Irritable Bowel Syndrome, or IBS, is a chronic condition of non-organic bowel pathology, when its normal functioning is disrupted with completely normal tests. Therefore, it is also called intestinal neurosis or dyskinesia. Dysfunction manifests itself in spastic abdominal pain, abdominal discomfort, changes in stool frequency and consistency.
Essence of pathology
According to statistics, the age category of sick people is the average age of people over 25 and up to 40. Moreover, women in this group get sick twice as often as men. And only after fifty years gender indicators are aligned. After the age of sixty, irritable bowel syndrome rarely occurs. The frequency of the female category can be explained by greater emotionality and frequent visits to doctors for various reasons.
Many people do not consider themselves sick and do not go to doctors, as they attribute digestive problems to stress or malnutrition.
ICD-10 code
According to ICD-10, IBS with diarrhea is listed under the code K58.0. However, there are othersdesignations. IBS without diarrhea - code K58.9. Such an unpleasant symptom as constipation is assigned the code K59.0. This is what concerns the classification according to the ICD code.
IBS with diarrhea as a diagnosis is divided into several types.
Classification
Doctors classify the disease according to the following indicators:
- intestinal dysfunction;
- pain syndrome;
- flatulence.
Systematization of the disease according to aggravating factors identifies several provocateurs of the disease:
- stress;
- food;
- after AII infection.
Etiology of the phenomenon
No organic cause identified. Today, the leading role is given to the action of stress factors. This opinion is confirmed by the fact that 60% of patients always have non-intestinal signs in the form of anxiety, depression and other neurotic manifestations.
Pathology develops more with increased nervous excitability in humans, which is not uncommon among young women.
Interesting! The neurogenic etiofactor leads to the formation of a kind of vicious circle: stress - irritable bowel syndrome - chronic IBS - nervous disorders.
There are also provocative moments. They can be external and internal. Exofactors - malnutrition, dysbacteriosis, hypodynamia, work with prolonged sitting in one position.
Domestic:
- hypersensitivity of nerve receptors, muscle fibers of the gastrointestinal tract, leading to increased peristalsis;
- hypersensitivity of some persons to the filling of their intestines, whichcauses abdominal pain;
- increased prostaglandins in women during MC;
- genetic feature - in one genus, the tendency to IBS is often inherited;
- impact on the intestinal microflora of antibiotics taken for various reasons;
- A third of patients with IBS develops during or after ACD. This is post-infectious IBS.
Important! Today, irritable bowel syndrome is not a completely curable condition, but it is quite possible to create a long-term remission of the disease through maintaining a he althy lifestyle.
It should also be noted that irritable bowel syndrome is not life-threatening or shortening. Pathology does not give organic changes and complications, but the quality of life worsens.
Symptoms of IBS
Painful cramps in the abdomen, discomfort here and stool disorders are considered the leading manifestations. Chief among them is abdominal pain. It is localized in the iliac region, can occur on any side.
Palpation of the colon is always painful. Going to the toilet and having a bowel movement relieves the pain. Almost always in the feces there is mucus from the intestines. In addition, there is bloating, a sense of peristalsis with rumbling at a distance. The spasm is not constant, it changes on different days according to localization.
Help! All sources emphasize that in irritable bowel syndrome all manifestations are only daytime, which can be considered a feature of the pathology. Explicitevidence of the neurogenic origin of IBS in the vast majority of cases is that algia and diarrhea do not occur at night during sleep or rest.
In IBS with diarrhea, 3 to 5 stools a day. Sometimes there is an urge, but there is no stool or it is normal. This is pseudodiarrhea. The volume of feces per day does not exceed 200 g. Diarrhea occurs in the morning after eating - it is called the morning onslaught syndrome; diarrhea may not occur during the day.
In IBS without diarrhea (with constipation) when the patient is sitting on the toilet, it was estimated that he spends 25% of his time on straining (passage). There may be no urge to pass the stool, and patients resort to laxatives or enemas.
