Irritable bowel syndrome, or IBS, is such a chronic condition of an inorganic pathology of the intestine when its normal functioning is impaired with completely normal analyzes. Therefore, it is also called intestinal neurosis or dyskinesia. Dysfunction manifests itself in spastic abdominal pain, abdominal discomfort, changes in stool frequency and its consistency.
The essence of pathology
According to statistics, the age category of the sick is the average age of people after 25 years and under 40. Moreover, women in this group are sick twice as often as men. And only after fifty years, gender indicators are aligned. After sixty years, irritable bowel syndrome rarely occurs. The frequency of the female category can be explained by a greater emotionality and frequent visits to doctors for various reasons.
At the same time, many people do not consider themselves sick and do not turn to doctors, as they attribute digestion problems to stress or poor nutrition.
ICD-10 code
According to ICD-10, IBS with diarrhea is listed under the code K58.0. However, there are other notation. 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 ailment according to the following indicators:
- intestinal dysfunction;
- pain syndrome;
- flatulence.
Systematization of the disease by aggravating factors distinguishes several provocateurs of the disease:
- stress;
- food products;
- after infection OKI.
Etiology of the phenomenon
No organic causes have been 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! A neurogenic etiofactor leads to the formation of a kind of vicious circle: stress - irritable bowel syndrome - chronic irritation of IBS - nerve disorders.
In addition, there are provocative moments. They can be external and internal. Exofactors - eating disorders, dysbacteriosis, lack of exercise, work with prolonged sitting in one position.
Internal:
- hypersensitivity of nerve receptors, muscle fibers of the gastrointestinal tract, leading to increased peristalsis;
- hypersensitivity of some individuals to the filling of their intestines, which causes abdominal pain;
- increased prostaglandins in women during MC;
- genetic feature - in one genus, the tendency to IBS is often inherited;
- the effect on the intestinal microflora of antibiotics taken for various reasons;
- in a third of patients, IBS develops with or after OCD. This is a post-infectious IBS.
Important! Today, irritable bowel syndrome is not a fully treatable condition, but it is quite possible to create a long-term remission of the disease due to a healthy lifestyle.
It should also be noted that irritable bowel syndrome does not threaten life and does not shorten it. Pathology does not give organic changes and complications, but the quality of life worsens.
Symptoms of IBS
The leading manifestations are painful abdominal cramps, discomfort here and stool disorders. 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 removes the pain. Almost always in the feces there is mucus from the intestines. In addition, there is bloating, a feeling of peristalsis with rumbling at a distance. The spasm is unstable; it changes on different days according to localization.
Reference! All sources emphasize that with irritable bowel syndrome, all manifestations are only diurnal in nature, which can be considered a feature of pathology. A clear evidence of the neurogenic origin of IBS in the overwhelming majority of cases is that algias and diarrhea do not occur at night during sleep or rest.
With IBS with diarrhea, stool is 3 to 5 times a day. Sometimes there is urging, but there is no stool or it is normal. This is pseudo diarrhea. The volume of feces per day does not exceed 200 g. Diarrhea occurs in the mornings after a meal - called morning onset syndrome; there may not be diarrhea during the day.
With IBS without diarrhea (with constipation) when sitting on the toilet, the patient was estimated that he spends 25% of his time on straining (passage). There may be no calls for stools, and patients resort to a laxative or enemas.
The chair is not more than twice a week, or even less. The nature of the chair resembles sheep feces. Often accompanied by nausea, bitterness in the mouth, the accumulation of gases with an unpleasant odor. There are, as a rule, non-intestinal symptoms of neurological and autonomic properties. They also focus on daylight only. Among them are:
- cephalgia, often of the type of migraine;
- sensation in the throat of a coma;
- lumbar pain
- myalgia;
- cardialgia;
- limb cooling;
- insomnia or drowsiness;
- sometimes it is difficult for the patient to inhale;
- at night, nocturia and frequent urination during the day may disturb.
The patient complains of increased fatigue, dysmenorrhea may occur. More than half of patients always have carcinophobia (which is quite natural).
What is needed to make a diagnosis? The criteria are as follows:
- Violations of the frequency of the stool - or less than three times a week, or more often three times a day.
- Abnormal stools - solid or liquid.
- Strain during bowel movements or a feeling of incomplete bowel movement.
- Imperative urges.
- Flatulence, mucus in the stool, bursting in the stomach.
Signs of IBS with diarrhea usually appear after eating or during stress.
Normalization of the mental state stops diarrhea. The presence of at least two symptoms is mandatory: a change in sensations during bowel movements and bloating. The foregoing applies to IBS with and without diarrhea. But there is also a mixed form. It is characterized by an alternation of diarrhea and constipation. The remaining symptoms do not change.
