Irritable Bowel Syndrome - Symptoms

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

The main complaints are abdominal pain, bowel disturbances and flatulence. Irritable bowel syndrome is typically characterized by the absence of symptoms at night.

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

Abdominal pain - observed in 50-96% of patients, localized around the navel or in the lower abdomen, have varying intensity (from minor aching to very pronounced intestinal colic). As a rule, the pain decreases or disappears after defecation or gas discharge. The basis of pain in irritable bowel syndrome is a violation of the nervous regulation of the motor function of the colon and increased sensitivity of the intestinal wall receptors to stretching.

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

Stool disorder - is observed in 55% of patients and is expressed in the appearance of diarrhea or constipation. Diarrhea often occurs suddenly after eating, sometimes in the first half of the day. The absence of polyfecal matter is characteristic (the amount of feces is less than 200 g per day, often it resembles "sheep"). Feces often contain mucus. Intestinal mucus consists of glycoproteins, potassium and bicarbonates and is produced by goblet cells. Increased mucus secretion in irritable bowel syndrome is caused by mechanical irritation of the colon due to the slowdown in the transit of intestinal contents. Many patients have a feeling of incomplete bowel emptying after defecation. Often the urge to defecate occurs immediately after eating, which is associated with the stimulating effect of gastrin and cholecystokinin on the motor-evacuation function of the intestine. This is especially pronounced after eating fatty and high-calorie foods. Diarrhea and constipation may alternate: in the morning the stool is dense or in the form of lumps with mucus, and during the day there are several semi-formed stools.

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

Splenic flexure syndrome is the most common. Due to anatomical features (high location under the diaphragm, acute angle) in the splenic flexure in patients with irritable bowel syndrome and motor dysfunction, favorable conditions are created for the accumulation of feces and gas and the development of splenic flexure syndrome. Its main manifestations are as follows:

• a feeling of distension, pressure, fullness in the left upper abdomen;
• pain in the left half of the chest, often in the heart area, less often in the left shoulder area;
• palpitations, a feeling of shortness of breath, sometimes these phenomena are accompanied by a feeling of fear;
• the appearance or intensification of the above symptoms after eating, especially a large meal, constipation, stressful situations, and a decrease after passing gas and defecation;
• bloating and severe tympanitis in the left hypochondrium;
• accumulation of gas in the area of the splenic flexure of the colon (detected by X-ray examination).

Hepatic flexure syndrome - manifests itself as a feeling of fullness, pressure, pain in the left hypochondrium, radiating to the epigastrium, to the right shoulder, to the right half of the chest. These symptoms imitate pathology of the biliary tract.

The blind colon syndrome is common and simulates the clinical picture of appendicitis. Patients complain of pain in the right iliac region, radiating to the right abdominal sections; the pain intensity may gradually increase, but, as a rule, does not reach the same intensity as in acute appendicitis. Patients are also bothered by a feeling of fullness, heaviness in the right iliac region. Palpation of the abdomen reveals pain in the blind colon. A. V. Frolkis (1991) points out that abdominal massage in the blind colon and palpation towards the colon ascendens promote the movement of chyme and gas from the blind colon to the ascending colon and bring significant relief to patients. Palpation of the ascending colon towards the blind colon may cause a significant increase in pain (usually with insufficiency of the ileocecal sphincter).

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

Expressed neurotic manifestations - are quite common in patients with irritable bowel syndrome. Patients complain of headaches (resembling migraines), a lump sensation when swallowing, dissatisfaction with inhalation (a feeling of shortness of breath), and sometimes are bothered by frequent painful urination.

Spastically contracted areas of the large intestine (usually the sigmoid colon) are detected by palpation in many patients (the term “spastic colitis” was previously often used to describe this condition).

Abdominal tenderness on palpation. A. V. Frolkis (1991) describes three situations that may occur during abdominal palpation in patients with irritable bowel syndrome.

1. situation - palpation pain of the abdomen of the neurotic type. It is characterized by diffuse palpation sensitivity of the entire abdomen both during palpation along the intestine and outside it. During palpation, the patient may behave inappropriately, even light palpation of the abdomen causes pain, sometimes patients scream, they have tears in their eyes (especially in women). Some patients have pronounced sensitivity during palpation of the abdominal aorta.
2. situation - pain upon palpation of the entire colon.
3. situation - during palpation, the sensitivity of individual sections of the intestine, mainly the descending sections, is determined.

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