Irritable bowel syndrome is a condition that is defined as a functional bowel disorder that is biopsychosocial in nature. The basis for the manifestation of this disease is considered to be the interaction of two different mechanisms.

This is a psychosocial effect and sensorimotor dysfunction, which is characterized by problems with motor activity and visceral sensitivity of the intestines. To provide high-quality treatment for this condition, a special approach to diagnosis, a differential diagnosis, and also ensuring the correct course of treatment for the disease are required.

Thus, irritable bowel syndrome is not a disease, but rather a syndrome - a set of symptoms characteristic of a functional disorder of this part of the gastrointestinal tract. They disturb a person for more than a month. Patients complain of abdominal pain, difficulty defecating, constipation, diarrhea, mucus in the stool, and flatulence.

Causes

Why does irritable bowel syndrome occur and what is it? Gastrointestinal system disorders in IBS are not an independent disease. If the intestines are irritated, then the reasons lie in various functional disorders of the digestive system.

In the event of a relapse or resumption of a pathological condition such as irritable bowel disease, which has already been treated, the digestive organ disorder may have completely different cause-and-effect relationships.

To the development of this syndrome often predispose:

• frequent stress;
• physical or sexual abuse;
• intestinal infections;
• genetic predisposition.

The peak incidence of irritable bowel syndrome falls on the young part of the population 24-40 years old, although cases of pathology manifesting in adolescence or even childhood are not uncommon. There are twice as many women with IBS as men.

Symptoms of irritable bowel

Irritable bowel syndrome can have three types of symptoms: with a predominance of complaints of abdominal pain and increased gas formation, with a predominance of constipation, with a predominance of loose stools. At the same time, in most patients, symptoms of IBS can occur in various combinations and change over time.

Consequently, this gradation is rather conditional. Features of the course of the pathology include: a long-term course of the disease that does not progress over time, a variety of manifestations, variability of symptoms, a connection between deterioration of well-being and stressful situations, as well as errors in diet.

The main symptoms of irritable bowel syndrome in adults:

1. Abdominal cramps and pain that go away after bowel movements. The nature of the pain is wandering, the patient cannot accurately determine the location of its localization.
2. Constipation (stool less than three times a week) or diarrhea (stool more than three times a day), in some cases these conditions may alternate.
3. Excessive gas formation (flatulence).
4. Swelling and...
5. Sudden and intense urge to defecate.
6. Feeling of incomplete bowel movement after stool.
7. The appearance of mucus in the stool.

All these signs can be combined with each other. For example, irritable bowel syndrome, accompanied by diarrhea, is often replaced by constipation and vice versa. Symptoms usually bother a person for more than three months of the year.

Due to the fact that the disease occurs against the background of emotional shock, the above symptoms are often accompanied by headache, weakness, heart pain, lower back pain, loss of sleep, painful urination, etc. Some pathologies, for example, ulcerative colitis or, can disguise themselves as a syndrome irritable bowel disease, so a differential diagnosis is indispensable.

There are four possible variants of irritable bowel syndrome:

• irritable bowel syndrome with constipation(hard or fragmented stool in >25%, loose or watery stool in<25% всех актов дефекации (опорожнения прямой кишки));
• irritable bowel syndrome with diarrhea(loose or watery stool in >25%, hard or fragmented stool in >25%);
• mixed form of irritable bowel syndrome(hard or fragmented stools in >25%, loose or watery stools in >25% of all bowel movements);
• undetectable form of irritable bowel syndrome(insufficient change in stool consistency to establish a diagnosis of irritable bowel syndrome with constipation, diarrhea, or a mixed form of the disease).

Very often, signs of intestinal irritation occur after eating, at a time of stress, in women during menstruation (or immediately before the onset of monthly bleeding).

