Click here to view next page of this article


Irritable Bowel Syndrome

Irritable bowel syndrome occurs in about15 to 20 percent of adults. The disorder is more common in women than in men. Symptoms typically begin during young adulthood.

Irritable bowel syndrome may be caused by alterations in bowel motility and visceral hyperalgesia have been demonstrated. Stress, gut neuropeptides and neuroendocrine connections to the brain are under investigation. There is a higher frequency of psychiatric diagnoses in patients with irritable bowel syndrome who have irritable bowel syndrome.


    Irritable bowel syndrome is a functional bowel dis­order. Functional gastrointestinal disorders can present with several constellations of symptoms for which an organic cause may not be identifiable.  Lactose intolerance, the use of products that contain sorbitol or fructose and the use of medications, such as laxa­tives and antacids, that affect the intestines may be easily treatable causes of diarrhea, cramps or bloating.

    A history of verbal or sexual abuse may also be important. Up to 50 percent of individuals with symptoms of irritable bowel syndrome report such a history. Other psychosocial factors and stres­sors should be identified, since it has been suggested that stress can exacerbate the symptoms of irritable bowel syndrome.

    Findings such as occult blood, fever, weight loss, anemia or other biochemical abnormalities should be investigated for more specific causes. The occurrence of pain or diarrhea that interferes with nor­mal sleep patterns or awakens the patient from sleep is suggestive of irritible.

Diagnostic Criteria for Irritable Bowel Syndrome

 Persistence or recurrence of the following symptoms for a period of at Abdominal pain or discomfort, relieved with defecation or associated with a An irregular (varying) pattern of defecation at least 25 percent of the time, with two or more of the following:


Stratifying patients into those with predominant constipation or diarrhea, or pain, gas and bloating can be a useful way of directing treatment. Specific foods that aggravate symptoms sometimes can be identified and eliminated.

    The risk of side effects is increased with chronic use of mineral oil, stimulant laxa­tives such as bisacodyl (Dulcolax), senna concentrates (Dosaflex, Senokot) and laxa­tives that cause increased intestinal secretion.

    For patients with predominant diarrhea, supplementation of soluble fiber intake can be helpful. Patients with predominant pain or gas syndromes may benefit.

    While antispasmodic drugs have often been used to treat pain symptoms, their efficacy remains unproved, and they may be associated with anticholinergic side effects. Dicyclomine (Bentyl), 10 to 20 mg three.

    Antidepressants. Several con­trolled and uncontrolled trials suggest that antidepressants help manage pain in patients with irritable bowel syndrome.


Antidepressant and Anxiolytic Drugs Used for Irritable Bowel Syndrome

Tricyclic antidepressants

Amitriptyline (Elavil, Endep)

 Course to Follow When Initial Treatment Fails

     Despite reassurance and conservative treatment, many patients with irritable bowel syndrome continue to have symp­toms. In rare cases, a reappraisal of the diagnosis may be indicated.