Stool is no more than twice a week, or even less. The character of the stool resembles sheep feces. Often accompanied by nausea, bitterness in the mouth, accumulation of gases with an unpleasant odor. There are, as a rule, non-intestinal symptoms of a neurological and autonomic nature. They also have a focus only on the daytime. Among them are:
- cephalgia, often migraine-like;
- coma feeling in throat;
- lumbar pain;
- myalgia;
- cardialgia;
- cold limbs;
- insomnia or drowsiness;
- sometimes the patient has difficulty inhaling;
- nocturia and frequent urination during the day can disturb at night.
The patient complains of increased fatigue, may experience dysmenorrhea. More than half of patients always have cancerophobia (which is quite natural).
What do you need to make a diagnosis? Criteriathe following:
- Irregular stool frequency - either less than three times a week, or more than three times a day.
- Disturbances in the shape of the stool - solid or liquid.
- Straining to have a bowel movement or a feeling of incomplete bowel movement.
- Imperative calls.
- flatulence, mucus in feces, distension in the abdomen.
Signs of IBS with diarrhea usually appear after meals or during times of stress.
Normalization of the mental state stops diarrhea. Mandatory is the presence of at least two symptoms: a change in sensations in the process of defecation and bloating. The above applies to IBS with and without diarrhea. But there is also a mixed form. It is characterized by alternating diarrhea and constipation. Other symptoms do not change.
The conclusion about the presence of irritable bowel syndrome in a patient is made only if there is chronic abdominal pain of a recurrent nature or a feeling of discomfort in the abdomen for three days every month in combination with other signs, such as relief after defecation, changes in the frequency and consistency of feces. Such ailments mark the beginning of pathology. These manifestations should be observed six months before the diagnosis.
Diagnostic measures
There is no special test for diagnosis, because there are no organic changes either. Blood is taken for a general analysis - to detect leukocytosis and anemia, as well as a general analysis of feces to detect mucus and fat in it, as well as occult bleeding. By the way, the presencefatty acids in feces indicates pancreatitis.
The level of thyroid hormones is determined. For lactase intolerance, a stress test is performed. Gastroscopy, irrigoscopy, colonoscopy and sigmoidoscopy are indicated. Abdominal and pelvic CT scans may be ordered to rule out other symptoms.
Principles of treatment
It is always only complex. IBS with diarrhea is treated as follows:
- Drugs to slow down intestinal motility: "Imodium", "Loperamide", "Stopdiar", "Lopedium" and others.
- "Smecta", "Tanalbin" have a sedative effect on the intestines.
- IBS with diarrhea responds well to herbal medicine - decoctions of pomegranate peel, alder, mountain ash, bird cherry.
- Sorbents reduce gases in the intestines - Laktofiltrum, Enterosgel, Polysorb, Polyphepan.
- Today, in the treatment of IBS with diarrhea, serotonin receptor regulators - Alosetron, Tegaserol, Prucalopride - are always used.
- IBS with constipation requires the exact opposite approach: soften the stool and make it easier to pass. For this purpose, lactulose preparations are used - Goodluck, Dufalac, Portalak. They work only in the intestines and are not absorbed into the blood. In order to increase the volume of masses in the intestines and quickly remove them, preparations based on plantain are prescribed - Solgar, Ispagol, Fiberlex, Mukofalk, etc. They also useproducts with artificial cellulose - "Fibercon", "Fiberal", "Citrucel". They show their effect after 10-11 hours, so it is better to take them before bedtime.
- Osmotic laxatives show themselves faster - their effect appears after 2-5 hours. The drugs in this group include Macrogol, Forlax, Lavacol, Relaxan, Exportal.
- Herbal laxatives based on senna herb: Senade, Alexandria leaf, Norgalax, Guttasil, Guttalax, Weak, Weak.
- As with diarrhea, serotonin modulators are prescribed. The therapeutic effect can also be given by therapeutic mineral waters such as "Essentuki 17" containing magnesium s alts; probiotics to improve intestinal microflora - "Bifiform", "Narine", "Hilak-Forte", "Lactobacterin", "Laktovit" and others.
