Irritable bowel, known in medicine as Irritable Bowel Syndrome, is an alteration of the motility (movement) of the digestive system that causes a variety of discomforts such as abdominal pain, bloating, diarrhea and constipation that occur mainly after eating.
Studies have determined that most of these discomforts are generated by emotional stress. This disorder can occur at any age, but usually begins in adolescence or early adulthood, and is more prevalent in women than in men, accounting for approximately 50% of consultations in general medicine and gastroenterology services.
In general, irritable bowel disease tends to be a chronic disease accompanying the patient throughout his life, sometimes with minimal discomfort and at other times, causing a significant disruption of the individual’s life.
With regard to irritable colon it is important to take into account the psychosocial sphere, since these patients are more likely to develop psychiatric diseases such as depression, anxiety, hysteria, personality disorders and a history of abuse.
Differential diagnosis of irritable bowel syndrome
There are diseases that can mimic the symptoms of irritable bowel syndrome and it is important for the physician to rule them out. Among the most important are:
-Diverticula in the colon.
-Mesenteric vascular insufficiency.
-Megacolon and intestinal torsion.
-Intestinal giardiasis (infestation by the parasite Giardia lamblia).
-Depression and panic attacks.
Irritable bowel syndrome is considered to be a motor disorder of the digestive tract function, and it is not clear why a person develops this disease. However, it has been established that stress can worsen it.
Other predisposing factors are diets with too little fiber and the use of laxatives in people who suffer from constipation. The characteristic discomfort of irritable bowel syndrome develops in the first year in 10% of patients, after a bacterial gastroenteritis. This fact is more prevalent in women and people with emotional disorders.
Although irritable bowel syndrome is a motility disorder of the gastrointestinal tract, the bowel structure is normal. The discomfort varies from patient to patient. Among the most characteristic symptoms are
-Disorders of defecation habits (chronic diarrhea or constipation).
-Diarrhea and constipation may occur alternately and sometimes with predominance of one of the two discomforts.
-Sensation of fullness.
Patients affected by irritable bowel disease with predominantly constipation report infrequent stools, generally less than three per week, of hard consistency and difficult to evacuate. Patients with irritable colon and diarrhea report loose or liquid stools, more frequent defecation, usually more than three times a day, often with urgency to defecate or fecal incontinence.
It is important to determine the presence of alarm symptoms in the patient, which suggest a diagnosis other than irritable bowel syndrome and therefore warrant further study of their discomfort. The rapid and abrupt onset of symptoms in a person over 40 to 50 years of age may indicate the presence of an organic bowel disease.
-Bleeding with defecation.
Patients with nocturnal diarrhea, bleeding with stool, severe constipation or severe diarrhea, and who have a family history of colon cancer, celiac disease, and inflammatory bowel disease should be evaluated more extensively. In a patient affected by irritable bowel disease, the physical examination is almost always normal. Hypersensitivity to palpation of the abdomen is very common.
The diagnosis of irritable bowel syndrome is established by clinical examination or by ruling out other organic diseases. However, it is prudent to perform some studies such as hemogram, serological tests to detect some diseases, erythrocyte sedimentation rate, which measures the degree of inflammation in the blood and study of feces to investigate occult blood and parasites. If the specialist considers it convenient, a sigmoidoscopy and radiological study of the colon (barium enema) will be performed.
Rome III Criteria for the diagnosis of irritable bowel disease
The patient must have recurrent abdominal pain or unpleasant abdominal sensation, at least three days per month in the last three months, associated with two or more of the following symptoms:
-Improvement with bowel movement.
-Onset of abdominal pain associated with a change in stool frequency.
-Onset associated with a change in stool consistency.
Criteria must be met within the last three months and the discomfort must have started at least six months before the diagnosis is established.
The main objective of the treatment of this disease is to relieve the discomfort. Taking into account that irritable bowel disease is a difficult disease to treat and diagnose, the physician must make the patient understand that his condition is of a functional nature, that is, that there is no structural damage in his digestive system. In some patients, lifestyle changes will be very helpful, for example, regular physical activity, encouraging better sleep habits that will reduce anxiety and help alleviate intestinal discomfort.
Dietary modifications are very important, although there is no specific diet for this condition. Some of the following tips are important:
-Avoid foods that stimulate bowel movement, such as cola, tea and caffeine.
-It is not advisable to eat large meals.
-Encourage the consumption of fiber in the diet such as wheat bran, psyllium plantago, etc.
-It is important to explain to the patient that alterations in intestinal motility and abdominal sensations can be increased by environmental, social or psychological factors, such as medications, food, hormonal treatments and stress.
-The patient should understand that irritable bowel syndrome is a benign condition that will not require surgery or develop into a serious disease.
As far as drugs are concerned, these will be used according to the discomfort presented by the patient: antispasmodics for abdominal pain, such as otilonium bromide and hyoscyamine; drugs such as attapulgite will be used for diarrhea; osmotic laxatives such as polyethylene glycol can be used for constipation.
In patients with irritable bowel syndrome, laxatives such as lactulose and sorbitol should be avoided because they increase discomfort such as flatulence and abdominal bloating. Patients with significant psychological disorders should receive supportive therapy since emotional disturbances increase the discomfort.
Most people who suffer from irritable bowel disease learn to know their condition well and to manage their discomfort, which allows them to lead a good quality of life. Being a functional and not a structural disease, the long-term prognosis is very favorable.
The following preventive measures are highly recommended
-Avoidance of large meals.
-Proper management of stress and emotions.
-Quitting smoking and reducing alcohol consumption.
-Increase consumption of a high-fiber diet.
-Drinking enough fluids.
-Do not eat high-fat foods.
-If the predominant symptoms are due to diarrhea, avoid dairy products, coffee, tea and chocolate.
-Maintain adequate physical activity.
-Control overweight and obesity.