Chronic irritable bowel syndrome treatment. Irritable Bowel Syndrome: Symptoms, Causes, Diagnosis and Treatment. Medical and preventive measures. Complementary treatment

Patients who have not regularly consumed alcohol and do not suffer from alcoholism should not start drinking after diagnosis. In their case, alcohol may not have played a significant role in the development of the disease, but it can still aggravate its course. In addition, many drugs used to treat irritable bowel syndrome are incompatible with alcohol. Their action can not only be neutralized, but also have a toxic effect, affecting the functioning of the liver, kidneys, and heart.

Drinking alcohol contrary to your doctor's instructions for irritable bowel syndrome can have the following consequences:

• more frequent and worse abdominal pain;
• gradual weight loss and wasting ( due to malabsorption - impaired absorption of food);
• increased frequency of episodes of constipation and diarrhea;
• overlapping the therapeutic effect of medications ( causing the illness in general to last longer);
• increased risk of infectious complications ( escherichiosis, salmonellosis and other intestinal infections);
• the risk of developing colon cancer ( with regular use).

Thus, alcohol addiction can worsen the prognosis, even though it is generally positive in irritable bowel syndrome. If possible, you should give up not only strong alcoholic drinks, but also beer ( even non-alcoholic), wine and even kvass. The fact is that they, even without causing alcohol intoxication, can contribute to fermentation processes in the intestines. This disrupts the balance of the intestinal microflora and causes flatulence ( flatulence in the intestines). In patients with irritable bowel syndrome, this symptom is especially pronounced, since due to impaired motility, gases are not excreted naturally.

In general, a single use of alcohol with this disease, of course, is not fatal. Most often, this only leads to an aggravation of the condition according to the above mechanisms. But the wrong combination of some drugs prescribed by a doctor for the treatment of irritable bowel syndrome with alcohol can cause more serious consequences and cause urgent hospitalization ( due to poisoning). In this regard, you should be very careful and, if possible, still adhere to the diet prescribed by your doctor. When you first contact a specialist to start treatment, you should notify him if there are problems with alcohol abuse. This can initially affect the tactics of treatment.

Do you have irritable bowel syndrome during pregnancy?

Irritable bowel syndrome during pregnancy is common, but not overwhelming. This disease is manifested by mild gastrointestinal symptoms. It is not accompanied by any irreversible pathological changes in the intestine, but is reduced only to disturbances in its work. Until now, it has not been possible to accurately determine all the mechanisms involved in the development of this syndrome. It is only known for certain that the innervation of the intestine, the state of the endocrine system and the psycho-emotional background play a certain role in it.

It is the above factors that appear during pregnancy that explain the high incidence of irritable bowel syndrome. In addition, statistically, this pathology occurs most often in women of childbearing age ( from about 20 to 45 years old). In pregnant women, this syndrome is somewhat more severe than in other patients. This is due to a large number of external and internal factors that provoke frequent exacerbations.

The following factors can influence the increase in exacerbations during pregnancy:

• hormonal changes;
• mechanical squeezing of the intestine and displacement of its loops by the growing fetus;
• weakening of immunity;
• changes in diet;
• psycho-emotional stress;
• mechanical pressure on the nerve fibers innervating the intestines;
• taking various drugs and dietary supplements.

Against the background of these changes, exacerbations become more frequent in women who have suffered from irritable bowel syndrome before. Symptoms that did not cause serious inconvenience before ( many patients do not even go to the doctor) become more pronounced. To confirm the diagnosis and prescribe symptomatic treatment, you should consult a gastroenterologist. Treatment of the underlying causes of the disease during pregnancy is not recommended ( this will be an extra risk for the fetus).

Symptomatic treatment of irritable bowel syndrome in pregnant women involves the appointment of the following drugs:

• antispasmodics and sedatives- with pain in the abdomen;
• laxatives(you can also folk remedies) - with prolonged constipation;
• fixing- with prolonged diarrhea;
• carminative- with a strong accumulation of gas in the intestine ( flatulence).

In addition, you should pay attention to lifestyle and nutrition. As mentioned above, pregnancy itself provokes an exacerbation of the disease. Therefore, you should avoid stressful situations, walk more, eat easily digestible food ( cereals, vegetables and fruits without hard plant fibers, dairy products).

Seeing a doctor at the first symptoms of the disease is mandatory. This is necessary in order to exclude more serious pathologies ( intestinal infections, adhesive disease of the intestines and pelvic organs, neoplasms in the abdominal cavity) that can affect the course of pregnancy. If doctors diagnose irritable bowel syndrome, then the prognosis for both the patient and the unborn child is favorable. This disease is not accompanied by serious systemic disorders, does not cause complications of pregnancy and does not threaten the fetus. Doctors continue to observe the patient according to the general scheme, periodically seeking advice from a gastroenterologist. Treatment is limited to relieving symptoms. After childbirth, the main manifestations of irritable bowel syndrome do not go away immediately and may even worsen. Usually, however, the frequency of exacerbations and the intensity of symptoms gradually decrease.

Does Irritable Bowel Syndrome Happen in Children?

Most often, irritable bowel syndrome occurs in people between 20 and 45 years old, but the disease may well develop in childhood. In these cases, the clinical manifestations will not be very different from those in adults, but with some distinctive features.

Children may experience the following symptoms of this disease:

• Stomach ache... In childhood, they are usually more frequent and more intense than in adults. This is partly because children are generally less tolerant of pain. In young children who cannot complain of pain, the symptom is manifested by anxiety, frequent crying, which increases with a change in position. Usually, pain is not well-defined, since it is caused by spasm of the smooth muscles of the intestine, and not by local inflammation of the peritoneum.
• Digestive disorders... As in adults, they can present with prolonged periods of diarrhea ( diarrhea) or constipation ( constipation) or the alternation of these symptoms. In young children without medical care, against the background of digestive disorders, nutrients begin to be absorbed worse. Because of this, the child may lag behind in height and weight. In children of school age and older, this is not so noticeable due to the slower growth rates.
• Flatulence... Bloating due to flatulence is generally a common problem in young children. Their intestines are more sensitive to the food they eat. Accordingly, children with irritable bowel syndrome are forced to adhere to a more strict diet. More often, the syndrome occurs in infants who, for various reasons, were transferred from breastfeeding to artificial nutrition.
• Frequent urge... Children of school age and older often complain of the urge to have a bowel movement. In this case, emptying itself provides temporary relief, but the feeling of fullness in the abdomen usually does not go away.
• Discharge of mucus... Mucous discharge without blood impurities is found mainly in young children. With age, the number of such secretions decreases.

Thus, the manifestations of the disease in children are usually more intense than in adults. The diagnosis of irritable bowel syndrome is also complicated due to the wide limits of the norm for different ages. Most often, the syndrome is not correctly diagnosed by either pediatricians or gastroenterologists. With age, due to changes in the structure of growing organs, "improvement" of nervous regulation and stabilization of hormonal levels, the disease can go away by itself, without any treatment.

Differences in the manifestations of the disease and difficulties in diagnosis are explained by the following anatomical and physiological characteristics in children:

• incomplete set of digestive enzymes ( due to which not all food is normally digested in the intestines);
• gradual reproduction of microflora in the intestine ( the older the child, the closer the composition of his microflora to normal);
• greater mobility of intestinal loops than in adults;
• insufficient control of the nervous system over the intestinal muscles;
• accelerated formation of feces;
• less intense bile production ( fats are digested worse);
• food allergies are more common;
• the growth and differentiation of cells in organs is accelerated;
• the fermentation process in the intestines of young children takes place more often than in adults ( because of this, gases accumulate);
• higher sensitivity to various intestinal infections;
• weaker fixation of the mucous membrane and submucosa in the rectum.

