Irritable bowel syndrome

Causes

Irritable bowel syndrome is common in adults.
Its worldwide prevalence can vary from 1 to 28%. The frequency of occurrence is influenced by place of residence (it is higher in European countries, in the USA, the condition is more often diagnosed in residents of cities rather than rural areas), gender (women consult a doctor with this problem on average twice as often as men). With this syndrome, abdominal pain occurs periodically. They are accompanied by flatulence, diarrhea, or, conversely, constipation. This occurs due to changes in intestinal motility and sensitivity to stimulation, which in turn may be associated with a combination of psychosocial and physiological factors.

Psychosocial disorders

Irritable bowel syndrome is associated with a number of conditions, including anxiety, depression, sleep disorders, chronic fatigue and others. Conflicts and stress can intensify symptoms and provoke exacerbation, but sometimes they do not affect the onset of illness at all.

Physiological changes

Gut physiology may influence the onset of symptoms. With hyperalgesia, the sensitivity of the intestine to normal stretching of the walls increases, and pain occurs. Discomfort can be caused by autonomic disorders, a history of acute gastroenteritis, or too strong a contractile response of the colon to food intake. In women, bowel function may be partly affected by fluctuations in hormone levels and changes during the menstrual cycle.

The appearance of irritable bowel syndrome can also be influenced by hereditary factors, physical stress, unbalanced nutrition, disruption of the autonomic nervous system, and disruption of the intestinal microflora. These factors can have a combined effect, increasing or decreasing the manifestations of the syndrome. At the same time, their presence does not mean that the syndrome will necessarily occur. It is not associated with structural changes in the intestine (diagnostics does not reveal them).

The keen eye of the endoscope.

What to do? Where to go for help? I would like to remind you that abdominal pain cannot be relieved with painkillers. You should also not use a heating pad if the cause of the pain is unknown. You can apply ice. First of all, if you experience pain in the abdominal area, you should at least consult a general practitioner. In our Center, the patient will be able not only to receive professional advice from a doctor, but also, if necessary, to immediately undergo an endoscopic examination, which allows not only to visually monitor the organ being examined, but also to record the examination. Thanks to the video monitoring system, we get an image magnified tens of times, which cannot be achieved with a conventional endoscope. This radically improves the quality of the examination and significantly reduces the error rate. And yet, after the procedure, both the patient himself and the doctor who referred him for examination, as well as the surgeon, if surgical treatment is necessary, can become familiar with the condition of the examined organ.

Symptoms

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With irritable bowel syndrome, abdominal pain occurs at least once a week, which is associated with the following symptoms or conditions:

• flatulence, rumbling in the stomach, increased gas formation, bloating;
• a feeling of straining during bowel movements or a feeling that the intestines are not completely emptied;
• too rare or frequent stools (less than three times a week or more than three times a day), changes in its shape, the presence of mucus in the stool.

The main symptom is abdominal pain. Their severity and frequency may vary: some patients experience abdominal pain almost every day, while others experience them less frequently, once every few weeks or even months. The stomach may hurt after eating, which is accompanied by bloating, diarrhea, and flatulence. Pain can also occur after waking up, stress, emotional arousal, or physical stress. It usually goes away after a bowel movement. The abdomen does not hurt at night, most often the pain appears on the left side in the iliac region (the pain can be diffuse). In general, the pain syndrome is stable, does not increase, and does not change over time.

Patients feel bloating as increasing discomfort. The lower abdomen increases in volume so that clothing may become tight. Rumbling appears, and increased gas formation in the intestines (flatulence) is observed.

Some patients may experience non-gastrointestinal symptoms:

• migraines, frequent headaches;
• weakness, fatigue, tiredness;
• difficulty breathing (feeling of incomplete inhalation or a lump in the throat);
• discomfort in the chest, heart (including at night);
• heartburn, nausea and early satiety;
• problems with urination (too frequent, the appearance of false urges, the feeling that the bladder is not completely emptied);
• back pain.

These symptoms appear more often in patients with serious psychological and emotional problems.

Why is my stomach churning?

There may be different reasons why the stomach twists strongly, but there is no diarrhea. As a rule, this disease is accompanied by other unpleasant symptoms, such as rumbling in the stomach, pain and cramps. Of course, the patient wants to alleviate this condition, but this can only be done after diagnosis and determination of the cause.

The most common factors causing the disease are:

• Unhealthy, unbalanced diet. Often, eating certain foods causes stomach cramps. In this case, painful symptoms appear almost immediately after eating food. In addition, diarrhea is often absent.
• Pyloric spasm. This disease is characterized by contraction of the pylorus of the stomach (the transition zone between the stomach and the duodenum). With this disease, food cannot move normally through the intestines, which leads to indigestion,
• With a spasm of the pylorus, the patient feels that he is nauseous, heaviness appears in the abdomen, seething and colitis.
• Chronic gastritis or peptic ulcer. Both of these diseases are characterized by inflammation of the mucous membrane of the stomach or duodenum. As a result, the damaged mucous membrane reacts very sharply to all irritants coming from food, which causes severe pain about an hour after eating, as well as rumbling in the stomach.

