IBS is the commonest Functional Gastro Intestinal Disorder. Female sufferers outnumber male counterpart. Reasons for this include the fact that anxiety and depression scores are higher in women than in men and the gut may be more sensitive to various stimuli in women. It is likely that men and women perceive internal events in the abdomen differently and that women may be more focused on these events. Food and eating are of more special psychological significance for women, as evidenced by a much higher incidence of eating disorders in women. The whole pelvic region carries a more specific significance for women, being associated not only with defecation, urination and sexuality but additionally with menstruation, pregnancy and childbirth.
IBS - a multisystem disorder
IBS patients suffer from a number of non-intestinal symptoms as stated below. The non-intestinal symptoms of IBS can be more intrusive than the classical features of IBS. IBS coexists with chronic fatigue syndrome, fibromyalgia and temporomandibular (Jaw joint) joint dysfunction
Gynaecological symptoms
Painful periods (dysmenorrhoea)
Pain following sexual intercourse (dyspareunia)
Premenstrual tension
Urinary symptoms
Frequency
Urgency
Passing urine at night (nocturia)
Incomplete emptying of bladder
Other symptoms
Back pain
Headaches
Bad breath, unpleasant taste in the mouth
Poor sleeping
Fatigue
Infectious diarrhoea precedes the onset of IBS symptoms in 7-30% of patients. Whether this is a factor for all patients or just a small subgroup remains controversial. Risk factors in these patients have been shown to include female gender, severity and duration of diarrhoea, pre-existing life events and high hypochondriacal anxiety and neurotic scores at the time of the initial illness.
Symptoms of anxiety and depression are more common in IBS patients and stress or life events often precedes the onset of chronic bowel symptoms.
Factors which are known to trigger IBS
Gastrointestinal infection
Antibiotic therapy
Pelvic surgery
Psychological stress
Psychological trauma
Sexual, physical, verbal abuse
Mood disturbances
Anxiety, depression
Eating disorders
Food intolerance
Diagnostic criteria (Rome II 1999)
These criteria state that, in the preceding 12 months there should be at least 12 weeks (consecutive) of abdominal discomfort or pain that has two of three of the following features:
Relieved with defecation; and/or onset associated with a change in frequency of stool; and/ or onset associated with a change in form(appearance) of stool.
The following symptoms cumulatively support the diagnosis of IBS:
#abnormal stool frequency ('abnormal' may be defined as > 3/day and <>
#abnormal stool form (lumpy/hard or loose/watery stool)
#abnormal stool passage (straining, urgency, or feeling of incomplete evacuation)
#passage of mucus
#bloating or feeling of abdominal distension.
These symptoms can be used to sub classify patients into diarrhoea- and constipation-predominant forms of IBS. In practice a third subgroup of alternating IBS exists, in which constipation and diarrhoea alternate. The three forms have equal frequency. Many patients with constipation have abdominal discomfort or pain with bloating or distension so there is considerable overlap with constipation-predominant IBS. The decision as to whether to investigate and if so what choice of investigations is required should be based on clinical judgement. Pointers to the need for thorough investigation are the presence of the above symptoms in association with rectal bleeding, nocturnal pain, fever and weight loss. Treatment Current strategies for treatment of IBS are based on the biopsychosocial conceptualization of IBS with targeting of central and end-organ therapies. End organ and central approaches to treatment should not be mutually exclusive and can be used in sequence and in combinations. Hydroxytryptamine (HT3)-receptor antagonists for diarrhea predominant IBS, HT4-receptor agonists for constipation predominant IBS as well as kappa opioid agonists for use in patients in whom visceral hyperalgesia plays a predominant role in the pathogenesis of their symptoms may become available.
These are the plan of management of IBS
Explore dietary triggers - Refer to dietician
High-fibre diet ± fibre supplements for constipation - Refer to dietician ± prescribe ispaghula husk
Anti-diarrhoeal drugs for bowel frequency – Loperamide, Codeine phosphate, Co-phenotrope
Smooth muscle relaxants for pain - Mebeverine hydrochloride, Dicycloverine hydrochloride, Peppermint oil
Central treatment consists of - Physiological explanation of symptoms, Psychotherapy, Hypnotherapy, Cognitive behavioural therapy and Antidepressant drug therapy
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