All this explains some of the differences in the clinical picture of irritable bowel syndrome. Nevertheless, the prognosis for children with this disease always remains favorable. There are practically no complications, and the disease itself gradually goes away. Prolonged flow ( decades, until adulthood) occurs mainly when trying to self-medicate or non-compliance with the diet and other prescriptions of the attending physician. Then, over the years of digestive disorders, a variety of problems can develop. The constant stagnation of feces in the body leads to intoxication, problems with the liver, skin, heart and other internal organs.

Does stress affect Irritable Bowel Syndrome?

According to the latest research, prolonged stress is one of the most common causes of irritable bowel syndrome. The fact is that with this disease there are no morphological ( structural) tissue disorders. The appearance of symptoms of the disease is usually explained by the influence of any external factors that affect the innervation and work of smooth muscles in the intestinal walls. When interviewing patients, it is most often possible to find out that exacerbations are associated precisely with increased psycho-emotional stress.

From a medical point of view, stress is the body's response to emotional or physical stress. Normally, they allow the body to better adapt to various situations, but prolonged stress has a negative effect. First of all, this is due to the activation of the autonomic nervous system and the release of a number of hormones. It is these reactions that cause disturbances in the work of smooth muscle tissue.

As a result, due to a violation of innervation, the following problems arise:

• Muscle spasm... Spasm is a reflex muscle tension ( in this case - in the intestinal wall). Because of this, the patient may experience recurrent abdominal pain.
• Motility disorders... Intestinal motility is the combination of contractions of its walls, which facilitates the passage of contents along from the stomach to the rectum. Due to the spasm, motility is impaired and the contents of the intestine are retained in certain areas. This creates a feeling of "overcrowding" in the abdomen.
• Flatulence... Delaying the content leads to an increase in fermentation processes ( especially when drinking beer, kvass, grapes and other products with a similar effect). As a result, gas accumulates in the intestines and a corresponding symptom occurs - flatulence.
• Disorders of food digestion... The nervous system not only coordinates intestinal motility, but also stimulates the secretion of digestive enzymes, regulates the absorption of nutrients and fluids. Innervation disorders can lead to alternating periods of constipation ( constipation) and diarrhea ( diarrhea).

Thus, stress has the most direct effect on bowel function. Similar effects can be noted even in healthy people who do not suffer from irritable bowel syndrome. In patients with this ailment, there are additional features in the structure of the nervous and muscular system. Because of this, the psychoemotional load causes a longer lasting effect in their bodies. The exacerbation lasts from several days to several weeks. The stronger the load and the longer its effect, the more pronounced the symptoms of the disease will be.

In addition to stimulating the nervous system, prolonged stress can weaken the immune system. As a result, disturbances in the work of the intestines are often complicated by dysbiosis ( the composition of the intestinal microflora changes), serious intestinal infections can develop. This will aggravate the course of the disease.

To prevent irritable bowel syndrome during stress, the following measures are recommended:

• reasonable mode of work and rest;
• quitting smoking, drinking alcohol, coffee and tea in large quantities ( substances that affect the psyche and the work of the nervous system);
• playing sports or periodic gymnastic exercises;
• outdoor recreation for at least an hour a day;
• preventive use of weak sedatives ( infusion of valerian, chamomile, motherwort);
• consultative help of a psychologist ( in case of serious psycho-emotional stress).

How should irritable bowel syndrome (IBS) be treated in adults? With such a question, they often turn to doctors of various specialties, because the treatment must necessarily be complex: taking medications, diet, lifestyle changes, psychotherapy and even surgery.

Only timely and complete treatment of IBS guarantees complete elimination of all symptoms of the disease and the preservation of the patient's physical health. Moreover, the earlier treatment is started, the greater the chances of recovery and the easier the therapy itself will be.

- This is a rather severe functional disease, which is manifested by abdominal pain, digestive disorders and changes in stool.

The reasons for the development of IBS are interesting, this disease can develop in full physical health, without organic intestinal pathologies. Psychoemotional factors are considered the main cause of the onset of the disease: stress, nervous tension, a sedentary lifestyle and unhealthy diet.

Also, hereditary diseases, bad habits, infectious diseases and hormonal disorders can provoke the disease.

Today, IBS is considered one of the most common diseases of the gastrointestinal tract; both adults, mainly at the age of 25-40, and children, from toddlers to adolescents, suffer from it.

Irritable bowel syndrome is manifested by:

• a feeling of pain, distention, heaviness in the abdomen - symptoms occur immediately after eating or after a while;
• violation of the stool - there may be constant constipation, diarrhea or their alternation;
• the appearance in the stool of mucus, blood, pieces of undigested food;
• frequent urge to defecate and a feeling of incomplete emptying of the intestines;
• additional symptoms: headache, feeling of constant fatigue, decreased performance and concentration.

The diagnosis of IBS is made only when organic intestinal pathologies and infectious diseases are excluded, as well as when several symptoms of the disease persist for 3 months or more.

Patient treatment should be comprehensive and must include not only medication, but also psychotherapy, diet and lifestyle changes.

Treatment

It is necessary to start treatment of the syndrome simultaneously with several methods:

All patients with irritable bowel syndrome need to tune in to long-term and fairly intense treatment.

Drug therapy

Drug therapy helps to get rid of the main symptoms of the disease: abdominal pain, digestive and stool disorders, as well as relieve anxiety and nervous tension that always accompany this disease.

For treatment use:

Diet

One of the most important conditions for successful treatment of IBS is diet. The diet and nature of the diet depends on the form of the disease: with a predominance of constipation or diarrhea, but there is general principles nutrition, which are the same for all patients with indigestion:

Diet for constipation

Foods should stimulate the intestines, speeding up digestion and making it easier to empty.

The basic principles of Pevzner's diet number 3 do not differ from those listed above:

• it is forbidden to use: smoked meats, fatty meats, pasta, fried eggs, pasta, rice, legumes, mushrooms, onions, garlic, cabbage, radishes, quince, dogwood, any products containing fats;
• allowed: stewed and boiled vegetables, dairy products, buckwheat, egg groats, millet, low-fat boiled or steamed meat and fish, bran, wheat bread, dried fruits, sweet fruits and berries.

Diet for diarrhea

Diet No. 4 according to Pevzner, used for frequent diarrhea, should provide the body with all the necessary nutrients. The number of calories with it is somewhat reduced, the dishes are subjected to minimal heat treatment, eating only in a warm form.

Psychotherapy

Psychotherapy is the only treatment that can be called etiological for irritable bowel syndrome.

Since this is a disease, it is the treatment by a psychotherapist that will help to cope with the problems that caused the development of the disease: nervous tension, constant stress, inability to build relationships with people around. Only by getting rid of internal problems and changing their lifestyle, patients will be able to fully cope with the symptoms of the disease and avoid a relapse of the disease.

Cognitive behavioral therapy, psychoanalysis and hypnosis are most commonly used to treat the disease.

One of the most important goals of such treatment is to combat the fear of an attack of illness. All patients with IBS are afraid that the symptoms of the disease may arise suddenly: with stress, fear, in an unpleasant situation for themselves, and so on. As a result, they diligently avoid such situations, try to leave the house less or get out only to well-known, close-located places where there is always an opportunity to visit the toilet. The ability to control their body helps such patients get rid of fear and significantly increases their social activity.

It is very important to educate patients in relaxation techniques and the ability to “dump” negative emotions, since this is the area that usually suffers in patients with IBS.

Cognitive behavioral therapy and psychoanalysis help the patient understand exactly what thoughts, attitudes and actions cause the development of stress, negative experiences, and so on. By learning to cope with these situations, patients get rid of most of the nervous tension and their condition improves.

