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Frequent stomachache, and you don't know why?

Autor: dr Bojan Jovanović   


The group of symptoms with dominating disorder in motor activity of the digestive tract along with the disorder in bowel movement and pains in abdomen with no known organic disease diagnosis, is called irritable colon syndrome or irritable bowel syndrome (IBS). It can be also called nervous or spastic colon and spastic colitis.

What may be the cause of the unexplained pain?

When taking about causes many factors are mentioned: constitutional, psychosomatic, neurohumoral, endocrine, etc. The constitution is mentioned as the possible cause, because the same disorder can be seen in several generation of the same family.

Stress increases the bowel activity with spasms and frequent bowel movements, and lazy bowel and slowed contractions occur in depression. Connections between food and gastrointestinal hormones (cholecystokinin, VIP, glucagons, secretin, etc.) can also have the influence on the bowel activity. The influence of some medical drugs should also be mentioned (for instance antibiotics and cholinergic and anticholinergic drugs). The modern lifestyle and dietary habits (fast, food with preservatives, hypersensitivity to preservatives, additives and other ingredients) possible have a strong influence on the disorder onset.

What do you feel when you have irritable bowel syndrome

Symptoms occur between 35 and 50 years of age. Irritable bowel syndrome can be manifested in three ways: pain and constipation (spastic colon), intermittent or constant diarrhea (functional diarrhea) and both constipation and diarrhea alternatively.
The pain is usually localized in lower left quadrant of the abdomen, and it is increased after the meal and decreased after bowel movements. Pain does never wake the patient up. The constipation is manifested objectively – with less than three stools per week, and/or subjectively – as difficult, incomplete and painful empting of the bowel. The stools are usually thin as a pen and small, which is caused by spasms. Diarrhea is manifested as mushy stools of small quantity, and it happens usually in the morning or after meals. The first empting contains usually a stool of normal consistency, and then several smaller emptings follow with unformed stool. Bloating of the abdomen and mucus in the stool can frequently occur.

Other gastrointestinal symptoms are: dyspepsia, heartburn, nausea and vomiting. Autoimmune innervation disorders are also frequent (headache, palpitation, perspiration, tiredness, urination and menstrual cycle disorders). Despite the given symptoms, which can be quite strong, general condition of the patient is well. The symptoms of irritable bowel syndrome are characteristically manifested or worsened during or after the period of emotional distress.

What to do if you develop these symptoms

The diagnosis is made based on anamnesis, clinical features, connecting the symptomatic episodes with the periods of distress and excluding of other diseases which can develop the same or similar symptoms. Rectosigmoidoscopy, stool, urine and blood examinations and colonoscopy are performed.

How is it treated

A diet with addition of fibers (bran, psylium seed) is widely accepted in IBS treatment. Systematic examination of the dietary habits can show those factors that cause the symptoms to worsen (coffee, milk, leguminose, food rich in fat). Pain can react well to anticholinergics. Spasmolitics (mebeverine before meals and sleep) help some patients with their pain. If diarrhea phases are severe, codeine phosphate and loperamide can be used. Emotional support is very important. If there is any psychological disorder, it should be treated. Bojan Jovanovic, MD

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