• Irritable bowel syndrome. This disease usually manifests itself against a background of severe stress and serious experiences. There are two possible forms of expression of the disease. In the first case, the patient develops diarrhea or, conversely, constipation. In the second case, irritable bowel syndrome is accompanied only by pain and discomfort in the abdomen.
• Lack of enzymes in the digestive tract. As a rule, this disease occurs due to improper functioning of the liver, pancreas and gall bladder. With diseases of these organs, the amount of enzymes required for digestion ceases to flow into the intestines. Undigested food particles begin to irritate the intestinal walls, which causes diarrhea. However, sometimes the disease can occur without diarrhea.
• Obstruction in the intestines. If any mechanical obstruction has formed in one of the areas of the intestine, which prevents food from passing through, intestinal peristalsis increases in this place. At the same time, the patient feels that his stomach is tightly twisted, sometimes the patient even feels sick.
• Condition during pregnancy. An enlarged uterus, as well as hormonal changes in the body, also affect the digestion process. The reasons lie in the increase in progesterone production. It is because of this that a woman begins to feel nauseous, as well as rumbling and discomfort in her stomach. In general, this condition is normal, however, if unwanted vaginal discharge also appears in combination with these symptoms, you should immediately consult a doctor.

As you can see, the reason why your stomach turns in the morning or at other times may be irritation of the mucous membranes of the stomach and gastrointestinal tract. The main thing is not to ignore such symptoms and take timely measures. You should be more attentive to your condition and record all the signs, especially for pregnant women.

Diagnostics

To diagnose irritable bowel syndrome, the clinical picture, medical history, potential influence of psychological factors are assessed, and an examination is performed.

To clarify the diagnosis and exclude other bowel disorders, a number of basic studies and tests are performed. (Table 1).

Additionally, the patient’s psychological status is assessed and, separately, the level of anxiety and depression.

Differential diagnosis is of great importance. It is important to exclude inflammatory diseases, infections, acute conditions, colitis, metabolic disorders, and other diseases. The following symptoms and conditions are not associated with irritable bowel syndrome:

• the occurrence of pain at night;
• weight loss;
• persistent abdominal pain in the absence of other symptoms;
• the disease progresses, its manifestations intensify;
• increased temperature, fever;
• presence of ulcerative colitis, celiac disease, Crohn's disease, colon cancer in relatives;
• in laboratory diagnostics - detection of hidden blood in the stool, changes in biochemical blood parameters, leukocytosis, increased ESR, decreased hemoglobin levels.

These are signs of organic changes that require in-depth examination.

And remember - no independence!

If you have abdominal pain, especially severe pain, do not self-medicate, and under no circumstances take painkillers!

By eliminating the pain and reducing the temperature (and many painkillers effectively reduce the temperature), you will make it difficult for doctors to make a diagnosis, and this can lead to serious complications. Remember that abdominal pain in almost all cases is a rather serious phenomenon that cannot be treated indifferently, because the most important human organs are located in the stomach. Problems of the heart, digestive and endocrine systems, and reproductive systems can manifest as abdominal pain. Therefore, they should not be taken lightly.

Treatment

Irritable bowel syndrome is influenced by a complex of factors, and treatment should compensate for this and eliminate the main symptoms. For successful therapy, cooperation between the doctor and the patient, the patient’s participation in treatment, and his motivation to overcome both psycho-emotional and physiological problems are important. Psychotherapy, diet therapy, and medications can be used for treatment. The doctor chooses treatment methods, taking into account which factors most influence the manifestations of the syndrome. They also take into account the patient’s health characteristics, the duration of the disease, and how exactly the syndrome manifests itself.

Medications

Medicines are chosen according to the set of symptoms:

• for diarrhea, medications that are enveloping, astringent, and reduce intestinal motility are prescribed to normalize peristalsis;
• for constipation, use herbal laxatives, osmotic saline solutions, and other drugs that enhance peristalsis;
• for flatulence, prokinetics and antispasmodics are used to normalize peristalsis;
• Antispasmodics are prescribed to relieve pain.

For severe emotional disorders (anxiety or excitability, neurasthenia, depression), antidepressants or sedatives may be additionally prescribed.

Important! Only a doctor can prescribe medications, give recommendations on their use, and set dosages after confirming the diagnosis. Self-medication can be dangerous, make you feel worse, and make diagnosis difficult.