Hypnosis is recommended in cases where the patient cannot remember the cause of the disease or has had a serious psychological trauma. A hypnosis session helps to cope with fear and remove the "barrier" that is preserved in the subconscious.

Home treatment

If you suspect developing irritable bowel syndrome or the first signs of illness, you can try to cope with the symptoms of the disease at home.

To do this, you must adhere to a diet, be sure to stop drinking and smoking, as well as change your daily routine and reduce stress levels.

The following measures will help restore the health of the nervous system and the whole body as a whole:

• reduce mental and physical stress - no more than 7-8 hours a day;
• sleep at least 8 hours a day;
• spend at least 1 hour in the fresh air;
• exercise;
• daily, at least 2-3 hours to rest, engage in hobbies, walk, but do not use any gadgets at this time, including watching TV;
• reduce the time spent at the computer and its analogs;
• it is imperative to relieve nervous and muscle tension once a day: this can be yoga, meditation, breathing exercises, sand or art therapy, or any other suitable method.

There are folk remedies that can also help treat IBS at home:

1. Coniferous baths are a relaxing remedy. To prepare such a bath, 15-20 drops are added to warm (38-39 degrees) water aromatic oil or 0.5 liters of needles infusion.
2. Peppermint infusion. 1 tsp dry raw materials for 1 tbsp of boiling water, insist for 10-15 minutes, take 1 \ 2 tbsp 2-3 times a day after meals.
3. Infusion of herbs or dill seeds. 1 tbsp. l. for 2 tbsp of boiling water, insist for 10-15 minutes and take 1/2 tbsp 3 times a day before meals.
4. Infusion of pomegranate peels. 1 tbsp. l. crushed crusts for 1 tbsp of boiling water, insist for several hours, take 1 time per day before meals.

Irritable bowel syndrome is a serious and serious illness, so you should not get carried away only with folk methods or treat it at home, refusing to see a doctor. Only timely and comprehensive treatment can completely relieve the patient of the symptoms of the disease and maintain the health of his digestive system.

Irritable Bowel Syndrome (IBS), spastic colitis

Version: MedElement Disease Handbook

Irritable bowel syndrome (K58)

Gastroenterology

general information

Short description

According to Rome III criteria, irritable bowel syndrome(IBS) is defined as a complex of functional intestinal disorders, which includes pain or discomfort in the abdomen, relieved after a bowel movement, associated with a change in the frequency of bowel movements and stool consistency for at least 3 days a month for 3 months over the past year.

Classification

There are four possible options for IBS:

- IBS with constipation(hard or fragmented stools - more than 25% of cases, loose or watery stools - less than 25% of cases from all acts of defecation);

- IBS with diarrhea(loose or watery stools - more than 25% of cases, hard or fragmented stools - less than 25% of cases from all acts of defecation);

- mixed form of IBS(hard or fragmented stools - more than 25% of cases, loose or watery stools - more than 25% of cases from all acts of defecation);

- unclassified form of IBS(insufficient change in stool consistency to establish a diagnosis of IBS with constipation, IBS with diarrhea, or mixed IBS).

This classification is based on the shape of the chair according to the Bristol scale, since there is a direct relationship between the time of passage through the intestine and the consistency of the stool. In particular, the longer the transit time of the contents, the denser the stool.

Bristol Chair Shape Scale:

Separate solid fragments;

The stool is shaped but fragmented;

The chair is shaped, but with an irregular surface;

The chair is shaped or serpentine, with a smooth and soft surface;

Soft fragments with smooth edges;

Unstable fragments with jagged edges;

Watery stools without solids, colored liquid.

However, it must be remembered that patients often move from one subgroup to another, and that the symptoms of diarrhea and constipation are often misinterpreted in patients with IBS. Consequently, many IBS patients who complain of "diarrhea" are referring to frequent, shaped bowel movements. Also, in the same patient population, the term "constipation" may refer to one of the complaints associated with attempted defecation, rather than simply infrequent bowel movements.

Other classifications based on clinical evidence can also be used.

Symptom-based classification:

IBS with a predominance of intestinal dysfunction;

IBS with a predominance of pain syndrome;

IBS with a predominance of flatulence.

Classification based on the presence of aggravating factors:

Post-infectious IBS;

IBS associated with certain foods;
- Stress-related IBS.

With the exception of post-infectious IBS, which is reasonably well defined, the relationship of these classification forms to prognosis or response to treatment remains to be seen.

Etiology and pathogenesis

Etiology

1. Stressful situations

It has been proven that the occurrence of IBS directly depends on the presence of stressful situations in the patient's life. A situation that traumatizes the psyche can be transferred in childhood (loss of one of the parents, sexual harassment), several weeks or months before the onset of the disease; can manifest itself in the form of chronic stress that persists at the present time (serious illness of someone close to you).

The incidence of mental disorders in patients with IBS under 50 years of age (Malakhov, Gataulina, 2001)

For an objective assessment of the psychological picture, the following can help:
1. The Hospital Anxiety and Depression Scale (HADS) is a simple 14-item questionnaire designed to assess the level of anxiety and depression.
2. Feeling of Closeness Test (SOC) - can be used to identify patients who have a low score but are responding to cognitive behavioral therapy.
3. Health questionnaire (PHQ-15) - contains 15 questions, the answers to which help to identify the presence of multiple somatic symptoms (somatization). PHQ-15 must be approved in each specific country before it can be introduced into clinical practice.

2. Personal characteristics

Personal characteristics include the inability to distinguish between physical pain and emotional distress; a tendency to transfer emotional stress into somatic symptoms (somatization); difficulties in the verbal formulation of sensations, a high level of anxiety. Personality traits are influenced by the environment or can be genetically determined. The likelihood of a genetic predisposition in the pathogenesis of functional disorders is mainly confirmed in relevant studies.

3. Postponed intestinal infection

In 6-17% of all cases of IBS, the post-infectious form of the disease is present. 7-33% of patients with acute intestinal infection suffer from IBS symptoms. In most cases (65%), the post-infectious form of the disease develops after shigellosis infection, and in 8.7% of patients it is associated with an infection caused by Campylobacter jejuni.

Pathogenesis

According to modern concepts, IBS is a biopsychosocial disease. Psychological, social and biological factors take part in its formation, the combined effect of which leads to the development of visceral hypersensitivity, impaired intestinal motility and a slowdown in the passage of gases through the intestine, which manifests itself as symptoms of the disease (abdominal pain, flatulence and stool disorders).

Epidemiology

In the world, IBS is present in 10-20% of the adult population. Two thirds of people suffering from this disease do not go to doctors due to the sensitivity of their complaints.

The peak incidence is 30-40 years, the average age of patients is 24-41 years. The ratio of women to men is 1: 1-2: 1. IBS is as common among men over 50 as among women.

Other observations on the epidemiology of IBS:

1. Basically, IBS develops between the ages of 15 and 65; the first visit to a doctor is at the age of 30-50. There is a trend towards a decrease in the incidence of IBS in older age groups.

2. In some cases, symptoms of IBS can develop even in childhood, while the incidence of IBS among children corresponds to the adult population.

3. The incidence of IBS is higher in women (there are exceptions, for example - India).

4. Typical symptoms of IBS are often found in the so-called. "Healthy" population and the bulk of patients suffering from this symptom does not have an official diagnosis. This fact may explain the differences in the statistical prevalence of IBS in different territories.

Clinical picture

Symptoms, course

According to the literature, complaints of IBS patients, can be conditionally divided into three groups:

Intestinal;

Related to other parts of the gastrointestinal tract;

Non-gastroenterological.

There is a high probability of diagnosing IBS when a patient has a combination of symptoms related to all three groups (and not just one), combined with the absence of organic pathology.

