‘Irritable Bowl Syndrome’ (IBS)
One of the most common disorders of the alimentary tract is that of the long standing dysfunction associated with abdominal pain for which no organic cause can be found. This disease has been in the past called spastic colon and idiopathic a nervous Diarrhea. It is thought that this disease has something to do with the nervous system that is located in the gastrointestinal tract. It is sometimes called the second brain or the gut brain. Causes of IBS are not known. Recent research has shown that people with IBS have abnormalities in gut motor function or mortality. Patients also have gastrointestinal hypersensitivity which results in the abdominal pain or discomfort. And even though stress does not cause this disorder, stress can aggravate it. The syndrome is most frequent in women between the ages of 20 to 40 years. The commonest symptom is pain referred to left or right iliac fossa or the upper abdomen. Pain often occurs in attacks usually relieved by defecation and sometimes provoked by food, and may be severe. Bowel habit is variable. Almost all patients at sometimes notice pellet like or ribbon like stools with or without mucus. Diarrhea may be painless and characteristically occurs in the morning and almost never at night. An urge to defecate after meals may be the consequences of an exaggerated gastro colic reflex. Other symptoms include abdominal distention, a sensation of incomplete emptying of the rectum, excessive flatus and audible borborygmi. There may be dyspepsia, heart burn, frequency and dysuria. IBS is diagnosed by taking detailed history from the patient and usually history is always suggestive. Doctor has to be very patient, sympathetic and friendly towards the patient. He has to put the leading questions to go into the depth of the life history of the patient because the symptoms of many other disorders mimic the symptoms of IBS. IBS is under-diagnosed in sixty percent of patients because they have mild symptoms and do not seek physicians help. 30 % of patients have moderate symptoms that may interfere with their functioning and about ten percent have very severe symptoms where they may be disabled. There are a number of reasons why patients don’t seek help of a gastroenterologist for IBS. Often times they attribute the symptoms to things they eat. They call it ‘bad-parhezi’. Sometimes they think tension and stress causes their symptoms, so they don’t really think that they have a GIT problem. They start taking tranquilizers of their own or go to peers, fakirs for their problem. Patients who did go to see a physician are told that they have IBS but there was not very much that could be done for them in terms of treatment. Or treatments that might have been offered may not have worked fully or could have caused side effects.
But there are new treatments that are becoming available for IBS, so these patients should come back and speak to their doctors and speak about these new medications. People suffering from IBS are reluctant to talk about their symptoms. It is difficult to talk about recurrent loose motions, cramping, constipation, bloating and gas. This is because these symptoms are related to GIT and patients in Kashmir are reluctant to talk about these symptoms (especially women). Many people suffer in silence and it isolates them socially. When a patient comes to a doctor the evaluation they can expect involves blood work and stool analysis. Majority of patients are not ready to undergo stool analysis for three consecutive days. In addition to a thorough medical history sometimes patients who are under age forty have to undergo a flexible sigmoidoscopy and those over forty a colonoscopy. This is an examination which visualizes the lining of the colon to rule out another gastrointestinal condition called inflammatory bowl disease (IBD) or Colo-Rectal Cancer. Patients in Kashmir are reluctant to undergo such tests; though these are helpful in ruling out colon cancer.The symptoms and signs that go against a diagnosis of IBS include weight loss, anemia and an elevated WBC Count, which suggest inflammation or infection. In patients who have diarrhea, electrolyte abnormalities in the blood suggest that the diarrhea may be significant and could lead to dehydration. A family history of colon cancer or inflammatory bowl disease such as Crohn’s disease or ulcerative colitis or a history of celiac sprue disease is other alarm symptoms. Symptoms occurring at night also point to a more serious condition. Generally, when people with IBS go to sleep, their gut also goes to sleep and they do not have symptoms at night. It is very important to establish a good doctor-patient relationship because this is a chronic, recurrent, intermittent disorder with symptoms that can be very frustrating. Both the patient and the doctor need to feel confident about the diagnosis and then form this therapeutic alliance. Together they can treat the condition and manage it as best as possible.