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A detailed explanation of irritable bowel syndrome (IBS): causes, symptoms and signs, effective treatment, diet. Irritable bowel syndrome

is a worldwide problem affecting all races and ages, as well as both genders of people. The individual symptoms of irritable bowel syndrome (IBS) are so widespread in society that they can be considered part of human existence. Almost every person experiences intestinal discomfort and defecation disorders for a certain time. However, not everyone develops these symptoms as a persistent painful condition. But if irritable bowel syndrome (IBS) as a disease has developed, it, without leading to mortality, nevertheless, is practically not completely cured and accompanies the individual throughout his life.

The exact prevalence of irritable bowel syndrome (IBS) is unknown, but the average prevalence in Western countries is thought to be around 10-20% of the general population. Irritable bowel syndrome (IBS) is the most common cause of intestinal disorders in society, causing patients to consult family doctors for intestinal complaints and is one of the most common diagnoses made by gastroenterologists.

The scale of the problem in developed countries can be judged from only one country - the United States, where patients with irritable bowel syndrome (IBS) make 2.4-3.5 million visits to doctors over the years (primarily to family doctors and gastroenterologists) and receive about 2.2 million appointments. In the United States, the diagnosis of irritable bowel syndrome (IBS) is the most common in gastroenterological practice (about 28% of all patients) and one of the most common diagnoses in the outpatient practice of a family doctor (about 12% of all initial visits).

Only 1-2% of all patients with irritable bowel syndrome (IBS) are referred to a gastroenterologist, but they make up 30-50% of all outpatients consulted by gastroenterologists in Europe and the USA. They also make up a significant proportion of patients in urological and gynecological clinics, which is associated with the widespread occurrence of extraintestinal manifestations of irritable bowel syndrome (IBS).

It should be noted that with regard to irritable bowel syndrome (IBS), like many other diseases, the “iceberg” rule or phenomenon applies. This means that while on average about 20-28% of patients with irritable bowel syndrome (IBS) turn to family doctors, only 1-2% go to gastroenterologists. About 70-80% of patients with irritable bowel syndrome (IBS) do not seek medical advice at all and fall out of the field of view of specialists.

IBS-like symptoms are observed in all age groups, and the onset of symptoms is in no way associated with young age. The peak incidence of irritable bowel syndrome (IBS) occurs between 45 and 65 years of age. In older age groups, the prevalence of irritable bowel syndrome (IBS) decreases. In Western countries, women suffer from irritable bowel syndrome (IBS) more often than men (ratio 1.3-2.6:1), and in all age groups.

Definition and classification.

Irritable bowel syndrome (IBS) belongs to a group of clinically defined conditions known as functional gastrointestinal disorders. They are traditionally defined as “functional” because the present clinical manifestations cannot be explained by structural or biochemical changes.

Classic irritable bowel syndrome (IBS) is characterized as a chronic condition with a variety of symptoms, the main ones being abdominal pain or discomfort, accompanied by constipation and/or diarrhea. The presence and severity of symptoms often varies not only among different patients, but also over time within the same patient.

According to the Roman criteria, Irritable bowel syndrome (IBS) is a complex of functional bowel disorders that has lasted for more than 3 months over the past 6 months. and includes abdominal pain or discomfort that is relieved or disappears after defecation and is accompanied by changes in the frequency or consistency of stools, in which a thorough examination of the patient fails to identify any organic causes of bowel dysfunction.

Currently, several classifications of irritable bowel syndrome (IBS) are used. The most widely used clinical classification of irritable bowel syndrome (IBS), proposed in 1992 by F. Weber and R. McCallum, which is based on clinical features and the predominance of any clinical symptom.

Clinical classification of irritable bowel syndrome (IBS) (F.Weber and R.McCallum, 1992)

Variant of IBS with predominance of abdominal pain and flatulence
Variant of IBS with predominance of diarrhea
Variant of IBS with a predominance of constipation

Irritable bowel syndrome (IBS) can manifest itself in various forms - from mild (mild) to severe. There is also a corresponding classification of irritable bowel syndrome (IBS) depending on the severity and severity of symptoms.

The spectrum of clinical manifestations of irritable bowel syndrome (IBS, depending on the severity of the disease

Patients with mild irritable bowel syndrome (IBS) - the most common type, which has milder symptoms that occur infrequently or intermittently, associated with clearly recognizable stressors that are directly related to altered intestinal physiology. In other words, these patients can predict in advance when their symptoms will get worse, such as after eating, during menstruation, or during psychological stress. These patients do not have psychosocial difficulties or associated psychiatric diagnoses. They control the situation and maintain a good lifestyle; they often do not go to doctors.

Atmoderate (moderate) form of irritable bowel syndrome (IBS), which is less common, symptoms appear intermittently, but in a more acute form and more often, sometimes depriving patients of their ability to work and forcing them to see a doctor and take sick leave.

Severe form of irritable bowel syndrome (IBS) doesn't happen that often. Such patients have constant or frequently recurring pain, which does not correspond to the altered physiology of the gastrointestinal tract. Although psychosocial difficulties (anxiety, depression, somatization) are common in patients, they may not recognize them. Instead, patients tend to focus on physical symptoms, seeking diagnostic evaluation and treatment for the “real” medical problem. Therefore, such patients do not easily agree to take antidepressants or psychological treatment. As a result, they often seek medical help, are often subjected to all kinds of tests and studies, and sometimes resort to the use of drugs. All this can lead to social isolation and job loss, which in turn causes worsening depressive symptoms.

Etiology and pathogenesis of irritable bowel syndrome (IBS).