Features of intestinal symptoms in IBS

1. Pain characterized as vague, burning, twisting, dagger, dull, aching, constant. Localization: mainly in the iliac regions, more often on the left. Also, pain can occur in the left upper quadrant in the standing position and relieve in the supine position with raised buttocks ("spleen curvature syndrome").
After eating, the pain usually intensifies, decreases after the passage of gas, the act of defecation, and the intake of antispasmodic drugs. In women, the pain increases during menstruation.
An important distinguishing feature of IBS pain is its absence at night.

2. Feeling bloated less pronounced in the morning hours and gradually becomes stronger during the day, especially after a meal.

3. Diarrhea appears, as a rule, in the morning, after breakfast. Stool frequency is 2-4 or more times in a short period of time. Patients often experience urgency and a feeling of incomplete bowel movement. During the first act of defecation, the stool is often denser than during subsequent ones. The total daily weight of feces does not exceed 200 g. There is no diarrhea at night.

4. When constipation possible types of stool such as "sheep" stool, stool in the form of a pencil, as well as cork stool (discharge of dense, shaped stool at the beginning of bowel movements, then mushy or even watery stool). The stool does not contain impurities of blood and pus.

With IBS, mucus is often excreted in the feces, especially in men.

The listed clinical symptoms are not specific only for IBS and can occur in other bowel diseases. Therefore, it is necessary to find out from the patient the presence of complaints related to other parts of the gastrointestinal tract, non-gastroenterological complaints (headache, feeling of internal trembling, back pain, feeling of incomplete inhalation).

According to a 1990 US study:
- 56% of patients diagnosed with IBS had symptoms of a functional disorder of the esophagus;
- in 37% of patients - signs of non-ulcer dyspepsia;
- in 41% of patients - symptoms of functional anorectal disorders.

The authors of publications on the clinical manifestations of IBS draw attention to the discrepancy between a large number of complaints, a long course of the disease and a satisfactory general condition of the patient.

Diagnostics

To make a correct diagnosis, it is especially important to collect a complete life history and medical history of the patient. When questioning, one should find out the composition of the family, the state of health of relatives, the presence of bad habits, the living conditions of the patient, the peculiarities of professional activity, violations of the regime and nature of the diet.
It is important to establish a relationship between the occurrence of clinical symptoms and the impact of external factors (nervous stress, intestinal infections, duration of the disease before the first visit to the doctor, the patient's age at the onset of the disease, previous treatment and its effectiveness).

IBS diagnosis process:

- Stage 1: setting up a preliminary diagnosis;

- Stage 2: identification of dominant symptoms and phase of the syndrome;

-Stage 3: elimination of symptoms of "anxiety" and carrying out a differential diagnosis;

- Stage 4: screening studies for organic pathology - determination and implementation of necessary and sufficient laboratory tests and the use of visualization methods of FEGDS, ultrasound, sigmo-, colonoscopy or irigoscopy. The detection of any abnormalities (hepato-, splenomegaly, edema, fistulas, etc.) is against the diagnosis of IBS.

- Stage 5: prescribing a primary course of treatment for a period of at least 6 weeks. Evaluation of the effect. Development of further tactics.

Signs of "anxiety":

Unexplained weight loss;

The presence of blood in the stool;

Family history of colorectal cancer, celiac disease Celiac disease is a chronic disease caused by a deficiency of enzymes involved in the digestion of gluten.
, inflammatory bowel disease;

Fever accompanying pain in the lower abdomen;

Increased ESR;
- connection with drug therapy;
- connection with menstruation;

Symptoms for the first time after 50 years.

Laboratory diagnostics

In general, laboratory diagnostics is aimed at excluding other intestinal pathologies, since pathognomonic Pathognomonic - characteristic of a given disease (about a sign).
signs of IBS are absent.

It is necessary to differentiate IBS with the following conditions:

- intestinal infections (bacterial, amoebic);
- reactions to food (caffeine, alcohol, fats, milk, vegetables, fruits, black bread, etc.), a plentiful meal, a change in eating habits;

Reactions to reception drugs(antibiotics, laxatives, iron or bile acid preparations);

Inflammatory bowel disease (ulcerative colitis, Crohn's disease);

Neuroendocrine tumors (carcinoid syndrome; tumor dependent on vasointestinal peptide);

Endocrine diseases (hyperthyroidism);
- malabsorption syndrome (postgastrectomy, pancreatic, enteral);

Psychopathological conditions;

Proctoanal pathology (dyssynergia of the pelvic floor muscles);
- gynecological diseases (endometriosis);

Functional states in women (premenstrual syndrome, pregnancy, menopause).

Treatment

Purpose of treatment a patient with IBS - achieving remission and restoring social activity. In most cases, outpatient treatment is indicated. For examination and in case of difficulties in the selection of therapy, hospitalization is possible.

Drug-free treatment

For the treatment of patients with IBS, the following are used:

Patient education (familiarization of the patient in an accessible form with the essence of the disease and its prognosis);

- "stress relief" - that is, focusing the patient's attention on the normal results of the research; it is necessary to inform the patient that he does not have a serious organic disease that threatens life;

Drug treatment

Since today it is generally accepted to divide patients according to the clinical course of the disease into three groups (with a predominance of constipation, diarrhea, or their alternation), it is more convenient to consider groups of drugs in accordance with their use for one or another variant of IBS.

1. IBS with alternating diarrhea and constipation

Complaints of abdominal pain, flatulence come to the fore. Anticholinergic drugs (bukospan) and myotropic antispasmodics such as drotaverine, mebeverin, pinaverium are widely used.

2. IBS with a predominance of diarrhea

Loperamide, dioctahedral smectite, 5-HT 3 receptor antagonists (alosetron, silansetron) and probiotics are prescribed.

The effectiveness of loperamide and dioctahedral smectite in patients with IBS has been proven in studies.

5-HT3 receptor antagonists are not used in Russia, because have significant side effects (ischemic colitis, constipation).

The effectiveness of probiotics for diarrheal IBS is being actively studied, but there are no definitive conclusions on this issue. It is assumed that the effect of probiotics depends on the type of microorganism that is part of it. The studies evaluated preparations containing lactobacilli, bifidobacteria, their combinations, including with other microorganisms. The greatest effect was noted when introduced into the probiotic Bifidobacterim infantis. There is an opinion that the successful use of probiotics is associated with their effect on the activation of the immune system (carried out by normalizing the ratio of pro-inflammatory and anti-inflammatory cytokines).
Despite the available data on the effectiveness of antibiotic therapy in patients with IBS, the appointment of antibiotics is not recommended without additional research in this group of patients.

3. IBS with a predominance of constipation

Laxatives that increase the volume of stool;
- osmotic laxatives;
- drugs that stimulate intestinal motility.

The first group contains laxatives that increase the volume of intestinal contents, give the feces a soft consistency, do not irritate the intestine, are not absorbed and do not cause addiction.
The drugs in this group include:
- Preparation of plantain seeds Plantago ovata (in addition to the main action, this preparation reduces the concentration of cholesterol and low density lipoproteins;
- Phytomucilr (husk of plantain seeds and homemade plums). The drug has a mild laxative effect, normalizes the lipid composition of the blood. The optimal group of drugs for administration to patients with IBS with constipation.

Osmotic laxatives help to slow down the absorption of water and increase the volume of intestinal contents, followed by irritation of the receptors. The drugs in this group help to restore the natural urge to defecate. They do not cause structural changes in the colon and addiction, are not absorbed and do not undergo metabolism in the gastrointestinal tract.
The drugs in this group include 6
- high molecular weight macrogol-4000;
- synthetic disaccharide lactulose (synthesized by chemical isomerization of lactose);
- saline laxatives (burnt magnesia).

TO laxative that stimulates intestinal motility relate:
- sodium picosulfate;
- bisacodyl.
This group of laxatives shows particular effectiveness in the case when the use of laxatives, increasing the volume of stool, and osmotic laxatives proved to be ineffective.
Laxatives that stimulate intestinal motility are prescribed for a period not exceeding 7-10 days.

