Irritable Bowel Syndrome Disease

BASICS

DESCRIPTION

Altered bowel habits, abdominal pain, gaseousness, in the absence of organic pathology (divided into four types):

Alternating diarrhea with constipation
Diarrhea predominant
Constipation predominant
Upper abdominal bloating and discomfort
System(s) affected: Gastrointestinal
Genetics: Unknown, but more common in families of patients
Incidence/Prevalence in USA:
- Unknown, but 50% of gastrointestinal visits, and second to upper respiratory infection as cause for lost workdays
- At least 15% of population (uncommon in children and early teens)
Predominant age:
- Late 20's, rarely in late teens
- If over age 40, other disease more likely
Predominant sex:
- Female > Male (2:1) in the US
- In other parts of the world - Male > Female

SIGNS AND SYMPTOMS

All present in most patients but not with every episode
Abdominal pain, usually lower quadrant, relieved by defecation
Mucus in stools
Constipation
Diarrhea
Distention
Upper abdominal discomfort after eating
Straining for normal consistency stools
Urgency of defecation
Feelings of incomplete evacuation
Scybalous stools
Nausea, vomiting (rarely)

CAUSES

Unknown but patients show some gut motility abnormalities with increased response to stress and stimulants, and increase in the 3 cycles/minute smooth muscle contractions

RISK FACTORS

Other members of the family with the same or similar gastrointestinal disorder
History of childhood sexual abuse
Sexual or domestic abuse in women

DIAGNOSIS

LABORATORY

As needed to rule out other pathology
- ESR
- CBC
- Stool for ova, parasites and culture

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

All labs normal except for sigmoidoscopy

SPECIAL TESTS

Not needed for diagnosis

IMAGING

Barium enema, if indicated is usually normal
Small bowel series

DIAGNOSTIC PROCEDURES

Sigmoidoscopy (often normal), can show spasm that reproduces pain and increase mucosal folds

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Heat to abdomen can help
Biofeedback may help
Reduce stress

SURGICAL MEASURES

N/A

ACTIVITY

As normal

DIET

Increase fiber - may make some patients worse
Avoid - large meals; spicy, fried, fatty foods; milk products, carbohydrates

PATIENT EDUCATION

Many materials available nationally and locally
Stress the organicity of the disease versus any psycho-social interpretation
Teach patient to avoid problem stimulants

FOLLOW UP

PREVENTION/AVOIDANCE

See Diet

POSSIBLE COMPLICATIONS

N/A

EXPECTED COURSE AND PROGNOSIS

No progression to cancer or inflammatory disease
Expect recurrences, when under stress, throughout life. Frequency lessens as age increases.

MISCELLANEOUS

ASSOCIATED CONDITIONS

Migraine
Bladder frequency
Nocturia
Urgency
Fecal incontinence
Fibromyalgia
Dyspareunia
Depression
Stress incontinence

AGE-RELATED FACTORS

N/A

Pediatric: N/A
Geriatric: N/A
Others: N/A

PREGNANCY

Anecdotal information implies that irritable bowel syndrome gets worse in pregnancy. But there are no increased risks to fetus or mother.

OTHER NOTES

Must not give patients the impression that this is a psychiatric illness

ABBREVIATIONS

IBS = irritable bowel syndrome

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.