Irritable Bowel Syndrome - Treatment

Treatment goals for irritable bowel syndrome

• Correction of the psycho-emotional sphere.
• Correction of impaired intestinal functions.
• Pain relief.

Indications for hospitalization

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

Non-drug treatment for irritable bowel syndrome

Before prescribing any drug therapy, it is necessary to carry out a wide range of measures aimed at modifying the diet, eliminating the impact of stress factors, informing the patient, and establishing a trusting relationship between the patient and the doctor (including the psychotherapist).

It is especially important to identify provoking factors, such as stress and psychological disorders. The following situations usually serve as the source of emerging psychological problems: tense family relationships; work problems; illness of a family member; financial difficulties.

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

Regimen

A full work and rest regimen, adequate but not excessive physical activity are necessary.

Diet

A diet is prescribed with the exclusion of a number of products. Most often, patients do not tolerate milk, carbonated drinks, animal fats, cabbage (including cauliflower, broccoli), legumes, and alcohol. Patients with constipation are recommended to consume large amounts of plant fiber: unrefined foods, vegetables and fruits, seaweed, and bran bread. Additional introduction of dietary fiber in the form of bran in increasing doses is effective. They help normalize the volume of intestinal contents and intraintestinal pressure, accelerate passage through the colon (which helps prevent constipation, but has virtually no effect on pain). The daily volume of fluid consumed should be at least 1.5-2 liters.

If diarrhea is present, lactase deficiency should be ruled out and it should be ensured that the patient does not consume large amounts of caffeine, fructose, sorbitol and laxatives (including those of plant origin, which are included in many dietary supplements).

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

Drug therapy for irritable bowel syndrome

Pain syndrome

As a rule, it is associated with an increase in the tone of the smooth muscles of the intestine. To relieve pain, antispasmodics are used (course of treatment 2-4 weeks):

• drotaverine 2 tablets 2-4 times a day;
• mebeverine 200 mg 2 times a day;
• pinaverium bromide 50 mg 3 times a day.

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

Tricyclic antidepressants are also indicated for pain relief, especially when pain syndrome predominates in the clinical picture. Smaller doses are used compared to those prescribed for the treatment of depression (for example, amitriptyline at a dose of 25-50 mg at night).

Diarrhea syndrome

Loperamide is used to treat diarrhea syndrome: 4 mg (2 capsules) after the first loose stool, then 2 mg after each loose stool, but not more than 16 mg per day. When taking loperamide, the frequency of stool should be no more than 3 times a day. If there is no stool or normal stool within 12 hours, treatment should be stopped. It is possible to use adsorbents: calcium carbonate, activated carbon, lyoctahedral emectite 3 g per day as a suspension. Tricyclic antidepressants are effective when diarrhea is combined with pain syndrome.

In women with a predominant clinical picture of diarrhea, significantly expressed and refractory to treatment, 5-HT ₃ -serotonin receptor antagonists are effective, which should be prescribed with great caution due to the risk of developing ischemic colitis.

Constipation

In patients with constipation, treatment is aimed at normalizing intestinal transit and the defecation reflex. If enriching the diet with plant fibers is ineffective, soft osmotic laxatives are used, such as lactulose at a dose of 30-50 ml / day or plantain seed husk (2-6 sachets per day). Senna-based drugs, phenolphthiazide should be excluded, since they can cause an increase in symptoms.

Flatulence

To reduce the severity of flatulence, the most effective is to take simethicone, 2 capsules 3 times a day, or a combination of alverine citrate and simethicone, 1 capsule 2 times a day.

Psychotherapy

Correction of psychopathological disorders occupies a special place. Various methods of psychotherapy are used in combination with antidepressants, tranquilizers, depending on the type of psychopathological syndrome. In severe irritable bowel syndrome, antidepressants from the group of serotonin reuptake inhibitors (paroxetine) may be prescribed. These drugs do not reduce the severity of pain syndrome, but improve the quality of life. It is advisable to conduct treatment together with a psychotherapist.

Surgical treatment of irritable bowel syndrome

Not performed.

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 initial therapy, the patient's condition should be monitored after some time, including to ensure that no organic disease was missed during the initial examination. Disease progression is not typical for irritable bowel syndrome, nor is refractoriness to treatment and persistence of symptoms. It is necessary to ensure that the treatment provided provides an adequate quality of life.

Patient education for irritable bowel syndrome

One of the most important aspects of treatment is the contact between the doctor and the patient, psychotherapeutic intervention with an explanation of the causes of the disease and possible ways to eliminate it.

The patient should be convinced that the symptoms of the disease do not pose a threat to life and are not caused by 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 occurrence of symptoms of the disease. In the process of questioning and further conversation, it is necessary to focus the patient's attention on the great significance of depressive emotional experiences (to which the patient usually adapts and does not notice), rather than directly painful sensations and discomfort in the abdomen.

Prognosis of irritable bowel syndrome

The prognosis for life expectancy is favorable, but complete recovery or stable improvement is often not achieved. Complete disappearance of clinical manifestations is observed in less than 1/4 of patients, although improvement in the condition occurs in many cases.

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