The simultaneous administration of laxatives of two groups is considered especially effective.

New developments in drugs for the treatment of IBS with constipation are devoted to 5-HT4 receptor agonists (tegaserod), 5-HT4 receptor agonists, 5-HT3 receptor mantagonists (renzapridr), and chlorine channel activators (lyubiprostonr).

It is possible to use psychotropic drugs in the therapy of IBS to reduce the severity of pain syndrome or to correct existing psychological disorders (prescribed in consultation with a psychiatrist).
The efficacy of tricyclic antidepressants, selective serotonin reuptake inhibitors and antipsychotics has been confirmed.

Currently, clinical trials are studying the effectiveness of such new groups of psychotropic drugs as serotonin reuptake inhibitors and norepinephrine reuptake inhibitors (duloxetine, venlaxatinr); benzodiazepine tranquilizers (dextophisopam); non-benzodiazepine tranquilizers (afobazole).

Attention!

• Self-medication can cause irreparable harm to your health.
• The information posted on the MedElement website and in the mobile applications "MedElement", "Lekar Pro", "Dariger Pro", "Diseases: Therapist's Guide" cannot and should not replace an in-person consultation with a doctor. Be sure to contact a healthcare provider if you have any medical conditions or symptoms that bother you.
• The choice of medicines and their dosage should be discussed with a specialist. Only a doctor can prescribe the necessary medicine and its dosage, taking into account the disease and the condition of the patient's body.
• MedElement website and mobile applications"MedElement (MedElement)", "Lekar Pro", "Dariger Pro", "Diseases: Therapist's Guide" are exclusively information and reference resources. The information posted on this site should not be used to unauthorized changes in the doctor's prescriptions.
• The editors of MedElement are not responsible for any damage to health or material damage resulting from the use of this site.

Disorder of the gastrointestinal tract, which is not an independent disease, but only a complex of symptoms arising from a very diverse disturbance in the body. The etiology of IBS today is not considered thoroughly studied. There are many causes of irritable bowel syndrome, for example:

• poor quality food,
• high stress levels,
• hormonal changes in the body,
• the use of certain categories of drugs.

This is usually a condition in which the motility of the digestive tract is impaired, but there are no inflammatory or tumor abnormalities. It has been suggested that there is a problem with signaling from the brain to the intestine.

There are periodic (intermittent), rhythmic and permanent types of this syndrome:

• Recurrent type of irritable bowel syndrome. Intestinal colic is the main clinical sign. As a rule, the patient wakes up in the morning as a result of sudden pain such as colic in the abdomen, which is accompanied by the urge to defecate. The first litter is cork-like (formed, dense), then there are repeated urges, in which the stool becomes less and less frequent, in the end, such fractional defecation ends with the release of light foamy feces with mucus. Attacks of intestinal colic, when, along with the appearance of pain, an emptying of the intestines occurs, are called debuckles. Debuckles occur, as a rule, after overeating, physical or mental stress, stress. They appear at intervals of several days or weeks. Between the debuckles, a person feels good, although there is constipation.
• Rhythmic type of irritable bowel syndrome. The symptoms are the same but appear daily. The day for such persons begins with a morning fractional bowel movement. The first litter in the morning is formed or cork-like, but after a few minutes or an hour the urge to defecate again appears, the feces thin out. These forced urges disturb the patient on the way to work. After a series of these fractional bowel movements, bowel movements cease and the person feels good for the rest of the day.
• A persistent type of irritable bowel syndrome. Debuckles are constant, occurring during the day. Such patients turn out to be disabled, they should be hospitalized in gastroenterological hospitals.

Atypical forms of irritable bowel syndrome:

• right hypochondrium syndrome (with Hilaiditi syndrome) - represented by the placement of the large intestine between the liver and the diaphragm; patients complain of pain in the right hypochondrium, resembling biliary colic (this is sometimes the cause of cholecystectomy); the diagnosis is made after an irrigoscopy;
• left hypochondrium syndrome - pain resembles angina pectoris; the splenic angle (as opposed to the hepatic angle) of the large intestine is acute, a large amount of gas often accumulates in it, as a result of which the intestine stretches, raises the diaphragm, changes the position of the heart; among the signs is colicky pain in the left hypochondrium, especially after eating dairy dishes, potatoes, a large amount of bread, some fruits (pears); the diagnosis is made by denying another pathology.

There are three clinical variants of IBS:

• with a predominance of diarrhea (functional diarrhea);
• with a predominance of constipation (spastic constipation);
• with a predominance of pain in the abdominal cavity and flatulence (abdominal pain syndrome).

Spastic constipation occurs due to impaired motor function of the large intestine, its hypokinesia. Signs: Irregular bowel movements and difficult bowel movements.

Functional diarrhea occurs when the stool is at least 3 times a day, with a liquid consistency (a consequence of intestinal hyperkinesis). In this case, hyperkinesia without dyskinesia is developed, so there is no pain (colic). The intestinal contents are liquid, without mucus or elements of inflammation (which is what distinguishes functional diarrhea from enterocolitis). Unlike irritable bowel syndrome, debuckles are not observed. Defecation with liquid feces is possible both during the day and at night, which is not at all typical for irritable bowel syndrome. Sometimes, with functional diarrhea, signs of fermentative dyspepsia appear, but there is never putrid or fatty dyspepsia.

How is irritable bowel syndrome treated?

Includes the following areas:

• general activities:
  • explaining to the patient the possible causes and mechanisms of the development of intestinal disorders;
  • keeping an individual diary for patients.
• recommendations for nutrition and medication, taking into account the dominant variant of irritable bowel syndrome:
  • with a predominance of diarrhea:
    • restriction of coarse dietary fiber; exclusion of sorbitol, fructose, coffee, alcohol, carbonated drinks; products that increase gas formation (milk, cabbage, legumes);
  • with a predominance of constipation:
    • a diet high in vegetable fiber, bran;
    • drug therapy:
  • with a predominance of abdominal pain:
    • antispasmodics (drotaverine, no-shpa);
    • selective anticholinergics (butyl bromide hyoscine);
    • sodium channel blockers (mebeverin, duspatalin);
    • selective calcium antagonists (schnaberium bromide, otylonia bromide).
  • with a predominance of diarrhea:
    • antidiarrheal agents (imodium, loperamide);
  • with a predominance of constipation
    • laxatives,
    • prokinetics,
    • prebiotics,
    • 5MH4 agonists,
    • lactulose (dufulak), macrogol.

Special irritable bowel syndrome treatment is aimed at regulating intestinal motility disorders and eliminating dysbiosis.

In case of dyskinetic syndrome (colic), the following are prescribed: peripheral anticholinergic (atropine sulfate, metacin) and antispasmodic (no-shpa, papaverine hydrochloride, platifillin tartrate, dibazol) agents. In case of constipation, they are prescribed carefully and in short courses.

The hexahydric alcohol sorbitol is effective, which accelerates motor skills. The same effect is produced by xylitol (also a highly alcoholic alcohol) in the same dose.

Tranquilizers - tranxen, elenium, seduxen, trioxazine, meprobamate, eunoktin - relieve emotional stress, anxiety, and improve sleep. With hypochondriacal syndrome, seduxen and triftazine are prescribed in combination. Tricyclic antidepressants (amitriptyline, imipramine), antispasmodics (hyoscine butyl bromide) have proven themselves well. Depressive syndrome is treated with fluoxetine.

A novelty in the treatment of irritable bowel syndrome is the use of selective calcium antagonists, among which the most effective is dicetel.

Calcium channel blockers such as pinaverium bromide are also effective.