The exact causes and pathogenesis of irritable bowel syndrome (IBS) are not fully known or understood, since this disease lacks any specific structural and/or biochemical markers. In order to understand the nature of the disease, it is necessary to examine many organs and systems of the body. However, the development of technologies that can directly or indirectly study intestinal function has allowed a better understanding of the mechanisms underlying the development of irritable bowel syndrome (IBS) and other functional disorders.

The pathophysiology of irritable bowel syndrome (IBS) is complex. Motility disorders, impaired visceral sensitivity, dysregulation of the central nervous system and psychopathological abnormalities, post-infectious inflammation and immune dysfunction, food allergies and food intolerance, and other external and internal trigger factors may play a role in its pathogenesis. In some patients, it is not possible to establish the exact pathophysiological mechanism of irritable bowel syndrome (IBS).

Pathophysiological mechanisms inirritable bowel syndrome (IBS).

Disorders of intestinal motility
Impaired visceral sensitivity/perception
CNS dysregulation/hypersensitivity
Psychopathological disorders
Post-infectious intestinal inflammation and neuroimmune modulation of intestinal functions
Food allergies and food intolerances
External and internal trigger factors (stress, bad habits, taking antibiotics, heredity, malabsorption of bile acids, hormonal imbalance, imbalance of intestinal microflora, etc.)

Clinical symptoms and syndromes of IBS.

Irritable bowel syndrome (IBS) is a combination of symptoms that doctors detect even when taking anamnesis. These symptoms are caused by intestinal dysfunction and are what is commonly called “functional”. These include abdominal pain, impaired intestinal function and other symptoms expressed to varying degrees, such as bloating, visible enlargement, a feeling of incomplete bowel movement, and the release of mucus in the stool. Chaotic bowel function is typical - sometimes constipation, sometimes diarrhea, sometimes their combination and alternation within one day.

Discomfort and pain in the abdomen (abdominal pain) in patients with irritable bowel syndrome (IBS) can take a wide variety of forms. The pain can be stabbing, cramping, sharp or aching. Often the pain can take on a pronounced intensity, simulating the picture of an “acute abdomen”. Discomfort is described as a feeling of heaviness (“rock”) in some area of the abdomen. Typically, the nature of the pain or discomfort does not change over time. Any changes of this kind should be considered a possible sign of the development of a concomitant disease. It was previously believed that pain in IBS was localized primarily in the lower left abdomen and was caused by spasm of the sigmoid colon, but this hypothesis was not confirmed. The pain can be localized in almost any area of the abdomen, due to the location of the colon.

Bloating due to flatulence, which the patient often describes as a feeling of fullness or enlargement, is also a characteristic complaint of a patient with irritable bowel syndrome (IBS). Very often, with irritable bowel syndrome (IBS), bloating is accompanied by pain. When examining a patient, it is necessary to find out what type of flatulence is - local or diffuse, and whether it is always localized in one place. Often, flatulence reaches such a degree that it causes an enlargement of the abdomen.

Intestinal dysfunction in irritable bowel syndrome (IBS):

Change in stool frequency (increased or slowed down) “Urgent” stool
Changes in stool consistency (from watery to lumpy)
Discomfort or difficulty in defecation
Discharge of mucus in stool
Tenesmus
Fecal incontinence

Constipation are also a characteristic symptom of irritable bowel syndrome (IBS). The very concept of “constipation” means the frequency of bowel movements less than 3 times a week. However, cases when the frequency of bowel movements changes (for example, from 1 time per day to 1 time every 2 days), the consistency of stool (from normal consistency to hard), or a feeling of incomplete bowel movement after defecation should also be classified as constipation.

Diarrhea, as well as constipation, is a characteristic symptom of irritable bowel syndrome (IBS). However, irritable bowel syndrome (IBS), in which diarrhea is the leading symptom, is less common than irritable bowel syndrome (IBS), with a predominance of constipation. This form is more difficult to manage clinically and can lead to social impairment. There is no exact definition of diarrhea (as well as constipation). Naturally, loose stool consistency and increased frequency of bowel movements are related. However, many patients have normal stools in the morning and then loose stools several times during the day. In other patients, diarrhea can take extremely severe forms, which manifests itself in the form of frequent urge to defecate with the release of normal feces, a small amount of mucus or no discharge at all. Thus, a thorough history is also critical to differentiate the diagnosis from organic causes of diarrhea.

Discharge of mucus in stool occurs quite often, mainly in patients with a predominance of constipation. However, in some patients, mucus is misinterpreted as loose stools and diarrhea is suspected. Endoscopically, increased mucus secretion can be detected in the rectosigmoid region. As a rule, it is not accompanied by inflammation, but is sometimes combined with pseudomelanosis of the colon. The pathophysiology of this symptom is unclear, but it is believed to be associated with laxative use and post-infectious irritable bowel syndrome (IBS).

Feeling of incomplete bowel movement may be combined with any of the above changes in bowel movements. IN In cases where this symptom has been present for a long time, an endoscopic examination and defecogram should be performed to exclude anatomical and/or functional obstruction of the anorectal region associated with prolapse, rectocele or spastic pelvic floor syndrome.

Upper gastrointestinal symptoms of irritable bowel syndrome (IBS) (nausea, lump sensation, heartburn, chest pain)

Non-gastroenterological(extraintestinal) symptoms of irritable bowel syndrome (IBS).

Unpleasant taste in the mouth, frequent urination, nocturia, gynecological problems, etc.
Psychological disorders (anxiety, phobias, somatization, paranoia, etc.)

In patients with irritable bowel syndrome (IBS) and other functional gastrointestinal disorders, not only “irritable bowel” symptoms, but also “irritable body” symptoms are often detected (in more than 50% of patients). This phenomenon is known as "somatization." However, patients often report a whole range of extraintestinal symptoms that at first glance do not relate to the intestines.

