Dr. Nazmul Hasan B.H.M.S

Irritable bowel syndrome can be defined as functional bowel disorder characterized by variable chronic or recurrent gastrointestinal symptoms essentially associated with abdominal pain and altered bowel habits. The symptoms can not be explained by structural or biochemical abnormalities.

Incidence- 18years to 40 years,  Women are more frequently affected than men.

 Aetiology

As it is a syndrome, a single cause is unlikely. On the other hand no definite or organic cause can be evaluated. Some factors are believed to be associated with the aetiology of I.B.S.

1) Psychosocial factors – about 50% patients are found to be associated with these problems, such as anxiety, depression, somatisation, neurosis, panic attacks, acute psychological stress etc.

2) Altered gastrointestinal motility-some motility disorders are found but none is diagnostic.

3) Abnormal visceral perception-I.B.S may be associated with increased sensitivity to intestinal distension.

4) Luminal factors – such as following gastroenteritis, dietary intolerance e.g wheat, dairy products etc.

Clinical features of IBS :

Patient of I.B.S commonly presents with –

1. Abdominal pain referred to the left or right iliac fossa or to the hypogastrium, usually colicky or cramping, diffuse or localized and rarely severe. It is generally relieved by defecation or with the passage of wind / fleatus and is sometimes provoked by food.
2. Pain may be associated with constipation, the stools being hard and pellet like & accompanied by mucous, but rectal bleeding does not occur. Tenderness is common over the pelvic colon.
3. In I.B.S diarrhea & alternate constipation is common phenomenon. Diarrhoea occurs characteristically in the morning; patient usually complaints of passage of frequent small volume stools & a feeling of incomplete emptying of the rectum.
4. Abdominal distension or bloating is very common.
5. Nausea, anorexia, tiredness & weakness occur. Vomiting is not common.
6. Patients may or may not loss weight.
7. Varying degrees of anxiety or depression is present. Patient may also have other functional complaints such as heartburn, chest pain, fatigue, urologic dysfunction, and gynecologic problems (In female patients).

Investigations of IBS:

In I.B.S the findings of investigations are usually normal. So, it is of no value to do a lot of tests. In most young patients diagnosis can confidently be made on clinical presentations. But, older patients coming with abdominal pain or diarrhea must be investigated before diagnosing as I.B.S. In most cases suspecting as I.B.S some routine and special investigations are done to exclude any organic disease or gynecological involvement.

Routine investigations:

1. Complete blood count & ESR- Hb% may reduce, ESR may elevate.
2. Serum albumin – usually no change.
3. Stool-routine & occult blood test- Microbiologist will decide.
4. Sigmoidoscopy – to exclude any intra or extra cellular lesion in the colon.

Special investigations: (to be done as indicated)

1) Ba-enema or colonoscopy – to exclude colorectal cancer or inflammatory bowel disease usually in patients of age over 40 yrs.

2) Ultrasonography of abdominal & pelvic organs-to exclude any organic or gynecological involvement.

3) Radiological investigations

4) Test for lactose intolerance.

5) Test for bile acid malabsorption.

Treatment of IBS:

Non medicinal:

1) Reassurance –in most patients where symptoms are not severe and stress-related, reassurance might be sufficient.

2) Patients with diarrhoea predominant- must rehydrate frequently and regularly.

3) Patients with constipation predominant- must take fibrous food to provoke bowel movement regularly.

Homeopathic Medicine:

Aconite, Arsenic Alb, Anacardium, Belladonna, Colchicum, China, Carbo veg, Dulcamara, Hepar sulph, Nux vomica, Merc, Merc Cor, Medorrhinum, Sulph, Thuja etc .