Diagnostics

Rome Foundation experts have proposed diagnostic criteria for IBS: recurrent abdominal pain or discomfort (appeared at least 6 months ago) at least 3 days per month in the last 3 months, associated with 2 or more of the following symptoms:

1. Pain and discomfort decrease after defecation;
2. The appearance of pain and discomfort coincided with a change in stool frequency;
3. The appearance of pain and discomfort coincided with a change in the shape (appearance) of the stool.
4. Discomfort refers to any unpleasant sensation other than pain.

How to treat irritable bowel syndrome

This disease consists of a whole set of symptoms, so the treatment of irritable bowel syndrome requires complex therapy, which includes:

• diet therapy;
• changes in lifestyle;
• pharmacotherapy;
• psychotherapy;
• physiotherapy;
• massage (abdominal or general, self-massage);
• physical therapy.

First of all, you need to establish a lifestyle, because... The main cause of the disease is stress. It is necessary to avoid stressful situations, devote more time to rest, sleep, and active walks in the fresh air. Diet for irritable bowel syndrome is also an important factor. Nutrition depends on the form of the disease.

If you are more often bothered by diarrhea, you need to exclude raw vegetables and fruits, coffee, alcohol, brown bread, garlic, and legumes from your diet. For flatulence (bloating), limit intake of carbonated drinks, legumes, and cabbage. If you are more likely to experience constipation, you should increase the amount of vegetables and fruits you consume, and it is also recommended to drink at least 1.5 liters of fluid per day. You should exclude foods that usually cause discomfort.

Drugs for the treatment of IBS

The choice of medication support depends on the symptoms of irritable bowel syndrome in a particular patient. The treatment complex may include the following medications:

1. Antispasmodics that eliminate pain if it is caused by intestinal hypertonicity (drotaverine, pinaverium bromide, mebeverine, etc.).
   M-anticholinergics that reduce spasms and have some antidiarrheal effect (buscopan, belloid, platifillin, riabal, metacin, etc.).
2. Antidepressants(“Imipramine”, “Fluxetine”, “Citalopram”). Designed to eliminate depression, neuropathic pain and irritable bowel.
3. Prokinetics – regulators of intestinal motility (metoclopramide, trimedate, tegaserod, itopride, alosetron, debridate, etc.).
4. Astringents(Smecta, Tanalbin). Prescribed for exacerbation of diarrhea. Maalox and Almagel are taken for the same purpose.
5. Laxatives – anthraglycosides (senna preparations, cofranil, ramnil, regulax, tisasen, etc., can be addictive).
6. – (“Hilak-Forte”, “Laktovit”, “Bifiform”). With the help of beneficial bacteria, intestinal function is improved.

How to treat irritable bowel syndrome developed due to disorders of the nervous system? In this case, experts recommend increasing stress resistance through relaxation methods, yoga and special breathing exercises.

Daily regime

Lack of sleep and physical activity significantly worsens the course of the disease. At the same time, the formed habit of emptying the intestines in the morning after breakfast prevents habitual constipation. A glass of cold water immediately after waking up in combination with morning exercises, especially “scissors” and “bicycle” exercises, promotes regular bowel movements.

Psychotherapy

Since frequent exposure to stress is one of the reasons for the development of IBS, patients are advised to avoid situations that cause strong emotional upheaval, try not to enter into conflicts and master techniques that help increase their own resistance to stress.

• breathing exercises;
• the art of meditation;
• yoga;
• Tai Chi and so on.

Hypnotherapy successfully reduces the influence of the subconscious on the appearance of certain clinical symptoms of the disease. Psychological training using relaxation techniques helps calm and strengthen the nervous system. Yoga classes, special breathing exercises and meditation will teach you how to quickly and correctly relax. Physical education and therapeutic exercises will help strengthen the body and improve the nervous system.

Prevention

As preventive measures for irritable bowel syndrome, it is worth noting the normalization of nutrition and lifestyle (balanced diet, regular meals, avoidance of physical inactivity, abuse of alcohol, coffee, carbonated drinks, spicy and fatty foods), maintaining a positive emotional environment, taking medications strictly according to indications.