The most common extraintestinal manifestations of irritable bowel syndrome (IBS), according to Whormell et al. (1986) are: dyspareunia, dysuria, dyspepsia, back pain, fatigue, migraine, bronchial hyperreactivity.

Although irritable bowel syndrome (IBS) is not a life-threatening condition, it usually lasts for years and can significantly impair the quality of life. The course of irritable bowel syndrome (IBS) is unpredictable and can consist of alternating periods of exacerbation and remission or be expressed in the long-term existence of symptoms. The clinical picture varies depending on the severity of the disease in each individual patient, which often determines the stage of diagnosis and medical care.

Diagnosis and diagnostic criteria for irritable bowel syndrome (IBS).

Unlike “organic” diseases such as peptic ulcers, with irritable bowel syndrome (IBS) there are no structural changes to explain the existing disorders and make a diagnosis. The symptoms of irritable bowel syndrome (IBS) do not yet have a clear and defined pathophysiological explanation. Despite the fact that the intestines function abnormally, existing technologies cannot accurately measure these abnormalities and there is no one test that allows a doctor to immediately diagnose irritable bowel syndrome (IBS).

Based on this, we know about the existence of irritable bowel syndrome (IBS) only from the patient’s description of their symptoms. Therefore, the art of a doctor is to correctly interpret the existing symptoms and, based on their analysis, diagnose irritable bowel syndrome (IBS).As is known, there is currently no specific diagnostic test for IBS.

Primary diagnosisIrritable bowel syndrome (IBS)established anamnestiically based on the Rome criteria in the absence of symptoms of organic pathology or biochemical abnormalities that could alert the doctor and require additional research. When consulting with a patient with symptoms consistent with irritable bowel syndrome (IBS), the doctor identifies possible diagnoses and then evaluates symptoms and signs of the disease to confirm or refute this assumption. Previously established diagnoses are also taken into account. Then, depending on age and main symptoms, the patient is prescribed certain tests.

The division into subtypes (IBS with diarrhea, IBS with constipation, IBS-mixed type, IBS-indeterminate type) is based not on frequency, but on stool consistency (according to the Bristol scale). Therefore, to correctly interpret stool abnormalities in irritable bowel syndrome (IBS), a careful history and assessment of the appearance of stool according to the Bristol scale below are necessary. The first and second types of stool are characteristic of constipation, and the sixth and seventh types are characteristic of diarrhea.

Rome III criteria for the diagnosis of irritable bowel syndrome (IBS).

At least 3 months of recurrent abdominal pain or discomfort associated with 2 or more symptoms for at least the last 6 months:

Improvement after defecation;

and/or

Onset is associated with a change in bowel frequency;

and/or

Onset associated with change in stool shape

The following symptoms occurring more than 25% of the time of day confirm the diagnosis of IBS:

Changes in stool frequency - constipation (stool less than 3 times a week) or diarrhea (stool more than 3 times a day);
Change in the consistency of stool (solid or, conversely, liquid, watery);
Disturbance in the process of defecation (excessive straining, sudden urge to defecate, feeling of incomplete bowel movement);
Discharge of mucus in feces;
Bloating, flatulence
Feeling of fullness and rumbling in the stomach.

Irritable bowel syndrome (IBS) - diagnosis of exclusion, it first of all requires the exclusion of organic pathology (nonspecific colitis ( UC , Crohn's disease ), infectious colitis, intestinal cancer , helminthic infestation, celiac disease , pancreatic insufficiency, metabolic and endocrine disorders) during endoscopic (colonoscopy, capsule endoscopy) and X-ray examinations of the gastrointestinal tract, ultrasound of the abdominal cavity, pelvis and thyroid gland, biochemical and enzyme immunoassay of blood, repeated stool tests.

In addition to clarifying and detailing the clinical criteria for diagnosis, the International Working Group on the Study of Functional Pathology of the Gastrointestinal Tract paid special attention to the criteria for excluding the diagnosis irritable bowel syndrome (IBS), the so-called “alarm” symptoms or “red flags” of IBS.

Red flag symptoms that exclude a diagnosis of Irritable Bowel Syndrome (IBS)

Clinical case of irritable bowel syndrome using capsule endoscopy in examination

Patient Ya., 26 years old, was examined at the proctology department of the Kyiv Regional Clinical Hospital with a diagnosis upon referral Irritable bowel syndrome .

From the anamnesis: She has been ill for 1.5 years, when she began to experience abdominal pain and frequent loose stools up to 5-6 times a day. The onset of the disease was associated with frequent flights for work. He has been examined over the past 3 months (FEGDS, colonoscopy, sigmoidoscopy, irrigography, stool culture, general clinical laboratory tests). According to the above paraclinical studies, the patient has atrophic gastritis and no organic pathology of the colon has been identified. Was treated by gastroenterologist for gastritis and irritable bowel syndrome, he received antidiarrheals, antifoams, and followed a diet, but no clinical effect was observed. To clarify the diagnosis, a study is recommended capsule endoscopy. Data obtained during capsule endoscopy: the esophageal mucosa is not changed. The gastric mucosa is moderately hyperemic and atrophic. The jejunal mucosa is pale pink, velvety is preserved with a single changed mucosa, erosion is 0.2 cm with hypertrophied mucosa. The ileal mucosa is pale pink, pink in places, the velvety is weakly expressed, the vascular pattern is enhanced.

The patient underwent a repeat colonoscopy with a biopsy of the terminal ileum. Morphological examination of the biopsy specimen revealed a diagnosis of Crohn's disease. . A course of basic conservative therapy (mesalazine, desensitizing and vitamin therapy) was prescribed.