- With severe abdominal pain, antispasmodics help - "Spazgan", "No-shpa", "Drotaverin", "Niaspam", "Sparex", "Mebeverin". The number of them today is huge. Calcium channel blockers have the same effect: "Spazmomen", "Dicitel". Improves the regulation of intestinal motility "Debridat".
- Flatulence always causes a lot of discomfort, defoamers are used to relieve discomfort - the most popular is Espumizan, also used"Zeolate", "Polysilane", activated carbon, fennel tincture.
Symptomatic treatment
Since non-intestinal symptoms also occur, and neurological and psychopathological manifestations predominate among them, antidepressants are prescribed. In the treatment of IBS with diarrhea, they have a double effect. They can eliminate the etiological factor when it comes to stress. At the same time, these drugs do not allow further neurogenic manifestations to develop.
In other words, they break the main vicious circle that has already been mentioned. Tricyclic antidepressants are more commonly used for IBS with diarrhea. They have a sedative effect, having a positive effect on the central nervous system. Normalize the transmission of pathological nerve impulses and reduce the sensitivity of pain receptors. The most traditional among them are Amitriptyline, Nortriptyline. They can be supplemented with other antidepressants - the doctor makes the choice.
To give a clear answer to the question of how to treat IBS with diarrhea, you need to consider that it is very useful for the body to receive lactobacilli in finished form. Eubiotics have been created for this: Linex, Acipol, Narine, Bifikol and others.
There are a lot of drugs for the treatment of IBS, but many prefer to take information on the Internet based on reviews. In IBS sufferers with diarrhea, reviews on the effectiveness of prescribed drugs vary, but the following are most often called others:
- "Trimedat","Imodium";
- diet;
- Psychotherapeutic techniques for relaxation, proper breathing, leveling of negatives are considered very effective;
- probiotics;
- "Laktofiltrum", "Polysorb", "Smecta", "No-shpa", "Cholestyramine".
Special Diet
Many patients with IBS try not to eat and restrict themselves in every possible way in food. This is an absolute mistake. The diet should be varied, but correct. The diet for IBS with diarrhea includes the intake of minerals that improve the condition of the intestinal wall - zinc, magnesium, omega-3 and omega-6 polyunsaturated fatty acids. It is also important to choose safe foods for yourself that do not adversely affect intestinal motility.
When such problematic foods are found, they should be eliminated or severely limited. Diet for IBS with diarrhea and flatulence requires the rejection of:
- alcohol, pastries, simple sugars and chocolate, caffeinated drinks - tea, coffee;
- soda;
- milk;
- sugar substitutes - xylitol, sorbitol,
- mannitols.
They all give a laxative effect to already existing diarrhea. Also, be careful when using:
- apples, plums and beets - they will not fail to cause diarrhea;
- legumes - beans, peas;
- cruciferous - all types of cabbage;
- grapes and pears, these products cause and enhance fermentation processes.
When prone toconstipation is strictly forbidden to eat fatty and fried foods.
Diet for IBS with diarrhea eliminates the presence in the diet of spicy foods, pickles and marinades, fresh fruits and vegetables, rye bread, one-day kefir and sour cream, cream, fatty meat, cold drinks and coffee, pastries.
Include in your diet:
- weak tea, compotes, unsweetened diluted juices, chicken broths;
- vegetables and fruits - boiled or baked;
- pasta dishes;
- soups and cereals.
Meals should be taken at the same time five to six times a day without overeating. The environment for eating should always be calm, without haste. Heat treatment - steam or cooking, baking. Add oil only at the end of cooking.
Prognosis for IBS is good, there are almost no complications.
Prevention measures
Because IBS cannot be prevented, there is no prevention. But everyone can improve their emotional background and normalize it. Very useful in this regard are psycho-training for relaxation, increasing stress resistance, meditation, achieving an alpha rhythm in the brain.
This should be supplemented with a balanced diet, improvement of the intestinal microflora, moderate physical activity, do not take laxatives and stool-fixing drugs on your own. When diagnosing irritable bowel syndrome, a person can create the correct routine and regimen for himself, however, after consulting with his doctor.