Forecast

The condition of patients with irritable bowel syndrome, the effectiveness of treatment and prognosis largely depend on the severity of concomitant disorders of the nervous system. In achieving recovery, overcoming conflicts that are the cause of the formation of neurosis in the patient is often crucial.

The ability to work of patients with irritable bowel syndrome and the prognosis for this disease largely depend on the severity of concomitant psycho-emotional disorders.

Irritable bowel syndrome affects 30 to 50% of all patients who consult a gastroenterologist. Presumably, about 20% of the population has manifestations of irritable bowel syndrome of varying severity.

Irritable bowel syndrome (IBS) is a functional disease, that is, a disease in which the intestines appear completely healthy and yet they do not function as they should. In particular, with IBS, colonic peristalsis is impaired. The irritation may be too strong, and then the patient suffers from diarrhea, as well as painful cramps in the abdominal area. The intestine may be sluggish, and then constipation and flatulence predominate. Peristalsis can either slow down or speed up, and then diarrhea and cramps alternate with constipation and bloating. Among the cases, young and middle-aged women predominate.

Although the nature of intestinal disorders in IBS is not fully understood, the following factors play a leading role in the occurrence of the disease:

• pronounced psycho-emotional vulnerability of the patient (hysterical reactions, depression, hypochondria, cancerophobia);
• imbalance of biologically active substances that regulate intestinal function (such as serotonin, histamine, bradykinin, cholecystokinin and others);
• a certain influence is exerted by the incorrect nature of nutrition (irregular meals, “dry food”, the predominance of refined carbohydrates in food with a lack of dietary fiber).

Symptoms of IBS

Regular (12 weeks in the last 12 months) violation of the act of defecation:

• pain and discomfort in the abdomen that goes away after defecation;
• change in stool frequency (more than 3 times a day or less than 1 time in 3 days);
• change in stool consistency (watery or, on the contrary, dense, “sheep” stool);
• straining during bowel movements;
• urgency to defecate, feeling of incomplete bowel movement after defecation;
• bloating;
• an admixture of mucus in the stool.

These symptoms can come in various combinations and usually intensify after an emotional experience.

Let's immediately clarify which symptoms never occur with IBS, and therefore are signs of other diseases (most often tumors and inflammatory processes):

• weight loss;
• fever, intoxication;
• stool mixed with blood and pus;
• severe diarrhea;
• the appearance of symptoms at night, forcing the patient to wake up to go to the toilet;
• the appearance of the first signs of the disease over the age of 50 years;
• the appearance of symptoms after the use of antibiotics;
• hereditary predisposition to cancer and inflammatory diseases of the colon.

All these complaints should alert you, becoming a reason for an in-depth examination. If you have such complaints, please consult a doctor immediately!

In the treatment of IBS, a large role is given to the correction of the psycho-emotional sphere. Therefore, identifying and addressing worries is in many ways the key to getting rid of IBS symptoms.

Next, you should pay attention to adjusting your diet. As a rule, IBS symptoms intensify after consuming large amounts of milk, animal fats, carbonated drinks, alcohol, and after smoking.

Prevention for constipation

1. The diet should include a large amount of plant fiber (whole grain cereals, bran, a variety of vegetables and fruits, kelp), the only thing that needs to be limited is legumes and cabbage of any kind, as they can increase the processes of gas formation in the intestines, causing bloating, increasing constipation and painful sensations.

2. It is necessary to drink enough water between meals (at least 2 liters) to make the stool softer.

3. Contrasting water procedures (alternating cool and warm water), if they are well tolerated, will help to establish proper intestinal motility.