Monitoring of clinical effectiveness: slight improvement after 7 days, resulting in a decrease in abdominal pain. After 2 months, normalization of stool - 1-2 times a day, formalized, without pathological impurities, the patient notes a significant improvement in general condition, the return of previous performance.

Ask a question to a specialist

Irritable bowel syndrome (IBS) is a complex of functional digestive disorders in the intestine, not associated with organic damage to the intestine itself, that last for more than three months. A person is considered to have irritable bowel syndrome if they are bothered by:

pain and discomfort in the abdomen (usually relieved after going to the toilet);
flatulence, rumbling;
a feeling of incomplete bowel movement or an imperative (urgent) urge to defecate;
stool disorders (constipation, diarrhea or alternation of diarrhea with constipation).

Worldwide, this disease, according to various sources, affects from 15% to 30% of the population. True, only a third of them turn to doctors for help. Irritable bowel syndrome occurs 2-4 times more often in women than in men. The peak incidence occurs in young working age - 25-40 years, and in people over 60, irritable bowel syndrome practically does not occur.

Reasons

Intestinal dysfunction is explained by the characteristics of the patient’s body. As a rule, this disease affects people who are emotional, mentally unstable, and prone to stress. Also important:

violation of the usual diet and diet;
lack of fiber in food;
sedentary lifestyle;
gynecological diseases (can cause reflex bowel dysfunction);
hormonal disorders - menopause, premenstrual syndrome, obesity, hypothyroidism, diabetes, etc.;
suffered acute intestinal infections with subsequent dysbacteriosis.

What's happening?

Under the influence of the above factors, a change in the sensitivity of receptors in the intestinal wall occurs, and as a result, its functioning is disrupted. The cause of pain is intestinal spasms or excessive gas formation with overstretching of its walls.

You can guess if you have irritable bowel syndrome by the following signs:

pain in the abdomen around the navel or lower abdomen after eating, it usually disappears after bowel movements or passing gas;
diarrhea after eating, usually in the morning and early afternoon;
constipation;
flatulence;
feeling of incomplete bowel movement after visiting the restroom;
sometimes - belching of air, nausea, a feeling of heaviness and fullness in the stomach.

It is characteristic that all these unpleasant symptoms arise from excitement or after it, as a result of prolonged physical and nervous stress. Often, intestinal disorders are accompanied by headache, a feeling of a lump in the throat, insomnia, a feeling of lack of air, frequent urination, tinnitus, a feeling of weakness, and dry mouth.

Diagnosis and treatment

It is very important to distinguish irritable bowel syndrome from other diseases of the digestive tract by excluding an organic cause of the disease. To make a diagnosis, a gastroenterologist will prescribe a number of studies:

general and biochemical blood test;
stool analysis;
irrigoscopy - x-ray examination of the intestines with preliminary filling with a contrast agent;
sigmoidoscopy - examination of the rectum and sigmoid colon (up to 30 cm) using a special endoscopic apparatus;
colonoscopy - a study similar to sigmoidoscopy, but a section of the intestine up to 1 meter in length is examined.

It is necessary to carefully prepare for irrigoscopy, sigmoidoscopy and colonoscopy.

Since mental stress contributes to the development of the disease, normalization of the emotional state plays an important role in the treatment of irritable bowel syndrome. The disease is best treated by two specialists: a psychologist will help eliminate the “provocateur” of the disease, and a gastroenterologist will help cope with the manifestations of the disease.

Has a certain significance diet. It is recommended to exclude smoked and spicy foods, alcohol, coffee, chocolate, and foods that cause excessive gas formation (cabbage, flour) from the diet. The basis of nutrition should be a variety of vegetables, fruits, and dairy products. Steamed or boiled meat and fish dishes are healthy. Wholemeal bread and wheat bran are recommended.

In addition to the diet, the doctor may prescribe medications: laxatives for constipation, constipating agents for diarrhea, drugs to improve the digestion of food and reduce the amount of gas, antispasmodics - drugs that relieve intestinal spasms. In some cases, intestinal dysbiosis is treated.

People suffering from irritable bowel syndrome benefit from exercise and walking. It is necessary to normalize the daily routine, avoid prolonged mental stress, learn not to worry about “trifles” and enjoy life.

Patients who do not drink alcohol regularly and do not suffer from alcoholism should not start drinking after diagnosis. In their case, alcohol may not have played a significant role in the development of the disease, but it can still aggravate its course. In addition, many medications prescribed to treat irritable bowel syndrome are incompatible with alcohol. Their effect can not only be neutralized, but also have a toxic effect, affecting the functioning of the liver, kidneys, and heart.

Drinking alcohol against your doctor's orders for irritable bowel syndrome can have the following consequences:

increased frequency and intensification of abdominal pain;
gradual weight loss and exhaustion ( due to malabsorption - impaired absorption of food);
increased episodes of constipation and diarrhea;
overlap of the therapeutic effect of medications ( because of which the disease as a whole will last longer);
increased risk of infectious complications ( Escherichiosis, salmonellosis and other intestinal infections);
risk of developing colon cancer ( with regular use).

Thus, addiction to alcohol may worsen the prognosis, despite the fact that in irritable bowel syndrome it is generally positive. If possible, you should avoid not only strong alcoholic drinks, but also beer ( even non-alcoholic), wine and even kvass. The fact is that they, even without causing alcoholic intoxication, can promote fermentation processes in the intestines. This disrupts the balance of intestinal microflora and causes flatulence ( accumulation of gases in the intestines). In patients with irritable bowel syndrome, this symptom is especially pronounced, since due to poor motility, gases are not eliminated naturally.