Psychotherapy

If the onset of symptoms of irritable bowel syndrome is associated with stress, emotional tension, or anxiety, psychotherapy can help solve the problem. Cognitive behavioral therapy is most often used. Usually this is a short-term treatment that helps to correct behavior, emotional response, thoughts, and existing attitudes. Less commonly, hypnosuggestive therapy, neurolinguistic programming, or other therapeutic techniques may be used.

Important! Before contacting a psychotherapist, you need to be examined by a therapist or gastroenterologist. It is necessary to make sure that the symptoms that arise are associated specifically with irritable bowel syndrome and not with other diseases.

Diet

Patients with irritable bowel syndrome are advised to follow the principles of a healthy diet:

• the diet should be balanced;
• It is better to eat in small portions, slowly;
• if you have bloating, avoid foods that provoke flatulence (legumes, cabbage, other foods high in fermentable fiber);
• reduce the consumption of sweeteners, sugar, fructose to reduce the risk of diarrhea and flatulence;
• To combat constipation, dietary fiber-containing dietary supplements are used.

When creating a nutrition plan to reduce the symptoms of irritable bowel syndrome, prepared diets can be used. The most commonly recommended diet is the Low-FODMAP diet. This is a diet of foods containing a minimum of FODMAP substances (so-called short-chain carbohydrates). Such substances include:

• oligosaccharides (found in rye, wheat, legumes, soy products, garlic, onions);
• disaccharides (found in dairy products);
• monosaccharides (fructose);
• polyols (found in plums, peaches, mushrooms, cauliflower).

Eliminating foods containing FODMAPs may reduce diarrhea and flatulence, but this diet may not be effective for all patients. If its use does not produce results, you should abandon it. A gluten-free diet can also be used to reduce the symptoms of irritable bowel syndrome. It is better to formulate a suitable diet together with your doctor after the examination.

Figure 1. Example of a food table for the FODMAP diet. Source: medicalnewstoday.com

What treatment methods are there?

Treatment of symptoms and manifestations, in which the patient notes that his stomach is twisting, he feels nauseous, but there is no diarrhea, will in any case depend on the cause of the disease.

Doctors do not recommend self-medication, since a seemingly ordinary symptom may turn out to be a sign of a serious organic pathology of the digestive tract.

In order to understand what could have contributed to the development of the disease, you should first exclude from your diet all foods and drinks that cause nausea and stomach cramps. For example, you need to give up carbonated drinks and any foods that can cause fermentation in the stomach or intestines. Many people are interested in why pain and discomfort appear after eating; in most cases, this is due to poor nutrition.

If any diseases are detected that lead to the appearance of unpleasant symptoms, it is necessary to carry out thorough therapy. Treatment will depend entirely on the nature of the disease:

1. In case of poisoning with low-quality products or intoxication of the body caused by other reasons, it is important to remove toxic substances from the body as soon as possible. Absorbents are perfect for this purpose; they absorb all harmful substances and remove them from the body, preventing them from being absorbed into the blood. These products include activated carbon, Smecta and Atoxil.
2. If the patient, in addition to stomach churning, also experiences severe rumbling and bloating, you can take an Espumisan tablet. This remedy very effectively eliminates bloating and normalizes digestion.
3. If a specialist has determined that the cause of pain and discomfort is a spasm, antispasmodics - No-shpa, Spazmalgon and Baralgin - can help. It is better to take medications only as prescribed by a doctor.
4. If enzyme deficiency was determined during diagnosis, medications such as Creon, Pancreatin, Festal and Mezim will help eliminate the disease.

It is important to understand! Medicines should be taken only as prescribed by a doctor.

Self-administration of painkillers and antispasmodics can even aggravate the body’s condition, significantly increasing the problem. In addition, such camouflage leads to the development of complications, some of which may require long-term treatment or even surgery. If symptoms recur regularly, it is extremely important to get qualified medical help.

Discomfort in the abdomen can manifest itself in different ways: heaviness in the stomach, a feeling of fullness and pressure, seething, rumbling, soreness, and even all of these at once. Of course, there is no need to talk about good health at such a time. The sufferer wants to quickly get rid of such unpleasant symptoms by taking a fast-acting medicine. But which one and from what?

The first thought that comes to mind: my stomach is churning due to diarrhea. In this case, as a rule, it is enough to use one of the many pharmaceuticals available today aimed at consolidating stool. However, what if there is no diarrhea? In this situation, it is better not to ignore the disease, but to visit a therapist in the near future, who, if necessary, can refer more specialized specialists (for example, a gastroenterologist, an infectious disease specialist, a surgeon) for consultations, because such a painful condition often signals poor metabolism due to disruption of certain organs.

Main reasons

If torsion in the abdominal cavity occurs during a meal or almost immediately after it, then most likely the culprit of the painful sensation is intolerance to some product, usually saturated with cholesterol and/or fats. After all, it is these substances that contribute to the formation and subsequent movement of stones (gallstones) - provocateurs of an unpleasant condition.