4. Moderate physical activity.

Be careful! Under no circumstances should you use laxatives based on senna or phenolphthalein (purgen), as they increase intestinal motility, and with it, spastic pain. In addition, senna preparations, when used frequently, are highly addictive, so that without them, the act of defecation becomes simply impossible. Among laxatives, preference is given to lactulose (Duphalac) and preparations based on psyllium seeds. The decision to prescribe them must be made by the doctor.

Prevention for diarrhea

1. You should limit dairy products, fats, foods that have a laxative effect (prunes, figs, apricots, fresh apples, beets, etc.), hot and spicy seasonings.

2. To relieve pain, relaxing warm baths and a heating pad on the abdominal area will help.

3. To reduce flatulence, it is possible to use sorbents (activated carbon), as well as simethicone (espumisan), infusions of carminative plants: fennel, anise and cumin.

With proper diet and elimination of the traumatic situation, in most cases it is possible to achieve a significant improvement in the condition.

Marina Pavlova, general practitioner

21 135

Irritable bowel syndrome (IBS) is a complex of functional intestinal disorders that are manifested by chronic pain and discomfort in the abdomen, bloating, impaired intestinal motility, changes in the frequency and shape of stools without any signs of damage and the absence of organic changes in the intestine itself.

Irritable bowel syndrome is a chronic, relapsing disorder in which symptoms can persist for years and vary in severity.

The word "syndrome" refers to a collection of specific symptoms, but not to a specific disease. Thus, IBS is not one disease, but a specific symptom complex that combines various forms of functional disorders of secretion, absorption and motility, mainly of the large intestine.

The term “irritable bowel” suggests that the bowel responds irritably to normally normal stimuli.

Irritable bowel syndrome is also often called spastic colitis, mucous colitis, intestinal neurosis - all these conditions reflect the symptoms of IBS.

Although IBS can cause a lot of discomfort, it does not cause changes in intestinal tissue and does not increase the risk of cancer, unlike inflammatory bowel diseases such as ulcerative colitis and Crohn's disease.

Few people with irritable bowel syndrome have severe symptoms. Many can control them by managing their diet and lifestyle.

This condition was first described in 1820, and the term “irritable bowel syndrome” came into use in 1967.

WITH irritable bowel syndrome: statistics

WITH irritable bowel syndrome(IBS) affects up to 30% of the adult population of the Earth, and among gastroenterological patients - up to 50-70%. About two-thirds are women, and nearly half develop symptoms before age 35. The average age of patients is 30 — 40 years. Only 25% of IBS sufferers seek medical help.

If the characteristic symptoms of IBS appear in people over the age of 60, then an organic disease, and primarily colon cancer, should be excluded.

Risk factors with

You are more likely to have IBS if you:

• Young. IBS typically occurs in people under 45 years of age.
• You are a woman. In general, women are about twice as likely as men to suffer from IBS.
• Have a family history of IBS. Research shows that people with family members with IBS have an increased risk of the disease. The influence of family history on disease risk may be due to genes or common factors in the family environment.
• Have mental health problems. Anxiety, depression, and personality disorders are risk factors. For women, domestic violence may be a risk factor.

Why is IBS a functional disease?

Functional disorders or diseases – these are those that are not associated with organic damage to the organ, i.e. in which the physiological functions are primarily changed, but no changes in the structure or biochemistry of the organ are detected.

In IBS, bowel abnormalities are noted, but they cannot be diagnosed in the traditional way, that is, they are not defined as inflammatory, infectious, or structural abnormalities that can be seen during examinations.

Thus, IBS is a condition in which the intestines appear normal, but do not function normally.

It is known that signs of many gastrointestinal diseases can be seen. For example, stomach ulcers can be seen during endoscopy or surgery. Celiac disease and collagenous colitis are diagnosed based on microscopic examination and biopsy of the small and large intestines, respectively. In contrast, signs that would be characteristic of IBS are not visible either during endoscopy or under a microscope. Accordingly, by default, SRS is a disease associated with dysfunction.

