Irritable Bowel Syndrome Symptoms

The general condition of patients on irritable bowel syndrome is usually good and does not correspond to numerous complaints. The nature of complaints is variable, there is a link between the deterioration of well-being and psycho-emotional factors.

The main complaints are abdominal pain, stool disorders and flatulence. For irritable bowel syndrome, there is typically no symptoms at night.

Symptoms of irritable bowel syndrome are extremely diverse. The most characteristic symptoms are the following:

Pain in the abdomen - observed in 50-96% of patients, they are localized around the navel or in the lower abdomen, have a different intensity (from minor aches to a very pronounced intestinal colic). As a rule, the pain decreases or disappears after defecation or the escape of gases. At the heart of pain in irritable bowel syndrome is a violation of the nervous regulation of motor function of the colon and increased sensitivity of receptors of the intestinal wall to stretching.

A characteristic feature - the occurrence of pain in the morning or afternoon (when the patient is active) and stagnation during sleep and rest.

Violation of the stool is noted in 55% of patients and is expressed in the appearance of diarrhea or constipation. Diarrhea often occurs suddenly after eating, sometimes in the morning. Characteristic of the absence of polyphecal (the amount of feces is less than 200 g per day, often it resembles "sheep"). Cal often contains mucus. Intestinal mucus consists of glycoproteins, potassium and bicarbonates and is produced by goblet cells. The increase in mucus secretion in irritable bowel syndrome is caused by mechanical irritation of the colon due to the slowing of the transit of intestinal contents. Many patients have a feeling of incomplete evacuation of the intestine after defecation. Often the urge to defecate occurs immediately after a meal, which is associated with the stimulating effect of gastrin and cholecystokinin on the motor-evacuation function of the intestine. This is especially pronounced after taking fatty and high-calorie food. It is possible to alternate diarrhea and constipation: in the morning hours, the feces are dense or in the form of lumps with mucus, during the day several times a semi-decorated stool.

Flatulence is one of the characteristic signs of irritable bowel syndrome, usually worse by the evening. As a rule, bloating accrues before defecation and decreases after it. Quite often meteorism has a local character. The combination of local meteorism with pain leads to the development of characteristic syndromes. A. V. Frolkis (1991) identifies three main syndromes.

Syndrome of splenic flexure - occurs most often. Due to its anatomical features (high location under the diaphragm, acute angle) in the splenic bend in patients with irritable bowel syndrome and motor dysfunction, favorable conditions for accumulation of fecal masses and gas and the development of splenic flexure syndrome are created. Its main manifestations are as follows:

• feeling of raspirany, pressure, fullness in the left upper abdomen;
• pain in the left half of the chest, often in the heart, less often in the left shoulder;
• palpitation, a sense of lack of air, sometimes these phenomena are accompanied by a feeling of fear;
• the appearance or intensification of these manifestations after eating, especially abundant, stool retardation, disturbing situations, and a decrease after gassing and defecation;
• bloating and severe tympanitis in the region of the left hypochondrium;
• accumulation of gas in the area of splenic flexure of the colon (revealed by X-ray examination).

The syndrome of hepatic flexure is manifested by a feeling of fullness, pressure, pain in the left hypochondrium, radiating into the epigastrium, in the right shoulder, right half of the thorax. These symptoms mimic the pathology of the biliary tract.

Syndrome of the cecum - occurs frequently and simulates the clinic of appendicitis. Patients complain of pain in the right ileal region, radiating to the area of the right abdomen; The intensity of pain can gradually increase, but, as a rule, does not reach such an extent as in acute appendicitis. Patients are also concerned about the feeling of fullness, heaviness in the right ileal region. When palpation of the abdomen is determined soreness in the region of the cecum. A. V. Frolkis (1991) indicates that a stomach massage in the cecal region and palpation towards colon ascendens promote the movement of chyme and gas from the cecum to the ascending section of the colon and provide significant relief to the patients. Palpation of the region of the ascending colon toward the cecum can cause a significant increase in pain (usually with an inadequate ileocecal sphincter).

The syndrome of nonulcer dyspepsia is observed in 30-40% of patients with irritable bowel syndrome. Patients complain of a feeling of heaviness and overfilling in the epigastrium, nausea, belching of the air. These symptoms are caused by a violation of the motor function of the gastrointestinal tract.

Expressed neurotic manifestations - quite often occur in patients with irritable bowel syndrome. Patients complain of headaches (reminiscent of migraines), a sensation of a lump in swallowing, dissatisfaction with inhalation (a feeling of lack of air), sometimes worried with frequent painful urination.

Spastically abbreviated portions of the large intestine (usually the sigmoid colon) - are detected on palpation in many patients (the term "spastic colitis" was often used to refer to this condition).

Tenderness of the abdomen with palpation. A. V. Frolkis (1991) describes three situations that can occur during palpation of the abdomen in patients with irritable bowel syndrome.

1. the situation is palpable tenderness of the abdomen according to the neurotic type. It is characterized by diffuse palpation sensitivity of the entire abdomen both during palpation along the bowel and outside it. During palpation, inadequate behavior of the patient is possible, even slight palpation of the abdomen causes pain, sometimes the patients scream, they have tears in their eyes (especially in women). In some patients, there is a marked sensitivity in the palpation of the abdominal aorta.
2. the situation is painful upon palpation of the entire colon.
3. The situation - with palpation, the sensitivity of individual segments of the intestine, mainly the descending sections, is determined.

[1], [2], [3], [4], [5], [6], [7], [8], [9]