Irritable Bowel Syndrome (IBS)

Irritable Bowel Syndrome (IBS) is a stress-related gastrointestinal disorder which has a chronic or recurrent abdominal pain with disturbed motion (sometimes diarrhoea and sometimes constipation) and often bloating. This is a very common psychological disorder where the gut seems little sensitive and affects 10-20% of the population. Medically it can be called Functional Bowel Syndrome as it has no pathological basis.
With the increasing stress in life, the number of people suffering from IBS all over the world especially in the developing country is increasing. It is said that 50% of the diarrhoea patients in a Government hospital OPD are suffering from IBS. This is also called stress-related loose motion. More females are affected compared to males. These disease numbers decreases with age.

Symptoms of Irritable Bowel Syndrome

Pain in the abdomen, bowel disturbance in the form of constipation or diarrhoea, the urgency of passing stool, feeling of incomplete evacuation or the passing of mucous – are some of the typical symptoms of IBS. Most of these symptoms occur for a small period and not present continuously for days or weeks. Many times distension of the abdomen is also associated with IBS. The pain in the abdomen is not localized and keeps on varying in nature and migrates in the abdomen. This pain is not relieved bypassing of the stool, mostly not related to any activity.

Diseases confused with IBS

• Constipation
• Diarrhoea
• Inflammatory bowel disease
• Colitis
• Depression
• Intestinal infections
• Cancer Irritable Bowel Syndrome (IBS)

Diagnosis of IBS

When we exclude the presence of all the other possible diseases the diagnosis point towards IBS. Most of the patients show symptoms of anxiety, depression and excessive stress.
The following tests can be done to exclude other diseases:

a. Blood count, Hb, ESR – To exclude anaemia, infection, inflammation
b. Liver function test, electrolytes – To exclude liver disease, electrolyte disturbance
c. Thyroid hormones – To exclude thyroid diseases
d. Stool for blood – To exclude bleeding
e. Rectal endoscopy – To exclude colitis, cancer
f. Stool – To exclude diarrhoea, germs
g. Lactose tolerance test – To exclude lactose intolerance

Treatment for IBS

The line of treatment is:

  1. Reassurance
  2. Diet
  3. Meditation and Yoga
  4. Stress management
  5. Medicines

(1). Reassurance

The patient must be told that the problem is real and they are very common in the general population. The assurance should also tell the patient that there are no life-threatening situations possible out of this problem like cancer. Providing an early correct diagnosis, spending time to explain the possible causes of the symptoms, telling them to be less concerned and take the symptomatic treatment is good enough for the patients. Many of them do not need any treatment once they are assured.

(2). Dietary Management

Patients of IBS should be prescribed a high fibre diet almost double than what they usually take. In some high fibre diet may cause gas formation; in such cases, isabgol or other fibre preparations can be given gradually increasing the dosage from one dose to two weeks till the symptoms improve. Cabbage, Beans, Lentils should be avoided by the patients as they produce a lot of gas and flatulence.

(3). Stress management techniques that can improve the patients

• Yoga/ Meditation
• Psycho therapy
• Development of positive
• Changing of mindset and attitude understanding of reality
• Regular Walk, Exercise

(4). Medicines

For Constipation: Bulk purgatives like Cremalax, isobgol, Cremaffin; Osmotic purgatives like Milk of magnesium, Lactulose: Enemas can be given.
For Diarrhoea: Loperamide (Lomotil, Lomofen, Loperamide), Simethicon can be given.
For Abdominal pain: Anti spasmodic drugs like baralgan, cyclopean, spamindon can be given.
For Flatulence or gas: Enzyme preparations like Aristozyme, fastal N, Gaskit, Pancreaflat can be given.
For Depression: Amitryptiline, Doxpin, Imipramine, nortryptiline, Trazodone, Floxetine can be given.