So, "functional disease" in this case only means that the muscles of the intestines or the nerves that control it do not work normally, and as a result, the intestines do not function normally. It should be noted that the nerves that control organs include not only the nerves located in the organs themselves, but also the nerves of the spinal cord and brain.

ClassificationWith irritable bowel syndrome

IBS can be classified according to several criteria.

1. Signs based on symptoms:

• With a predominance of diarrhea (up to 65%)
• With a predominance of constipation (up to 27%)
• With changing chair
• With predominant pain and flatulence

1. Signs based on the presence of provoking factors:

• Post-infectious IBS (PI-IBS)
• IBS associated with certain foods
• Stress-related IBS.

Symptoms with irritable bowel syndrome

The signs and symptoms of irritable bowel syndrome can vary widely from person to person and often resemble other diseases.

IBS is a chronic disease in which the symptoms of the disease periodically increase, and sometimes decrease or even disappear completely. IBS symptoms may or may not be related to food at all.

Despite the functional nature of the disease, IBS is sometimes significantly disrupts the quality of life, and sometimes forces you to miss work or school.

The main symptoms of the disease include:

• Pain or discomfort in the abdomen, with defecation accompanied by pain, and after defecation the pain decreases.
• Flatulence, feeling of fullness or bloating.
• Visible bloating of the abdomen.
• Diarrhea or constipation, sometimes diarrhea alternating with constipation.
• Sudden, irresistible urge to have a bowel movement.
• Rumbling in the stomach.
• Mucus in stool.
• False urge to defecate.
• Urge to defecate - a sudden, irresistible urge, the inability to control the process of bowel movement.
• Feeling of incomplete bowel movement.
• Sensation as if there is an obstruction in the anorectal area that prevents evacuation. Some patients are forced to provide manual assistance during defecation (for example, digital evacuation or hand support of the perineum).

Bowel changes in IBS

• For constipation, stool frequency is less than 3 times a week. The stool may be hard/sheep-like or fragmented;
• With diarrhea, the frequency of stools is more than 3 times a day. The stool may be soft (mushy) or watery.

Extraintestinal symptoms

• Chronic fatigue syndrome
• Headache
• Muscle and back pain
• Sleep disorders
• Depression and anxiety, neuroses, panic attacks, hypochondria, hysteria
• Dyspepsia - heaviness in the stomach, nausea, feeling of fullness and early satiety (25%)
• Gastroesophageal reflux
• Decreased libido (in 30% of cases)
• Irritable bladder syndrome (30%)
• Autonomic disorders with a predominance of the influences of the parasympathetic nervous system (migraine, lump in the throat, chilly hands, inability to take a deep breath, etc.) (in 50% of cases)
• Symptoms of “anxiety” - weight loss, fever, etc., not associated with pathology of the digestive organs (in 30% of cases).

Reasons with irritable bowel syndrome

It is not known exactly what causes irritable bowel syndrome, but various factors play a role.

The main trigger for the development of IBS is disruption of the brain/gut system. We are talking about both the central and autonomic nervous systems.

The main factors contributing to the development of IBS:

• Stress, social and psychological factors, mental disorders. Biological reasons. As a rule, they are associated with previous intestinal infections.
• Disturbance of intestinal microflora (dysbacteriosis), excessive bacterial growth.
• Genetic factors.
• Food sensitivity.
• Lack of ballast substances (dietary fiber) in food.

Since 2001, there has been more and more talk about external irritants (stress) as the most important trigger not only for irritable bowel syndrome, but also for all functional disorders of the gastrointestinal tract.

The central nervous system plays a significant role in the development of IBS.

As is known, the central nervous system is connected with internal organs through biochemical signaling. This functional connection is provided by substances - neurotransmitters - serotonin, cholecystokinin, etc.

The walls of the intestines are made up of muscles that contract and relax in a regular and coordinated rhythm, moving food from the stomach through the gastrointestinal tract to the rectum.