Also, the culprit of twisting pain in the abdomen can be pylorospasm - a functional disorder of the muscles of the pyloric segment of the stomach. Despite the fact that this disease is more common in young children, its development in adults is not excluded. It is not difficult to recognize the pathology: the patient feels nauseous (or severely nauseous and vomits, but this is in advanced situations), there is a urinary crisis, colicky ailments and a feeling of heaviness appear simultaneously, localized in the epigastric region, and weight loss is observed against the background of dehydration.

Another reason why the stomach may twist, but there is no diarrhea, is a stomach ulcer. Of course, in most cases, peptic ulcer disease manifests itself acutely: an hour and a half after eating, a person feels a painful pain in the epigastrium. But it also happens that after a meal the pain attack does not gain intensity, but is replaced by torsion, as with diarrhea. The patient, just as with pylorospasm, feels nauseous, and sometimes loses weight. Manifestations of dyspepsia are always present: retrosternal burning, belching of food residues with an acidic taste or air, flatulence, constipation.

A less rare source of abdominal twisting pain, but still possible, is appendicitis. And the main symptom of this disease is the absence of diarrhea.

Discomfort during pregnancy

It is worth mentioning separately the reasons why the stomach may twist during pregnancy, but there is no diarrhea:

1. Due to the growth and position of the fetus.

The fetus, which has increased in size and assumed a special position, is able to put pressure on the internal organs, as a result of which malfunctions appear in their functioning. For example, compression of the gallbladder leads to a lack of fluid in the stomach and, as a result, a difficult digestion process, which causes painful sensations.

2. Because of progesterone.

During pregnancy, as is known, progesterone (a steroid hormone of the adrenal glands and corpus luteum of the ovaries) is produced in large quantities in the body of expectant mothers. The need for this is determined by its main function - weakening the muscles of the uterus in order to painlessly stretch it during the fetal development phase. And since other organs with smooth muscles are located in the abdominal space, they too, including the stomach, undergo softening. The loss of its elasticity leads to a slowdown in digestive processes, resulting in colic, bloating and torsion. By the way, women feel sick during pregnancy also because of progesterone.

If any product is a provocateur of twisting pain, then it should be urgently excluded from the diet. You should also follow a diet for some time, giving up foods that cause bloating (brown bread, legumes, apples, and so on). It is reasonable to drink plenty of still water or rosehip tea (in the absence of contraindications to its intake) - the liquid will allow the gastrointestinal tract to function better. If additional symptoms are present (for example, the patient feels nauseous, vomiting, shivering), the abdominal pain becomes acute or torsion appears at fairly frequent intervals, there is no point in postponing a visit to the doctor.

Forecast

With irritable bowel syndrome, the prognosis is favorable: the patient's condition does not worsen, and with proper treatment, symptoms can be controlled or completely eliminated. With a mild form of the syndrome, a diagnosis, consultation, dietary recommendations, and prescription of medications to take when symptoms appear are usually sufficient. If the condition lasts a long time, is moderate or severe, complex treatment is prescribed. The patient is referred to a gastroenterologist, psychotherapist and algologist (pain treatment specialist). Usually, if you follow doctors' recommendations, your condition can quickly improve.

Prevention

Prevention measures help reduce the symptoms of irritable bowel syndrome, better control it, and avoid pain and other symptoms.

For prevention, the doctor may prescribe a diet: a balanced, moderate diet. The diet should not contain foods that can cause diarrhea or constipation, flatulence, or abdominal pain. It is advisable to consume as little alcohol as possible, carbonated drinks containing caffeine or sweeteners, and eat less salty, spicy, and fried foods. It is better to consume food in small portions, at regular intervals. If the syndrome is accompanied by constipation, it is better to drink more clean water.

It is important to take care of your own psychological state and maintain emotional balance. You need to learn to control emotional reactions and master relaxation methods. To reduce stress levels, follow a daily routine, control the level of stress, and make sure you get enough rest. Hobbies, creative activities, and interests help reduce emotional stress and reduce the risk of the syndrome.

Physical exercise

Physical exercise and sports are effective in preventing irritable bowel syndrome. Loads should be moderate and feasible. This could be walking, swimming, gymnastics, yoga, qigong, or other types of training.

The effect of physical activity on the health of a patient with irritable bowel syndrome:

• playing sports relieves mental stress, helps resist stress, and improves emotional well-being;
• in combination with a diet, physical activity normalizes weight, improves overall well-being, and protects against illness;
• the formation of a muscle corset in the abdominal area can correct peristalsis.

Recommendations for physical activity can be given by your primary care physician, physical therapy specialist, or rehabilitation physician. The training plan is drawn up taking into account physical fitness and health status. The diet when playing sports is structured so that at least 1.5-2 hours pass between meals and the start of training.