In general, one-time consumption of alcohol with this disease is, of course, not fatal. Most often, this only leads to a worsening of the condition through the mechanisms described above. But the wrong combination of some medications prescribed by a doctor for the treatment of irritable bowel syndrome with alcohol can cause more serious consequences and cause urgent hospitalization ( due to poisoning). In this regard, you should be very careful and, if possible, still adhere to the diet prescribed by your doctor. When you first contact a specialist to begin treatment, you should notify him if you have problems with alcohol abuse. This may initially affect treatment strategy.

Does irritable bowel syndrome occur during pregnancy?

Irritable bowel syndrome during pregnancy is a fairly common, but not very serious problem. This disease manifests itself with moderate symptoms from the gastrointestinal tract. It is not accompanied by any irreversible pathological changes in the intestines, but comes down only to disturbances in its functioning. To date, it has not been possible to accurately determine all the mechanisms involved in the development of this syndrome. It is only known for certain that the innervation of the intestine, the state of the endocrine system and the psycho-emotional background play a certain role in it.

It is the above factors that appear during pregnancy that explain the high incidence of irritable bowel syndrome. In addition, statistically this pathology occurs most often in women of childbearing age ( approximately from 20 to 45 years). In pregnant women, this syndrome is somewhat more severe than in other patients. This is due to a large number of external and internal factors that provoke frequent exacerbations.

The following factors may influence the increased frequency of exacerbations during pregnancy:

hormonal changes;
mechanical compression of the intestines and displacement of its loops by the growing fetus;
weakened immunity;
changes in diet;
psycho-emotional stress;
mechanical pressure on the nerve fibers innervating the intestines;
taking various medications and dietary supplements.

Against the background of these changes, exacerbations become more frequent in women who have previously suffered from irritable bowel syndrome. Symptoms that previously did not cause serious inconvenience ( many patients do not even see a doctor), become more pronounced. To confirm the diagnosis and prescribe symptomatic treatment, you should consult a gastroenterologist. Treatment of the underlying causes of illness during pregnancy is not recommended ( this would be an unnecessary risk for the fetus).

Symptomatic treatment of irritable bowel syndrome in pregnant women involves the use of the following drugs:

antispasmodics and sedatives- for abdominal pain;
laxatives(folk remedies are also possible) - for prolonged constipation;
securing- with prolonged diarrhea;
carminative- with a strong accumulation of gases in the intestines ( flatulence).

In addition, you should pay attention to lifestyle and nutrition. As mentioned above, pregnancy itself provokes an exacerbation of the disease. Therefore, you should avoid stressful situations, walk more, eat easily digestible food ( cereals, vegetables and fruits without hard plant fibers, dairy products).

Seeing a doctor at the first symptoms of the disease is mandatory. This is necessary in order to exclude more serious pathologies ( intestinal infections, adhesive disease of the intestines and pelvic organs, neoplasms in the abdominal cavity), which may affect the course of pregnancy. If doctors diagnose “irritable bowel syndrome,” then the prognosis for both the patient and the unborn child is favorable. This disease is not accompanied by serious systemic disorders, does not cause pregnancy complications and does not threaten the fetus. Doctors continue to monitor the patient according to the general scheme, periodically seeking advice from a gastroenterologist. Treatment focuses on relieving symptoms. After childbirth, the main symptoms of irritable bowel syndrome do not go away immediately and may even intensify. However, usually the frequency of exacerbations and the intensity of symptoms gradually decline.

Does irritable bowel syndrome occur in children?

Most often, irritable bowel syndrome occurs in people between 20 and 45 years old, but the disease can also develop in childhood. In these cases, the clinical manifestations will not differ much from those in adults, but with some distinctive features.

Children may experience the following symptoms of this disease:

Stomach ache. In childhood they are usually more frequent and more intense than in adults. This is partly because children are generally less able to tolerate pain. In young children who cannot complain of pain, the symptom is manifested by restlessness, frequent crying, which intensifies when changing position. Usually the pain does not have a clear localization, since it is caused by spasm of the smooth muscles of the intestine, and not by local inflammation of the peritoneum.
Digestive disorders. As in adults, they may present with long periods of diarrhea ( diarrhea) or constipation ( constipation) or alternating these symptoms. In young children without medical assistance, due to digestive disorders, nutrients begin to be absorbed worse. Because of this, the child may be behind in height and weight. In children of school age and older, this is not as noticeable due to slower growth rates.
Flatulence. Bloating due to gas accumulation is a common problem in young children in general. Their intestines are more sensitive to the food they eat. Accordingly, children with irritable bowel syndrome are forced to adhere to a stricter diet. More often, the syndrome occurs in infants who, for various reasons, were transferred from breastfeeding to artificial nutrition.
Frequent urge. Children of school age and older often complain of the urge to have a bowel movement. In this case, the emptying itself provides temporary relief, but the feeling of fullness in the stomach usually does not go away.
Mucus discharge. Mucous discharge without blood is found mainly in young children. With age, the amount of such secretions decreases.

Thus, the manifestations of the disease in children are usually more intense than in adults. Diagnosis of irritable bowel syndrome is also difficult due to the wide range of normal values for different ages. Most often, the syndrome is not diagnosed correctly by either pediatricians or gastroenterologists. With age, thanks to changes in the structure of growing organs, “improvement” of nervous regulation and stabilization of hormonal levels, the disease can go away on its own, without any treatment.

Differences in the manifestations of the disease and difficulties in diagnosis are explained by the following anatomical and physiological features in children:

incomplete set of digestive enzymes ( which is why not all food is digested normally in the intestines);
gradual proliferation of microflora in the intestines ( the older the child, the closer the composition of his microflora is to normal);
greater mobility of intestinal loops than in adults;
insufficient control of the nervous system over the intestinal muscles;
accelerated formation of feces;
less intense bile formation ( fats are less digestible);
food allergies are more common;
growth and differentiation of cells in organs is accelerated;
the fermentation process in the intestines of young children occurs more often than in adults ( This causes gases to accumulate);
higher sensitivity to various intestinal infections;
weaker fixation of the mucous membrane and submucosa in the rectum.