Poorly coordinated communication between the brain and the gut can cause the gut to overreact to changes that normally occur during digestion. This overreaction can cause pain and diarrhea.

Or the opposite may occur, where weak intestinal contractions slow the evacuation of food, causing feces to stagnate, leading to dry stools, constipation, bloating and pain.

Changes in the tone of the central or peripheral nervous system can lead to an increase in the sensitivity of intestinal receptors to neurohumoral and mechanical stimulation and its hyperreflexia, which plays a direct role in the development of irritable bowel syndrome.

Stress and other psychological factors (mood changes, irritability, pain perception, depression) can activate certain nerves and release chemicals. This causes stronger stimulating signals that cause the intestines to work more actively than usual, and respond to normal irritants as if they were very strong. In this case, contractions of the intestinal wall may be stronger and longer than usual, resulting in the formation of gas, bloating and diarrhea.

Also, for many reasons, the sensitivity of the nervous system of the intestine itself to various influences may increase.

One of these reasons may be acute intestinal infections. In this case, symptoms of intestinal infection such as fever and vomiting disappear after a few days, but diarrhea, constipation, abdominal pain or flatulence remain. Ppost-infectious IBS occurs in approximately 25% of people who have had acute intestinal infections.

The mechanism of its occurrence is due to the fact that with inflammation of the intestinal mucosa, its sensitivity to various influences increases. In the chronicity of the disease, excessive growth of bacterial flora in the intestine and a decrease in the body’s immune defense are important.

Additionally, because patients with IBS have a more sensitive nervous system, they may experience more pain than healthy individuals. Sometimes even normal eating, passing stool or even gas can cause pain.

Diagnostics with irritable bowel syndrome

There are no specific signs to definitively diagnose IBS, so the diagnosis is often made by ruling out other conditions.

The diagnosis is established based on the patient’s complaints (symptoms) and the history of the disease in the absence of alarming signs (see below).

Before making this diagnosis, the doctor has to exclude a number of more serious diseases, because their symptoms may resemble IBS. We are talking about organic intestinal diseases - ulcerative colitis, Crohn's disease, malabsorption syndrome, colon cancer. And only without identifying other diseases can IBS be diagnosed.

Criteria for diagnosis

To aid the diagnostic process, researchers have developed diagnostic criteria for IBS. These criteria are based on symptoms after other diseases have been ruled out.

The most important of which are abdominal pain and discomfort for at least 3 days per month during the last 3 months. These pains should be related to the following conditions: improvement after defecation, as well as a change in stool frequency or stool consistency.

Other symptoms are also taken into account: a feeling of incomplete bowel movement, mucus in the stool, etc.

If the specified criteria for IBS are met, and there are no warning signs or symptoms, the doctor may suggest a course of treatment without doing additional research. But if treatment doesn't provide relief, more research will likely be needed.

Alarming symptoms, which may indicate organic bowel disease include:

• Bleeding from the rectum
• Abdominal pain that gets worse or occurs at night
• Weight loss
• Fever
• Iron-deficiency anemia
• Onset of symptoms after age 50
• Presence of colon cancer or inflammatory bowel disease in relatives.

The presence of at least one of the symptoms of anxiety excludes the diagnosis of IBS and requires a full examination.

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 intestines, 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 your lifestyle and diet. 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. Protracted current ( 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).

Irritable bowel syndrome, or IBS, is a persistent functional disorder in the intestines, expressed in chronic discomfort, pain and cramps in the abdomen and accompanied by changes in the frequency and consistency of stools in the absence of organic causes. This is not even a disease, but rather a syndrome that has a psychological basis and arises as a result of the reaction of an overly sensitive intestine to stress and other unfavorable life situations.

IBS is considered one of the most common diseases in the world, affecting up to 20% of the adult population of the Earth. Doctors note that the syndrome most often appears between the ages of 25 and 40, although it often begins in childhood and adolescence. In representatives of the fairer sex, this pathology is observed twice as often as in men. It has been noted that in most cases, people with irritable bowel syndrome do not seek medical help in a timely manner, as they consider the ailment to be the result of poor nutrition or physiological characteristics of the body.

