THE IRRITABLE BOWEL SYNDROME
WHAT IS IRRITABLE BOWEL SYNDROME ?
It is the most common disorder of the alimentary tract associated with abdominal pain for which no organic cause can be found.
Bowel habits are disturbed by diarrhoea or constipation occurring alone, or alternating. Some forms of this irritable bowel syndrome are also known as SPASTIC COLON and IDIOPATHIC or NERVOUS DIARRHOEA.
When constipation and pain are the predominant symptoms,intraluminal pressure is increased and there is an increase frequency of pressure waves, whereas motor activity is often reduced in patients with painless diarrhoea.
Aetiology of irritable bowel syndrome is uncertain,psychological disturbances especially anxiety, are frequent ,patients are often tense, conscientious individuals who worry excessively about family or financial affairs. some patients relate the onset of their syndrome to an attack of infective diarrhoea, in others certain foods may precipitate the symptoms.
WHAT ARE THE CLINICAL FEATURES ?
1) The syndrome is most common in women between the ages of 20-40 years.
2) Most common symptom is pain referred to the left or right iliac fossa or the hypogastrium,sometimes flitting from site to site.
3) Pain often occurs in attacks usually relieved by defecation and sometimes provoked by food and may be severe.
4) Bowel habit is variable.Almost all patients notice pellet like or ribbon like stools with or without mucus at some time.
5) Diarrohea may be painless and characteristically occurs in the morning and almost never in night.Defecation after meals may be precipitate due to an exaggerated gastrocolic reflex.
6) other symptoms include bloating or abdominal distention,a sensation of incomplete emptying of the rectum.
7) There is excessive flatus and audible borborygmi.
8) Nausea,anorexia,headache and tiredness may also occur.
9) The descending colon may be palpable and tender.
10) Rectal examination is normal.
WHAT INVESTIGATION WE SHOULD DO ?
Sigmoidoscopy is essential.
WHAT TREATMENT WE SHOULD GIVE ?
1) Patients must be reassured on the basis of normal findings on examination and investigations.
2) Anxiety may precipitate or aggravate the condition and there is sometimes an underlying fear of cancer.
3) In patients with persistent or troublesome symptoms measures designed to modify the intestinal dysmotility are required.
4) For constipation and pain patients should be encouraged to increase the roughage content of the diet, and one of the hydrophilic colloids are prescribed in a dose sufficient to ensure a normal bowel movement.
5) It is important that patient should stop taking laxatives.
6) Pain and Diarrhoea are relieved by an anticholinergic drug such as Dicyclomine or an antispasmodic such as mebeverine hydrochloride thrice daily.
7) For patients with painless diarrhoea , dietary restriction is advice, particularly avoidance of fresh fruits and salads.
8) Codeine phosphate and Loperamide are useful drugs which acts quickly and can be carried by the patients to use in emergency or they can be taken before any event which is known to precipitate diarrhoea.
9) In all patients the psychological component of the syndrome should be explained.