Local effects on the intestines are achieved through the use of astringent, coating and absorbent agents. These are preparations of bismuth and aluminum. For the same purpose, modern medicine uses colloidal gels, the most effective of which are maalox and phosphalugel. They are produced in packages, each of which contains aluminum phosphate gel (8.8 g), pectin gel and agar-agar (16 g); natural orange extract is added to improve the taste. The antacid effect is manifested in the stomach and in the upper parts of the colon, where the products of bacterial fermentation are neutralized. The micelles of the drug swell in the stomach and intestines, as a result of which a homogeneous layer forms that covers the gastrointestinal mucosa. This promotes the adsorption of bacteria, viruses, various harmful products, gases on the surface of the gel. The drug does not cause constipation.

Smecta, tour, erbisol are also widely used.

Duspatalin (mebeverine hydrochloride) deserves special attention. It has an exceptional effect on the smooth muscles of the alimentary canal (relieves spasm and hyperactivity). As a blocker of sodium channels, it inhibits the flow of sodium into the muscle cell, partially promotes the closure of calcium channels and weakening muscle contractions, spasms and abdominal pain, eliminates hypermotility, and normalizes intestinal contractions. It is also indicated for chronic ulcerative colitis, Crohn's disease. Does not cause intestinal hypotension, therefore it can be prescribed for functional diarrhea and spastic constipation. Duspatalin is an effective and safe drug that is safe to use for a long time - up to 2 months without interruption.

Criteria for the effectiveness of treatment: reduction or disappearance of symptoms, improvement of the quality of life.

What diseases can it be associated with

Irritable bowel syndrome is a complex of disorders, the nature of which has not been fully established.

They associate a violation in the functioning of the digestive tract with and with, and with a violation of the transmission of nerve impulses from the brain to the intestines.

Irritable bowel syndrome manifests itself:

• colicky pain and.

Treating irritable bowel syndrome at home

The vast majority of patients with IBS syndrome are treated and examined on an outpatient basis. Only if it is necessary to exclude organic pathology, patients are hospitalized in gastroenterological or general therapeutic departments for a period of 1 week.

Irritable Bowel Syndrome Treatment is largely to calm the patient down - psychotherapy is central to this disease. In addition, you should follow a rational lifestyle:

• physical and mental hygiene,
• limiting smoking and alcohol consumption,
• a diet that excludes a number of foods.

Diet nutrition is an important treatment for functional intestinal dyspepsia. During the period of exacerbation, diet No. 4b is prescribed. This is a physiologically full-fledged diet - a colitis-wiped table with a restriction on the use of proteins (with putrefactive dyspepsia), carbohydrates (with fermentative dyspepsia), fats (with fatty dyspepsia). All dishes are eaten boiled or pureed.

Diet No. 4c is a colitis-rational diet; raw vegetables and milk are excluded from the diet. Dishes do not have to be pureed or steamed, they can be fried and stewed. The patient must follow such a diet constantly or switch to diet No. 2 or No. 15 (as a full-fledged one). It should be remembered that:

• promote bowel emptying - honey, jam, sugar, plums, black bread, cold food, kefir, dry white wine, plant products;
• delay emptying - tea, coffee, red natural wines, blueberries, rose hips, St. John's wort, mashed soup, dark liquids;
• meat and fish, well-baked wheat bread, flour for baby food are indifferent to intestinal motility.

For spa treatment, the resorts Morshyn, Truskavets, Mirgorod, Berezovsky mineral waters, sanatoriums of Transcarpathia and the Satanovskaya resort zone are shown.

What drugs are there to treat irritable bowel syndrome?

• - 50-150 ml of 10% solution 2-3 times a day 30 minutes before meals,
• - a single dose ranges from 2 to 15 mg,
• - a single dose ranges from 10 to 40 mg.
• - at a dose of 20 mg per day,
• - in the first 7 days, it is prescribed 100 mg, in the next 14 days, 50 mg 3 times a day with meals,
• - 200 mg 2 times a day,
• Bismuth gallate - 500-1000 mg 3-4 times a day,
• - 1-2 sachets 2-3 times a day 30 minutes before meals,
• - 1-2 sachets 2-3 times a day 30 minutes before meals.

Treatment of irritable bowel syndrome with alternative methods

Irritable Bowel Syndrome Treatment can be carried out with herbal extracts purchased from a pharmacy or prepared independently:

• for example, phytopreparation Romazulan - contains chamomile extract, chamomile, caraway essential oil; appoint ½ teaspoon of romazulan in a glass of water;
• for example, herbal collection - combine 25 g each of St. John's wort, buckthorn bark, 10 g each of water pepper herb, mint leaves, chamomile herb, 5 g of juniper berries; 1 tbsp pour the mixture with a glass of boiling water, insist for 1 hour, strain; take ½ cup 3 times a day half an hour before meals for 1-2 months;
• for microclysters, combine 25 g of an alcoholic solution of propolis, 75 g of sunflower oil, 1 g of antipyrine, 0.5 g of anestezin, 1 g of vitamin E; put after a cleansing enema with a catheter in the rectum in the evening, the course of treatment has 10-12 injections.

Irritable Bowel Syndrome Treatment During Pregnancy

Irritable Bowel Syndrome Treatment during pregnancy, it is often carried out according to the standard scheme. At the same time, doctors note that the onset of pregnancy also affects the symptoms. Due to changes in hormonal levels (increased progesterone levels), the intestines and gastrointestinal tract relax, stomach cramps, flatulence, diarrhea / constipation decrease. At the same time, hormonal changes can also reduce the tone of the gastrointestinal tract, and therefore, cause an aggravation of constipation.

Pharmaceutical drugs previously taken for IBS should be discussed by a pregnant woman with the attending physician - perhaps, cancel and replace with alternative ones, possibly reduce the dose, and possibly continue to take. Treatment is mostly symptomatic, but any medication to relieve symptoms should be discussed with your doctor.

Which doctor should I contact if you have irritable bowel syndrome?

Irritable bowel syndrome is usually a diagnosis of denial of previously suspected organic disease.

Roman Criteria for Irritable Bowel Syndrome - Abdominal discomfort or abdominal pain has been observed for 12 weeks or more in the past 12 months, combined with two of the following three symptoms:

• relief after a bowel movement;
• change in stool frequency;
• change in stool consistency.

The following symptoms confirm irritable bowel syndrome if they are observed for more than four days:

• change in stool frequency (more than 3 times a day or less than 3 times a week);
• changes in the shape of the stool (cork-like solid or loose liquid);
• violation of the act of defecation (difficulty, incontinence or feeling of incomplete defecation);
• excretion of mucus in the feces;
• feeling of bloating and fullness in the abdomen.

The diagnosis of irritable bowel syndrome is established if there is pain and three of the five symptoms above the specified group.

Scope of additional diagnostics:

• esophagogastroduodenoscopy with biopsy from the descending duodenum (in case of suspicion of celiac disease, Whipple's disease, bacterial overgrowth);
• X-ray examination of the colon (irrigoscopy) and / or small intestine (passage of barium through the small intestine);
• video capsule endoscopy of the small intestine;
• ultrasound examination of the thyroid gland, pelvic organs;
• study of thyroid hormones (to deny hyper- or hypothyroidism);
• test with a load of lactose (if lactase deficiency is suspected);
• analysis of feces for elastase-1 (to deny exocrine pancreatic insufficiency);
• enzyme immunoassay of antigliadin and antitransglutaminase antibodies (if there is a suspicion of celiac disease).

Treatment of other diseases with a letter - c

Curing irritable bowel syndrome with or without diarrhea is often problematic, even despite the active development of medicine and pharmacology around the world. For example, in the United States, more than 20% of the total population suffers from this pathology. With irritable bowel syndrome, the symptoms and treatment are under the jurisdiction of a gastroenterologist, who should be contacted for this disease. If all people face periodic stool problems and usually know what to do, then the pathology in question causes a debilitating, chronic digestive upset, which seriously affects the general performance of a person, his physical and psychological state.

