Irritable Bowel Syndrome Symptoms, Diagnosis And Treatment

Irritable Bowel Syndrome (IBS), Diet & Fiber

Diarheal stools appear more often in the morning, postprandial or at emotions; Emission of mucus is common and accompanies the stools. In the clinical picture of irritable bowel syndrome, blood does not appear in stool, hard stools can create anal fissures that will bleed; Bloating is common in patients with irritable bowel syndrome, the patient feels the bloating diffuse or localized in certain areas of the abdomen. Gas emissions may ease in a transitory way the suffering of the patient. Diagnosis The diagnosis of irritable bowel syndrome is made by excluding organic disease of the colon, so based on laboratory exploration. There are certain criteria that suggest the diagnosis of irritable bowel syndrome called Manning criteria, these are: abdominal pain that fails after the the emission of stools; stools become more frequent and softer in the presence of pain; bloating, abdominal distension; sensation of incomplete evacuation of the rectum; elimination of mucus in the stool; imperative criteria of bowel movement. Paraclinical examination Paraclinical examination in irritable bowel syndrome are needed to exclude abdominal organic disease and consists of: Anoscopy, rectoscope, colonoscopy to detect colon organic pathology; Gastroscopy to exclude gastric pathology; Pelvic and abdominal ultrasound to exclude gallbladder, pancreas or genital pathology; Radiological evaluation of the intestine (entero-enema or barium-passage) or enteroscopy to exclude enteral pathology. The diagnosis of irritable bowel syndrome is put on the exclusion of organic lesions in paraclinical explorations, and the Manning criteria for irritable bowel syndrome. Evolution Evolution of irritable bowel syndrome is favorable because complications will not arise. In general the disease evolves with time long quiet periods, accompanied by exacerbations, which are usually related to stress. There are some situations in which the colon diverticulosis is associated with irritable bowel syndrome. Treatment The treatment of irritable bowel syndrome is generally difficult and the results are often not the expected. Being a functional pathology, the mental component is important, so the role of psychological balancing is also important. Diet should be a high-fiber, if constipation is predominant. If the diet is not sufficiently to combat constipation, than should be used laxatives that are growing the volume of the stool. It should be indicated a diet that the patient tolerates and the patient must avoid foods that cause symptoms; Antidiarrheal, in cases of diarrhea; Antispasmodics indicated for pain control, should be administered only if are necessary; Sedatives. index site

Wascher, MD, FACS Updated: AA08/30/2009 The information in this column is intended forAAinformational purposes only, and does not constitute medical advice or recommendations by the author.AA Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health. IRRITABLE BOWEL SYNDROME (IBS), DIET & FIBER An estimated 10 to 20 percent of the population suffers from a complex of gastrointestinal symptoms that are collectively referred to as irritable bowel syndrome (IBS).AAIrritable bowel syndrome affects women three times more commonly than men, and has historically been considered a AaAwastebasketAaA diagnosis for patients with functional gastrointestinal (GI) complaints when no other specific diagnosis can be found. While the precise mechanisms underlying IBS are not well understood at this time, various theories have been proposed.AAThese include abnormal responses to infections of the GI tract, abnormal hormonal and neurologic function of the intestines, hypersensitivity to certain types of foods, abnormal motility of the colon, a AaAhyper-awarenessAaA of bodily functions, and certain psychiatric conditions, in addition to other hypotheses.AA(It is almost certain, however, that there is more than one cause for IBS.) There are a variety of symptoms that have been associated with IBS, and the incidence, severity and frequency of each of these symptoms varies considerably from one IBS patient to another.AATypically, however, IBS-associated symptoms include bloating, crampy abdominal pain, diarrhea alternating with periods of constipation, and the passage of clear or white mucus from the rectum.AAIn many cases, IBS symptoms are more pronounced after eating, and patients with IBS often experience a powerful urge to move their bowels after meals.AAIBS symptoms are also more frequent and more severe during times of stress.AAIn women with IBS, these distressing symptoms may become more intense around the time of patientsAaa menstrual periods.AAOther symptoms that have been commonly observed in patients with IBS include frequent heartburn, nausea and vomiting. Because the true causes of IBS are poorly understood, there have been a wide range of treatments recommended for this syndrome.AAFor example, exercise and other stress-reducing activities may be helpful for some IBS sufferers.AAGiving up tobacco, and reducing or eliminating alcohol consumption may also help to reduce IBS symptoms, while promoting improved overall health at the same time.AAKeeping a food diary can also help to identify foods that tend to provoke or worsen IBS symptoms in many patients.AAFinally, dietary fiber supplementation has been almost universally advocated by most IBS experts.AAUnfortunately, these and other recommended treatments for IBS are often ineffective in reducing the troubling GI symptoms of irritable bowel syndrome for many patients.AAMoreover, there have been only a handful of small, prospective, randomized clinical research studies, to date, looking at dietary interventions for IBS.AANow, a newly published prospective, randomized, placebo-controlled fiber supplement study offers some helpful new clinical data regarding the treatment of IBS, and this data offers some hope for IBS sufferers. This new clinical study, just published in the British Medical Journal, enrolled 275 adult patients with IBS.AAPatients were then randomized to one of three different groups within this study.AAA control group was given rice flour, which is a starch and contains no significant fiber.AAA second group of patients were given supplements of indigestible (insoluble) fiber in the form of bran.AAThe third group received digestible (soluble) supplementation with psyllium powder (Metamucil).AAThe type of supplement received by each patient wasnAaat revealed until the end of the study. Following 12 weeks of fiber (or placebo) treatment, the participants in this study were reassessed for the severity of their symptoms.AAAmong the three treatment groups in this IBS fiber supplementation study, only supplementation with psyllium significantly improved IBS-related symptoms.AAWhen compared to the placebo group, IBS patients who had been randomized to receive psyllium were 22 percent more likely to report improved IBS symptoms.AAIn comparison, there was no statistically significant improvement in IBS symptoms with bran fiber supplementation when compared to placebo, and, in fact, many IBS patients in this group actually dropped out of this clinical study because their IBS symptoms worsened while taking bran fiber supplements. It should be noted there were two significant limitations of this study.AAFirst of all, nearly 40 percent of the patients who volunteered for this trial dropped out prematurely.AAHowever, this is a rather common phenomenon in clinical studies where the treatments are unpleasant, or when the response to such treatments is not immediate or dramatic.AAA second limitation is that, despite the researchersAaa efforts to AaAblindAaA the patients as to which supplement they were actually receiving, three-fourths of the patients were still able to accurately guess the supplement that they had been randomized to receive.AAThis finding, of course, introduces the possibility of bias in the perceptions and responses of these patients at the conclusion of the study. AAMoreover, to complicate matters further, and as prior studies have also shown, 35 percent of the control group of patients also reported an improvement in their IBS symptoms with a placebo supplement. While there are significant limitations inherent in this study, it still represents one of only a very few existing prospective, randomized, placebo-controlled clinical research studies of fiber supplementation as a treatment for IBS.AABased upon the findings of this study, despite its limitations, dietary supplementation with soluble (digestible) fiber appears to be a prudent and potentially helpful intervention for patients suffering from IBS-related symptoms; while insoluble (indigestible) fiber supplements, like bran, may actually worsen the symptoms of IBS. Disclaimer:AA As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity Dr.AAWascher is an oncologic surgeon, a professor of surgery, a widely published author, andAAa Surgical Oncologist at the Kaiser Permanente healthcare system in Orange County, California (Anticipated Publication Date: AAMarch 2010) (Click above image for TV36 interview of Dr. Wascher) Send your feedback to Dr. view website