IRRITABLE BOWEL SYNDROME – INFORMATION FOR PATIENTS
Irritable Bowl Syndrome – Information for Patients: Overview
— Irritable bowel syndrome (IBS) is a common, chronic condition of the digestive system. Its primary symptoms are abdominal pain and altered bowel habits (eg, constipation and/or diarrhea). These symptoms have no definitive and directly identifiable cause.
Irritable Bowel Syndrome – Information for Patients — theories:
There is no definitive theory for your irritable bowel syndrome which accounts for the causes of this phenomena. Below are presented several speculations which may have some validity:
irritable bowel syndrome may be caused by contractions of the colon, called spasms. These spasms cause increased pressure within the bowl, and this increased pressure as well as muscle movement of this spasm activate certain neural receptors. The impulses from the receptors are interpreted by the brain as crampy pain. One of the treatments for irritable bowel syndrome is aimed at this theory, and many patients feel that they benefit from the use of both antispasmodics and increased soluble fiber. However, these medications do not help all patients. It is possible that there are certain subtypes of irritable bow syndrome – in some spasm is a problem and in others it is not. It is also possible that spasm is simply a symptom of an underlying process and not the cause of the disease.
There our cases of irritable bowl now syndrome which developed after infection with Salmonella or Campylobacter, or viruses. Again, it is not known whether the infection causes the disease, or whether the infection trigger symptoms from a pre-existing and underlying disease.
Anxiety and stress are more common in people with irritable bowels syndrome than they are in the general population. Some studies have indicated that people with irritable bowel syndrome are more likely to have suffered a history of physical, verbal, or sexual abuse then their age and sex matched peers. Anxiety does trigger and worsen irritable bowel syndrome. However, Stress is not a cause of irritable bowel syndrome, it is a trigger. Nonetheless, treatment for stress often improves symptoms of irritable bowl syndrome.
It is believed that food sensitivities, food intolerance’s, and allergies can trigger or worsen irritable bowel syndrome. For this reason food elimination diets have been systematically tried ( Elimination diet). These diets can be dangerous as they can cause a deficiency in valuable and important vitamins, minerals, and other nutrients. Such deficiency can worsen irritable bowel syndrome and cause other problems. These diets should only be tried once they are recommended by Dr. Kline, and instituted under the supervision of a nutritionist or dietitian. Some foods which may have worsened irritable bowel syndrome include foods that are difficult to digest or absorb. Also certain foods that irritate the intestinal tract can worsen irritable bowel syndrome. Included in the list of foods that worsen irritable syndrome are dairy products (which contain lactose), legumes (such as beans), and cruciferous vegetables (such as broccoli, cauliflower, Brussels sprouts, and cabbage). These foods increase intestinal gas, which can cause cramps. Caffeine can also worsen irritable bowel syndrome symptoms.
A newer theory suggests that an increased neurological intestinal sensitivity ( “visceral hyperalgesia”) may be responsible for some or all of these symptoms of irritable bowel syndrome. This increased sensitivity causes normal sensations to be perceived as painful in people with irritable bowel syndrome. There Is a subsection of people with irritable bowel syndrome who respond to tricyclic antidepressants, and this response bolsters the evidence for the theory of visceral hyperalgesia.
Irritable Bowl Syndrome – Information for Patients: Symptoms
— Irritable bowel syndrome (IBS) usually has its onset among teenagers. Women are diagnosed more than men in Western countries. The most common symptom of irritable bowel syndrome is crampy abdominal pain in association with changes in bowel habits (diarrhea and/or constipation). Menstruation frequently worsens abdominal cramping. Changes in bowel habits can include diarrhea, constipation, or alternating diarrhea and constipation. IBS is defined as either cramping, constipation, or diarrhea predominant in its symptoms, however most irritable bowel syndrome has some combination of symptoms.
Irritable Bowl Syndrome – Information for Patients: Diagnosis
The differential diagnosis of irritable bowel syndrome includes: malabsorption (abnormal absorption of nutrients), inflammatory bowel disease (such as ulcerative colitis and Crohn’s disease), celiac disease, and microscopic colitis (uncommon diseases associated with intestinal inflammation), scleroderma ( and autoimmune disease), atrophic gastritis, small intestinal bacterial overgrowth syndrome, aids, alcoholism, and at times, liver and kidney disease.
Tests are usually not done to include the diagnosis of irritable bowel syndrome, but instead to exclude other diagnoses. These tests may include a CBC ( complete blood count), sigmoidoscopy, or colonoscopy.
Irritable Bowl Syndrome – Information for Patients: TREATMENT
There is no cure for irritable bowel syndrome, instead treatments are designed to decrease symptoms. Treatments are typically given lifelong, and combination treatments are common. Attention to anxiety and psychic issues are very important, these may be treated with talk therapy or with medications. It may be useful to keep a log of symptoms and investigate correlation’s between events, foods, and other stimuli and resultant symptoms. This can help decrease symptoms by eliminating their precipitates. Changing diet is very useful. Increasing fiber, adding fennel, flaxseed and other food products, as well as decreasing non-absorbable foods and simple carbohydrates can be quite useful. Evaluation of lactose intolerance can be very important in people who appear to have lactose intolerance. A careful trial of eliminating or decreasing gas producing foods such as beans, brussels sprouts, cabbage, cauliflower, broccoli may be beneficial. Increasing bulk forming medications such as Metamucil may be helpful, if fiber is started, it should be begun in low dose since it can also precipitate irritable bowl syndrome symptoms. Exercise helps many people with irritable bowl syndrome, as does yoga and tai chi. Medications can be used for people who do not respond to the lifestyle modifications described above, or for people who find themselves in special situations ( for example in important meetings where stress is more likely to be high.) Medications can include anti-spasmotic medications, tricyclic antidepressants, and anti-anxiety medications. Other psychic medications used to treat depression (serotonin reuptake inhibitors- SSRI’s) can help people who have depression as comorbidities to their irritable bowel syndrome. SSRIs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro). Other antidepressant medications that may be helpful include venlafaxine (Effexor), and duloxetine (Cymbalta). A newer medication for ibs is Alosetron (Lotronex). This blocks a hormone which may increase intestinal contraction and hypersensitivity, and is approved by the FDA for the use of these symptoms in women who have diarrhea. This medication is effective but has significant intestinal risks which can even be life-threatening. Lubiprostone — (Amitiza) works by increasing fluid secretion in the intestine, and is used to treat severe constipation in women over 18 years old. It is expensive and its safety and efficacy are uncertain. Antibiotics are an experimental treatment for irritable bowl syndrome. Alternative medications include peppermint, probiotics including acidophilus, and Chamomile. Alternative medications which are usually not used because they are felt to be unsafe include Wormwood and Comfrey.
Irritable Bowl Syndrome – Information for Patients: SUMMARY
IRRITABLE BOWEL SYNDROME is a non-lethal but common disease which can cause significant discomfort and disability. It’s cause is not known, and different patients respond differently to various treatments. There can be important and dangerous diseases which mimic irritable bowl syndrome, and it is important to work with Dr. Kline to eliminate them as possibilities in the differential diagnosis, when evaluating this disease.
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