The essence of the phenomenon

At its core, this pathology (IBS) is a chronic bowel disorder with impairment of its functions for no apparent reason. This phenomenon is accompanied by painful sensations of an abdominal nature, stool disorders, discomfort, while no inflammatory reactions or infectious lesions are found. Even blood and feces tests do not give an informative result.

Irritable gut can affect people of all ages and genders. However, women suffer from this phenomenon more often (almost 2 times). The peak manifestation of pathology falls on the age of 32–38 years. Unfortunately, up to 2/3 of all affected people do not go to the doctor, trying to cope with this on their own. In principle, this problem in the intestine extremely rarely leads to organic disorders, but it cannot be started, since the nervous system suffers significantly, and the body's being in a constant stress state cannot pass without a trace.

Irritable bowel pathology as a disease is characterized by functional disorders in the form of deterioration of intestinal motility and susceptibility to its stimulation of a neurohumoral or mechanical nature.

In other words, under the influence of non-pathogenic factors, the intestine ceases to adequately respond to the corresponding signals, which disrupts the mode of its emptying.

The phenomenon under consideration can develop both in the large and in the small intestine. The most common is irritable bowel syndrome (IRS). It is in it that the formation of feces occurs, and therefore a violation of peristalsis leads to stool disorders and problematic defecation. By the nature of the manifestations, irritable bowel syndrome, like IBS as a whole, is divided into 3 types: the predominance of abdominal pain and flatulence; IBS with diarrhea and IBS with constipation.

Etiology of the disease

The causes of irritable bowel syndrome have not yet been fully elucidated. However, medical statistics and the results of numerous studies provide an overall picture of the most common etiological mechanism. Most experts believe that most often the pathology is caused by nervous stress or prolonged psychological overload.

It has been unequivocally established that the syndrome appears in people with increased nervous excitability against the background of psychological stress. As a rule, this factor predominates among young women.

The influence of a neurogenic factor resembles a vicious circle: stressful situations give rise to IBS, and its chronic course causes nervous disorders. They further enhance the manifestation of the symptoms of pathology. As a result of such mutual influence, neuroses and psychopathies of various varieties often arise. Irritable bowel syndrome is rarely caused by nervous influence, but if it has already appeared, then stress can greatly exacerbate the clinical picture.

In irritable bowel syndrome, the causes are associated with other endogenous and exogenous factors:

1. Increased activity of the muscles and nerve endings of the digestive tract, which causes impaired intestinal motility. In such cases, no visible disturbances in the stenotic structure or the intestinal nervous apparatus are found, but the regulation of intestinal motility is still disturbed.
2. Individual hypertrophied sensitivity of the body to filling and stretching of the intestine, which causes painful sensations with small loads on the intestines, although in other people they are considered the norm.
3. Hormonal factor. During periods of a sharp change in the hormonal balance in the body, signs of IBS are noted. In women, at the beginning and at the end of menstruation, they are associated with a significant increase in the blood level of prostaglandin.
4. One of the most common etiological factors is unhealthy diet. The irritating effect is created by fatty foods with excessive calorie content and simple overeating. The risk of pathology increases with the use of strong coffee and tea, sweet mineral water with gas, and especially alcoholic beverages. In addition, it is necessary to take into account the individual intolerance of the body to certain foods.
5. Hereditary predisposition often becomes a decisive factor in the onset of the disease.
6. Gastroenteritis attacks can trigger chronic bowel distress, triggering the IBS mechanism. A similar effect can be expected from dysbiosis.
7. The question of how to get rid of irritable bowel syndrome also has to be addressed with prolonged use of certain medications. Especially in this direction, antibiotics are allocated, which, in addition to pathogenic microorganisms, destroy the beneficial microflora, upsetting the balance.

In summary, the etiological mechanism of IBS can be characterized as follows. The small and large intestine are elements of the digestive tract, and the passage of processed food is provided by the contractile functions of the muscular layer of the intestinal walls. With a slowdown or excessive activation of contractions, the process of formation and excretion of feces is disrupted, and other signs of pathology appear. If muscle dysfunction persists for a long time, then we can talk about the appearance of irritable bowel syndrome. In this case, pain, diarrhea or constipation appear.

Symptomatic manifestations

Irritable bowel syndrome symptoms manifest as functional intestinal and extraintestinal abnormalities. The first category, depending on the type of pathology, includes the following main symptoms: abdominal pain, diarrhea (bowel movements more often 3 times a day with a liquid feces consistency) or constipation (bowel movements less than 3 times a week). Extraintestinal manifestations include neurological, autonomic, psychopathological disorders, as well as disorders in other digestive organs.

When IBS proceeds according to the variant with a predominance of diarrhea, the following features of the symptomatology are noted. The most characteristic symptom is diarrhea, which occurs very often for various reasons. Food intake is especially noticeable. Desires for urgent bowel movements occur immediately after lunch or during meals, and the symptom manifests itself most intensely in the first half of the day. A person begins to suffer from the so-called "bear disease", when diarrhea violently manifests itself with any psychological stress, emotional excitement, fear. In addition to diarrhea, with the development of IBS of this type, other symptoms can be observed: bloating, pain in the abdomen on the sides, aggravated by unexpected urge to defecate and disappear after it.

Constipation-dominated syndrome, on the other hand, leads to a significant delay in bowel movements. Breaks between processes can be more than 3 days. The fecal mass becomes dense, often takes the form of small "mutton coils". An impurity may be released from whitish or transparent mucus. Prolonged stool stagnation leads to pain along the entire length of the colon in the form of colic or aching sensations. Chronic constipation causes poor appetite, heartburn, nausea, and an unpleasant taste in the mouth.

Finally, IBS may develop according to option 3, when abdominal pain predominates. In this case, stool disturbance looks like an alternation of diarrhea and constipation according to an unpredictable pattern. The most common symptom is persistent abdominal pain.

Finally, the following signs characterizing IBS can be distinguished: abdominal pain of a spastic, stabbing or aching type, becoming less intense or disappearing altogether after a bowel movement; violation of the stool; the inability to contain the urge to defecate; a constant feeling of filling the intestines even after they have been emptied; flatulence and bloating; nausea; the appearance of mucous impurities in the feces. These signs are distinguished by their duration, that is, by the chronic nature of the entire phenomenon.

Prolonged disturbances in bowel movement lead to numerous disorders of extraintestinal localization. The most characteristic symptoms should be noted:

1. Disorders of the neurological and autonomic type: migraine (felt by almost half of all patients), lumbar pain, a feeling of a lump in the throat, chilly hands, insomnia at night and drowsiness during the day, poor-quality breath, dysmenorrhea, dysuria of various types, impotence.
2. Psychopathological disorders: various phobias, depression, panic attacks, hypochondria, anxiety syndrome, hysteria (such disorders are observed in almost 2/3 of patients).
3. Disorder of other digestive organs: pain in the hypochondrium on the right side, vomiting, a feeling of heaviness in the epigastrium, signs of non-ulcer dyspepsia (observed in almost 85% of all victims). In addition, irritable bladder syndrome often develops.

Lack of treatment or poorly treated IBS leads to serious deviations. The apparent relative health safety is deceiving. The psychological effects are so great that they can cause severe neurological disorders. Constant diarrhea exhausts the body, leading to dehydration and leaching of important trace elements. Naturally, a person's working capacity decreases, insomnia appears.

Methods for detecting the disease

In irritable bowel syndrome, diagnostics encounters certain difficulties in differentiating pathology. IBS symptoms are similar to many other gastrointestinal conditions. Most often, the diagnosis of this phenomenon is made by the method of exclusion, that is, by external examination, other diseases are excluded by laboratory and instrumental methods.

