Irritable Bowel Syndrome
Irritable Bowel SyndromeIrritable bowel syndrome is a functional pathology which is widespread in the population, characterized by a disturbances of the bowel transit, consisting in general by alternation of constipation with diarrhea, diffuse abdominal pain, usually in the form of cramps, sometimes the emission of mucus. Rectoragia, anemia or weight loss are not a part of the pictures of irritable bowel syndrome .
Irritable bowel syndrome received a lot of synonyms, such as diarrhea nervosa, but the most suggestive name would be “unhappy colon.
Patients with irritable bowel syndrome generally see a lot of doctors, from the family physician to the gastroenterologist or even surgeon due to fear of cancer, but also because of the long evolution of this disease. Usually, patients are concerned about the disease, anxious, depressed and often working under stressful conditions. Anxiety and depression are common in these patients so that they will present to the doctor a very thorough, detailed history of the disease, often with dramatic characters. The fund of this disease can be constipation, which can be linked to lack of fiber in the diet and sedentary lifestyle, with the appearance of mucus stools or diarrhea, which occur most often under stressful conditions.
Irritable bowel syndrome is a functional disease, so organic lesions, detectable by laboratory techniques are absent.
Irritable bowel syndrome symptoms include:
- Abdominal pain, which can be diffuse or localized on colic tract. The pain may be dull, but often have the character of a cramp, lasting seconds or minutes. Sometimes the patient feels only abdominal discomfort. Symptoms often disappear during periods of relaxation;
- Intesinal transit disorders are common. Their main feature is alternation of constipation with diarrhea. Typically, the stool is hard, fragmented, covered with mucus. Often a false diarrhea can occur, because after the emission of hard stool, will appear the emission of a liquid stools, which is characteristic for colonic irritation. Diarrheal stools occur most often in the form of compelling stools. Diarheal stools appear more often in the morning, postprandial or at emotions;
- Emission of mucus is common and accompanies the stools. In the clinical picture of irritable bowel syndrome, blood does not appear in stool, hard stools can create anal fissures that will bleed;
- Bloating is common in patients with irritable bowel syndrome, the patient feels the bloating diffuse or localized in certain areas of the abdomen. Gas emissions may ease in a transitory way the suffering of the patient.
The diagnosis of irritable bowel syndrome is made by excluding organic disease of the colon, so based on laboratory exploration.
There are certain criteria that suggest the diagnosis of irritable bowel syndrome called Manning criteria, these are:
- abdominal pain that fails after the the emission of stools;
- stools become more frequent and softer in the presence of pain;
- bloating, abdominal distension;
- sensation of incomplete evacuation of the rectum;
- elimination of mucus in the stool;
- imperative criteria of bowel movement.
Paraclinical examination in irritable bowel syndrome are needed to exclude abdominal organic disease and consists of:
- Anoscopy, rectoscope, colonoscopy to detect colon organic pathology;
- Gastroscopy to exclude gastric pathology;
- Pelvic and abdominal ultrasound to exclude gallbladder, pancreas or genital pathology;
- Radiological evaluation of the intestine (entero-enema or barium-passage) or enteroscopy to exclude enteral pathology.
The diagnosis of irritable bowel syndrome is put on the exclusion of organic lesions in paraclinical explorations, and the Manning criteria for irritable bowel syndrome.
Evolution of irritable bowel syndrome is favorable because complications will not arise. In general the disease evolves with time long quiet periods, accompanied by exacerbations, which are usually related to stress. There are some situations in which the colon diverticulosis is associated with irritable bowel syndrome.
The treatment of irritable bowel syndrome is generally difficult and the results are often not the expected. Being a functional pathology, the mental component is important, so the role of psychological balancing is also important.
- Diet should be a high-fiber, if constipation is predominant. If the diet is not sufficiently to combat constipation, than should be used laxatives that are growing the volume of the stool. It should be indicated a diet that the patient tolerates and the patient must avoid foods that cause symptoms;
- Antidiarrheal, in cases of diarrhea;
- Antispasmodics indicated for pain control, should be administered only if are necessary;
- Sedatives. Sedative medication is as useful as psychotherapy. Often rule out the diagnosis of colon cancer (the patient imagines it), can lead to symptoms improvement;
In the irritable bowel syndrome, diet and drug therapy are individualized, and the role of patient trusting in his physician is very important.