Irritable bowel syndrome, Diagnosis, Treatment

Definition of Irritable bowel syndrome
Irritable bowel syndrome represents a functional disease, characterized by transit disorders, generally constipation alternating with diarrhea, diffuse abdominal pain, sometimes mucus emission.
Clinical features

• diffuse abdominal pain, or located along the colon. They may be smothered, but often have a cramp character, duration of seconds to minutes. Other times the patient feels only an abdominal discomfort. The most often symptoms disappear in the relaxing periods, holiday etc.
• transit disorders are frequent, characteristic being the alternation  constipation-diarrhea. The stool emission is often hard, fragmented, covered with mucus.
• mucus emission accompanies the hard stool. Blood does not appear in stool in the irritable bowel syndrome, but the hard, rough stools may create anal fissures that may bleed.
• bloading 

Diagnosis
Manning criteria:

• abdominal pain that disappear after stool emission
• stool becoming more frequent and soft in the presence of pain
• bloating, flatulence
• sensation of incomplete evacuation of the rectum
• elimination of mucus in stools
• imperious character of defecation

Clinical data of the irritable bowel syndrome diagnosis

• elevated ESR
• leukocytosis
• pus, blood or fat in the stools
• more than 200g of stool per day
• persistent diarrhea
• hipokaliemia
• no spastic response to rectal distension during manometry

Paraclinic diagnosis

• anoscopy, rectoscopy, colonoscopy (sometimes barium enema), to evidence the organic pathology of colon;
• gastroscopy, to show the possible gastric lesions;
• abdominal and pelvic ultrasonography, to show the gallbladder, pancreas and genital organs;
• radiologic evaluation of intestine (enteroclysis or barium examination) or enteroscopy for small bowel pathology.

Differential diagnosis

• ano-rectal and colon neoplasm
• inflammatory bowel disease(ulcerative colitis, Crohn’s disease)
• colonic diverticulosis and diverticulitis
• lactase deficit
• functional dyspepsia

Evolution
The irritable colon evolution is favorable, since there are no complications.
In general, the disease evolves for a long time, with periods of silence or with exacerbations, usually related to stress.

Treatment of irritable colon
1. Diet. When the constipation predominates, the diet will be rich in alimentary fibers. If the diet is not sufficient, constipation will be controlled with laxatives type Forlax (that increase the stool volume). The patients should avoid consuming certain food that induces symptoms.
2. Medication. The therapy consists in:
- antidiarrheic drugs - Smecta(smectitis) or Imodium(loperamid)
- antispastic - Spasmomen
                   -Debridat
                   -Dicetel
                   -No-Spa
                   -the medication is given only when needed
- sedatives - Hidroxizin
-Rudotel