks, grandaxin, phenazepam, azafen, elenium, preparations of valerian, motherwort, etc.);
- Carminative (diflatil, pepfiz, espumizan, sub-simplex, etc.).
In addition to psychopharmacological drugs, some patients need to work with a psychotherapist or even a psychiatrist using other techniques (hypnosis, auto-training, group or individual activities, etc.).
In patients with IBS, physiotherapy can help normalize the tone of the intestine: eliminate spastic phenomena or atony.
Eliminating intestinal spasms helps to remove pain and constipation if they are associated with excessive tone. To do this, use paraffin and ozocerite applications, electrophoresis with papaverine, magnesium salts, platyphylline, diathermy, inductothermia, UHF, mud applications, acupuncture, coniferous baths, aeroionotherapy.
Constipation due to the weakening of intestinal motility is treated by electrophoresis with calcium chloride or proserin, faradization, ultrasound, ultraviolet irradiation, diadynamic currents, contrast baths, acupuncture.
Many patients and doctors neglect physical exercises. Meanwhile, therapeutic gymnastics helps:
- To restore the disturbed intestinal regulation;
- Improve metabolic processes;
- Eliminate constipation;
- Stabilize the nervous system;
- Have a general toning effect.
The patients are the whole complexes of exercises for the body (turns, inclinations), the abdominal press (slopes, legs lifts, etc.). In addition, breathing exercises are recommended (including exercises to stimulate diaphragmatic breathing), rhythmic contraction-expansion of the anal (anus) of the sphincter. A good effect is systematic walking, mobile sports games, swimming, running.
For patients with constipation of psychogenic origin, a special technique was developed-the Trusso-Bergman gymnastics, combining breathing exercises with voluntary movements (protrusion) of the abdominal wall and straining.
The presence of IBS absolutely does not affect life expectancy at all. The probability of oncological diseases in patients with IBS does not differ from the risk of these diseases in healthy people. The disease has not progressed for years, but its course is chronic with periodic recurrence of the existing symptoms. But only one-third of these patients manage to achieve complete and complete disappearance of the disease or prolonged stable remission.
Preventive measures have not yet been developed.
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