It is a common long-term disease that affects digestion and can have many extra intestinal manifestations as well. Few of the factors that can trigger onset of irritable bowel syndrome(IBS) are psychiatric conditions as depression, anxiety, psychological stress, gastrointestinal infections, sexual, verbal or physical abuse and antibiotic therapy,
There are four subtypes of irritable bowel syndrome as,
- IBS-C which includes having hard lumpy stools for more than 25% and loose or watery stools for less than 25% of the bowel movements
- IBS-D with hard lumpy stools for less than 25% and loose or watery stools for more than 25% of the bowel movements
- IBS- M with mixed episodes of both watery stools and hard lumpy stools
- Unsub typed IBS which shows insufficient abnormalities of stool consistency to meet criteria for above three subtypes
Clinical Manifestations
- Abdominal pain
- Increased abdominal cramps which are relieved after defecation
- Change in bowel output due to recurrent episodes of constipation, diarrhea or both
- Abdominal bloating and associated feeling of abdominal emptiness
- Excessive flatulence
- Increased need for defecation with feeling of inadequate evacuation
- Lack of energy
- Feeling sick
- Heartburn
- Depression with low mood
- These symptoms can significantly affect a person’s day to day life and can impair the productivity of a person.
Risk Factors
The factors that predispose a person to get irritable bowel syndrome are
- Female gender
- Severity
- Duration of the initial episodes of diarrhea
- Preexisting adverse events of life
- High level of anxiety
Diagnosis
According to the Rome 3 diagnostic criteria, if a person is having
- Recurrent abdominal pain
- Discomfort associated with two or more of the following features
for at-least 25% of the times in the time period of past three months for at least 3 days per month. The features include
- Improvement of abdominal discomfort following defecation
- Onset being associated with a change in frequency of stool
- Onset being associated with a change in form of stool
After clinical judgment the decision for further investigations can be made. Presence of
- rectal bleeding
- Nocturnal pain
- Fever
- Weight loss
along with the above features can suggest the need for further investigations as it can be due to organic diarrhea.
Management
Pharmacological Management
- The microorganisms in the gut flora must be altered with probiotics or prebiotic and with broad spectrum antibiotics as Rifaximin.
- Anti diarrheal drugs can be given for symptomatic relief of patients presenting with diarrhea which include drugs as Loperamide and Codeine phosphate. Constipation can also be treated with medications as Prucalopride.
- Pain relief can be achieved by prescribing smooth muscle relaxants as Mebevarine hydrochloride which is also called the drug of choice for irritable bowel syndrome.
Non-Pharmacological Management
- Dietary triggers that can increase the onset of symptoms can be explored and advised to be avoided and a high fiber diet can be recommended for patients with constipation.
- It is important to educate the patient about how the disease is caused with the psychological effect and how they can minimize the symptoms.
- Psychotherapy can be achieved by referring to clinical psychologist, cognitive behavioral therapy be achieved by referring to psychiatrists, antidepressants as Amitriptyline can be prescribed for stress relief and reduce the psychological effect of the disease.
- Various relaxation techniques and methods which relief stress can be used to reduce the depressive moods of these patients as well.
References
- Kumar and Clerk’s Clinical Medicine -8th Edition- Parveen Kumar, Michael Clark
- Oxford Handbook of Clinical Medicine – 10th Edition