All this explains some of the differences in the clinical picture of irritable bowel syndrome. However, the prognosis for children with this disease always remains favorable. There are practically no complications, and the disease itself gradually goes away. Prolonged flow ( decades, until adulthood) occurs mainly when trying to self-medicate or non-compliance with diet and other prescriptions of the attending physician. Then, over the years of digestive disorders, a variety of problems can develop. Constant stagnation of feces in the body leads to intoxication, problems with the liver, skin, heart and other internal organs.

Does stress affect irritable bowel syndrome?

According to recent research, long-term stress is one of the most common causes of irritable bowel syndrome. The fact is that with this disease there are no morphological ( structural) tissue disorders. The appearance of symptoms of the disease is usually explained by the influence of any external factors affecting the innervation and functioning of smooth muscles in the intestinal walls. When interviewing patients, it is most often possible to find out that exacerbations are associated precisely with increased psycho-emotional stress.

From a medical point of view, stress is the body's response to emotional or physical stress. Normally, they allow the body to better adapt to various situations, but prolonged stress has a negative effect. First of all, this is due to the activation of the autonomic nervous system and the release of a number of hormones. It is these reactions that cause disturbances in the functioning of smooth muscle tissue.

As a result, due to disruption of innervation, the following problems arise:

Muscle spasm. Spasm is a reflex muscle tension ( in this case - in the intestinal wall). Because of this, the patient may experience periodic abdominal pain.
Motor disorders. Intestinal motility is a set of contractions of its walls, which promotes the passage of contents along from the stomach to the rectum. Due to spasm, motility is impaired and intestinal contents are retained in certain areas. This causes a feeling of "fullness" in the abdomen.
Flatulence. Delay of contents leads to increased fermentation processes ( especially when consuming beer, kvass, grapes and other products with similar effects). As a result, gas accumulates in the intestines and a corresponding symptom occurs - flatulence.
Digestive disorders. The nervous system not only coordinates intestinal motility, but also stimulates the release of digestive enzymes and regulates the absorption of nutrients and fluids. Innervation disorders can lead to alternating periods of constipation ( constipation) and diarrhea ( diarrhea).

Thus, stress has a very direct effect on bowel function. Similar effects can be noted even in healthy people who do not suffer from irritable bowel syndrome. Patients with this disease have additional features in the structure of the nervous and muscular systems. Because of this, psycho-emotional stress causes a longer lasting effect in their body. The exacerbation lasts from several days to several weeks. The stronger the load and the longer its influence, the more pronounced the symptoms of the disease will be.

In addition to stimulating the nervous system, prolonged stress can weaken the immune system. As a result, disturbances in intestinal function are often complicated by dysbiosis ( the composition of the intestinal microflora changes), serious intestinal infections may develop. This will worsen the course of the disease.

To prevent irritable bowel syndrome due to stress, the following measures are recommended:

reasonable work and rest schedule;
quitting smoking, drinking alcohol, coffee and tea in large quantities ( substances that affect the psyche and nervous system);
playing sports or periodic gymnastic exercises;
rest in the fresh air for at least an hour a day;
prophylactic use of mild sedatives ( infusion of valerian, chamomile, motherwort);
counseling assistance from a psychologist ( in case of serious psycho-emotional stress).

Unfortunately, almost every second person sought help from a specialist with symptoms of diseases in the stomach. There are many reasons why disorders and disruptions in the functioning of the stomach develop.

One of the most common pathologies is irritable stomach syndrome. Further in the article we will talk about the reasons why the disease develops, and also talk about therapeutic measures that will save a person from this disease.

Symptoms and treatment of the syndrome depend on what caused the development of the disease. This disease is localized not only in the stomach, but also covers the entire digestive system. As a result of the fact that people do not go to the hospital in a timely manner, they develop all possible complications, which also have a negative impact on surrounding organs. But there are main reasons that provoke the development of irritable stomach syndrome:

Non-compliance with the diet and regime. This list also includes frequent consumption of fast food, dry food, quick snacks (this lifestyle is often led by students or schoolchildren who do not particularly bother to watch what they eat).
Eating spicy foods (badly affects the gastric mucosa, irritating it and causing excessive secretion of gastric juice).
Eating fatty foods. In this case, a disturbance in the functioning of the stomach occurs. Also, because of this, the level of cholesterol in human blood increases greatly.
Eating excessively hot foods. When eating such foods, the mucous membrane is subject to inflammatory processes and is burned.
Eating cold foods. Foods of this category can cause severe cramps and pain.
Negative human habits. These include drinking alcohol (they affect the organ, thereby irritating its walls), and smoking.
Long-term coffee consumption. Caffeine can also cause inflammatory reactions in the stomach;
Consumption of stale, low-quality products.
Prolonged depression, stress, emotional tension, work overload, emotional disorders.

Symptoms of an irritable stomach

Symptoms and treatment of an irritable stomach also depend on the degree of neglect of the process. There are several main symptoms that appear most often in patients with gastrointestinal disease:

Constant feeling of nausea, especially after eating food. How severe this symptom is depends on the stage of irritable stomach disease.
Unpleasant belching with a rotten smell. Most often, this can also happen after a meal (it can continue throughout the disease).
Severe heartburn after eating food.
Pain syndrome, which can come on suddenly or appear gradually, gaining momentum. Some patients report that after eating they have a feeling of heaviness in their stomach. This gives the patient a completely unpleasant sensation.
Profuse vomiting. Naturally, this has a bad effect on the patient’s well-being, since this act releases a large amount of juice.
Irritable stomach syndrome can also be manifested by a sudden loss of body weight, which can lead to complications and a deterioration in the general condition of the patient’s body.
Intolerance to certain types of food. These are mainly hot spices, fatty foods, and over-salted fish.

