According to modern ideas,irritable bowel syndrome is a biopsychosocial functional bowel disorder, which is based on the interaction of 2 main mechanisms: psychosocial impact and sensorimotor dysfunction, i.e. violations of visceral sensitivity and motor activity of the intestine. Characterization of the syndrome requires a specific strategy for diagnosis, differential diagnosis, and implementation of a treatment program.
The average age of patients is 24–41 years. The appearance of signs of the disease after 60 years casts doubt on the diagnosis of irritable bowel syndrome. In such patients, colorectal cancer, diverticulosis, polyposis and other organic bowel diseases should be excluded.
Irritable bowel syndrome is a stable set of functional disorders lasting at least 12 weeks over the next 12 months, manifested by pain and / or discomfort in the abdomen, which disappear after defecation, are accompanied by changes in the frequency and consistency of the stool and are combined for 25% of the time of the disease with at least two persistent symptoms of impaired bowel function – changes in stool frequency, fecal consistency, the act of defecation itself (urgent urge, tenesmus, feeling of incomplete emptying of the intestine, additional efforts during bowel movements), mucus with feces, flatulence.
In addition, the following features testify in favor of the functional genesis of clinical disorders:
- variability of complaints;
- recurrent nature of complaints;
- no progression;
- lack of weight loss;
- increased stress disorder;
- connection with other functional disorders, such as irritable stomach syndrome, vegetative asthenia syndrome, orthostatic vascular disorders, neuroses, irritable bladder syndrome, etc.
Depending on the leading symptom, three variants of the course of irritable bowel syndrome are distinguished:
- with predominant abdominal pain and flatulence;
- with predominant diarrhea;
- with predominant constipation.
Diagnosis should exclude the simplest causes of intestinal irritation, which include chronic exposure to dietary factors and medicinal products. Common food irritants include fatty foods, alcoholic beverages, coffee, gas-producing foods and drinks, large (banquet) meals, changes in eating habits during business trips and travel. Among the medicinal products that irritate the intestines are laxatives, antibiotics, products of potassium, iron, bile acids, potassium, mesoprostol, etc.
The physiological conditions of women – the premenstrual period, pregnancy, menopause can occur with symptoms of irritable bowel syndrome. Prolonged psycho-emotional and intellectual overstrain, fear, excitement can lead to the development of signs of irritable bowel syndrome, which quickly disappear after rest and resolution of a stressful situation. As a peculiar form of the course of the disease can be considered “bear disease”.
The effectiveness of treatment is determined not so much by the subjective state and complaints, but by the improvement of the psychosocial state and quality of life of the patient.