Today, most doctors believe that the main cause of IBS is stress and psycho-emotional stress. Constant negative emotions, depression, anxiety, panic disorders negatively affect the state of the nervous system, constantly maintaining it in an excited state.

This leads to disturbances in intestinal motility and excessive sensitivity of its inner lining to any adverse effects. In such conditions, even minor errors in the usual diet or consumption of a particular food can trigger symptoms of IBS. In addition, there are a number of possible causes of pain and discomfort. This:

The more of the above factors cause IBS, the stronger its symptoms will appear.

Symptoms of the disease

Irritable bowel symptoms usually appear after eating and are paroxysmal in nature. Uncomfortable and painful sensations last from two to four days, after which they disappear without a trace. The presence of this disease is indicated when the symptoms persist for a long time (more than a month) or unpleasant and painful manifestations are repeated over the past three months, and each month last for 2-3 days in a row.

Main symptoms:

• Abdominal cramps and pain that go away after bowel movements. The nature of the pain is wandering, the patient cannot accurately determine the location of its localization
• Constipation (stool less than three times a week) or, in some cases, these conditions may alternate
• Excessive gas formation (flatulence)
• Swelling and bloating
• Sudden and intense urge to defecate
• Feeling of incomplete bowel movement after stool
• The appearance of mucus in the stool

In addition to these symptoms, there are general signs of the disease that are not related to intestinal symptoms:

• Anxiety and depression, headaches
• Pain in the lumbar region, heart rhythm disturbances
• Decreased libido
• Frequent urge and discomfort when urinating
• Autonomic disorders
  a (chilliness, lump in throat, difficulty breathing)

Signs of intestinal irritation may appear immediately after eating, or in a stressful situation. In women, symptoms of IBS may occur before menstruation.

Classification of irritable bowel syndrome

Depending on which symptom is the leading one, intestinal irritation is divided into three types:

1. IBS accompanied by diarrhea
2. IBS with constipation predominance
3. IBS accompanied by cramping abdominal pain and flatulence

How is IBS diagnosed?

Since this disease does not cause pathological changes in the gastrointestinal tract, there is no single test to determine the disease. To diagnose a disease, an experienced doctor must rule out other possible diseases with similar symptoms. If at least two of the following symptoms are present, a specialist may suspect that the patient has IBS:

• The patient complains of constipation or diarrhea, pain or bloating that goes away after defecation
• Frequent sudden urge to defecate, a feeling of incomplete bowel movement after it, the appearance of mucus in the stool
• Unpleasant symptoms are most severe after eating

Having identified these symptoms, the doctor can prescribe a number of tests to help confirm the diagnosis. General and biochemical blood test. The study will determine the number of blood elements such as leukocytes, erythrocytes, and platelets. The erythrocyte sedimentation rate (ESR) and white blood cell count will indicate whether there is an infectious process in the body.

Test for celiac disease. It will help to exclude a digestive tract disease such as celiac disease. A blood test is done to check the body's immune response to gluten. This reaction damages the small intestine and causes frequent bouts of diarrhea and difficulty digesting food.

Colonoscopy and sigmoidoscopy. to examine the rectum and colon, and sigmoidoscopy will allow you to examine the rectum and sigmoid colon. Such examinations are carried out after special preparation of the patient; the procedures are performed in a medical institution by experienced specialists.

MRI and computed tomography. Prescribed in order to exclude such serious diseases as fecal stones, inflammation of appendicitis or cancer.

Treatment of IBS (irritable bowel syndrome): drugs and folk remedies

Complex therapy for the treatment of irritable bowel syndrome includes the use of medications in combination with the correction of psycho-emotional states and adherence to a certain diet.