It will not be possible to establish IBS directly by tests, given the absence of changes in the composition of blood, urine or feces. There is also no infectious component. Taking into account such features of the pathology, the criteria for making a diagnosis were adopted:

• discomfort and recurrent pain in irritable bowel syndrome are long lasting, and they coincide with the period of increased urge to defecate and changes in the nature of feces;
• pain sensations significantly decrease or disappear after bowel movement;
• pain symptoms and discomfort last at least 5 months, and are felt for at least 3-4 days during a month throughout the entire period.

It is on the basis of the presence of these criteria that the diagnosis is made, but then it is necessary to conduct an examination to exclude other diseases. With the manifestation of symptoms such as a disturbed bowel movement, unstable stool, abdominal pain, the following diagnostic procedures are performed:

• general and biochemical analysis of blood and feces;
• X-ray with the introduction of a contrast agent (usually barium sulfate);
• endoscopic studies by introducing a special endoscope through the anus - the device allows you to visually assess the condition of the colon and take a sample for biochemical analysis;
• coprogram, and, if necessary, sigmoidoscopy, irrigoscopy.
• biopsy of the intestinal walls.

When conducting research, first of all, it is necessary to differentiate irritable bowel syndrome (or small intestine) from anemia of iron deficiency type, deficiency of B vitamins, lactose deficiency, celiac disease, tumor formations.

Diet for illness

Improper and excessively plentiful nutrition often provokes the syndrome in question. Given this circumstance, treatment for irritable bowel syndrome begins with providing optimal nutrition (regimen and menu). It is most important to organize frequent, fractional meals with the exclusion of foods that can have a negative impact.

The following products can be distinguished, which are recommended to be significantly limited, and it is better to remove them from use altogether. The following influence of products is noted:

• stimulate the appearance of diarrhea: apples, plums, beets, fiber-rich foods;
• increase gas formation and flatulence: legumes, baked goods, cabbage, nuts, grapes;
• contribute to constipation: fried foods and fatty foods.

It should be borne in mind that quite often people have individual milk intolerance. It is recommended to replace whole milk with fermented milk products (kefir, yogurt, fermented baked milk). If you are at risk of celiac disease, avoid gluten-containing foods. It is better to remove sugary sodas and gum from consumption.

• food should be regular, without long breaks, uncontrolled fasting and overeating;
• it is recommended to drink at least 1.5–2 liters of liquid, but without caffeine (it is best to drink herbal tea);
• coffee and tea - no more than 0.5 liters per day;
• the use of drinks with gas and alcoholic beverages should be excluded;
• it is recommended to introduce a restriction on fresh fruits - no more than 250-300 g per day;
• to reduce gas formation, flaxseeds and oats (can be in the form of porridge) are great help.

An alternative approach is needed when consuming fiber-rich foods. The fact is that with diarrhea, such foods are banned as diarrhea stimulants. However, for chronic constipation, dietary fiber (fiber) can help soothe irritable bowels. The most common suppliers of dietary fiber are bran, coarse flour baked goods, grains, some fruits and vegetables (plums, cabbage, zucchini, carrots, beets).

A distinction should be made between the types of fiber (soluble and insoluble). For dietary nutrition, a soluble type is needed, which is found in oats, nuts, seeds, pectins. You can use the pharmacy option - Nefagula powder.

Principles of pathology treatment

Questions about how to treat pathology and how to calm an irritated organ are solved in a complex way: optimization of nutrition, elimination of psychoemotional effects, optimization of lifestyle with increased physical activity, drug therapy. Therapeutic and prophylactic measures are carried out for any type of IBS, but in order to cure the disease by traditional means, it is necessary to take into account the specifics of the manifestation of the disease.

What should be the treatment?

To cure IBS with a predominance of diarrhea, the following remedies help:

1. Before eating, a remedy is prescribed that can slow down motor functions. The most common drugs for irritable bowel syndrome are: Diphenoxylate, Loperamide, Imodium, Lopedium.
2. A calming effect is provided by a remedy such as Smecta.
3. Decoctions of medicinal plants are recommended: sweet cherry, bird cherry berries, pomegranate skin, alder.
4. Sorbents are capable of reducing gas formation: Polysorb, Polyphepan, Filtrum, Enterosgel.
5. A modern medicine for irritable bowel syndrome with diarrhea is a serotin receptor modulator, the drug Alosetron.

In the variant of IBS with constipation, pathology is treated with the help of agents that can facilitate bowel movements and soften stool. The most commonly prescribed drugs are:

1. Medicines based on plantain to increase the volume of contents in the intestine: Naturolax, Mukofalk, Solgar, Metamucil, Fiberlex, Ispagol. In addition, agents based on agar and artificial cellulose are used: Citrucel, Fiberal, Fibercon. These drugs usually take effect 9-11 hours after they are given.
2. The softening of feces is provided by preparations with lactulose: Duphalac, Portolac, Goodlak. They, without getting into the blood, are able to change the consistency of the feces.
3. Means of the category of osmotic laxatives: Macrogol, Forlaks, Lavakol, Relaxan, Exportal. These funds give an effect in 2-5 hours.
4. Mild laxatives: Norgalax, Guttasil, Guttalax, Slabikal, Slabilen.
5. Serotin modulators: Tegaserol, Prucaloprid.
6. To create a mild laxative effect, Essentuki 17 mineral water is recommended, containing magnesium ions.

If abdominal pain predominates in the manifestation of irritable bowel syndrome, then the following drugs are prescribed as drug therapy:

• antispasmodic drugs: No-shpa, Drotaverine hydrochloride, as well as anticholinergic drugs: Hyoscyamine, Zamifenacin, Darifenacin;
• calcium channel blockers: Spasmomen, Ditsitel;
• means for regulating intestinal motility - Debridat;
• drugs to reduce gas formation (defoamers): Espumisan, Zeolat, Polysilan.

Symptomatic therapy

With complex treatment, therapy is carried out for the most pronounced symptoms that can worsen the condition of a sick person. Antidepressants are prescribed to reduce neurological and psychopathological disorders. This effect has a double effect: it eliminates the psychogenic etiological factor and prevents the development of neurogenic abnormalities as a symptom of the disease. The most commonly used antidepressants are tricyclic antidepressants. They reduce the sensitivity of brain receptors to pain and normalize the transmission of nerve regulatory impulses. Traditional drugs are: Amitriptyline, Imipramine, Nortriptyline. In addition, modern drugs are prescribed: Befol, Fenelzin, Pyrazidol.

An important role in the treatment process is assigned to the improvement of the intestinal microflora and the elimination of signs of dysbiosis. With the development of IBS, pathogenic microorganisms are activated and a deficiency of lactobacilli and bifidumbacteria appears. Suppression of pathogenic bacteria is carried out by probiotics: Enterol, Bactisuptil. With a more severe course of the disease, nitrofurans, fluoroquinolones, intestinal antiseptics (Rifaximin) are prescribed. The normalization of the content of beneficial microflora is provided with the help of eubiotics (Linex, Bifikol) and prebiotics (Lactulose, Khilak-forte).

The positive effect is noted when using folk remedies in the form of medicinal plants. The following compositions are especially noted: mint oil for aromatherapy; infusions and decoctions from pharmacy chamomile, oak bark, caraway seeds, valerian root; infusions against constipation from licorice root, yarrow, buckthorn bark. In the fight against diarrhea, the roots of burnet, cinquefoil, plantain, blueberry, sage, and walnut are used.

IBS is a common phenomenon that people do not always have an adequate attitude towards. To exclude neurological abnormalities and other complications, this pathology must be treated with effective methods.