Diagnosis of the disease

The main goal of diagnostic studies is to make the correct diagnosis of the patient. And only after you have completed all the comprehensive studies can you begin to treat irritable stomach syndrome. The specialist will prescribe you the diagnostics that will be most informative. The most accurate method is x-ray diagnostics. The amount of juice that is in the stomach cavity will be clearly visible on the screen.

The next option is to diagnose the concentration of acid in the stomach. In this case, probing is carried out. Thanks to it, you can accurately find out about the increased or decreased level of acidity in the body. Also, diagnosing diseases of the digestive system is carried out using stimulants. They have an activating effect. Thanks to this technique, the doctor can completely examine the condition of the stomach, again determine the level of acid concentration in it, and determine whether the duodenum has undergone changes.

Ultrasound diagnostics. Thanks to this type of examination, the doctor will determine whether there are any abnormalities in other surrounding organs.

Treatment of irritable bowel syndrome

Treatment of irritable stomach syndrome is most often complex. In order for your health to be significantly better and to recover from the disease as quickly as possible, you need to adhere to all the instructions of the gastroenterologist. Therapy will consist of the following:

Including only fresh, high-quality, well-cooked foods in your diet.
Complete rejection of fatty and spicy foods.
Strict adherence to a special diet prescribed by your doctor.
Taking antidepressants and muscle relaxants. They have a positive effect on the nervous system, thereby being antidepressants, helping to restore the normal mental well-being of patients.
Use of antacids. They reduce the production of gastric juice, thereby reducing the pain that often occurs after eating food.
Taking Mezim, activated carbon.
Use of specific enzymes.

You can also resort to treatment with folk remedies, but it is important to remember that the use of decoctions and tinctures is possible only after the recommendation of a specialist.

Nutrition during illness

Using proper nutrition is the basis for a speedy recovery. Eating healthy foods, fresh fruits, playing sports, walking in the fresh air - significantly affect your health. There are foods that are included in the list of taboos for stomach pathologies. These include: fast food, excessively fatty and spicy foods, spices. It is important to eat small portions 5-6 times a day (this activates the digestive system).

Doctors recommend consuming low-fat dairy products, cereals (buckwheat, semolina, rice), nuts, juices, and vegetable purees. If, out of habit, you have eaten fatty, unhealthy food, then it is recommended to drink activated charcoal or Pancreatin. The table below shows foods that you should avoid eating if you have irritable stomach syndrome, especially on an empty stomach.

Products:	Cause:
Bananas:	Bananas should be avoided as they contain a lot of magnesium. Excessive consumption of bananas on an empty stomach increases the likelihood of calcium and magnesium imbalance in the body.
Citrus:	It is better to avoid eating them, as citrus fruits cause an allergic reaction and exacerbation of gastritis. Citrus juice can be drunk only after eating food, and then only in small quantities.
Raw vegetables:	They are excluded because they contain a lot of acid, which irritates the gastric mucosa.
Meat:	You should avoid meat dishes in the first half of the day, as it will be difficult for the body to cope with the breakdown of such a large amount of pure protein.
Sweets:	It is better to avoid eating sweet treats in the morning on an empty stomach, because at the beginning of the day it is very difficult for the stomach to cope with sufficient insulin production, which will lead to an increase in blood sugar levels.
Coffee:	This drink, drunk in the morning on an empty stomach, irritates the mucous surfaces and increases the production of gastric secretions.

An irritable stomach is a fairly common syndrome. Therefore, in order to avoid all sorts of complications in the future, you need to adhere to an active lifestyle, eat right and, at the slightest suspicion of gastrointestinal ailments, visit a medical institution to receive highly qualified advice and medical care.

Symptoms of IBS affect 10–20% of the adult population of economically developed and urbanized countries; women suffer from it twice as often as men. IBS causes the patient a lot of inconvenience every day, significantly reducing his quality of life. But the delicacy of the problem in general and each of the complaints in particular forces patients to hide symptoms from the doctor.

Most patients with symptoms of IBS prefer to seek help from pharmacists with a request to “advise something for the stomach,” since all suitable remedies are over-the-counter forms.

What is IBS

The term IBS appeared in medical practice about twenty years ago; before that, doctors operated with the diagnosis “chronic spastic colitis.” With the spread of the endoscopic method of examining the intestines, a large group of patients was identified who presented complaints typical of spastic colitis, but had no signs of inflammation of the colon mucosa during endoscopy. It was concluded that the patients had impaired nervous regulation of intestinal motility.

Such conditions were identified as a complex complex of motor and secretory dysfunctions of the intestine, accompanied by neuropsycho-emotional dysfunctions.

Mechanism of occurrence of IBS

The development of IBS is based on the hypersensitivity of the patient’s intestinal sensory receptors, which is the cause of a pathological response to a common irritant. An equally important role is played by the patient’s reduced pain sensitivity threshold.

People who experience constant stress and suffer from the consequences of previous psycho-emotional trauma are predisposed to the occurrence of IBS. The connection between psycho-vegetative and emotional states and the state of the patient’s digestive system is explained by their general humoral regulation. The leading role here is played by the biogenic amine serotonin, which regulates sleep, appetite, memory, pain perception, smooth muscle tone and potassium-sodium metabolism.