Drug therapy for IBS includes the use of the following drugs:

Considering the fact that stress factors play a major role in the onset of the disease, psychotherapeutic measures will help to significantly improve well-being and reduce the intensity of IBS manifestations. Patients with a similar diagnosis are recommended to consult a psychotherapist. Psychological techniques will help reduce anxiety levels, help avoid panic attacks, teach you how to withstand stressful situations and respond adequately to problems.

Hypnotherapy successfully reduces the influence of the subconscious on the appearance of certain clinical symptoms of the disease. Psychological training using relaxation techniques helps calm and strengthen the nervous system. Yoga classes, special breathing exercises and meditation will teach you how to quickly and correctly relax. Physical education and therapeutic exercises will help strengthen the body and improve the nervous system.

Diet for IBS: proper nutrition

With irritable bowel syndrome, a very important factor is following a certain diet. It should contribute to the normal functioning of the digestive system, be balanced, rich in vitamins and essential nutrients. For constipation, a proper diet performs a cleansing function, and for diarrhea, it reduces indigestion. You need to eat fractionally, in small portions, every three to four hours, the daily caloric content of the diet should not exceed 2500-2800 kcal.

In case of IBS, it is necessary to exclude from the diet foods that cause putrefactive and fermentation processes in the body, nausea and bloating. Give preference to foods high in protein and dietary fiber, and avoid those that your body does not tolerate well.

If the syndrome is accompanied by constipation, include in your diet foods that improve intestinal motor function:

For constipation, exclude from the diet flour and confectionery products made from butter dough, jelly, slimy soups, pureed porridge, chocolate, strong coffee, tea. If you suffer from flatulence during constipation, remove whole milk, rye bread, legumes, grapes, cabbage, and potatoes from the diet.

Nutritionists advise eating beets, prunes, freshly squeezed vegetable and fruit juices, carrots, and pumpkin. Avoid hot dishes; they should be served warm. If IBS occurs with diarrhea, the foods included in the daily menu should reduce intestinal motility. You should not eat foods that cause stool liquefaction and stimulate bowel movements. Products recommended for consumption:

Sausages, sugar, salt, spices, seasonings, sauces, spicy and pickled dishes are removed from the diet. Exclude from the menu fruits, vegetables, fatty fish and meats, whole milk and fresh fermented milk products, bran bread, baked goods, and carbonated drinks. Food is taken in small portions, as often as possible, up to six times a day. Such a low-calorie diet is not prescribed for a long time, as it can cause vitamin and protein starvation and lead to exhaustion of the body.

Treatment of IBS (irritable bowel syndrome) with traditional methods

Before using traditional medicine, you must consult with a gastroenterologist and your doctor and avoid factors that provoke the occurrence of the syndrome. During treatment, try to abstain from alcohol, smoking, eat right and avoid physical activity and nervous strain.

For diarrhea, medicinal plants such as sage, white cinquefoil, serpentine, and blueberries help well. You can prepare decoctions and infusions from medicinal herbs, and brew strong tea with blueberries. Herbs such as fennel, mint, and valerian will help relieve pain. With severe flatulence, anise, cumin and chamomile are great help.

As preventive measures for irritable bowel syndrome, doctors advise giving up smoking and alcohol, leading an active lifestyle, not overeating, including foods rich in fiber in your diet, playing sports and avoiding stressful situations.

It is necessary to avoid foods that cause intestinal irritation, eat whole grain bread, dairy products with bifidobacteria, and drink up to one and a half liters of liquid daily. This will help achieve normal bowel function and avoid unpleasant symptoms.

In any case, patients with IBS should not neglect the disease, take into account their individual characteristics when drawing up a menu, do not look for recommendations and folk remedies on Internet forums, but seek help from specialists in a timely manner. Doctors will conduct the necessary examination, help adjust the menu and prescribe all the necessary medications. Only through joint efforts can we achieve improved well-being and defeat the disease.