Irritable Bowel Syndrome: Treatment

Objectives of treatment of irritable bowel syndrome

• Correction of the psychoemotional sphere.
• Correction of impaired intestinal functions.
• Management of pain syndrome.

Indications for hospitalization

Patients who need in-depth examination and / or clarification of diagnosis are subject to inpatient treatment.

Non-drug treatment of irritable bowel

Prior to the appointment of any drug therapy it is necessary to conduct a wide range of measures aimed at modifying the diet, eliminating the impact of stress factors, informing the patient, establishing a trusting relationship between the patient and the doctor (including the therapist).

It is especially important to identify provoking factors, for example stress and psychological disorders. The source of emerging psychological problems usually are the following situations: tense family relationships; service problems; illness of any member of the family; financial difficulties.

Psychotherapy is most effective in emotional disorders: general low emotional background, anhedonia (mental disorder in the form of loss of feelings of joy, pleasure), vegetative manifestations of depression, anxiety, sleep disorders.

Mode

A full-fledged mode of work and rest is needed, adequate, but not excessive physical exertion.

Diet

Assign a diet with the exclusion of a number of foods. Most often, patients suffer from poor milk, carbonated beverages, animal fats, cabbage (including colored, broccoli), legumes, and alcohol. Patients with constipation recommend the consumption of a large amount of plant fiber: unrefined foods, vegetables and fruits, sea kale, bread with bran. It is effective to additionally introduce dietary fiber in the form of bran in increasing doses into the diet. They help to normalize the volume of intestinal contents and intestinal pressure, accelerate passage through the large intestine (which helps to prevent constipation, but virtually no effect on pain syndrome). The daily volume of consumed liquid should be at least 1.5-2 liters.

In the presence of diarrhea, lactase deficiency should be eliminated and it should be ensured that the patient does not consume a large amount of caffeine, fructose, sorbitol and laxatives (including vegetable origin, included in many biological food additives).

The use of carbonated drinks, drinking drinks through a straw, chewing gum leads to aerophagia and can provoke the appearance of abdominal pain and flatulence.

Drug therapy of irritable bowel syndrome

Pain syndrome

Typically, it is associated with an increase in the tone of the smooth muscles of the intestine. To stop pain, spasmolytics are used (treatment course 2-4 weeks):

• drotaverin 2 tablets 2-4 times a day;
• mebeverin 200 mg twice a day;
• pinaverium bromide 50 mg 3 times a day.

In some cases, a positive effect is the combination of antispasmodics with drugs that have sedative properties.

Tricyclic antidepressants are also indicated for pain relief, especially when the pain pattern prevails in the clinical picture. Apply lower doses than those prescribed for the treatment of depression (eg, amitriptyline at a dose of 25-50 mg per night).

Diarrheal syndrome

To treat diarrheal syndrome, loperamide is used: 4 mg (2 capsules) after the first liquid stool, then 2 mg after each loose stool, but not more than 16 mg per day. When taking loperamide, the frequency of the stool should be no more than 3 times a day. In the absence of stools or normal stools for 12 hours, treatment should be discontinued. It is possible to use adsorbents: calcium carbonate, activated carbon, lyucta-ejectite, 3 g per day as a suspension. When a combination of diarrhea and pain is effective tricyclic antidepressants.

In women with a predominance in the clinical picture of diarrhea, which is significantly expressed and refractory to treatment, antagonists of 5-HT ₃ -receptor serotonin are effective , which should be administered with great care because of the risk of developing ischemic colitis.

Constipation

In patients with constipation, treatment is aimed at normalizing intestinal transit and reflex to defecation. If inefficient enrichment of the diet with pantile fibers is used soft osmotic laxatives, for example lactulose in a dose of 30-50 ml / day or plantain seed coat (2-6 bags per day). Preparations based on senna, phenolphthiazide should be excluded, since they can cause an increase in symptoms.

Flatulence

To reduce the manifestation of flatulence, the most effective use of simethicone is 2 capsules 3 times a day, or a combination of al- verine citrate and simethicone in 1 capsule 2 times a day.

Psychotherapy

A special place is occupied by correction of psychopathological disorders. Apply different methods of psychotherapy in combination with antidepressants, tranquilizers, depending on the type of psychopathology syndrome. In severe irritable bowel syndrome, antidepressants from the group of serotonin reuptake inhibitors (paroxetine) can be prescribed. These drugs do not reduce the severity of the pain syndrome, but improve the quality of life. Treatment is desirable to be carried out together with a psychotherapist.

Surgical treatment of irritable bowel syndrome

Do not spend.

Indications for specialist consultation

Medical psychologist, psychotherapist - for joint management of a patient with severe psychopathological disorders.

Further management of the patient with irritable bowel syndrome

After the initial therapy, after a while, it is necessary to monitor the patient's condition, including to make sure that during an initial examination no organic disease was missed. Progression of the disease is not typical for irritable bowel syndrome, as well as refractory to treatment and persistence of symptoms. It is necessary to make sure that the treatment provides an adequate quality of life.

Training of a patient with irritable bowel syndrome

One of the most important moments of treatment is contact of the doctor with the patient, psychotherapeutic influence with an explanation of the causes of the disease and possible ways of its elimination.

The patient should be convinced that the symptoms of the disease do not pose a danger to life and are not caused by a serious organic pathology. It is necessary to explain to the patient that with the help of simple psychological techniques he is able to control the appearance of the symptoms of the disease. In the process of questioning and further conversation, it is necessary to focus the patient's attention on the great importance of precisely depressive emotional experiences (to which the patient usually adapts and who does not notice), than the pain and discomfort in the abdomen.

Prognosis of irritable bowel syndrome

The prognosis of the disease with regard to life expectancy is favorable, but it is often impossible to achieve full recovery or stable improvement. Complete disappearance of clinical manifestations is observed in less than 1/4 of patients, although the improvement of the condition occurs in many cases.

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