All you need to know about the Irritable Bowel Syndrome

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Contd. from last issue

Imaging tests can include:

  • Flexible sigmoidoscopy. Your doctor examines the lower part of the colon (sigmoid) with a flexible, lighted tube (sigmoidoscope).
  • Colonoscopy. Your doctor uses a small, flexible tube to examine the entire length of the colon.
  • X-ray or CT scan. These tests produce images of your abdomen and pelvis that might allow your doctor to rule out other causes of your symptoms, especially if you have abdominal pain. Your doctor might fill your large intestine with a liquid (barium) to make any problems more visible on X-ray. This barium test is sometimes called a lower GI series.

Laboratory tests can include:

  • Lactose intolerance tests. Lactase is an enzyme you need to digest the sugar found in dairy products. If you don’t produce lactase, you may have problems similar to those caused by IBS, including abdominal pain, gas and diarrhoea. Your doctor may order a breath test or ask you to remove milk and milk products from your diet for several weeks.
  • Breath test for bacterial overgrowth. A breath test also can determine if you have bacterial overgrowth in your small intestine. Bacterial overgrowth is more common among people who have had bowel surgery or who have diabetes or some other disease that slows down digestion.
  • Upper endoscopy. A long, flexible tube is inserted down your throat and into the tube connecting your mouth and stomach (oesophagus). A camera on the end of the tube allows the doctor to inspect your upper digestive tract and obtain a tissue sample (biopsy) from your small intestine and fluid to look for overgrowth of bacteria. Your doctor might recommend endoscopy if celiac disease is suspected.
  • Stool tests. Your stool might be examined for bacteria or parasites, or a digestive liquid produced in your liver (bile acid), if you have chronic diarrhoea.

Treatment

Treatment of IBS focuses on relieving symptoms so that you can live as normally as possible.

Mild signs and symptoms can often be controlled by managing stress and by making changes in your diet and lifestyle. Try to:

  • Avoid foods that trigger your symptoms
  • Eat high-fiber foods
  • Drink plenty of fluids
  • Exercise regularly
  • Get enough sleep

Your doctor might suggest that you eliminate from your diet:

  • High-gas foods. If you experience bloating or gas, you might avoid items such as carbonated and alcoholic beverages, caffeine, raw fruit, and certain vegetables, such as cabbage, broccoli and cauliflower.
  • Gluten. Research shows that some people with IBS report improvement in diarrhoea symptoms if they stop eating gluten (wheat, barley and rye) even if they don’t have celiac disease.
  • FODMAPs. Some people are sensitive to certain carbohydrates such as fructose, All you need to know about the Irritable Bowel Syndrome fructans, lactose and others, known as FODMAPs — fermentable oligo-, di-, and monosaccharides and polyols. FODMAPs are found in certain grains, vegetables, fruits and dairy products. Your IBS symptoms might ease if you follow a strict lowFODMAP diet and then reintroduce foods one at a time.

A dietitian can help you with these diet changes.

If your problems are moderate or severe, your doctor might suggest counseling — especially if you have depression or if stress tends to worsen your symptoms.

In addition, based on your symptoms your doctor might suggest medications such as:

  • Fiber supplements. Taking a supplement such as psyllium (Metamucil) with fluids may help control constipation.
  • Laxatives. If fiber doesn’t help symptoms, your doctor may prescribe magnesium hydroxide oral (Phillips’ Milk of Magnesia) or polyethylene glycol (Miralax).
  • Anti-diarrheal medications. Overthe-counter medications, such as loperamide (Imodium), can help control diarrhoea. Your doctor might also prescribe a bile acid binder, such as cholestyramine (Prevalite), colestipol (Colestid) or colesevelam (Welchol). Bile acid binders can cause bloating. 4Anticholinergic medications. Medications such as dicyclomine (Bentyl) can help relieve painful bowel spasms. They are sometimes prescribed for people who have bouts of diarrhoea. These medications are generally safe but can cause constipation, dry mouth and blurred vision.
  • Tricyclic antidepressants. This type of medication can help relieve depression as well as inhibit the activity of neurons that control the intestines to help reduce pain. If you have diarrhoea and abdominal pain without depression, your doctor may suggest a lower than normal dose of imipramine (Tofranil), desipramine (Norpramine) or nortriptyline (Pamelor). Side effects — which might be reduced if you take the medication at bedtime — can include drowsiness, blurred vision, dizziness and dry mouth.
  • SSRI antidepressants. Selective serotonin reuptake inhibitor (SSRI) antidepressants, such as fluoxetine (Prozac, Sarafem) or paroxetine (Paxil), may help if you’re depressed and have pain and constipation.
  • Pain medications. Pregabalin (Lyrica) or gabapentin (Neurontin) might ease severe pain or bloating.

Dr. Pargat Singh Bhurji
MD,FRCP ( C ) Consultant Pediatrician Surrery BC

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