The conclusion about the presence of irritable bowel syndrome in a patient is made only with a recurring chronic abdominal pain or a feeling of discomfort in the abdomen for three days every month in combination with other symptoms, such as relief from bowel movements, changes in the frequency and consistency of feces. Such ailments mark the beginning of a pathology. These manifestations should be noted six months before the diagnosis.
Diagnostic measures
There is no special test for diagnosis, because there are no organic changes. 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 hidden bleeding. By the way, the presence of fatty acids in feces indicates pancreatitis.
The level of thyroid hormones is determined. In case of lactase intolerance, a load test is performed. Gastroscopy, irrigoscopy, colonoscopy and sigmoidoscopy are shown. CT of the abdomen and pelvic organs may be prescribed to rule out other symptoms.
Treatment principles
It is always only complex. IBS with diarrhea is treated as follows:
- Drugs to slow 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 the gases in the intestines - Lactofiltrum, Enterosgel, Polysorb, Polyphepan.
- Today, in the treatment of IBS with diarrhea, regulators of serotonin receptors are always used - "Alosetron", "Tegaserol", "Prucaloprid".
- IBS with constipation requires a completely opposite approach: you need to soften the stool and facilitate its release. For this purpose, lactulose preparations are used - Goodluck, Dufalac, Portalac. 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 are prescribed on the basis of plantain - "Solgar", "Ispagol", "Fiberleks", "Mukofalk", etc. Also use means with artificial cellulose - "Fibercon", "Fiber", Citrusel. They show their effect after 10-11 hours, so they are best taken before bedtime.
- Osmotic laxatives manifest themselves faster - their effect appears after 2-5 hours. The drugs of this group include Macrogol, Forlax, Lavacol, Relaxax, Exportal.
- Vegetable laxatives based on senna grass: Senade, Alexandrian leaf, Norgalax, Guttasil, Guttalaks, Slabikal, Weak.
- As with the diarrhea variant, serotonin modulators are prescribed. The therapeutic effect can also be given by therapeutic mineral waters of the "Essentuki 17" type with the content of magnesium salts; probiotics to improve intestinal microflora - "Bifiform", "Narine", "Hilak-Forte", "Lactobacterin", "Lactovit" and others.
- With severe abdominal pain, antispasmodics help - Spazgan, No-Shpa, Drotaverin, Niaspam, Sparex, Mebeverin. Their number today is huge. Calcium channel blockers have the same effect: "Spasmomen", "Ditsitel". Improves the regulation of intestinal motility "Debridate".
- Flatulence always causes a lot of unpleasant sensations, antifoam agents are used to relieve discomfort - the most popular are Espumisan, also Zeolat, Polysilan, activated carbon, and fennel tincture are used.
Symptomatic treatment
Since non-intestinal symptoms also occur, and among them neurological and psychopathological manifestations predominate, 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. Most often, with IBS with diarrhea, antidepressants are used tricyclic. 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 their finished form. For this, eubiotics were created: 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 from reviews. In patients with IBS with diarrhea, reviews about the effectiveness of the prescribed drugs vary, but the following are called more often than others:
- "Trimedat", "Imodium";
- diet;
- considered very effective psychotherapeutic methods for relaxation, proper breathing, leveling negatives;
- probiotics;
- Lactofiltrum, Polysorb, Smecta, No-shpa, Cholestyramine.
Special diet
Many patients with IBS try not to eat and limit themselves to eating in every way. 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 products for yourself that do not adversely affect intestinal motility.
If such problematic products are found, they should be eliminated or sharply limited. Diet for IBS with diarrhea and flatulence requires the abandonment of:
- alcohol, pastries, simple sugars and chocolate, caffeinated drinks - tea, coffee;
- soda;
- milk;
- sugar substitutes - xylitol, sorbitol,
- mannitols.
All of them give a laxative effect to already existing diarrhea. Also, caution should be exercised for use:
- 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 the fermentation processes.
With a tendency to constipation, it is strictly forbidden to eat fatty and fried.
The 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.
The diet should include:
- weak tea, compotes, unsweetened diluted juices, chicken broths;
- vegetables and fruits - boiled or baked;
- pasta dishes;
- soups and cereals.
Eating should occur at one time five to six times a day without overeating. The atmosphere of eating should always be calm, without rushing. Heat treatment - steam or cooking, baking. Add oil only at the end of cooking.
The prognosis for IBS is good, there are practically no complications.
Preventive actions
Since it is impossible to prevent IBS, there is no prevention. But everyone can improve their emotional background and normalize it. Psychotraining for relaxation, increasing stress tolerance, practicing meditation, and achieving an alpha rhythm in the brain is very useful in this regard.
It is necessary to supplement this with a balanced diet, improvement of intestinal microflora, moderate physical activity, do not take laxatives and stool fixing drugs on your own. When diagnosing irritable bowel syndrome, the person can create the correct routine and regimen for himself, however, after consultation with the attending physician.