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Irritable Bowel Syndrome

Irritable bowel syndrome (also called spastic colon, spastic colitis, mucous colitis) is a common condition marked by chronic or periodic diarrhea alternating with constipation. It's accompanied by straining and abdominal cramps.

Irritable bowel syndrome occurs mostly in women, with symptoms first emerging before age 40. The prognosis is good.

Causes

Irritable bowel syndrome is characterized by a combination of abdominal pain and altered bowel function. There are many possible causes. For instance, there may be a disturbance in the muscle movement of the intestine or a lower tolerance for stretching and movement of the intestine. There is no abnormality in the structure of the intestine.

The condition occurs more frequently in women and usually begins between the ages of 20 and 30. Predisposing factors may be a low-fiber diet, emotional stress, and use of laxatives.

Signs and Symptoms

Typically, the patient reports a history of chronic constipation, diarrhea, or both. She may complain of lower abdominal pain (usually in the left lower quadrant) that is often relieved by defecation or passage of gas. She may report bouts of diarrhea, which typically occur during the day. This symptom alternates with constipation or normal bowel function.

The patient may describe her stools as small with visible mucus. Or she may have small, pasty, and pencil-like stools instead of diarrhea. Other common complaints include dyspepsia, abdominal bloating, heartburn, faintness, and weakness.

During the patient history, investigate possible contributing psychological factors such as a recent stressful life change that may have triggered or aggravated symptoms

On inspection, the patient may seem anxious and fatigued, but otherwise normal. Auscultation may reveal normal bowel sounds. Palpation typically discloses a relaxed abdomen. Occasionally, percussiop reveals tympany over a gas-filled bowel.

Diagnostic tests

Because no definitive test exists to confirm irritable bowel syndrome, the diagnosis typically involves studies to rule out other, more serious disorders, such as diverticulitis or colon cancer. The most frequently performed tests include barium enema, sigmoidoscopy, and stool examination. Barium enema may reveal colonic spasm and a tubular appearance of the descending colon. It's also used to rule out certain other disorders, such as diverticula, tumors, and polyps.

Sigmoidoscopy may disclose spastic contractions.

Stool examination for occult blood, parasites, and pathogenic bacteria is negative.

Treatment

The goal of therapy is to control symptoms through dietary changes, stress management, and lifestyle modifications. Medications are reserved for severe symptoms and, if used, are discontinued as the patient learns to control her symptoms through diet and stress reduction.

The type of dietary therapy depends on the patient's symptoms. If she has diarrhea, an elimination diet may help determine whether her symptoms result from food intolerance. In this type of diet, certain foods, such as citrus fruits, coffee, corn, dairy products, tea, and wheat, are sequentially eliminated. Then, each food is gradually reintroduced to identify which foods, if any, trigger the patient's symptoms.

Other dietary changes include elimination of sorbitol, an artificial sweetener that may cause diarrhea, abdominal distention, and bloating. Also helpful is dietary elimination of nonabsorbable carbohydrates, such as beans and cabbage, and lactose-containing foods, all of which can cause flatulence.

To control diarrhea, bran may be added to increase dietary bulk. By increasing the time the stool remains in the bowel, bran helps to promote stool formation.

If the patient has constipation and abdominal pain, her diet should contain at least 15 g per day of bulky foods, such as wheat bran, oatmeal, oat bran, rye cereals, prunes, dried apricots, and figs. These foods help to minimize the effect of nonpropulsive colonic contractions that may trap stool or retard its passage, causing abdominal pain. The patient should also increase her water intake to at least eight glasses per day.

Counseling to help the patient understand the relationship between stress and her illness is essential, as is instruction in stress-management techniques.

Drug therapy, if required, may include:

  • anticholinergic, antispasmodic drugs such as propantheline bromide to reduce intestinal hypermotility
  • antidiarrheals, such as diphenoxylate and atropine, to control diarrhea
  • laxatives for constipation
  • antiemetics such as metoclopramide to relieve heartburn, epigastric discomfort, and after-meal fullness
  • simethicone to relieve belching and bloating from gas in the stomach and intestines
  • mild tranquilizers such as diazepam prescribed for a short time to reduce psychological stress associated with irritable bowel syndrome
  • tricyclic antidepressants, if depression accompanies the disorder.
Prevention

Regular exercise, yoga, massage or meditation. These can all be effective ways to relieve stress. You can take classes in yoga and meditation or practice at home using books or tapes.

Other techniques. Set aside at least 20 minutes a day for any activity you find relaxing — listening to music, reading, playing computer games or just soaking in a warm bath.



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