Foodborne toxic infections can give rise to the development of the syndrome; a third of IBS patients have a history of an intestinal infection. Studies of the influence of intestinal microflora on the vegetative and psycho-emotional status of the patient have proven that E. coli produces bacterial neurotransmitters, glutamate and γ-aminobutyric acid, which are involved in the formation of anxious-phobic states. Sanitation of the intestinal microflora normalizes the neuropsychic state of patients.

Main complaints in IBS

IBS is characterized by a combination of vivid and contradictory complaints in the patient:

abdominal pain, dysphagia and digestive disorders;
headaches, sleep disturbances, weakness, general malaise;
feeling of a “lump in the throat” while swallowing;
vegetative and psychoemotional disorders.

Of course, the complaints are not fictitious, but real, although the objective status of the patients does not confirm them. IBS is characterized not only by the variety and severity of complaints, but also by their connection with external aspects, in particular with nutritional and psychogenic factors, as well as the circadian rhythm of the patient’s well-being, namely, his improvement in the evening and complete well-being at night.

Main symptoms of IBS

When diagnosing a patient, in addition to complaints, it is necessary to identify the main symptoms of irritable bowel:

having bowel movements only twice a week;
having bowel movements more often than three times a day;
presence of hard or bean-shaped stool;
presence of loose or watery stools;
straining lasts longer than 25% of the entire duration of bowel movement;
uncontrollable urge to defecate;
feeling of dissatisfaction after bowel movement;
mucus in stool;
bloating, distension, fullness or gurgling and a feeling of transfusion in the abdomen.

Diagnosis of IBS

According to international recommendations, namely the Rome II Criteria of 1999, a patient is fully diagnosed with IBS if, over a total of 12 weeks over the past year, abdominal pain and discomfort were combined with two of three circumstances:

they stopped after successful defecation;
they depended on the frequency of bowel movements;
they changed as the shape of the stool changed.

The diagnosis of IBS is valid if the listed signs and complaints are observed in the patient for at least six months. At the same time, patients with “alarming” symptoms, such as fever, unmotivated weight loss, hepatomegaly or splenomegaly, leukocytosis, accelerated ESR, anemia, changes in biochemical tests, blood in the stool, are identified and screened out. They and patients over 50 years of age undergo colonoscopy and endoscopy of the rectum to confirm somatic pathology.

Variants of the course of IBS

There are main options for the course of IBS:

with dominance of pain and flatulence;
with dominance of regular constipation;
with predominant symptoms of diarrhea;
PSRC – post-infectious RK.

Treatment tactics for IBS

Treatment of irritable bowel syndrome begins after a complete examination of the patient. The success of IBS treatment largely depends on the correct assessment of the patient’s psycho-emotional characteristics, on the assessment of his scale of the significance of psychosocial stress, on the doctor’s ability to compare the patient’s somatic and mental problems.

First of all, the patient will have to normalize his lifestyle, rationalize his diet and diet, that is, ultimately, achieve maximum personal discipline. The tactics and volume of treatment will be dictated by the course of IBS characteristic of the given patient. How to treat IBS:

IBS, which occurs with a predominance of pain, requires the exclusion of coarse plant fibers from the patient’s diet and the use of antispasmodics, for example, Butylscopolamine, Otilonium bromide or the well-proven Mebeverine.
IBS with predominant complaints of constipation, first of all, requires modification of the diet, in particular, enriching the diet with coarse ballast foods rich in dietary fiber, frequent meals and introducing a larger volume of fluid into the patient’s diet than usual. Patients are advised to exercise daily. If health-improving and dietary measures are ineffective, drugs that enhance intestinal motility are used, for example, Coordinax.
IBS with predominant symptoms of diarrhea requires the exclusion of gas-forming and coarse fiber-rich foods from the patient’s diet. If dietary measures are ineffective, adsorbent substances are used, for example, calcium carbonate, Loperamide or activated carbon.
When PSG is confirmed, Rifaximin, Nitroxoline, 5-NOK, Nevigramon, Furazolidone, Intetrix, Ersefuril are used to sanitize the intestinal microflora.

The presence of depression or hypochondria in a patient requires the prescription of antidepressants or anxiolytics. In such cases, the course of treatment combines the use of psychotropic drugs and psychotherapy sessions. All variants of the course of IBS require the prescription of drugs that normalize the digestive function of the intestine, namely, enzymatic preparations - Pancitrate, Lycrease, Creon.

The doctor decides how to treat a particular patient after a full examination; self-medication can lead to unforeseen complications.

Treatment with folk remedies

Patients with IBS successfully use alternative treatment methods, namely herbal medicine. Herbal remedies, as a rule, have a diverse complex effect, which is optimal for the treatment of dysfunctional pathology.

To relieve the symptoms of IBS at home, infusions of plants with antispastic and carminative properties are used. The fruits of fennel and dill seeds are popular among patients; the fruits of garden parsley and coriander are in demand; many prefer marjoram and chamomile flowers; herbal sedative infusions containing valerian root, lemon balm leaf or chamomile flowers are successfully used.

The use of pharmaceutical herbal preparations for IBS is indicated, for example, the drug Iberogast, which has a prokinetic effect, that is, it effectively eliminates spasms without affecting the general intestinal motility, and with a decrease in tone and motility, it acts as a tonic. In addition, the drug simultaneously has pronounced anti-inflammatory and carminative effects and has a sedative effect.

Forecast

No doctor can guarantee a complete recovery for a patient with IBS, since the syndrome occurs with alternating remissions and exacerbations, depending mainly on the psycho-emotional state of the patient. The advantage is that IBS does not have a tendency to progress, and subject to clear interaction between the doctor and the patient during the treatment process, it is possible to achieve a fairly comfortable quality of life for the patient.