What are the symptoms of irritable bowel syndrome?

Irritablebowelsyndrome (IBS) refers to a group of clinical syndromes, including abdominal pain, abdominal distension, change of defecation habits, abnormal stool properties, sticky stool and so on. Persistent or recurrent, and organic diseases that can cause these symptoms are excluded after examination. IBS is the most common functional intestinal disease. A questionnaire survey was conducted among ordinary people. The reporting rate of IBS symptoms in Europe and America is 10%-20%, and that in China and Beijing is 8.7%. Most of the patients are young and middle-aged, and the first onset after 50 years old is rare. The ratio of male to female is about 1:2. The etiology and pathogenesis are still unclear, which may be related to many factors. At present, it is considered that the pathophysiological basis of IBS is mainly abnormal gastrointestinal motility and visceral sensation. The mechanism of these changes is still unclear. It is considered that mental disorder is an important factor in the pathogenesis of IBS. 1. The gastrointestinal motility is abnormal under physiological conditions. The basic electric rhythm of colon is slow wave frequency of 6 times/min, and the slow wave frequency of IBS with constipation and abdominal pain is obviously increased to 3 times/min. 2. Abnormal visceral perception. The rectal balloon inflation test showed that the inflation pain threshold of IBS patients was significantly lower than that of the control group. 3. Mental factors and psychological stress have obvious influence on gastrointestinal movement. A large number of investigations show that IBS patients have personality abnormalities, and their scores of anxiety and depression are significantly higher than those of normal people. The frequency of stress events is also higher than normal people. 4. Other patients (65,438+0/3) were intolerant of certain foods, which aggravated their symptoms. IBS symptoms in some patients appear after the intestinal infection is cured. Recent studies have shown that the disease may be related to low-grade inflammation of intestinal mucosa, such as degranulation of mast cells and over-expression of inflammatory mediators. The main clinical manifestations are abdominal pain, changes in defecation habits and fecal characteristics. First, abdominal pain. Almost all IBS patients have different degrees of abdominal pain. The position is uncertain, mostly in the lower abdomen and left lower abdomen. Symptoms will be greatly relieved after defecation or exhaust. Second, diarrhea is generally about 3-5 times a day, and a few serious cases can reach more than a dozen times. Most stools are thin paste, which can also form soft stools or thin water samples. Most of them have mucus. Some patients have less feces and more mucus, but no pus and blood. Defecation does not interfere with sleep. Some patients have diarrhea and constipation alternately. 3. constipation is difficult to defecate, and the feces are dry and small, like sheep manure or thin sticks, with mucus on the surface. 4. Other gastrointestinal symptoms are often accompanied by bloating or bloating. There may be a feeling of incomplete defecation and embarrassing defecation. 5. Some patients with systemic symptoms may have mental symptoms, such as insomnia, anxiety, depression, dizziness and headache. 6. There are no obvious signs, and the corresponding parts may have mild tenderness. Some patients can feel the sausage-shaped intestine, and rectal digital examination can feel anal spasm and high tension. There may be tenderness. 7. Classification can be divided into diarrhea type, constipation type, alternating diarrhea and constipation type and flatulence type according to clinical characteristics. Diagnostic criteria: 1986. The reference standard for clinical diagnosis of IBS in China is: 1. Abdominal pain, abdominal distension, diarrhea or constipation are the main complaints, accompanied by systemic nervous system symptoms (symptoms persist or recur for more than 3 months). 2. Systematic physical examination only found that stool routine and culture (at least three times) were negative, stool occult blood test was negative, X-ray barium enema examination was negative, or colon had irritation sign, colonoscopy showed that some patients had hyperactivity, no obvious mucosal abnormalities, and histological examination was basically normal. 6. Blood routine and urine routine are normal, and ESR is normal. 7. No history of parasites such as dysentery and schistosomiasis. If the experimental treatment is ineffective (note: metronidazole experimental treatment and stop using dairy products), a clinical diagnosis can generally be made. However, we should pay attention to distinguish it from other diseases with hidden manifestations or atypical symptoms, and those who have doubts about the diagnosis can choose relevant further examinations. Differential diagnosis: Abdominal pain should be distinguished from the diseases that cause abdominal pain. Diarrhea should be distinguished from diseases that cause diarrhea. Lactose intolerance is common and difficult to distinguish. Constipation should be distinguished from diseases that cause constipation, among which habitual constipation and constipation caused by adverse drug reactions are more common. At present, Rome standard is widely used in the world, and the latest Rome 3 standard was released in 2006. Treatment 1. General treatment: establish good living habits. Foods in the diet that avoid inducing symptoms vary from person to person. Generally speaking, gas-producing foods, such as dairy products and soybeans, should be avoided. High fiber food helps to improve constipation. Insomnia and anxiety can be appropriately given sedatives. 2. Drug therapy: 1. Gastrointestinal antispasmodic anticholinergic drugs can be used as short-term symptomatic treatment for abdominal pain with severe symptoms. Calcium channel blockers such as nifedipine have a certain effect on abdominal pain and diarrhea, and pinaverium bromide is a calcium channel blocker that selectively acts on gastrointestinal smooth muscle. Usage: 50mg, three times a day. 2. The antidiarrheal drug loperamide or compound diphenoxylate has a good antidiarrheal effect and is suitable for patients with severe diarrhea symptoms, but it is not suitable for long-term use. For general diarrhea, smecta, medicinal charcoal and other absorbent antidiarrheal drugs should be used. 3. laxatives should be used for constipation patients as appropriate, but not for a long time. Hemicellulose or hydrocolloid is not digested and absorbed in the intestine, but it has strong hydrophilicity. Absorbing water and swelling in the intestinal cavity can increase the moisture and volume of intestinal contents, promote intestinal peristalsis and soften stools. It is considered to be an ideal drug for treating IBS constipation, such as plantain preparation and natural macromolecular polysaccharide. 4. Patients with severe abdominal pain and diarrhea can try antidepressants, but the above treatment is ineffective and the mental symptoms are not obvious. 5. Other intestinal flora regulators, such as Bifidobacterium and Lactobacillus, can correct intestinal flora imbalance. It is effective for abdominal distension and diarrhea. Gastrointestinal motility drugs such as cisapride can improve constipation. 3. Psychological and behavioral therapy, including psychotherapy, hypnosis and biofeedback therapy, has been reported in foreign countries. Etiology The etiology of irritable bowel syndrome (IBS) is unclear, and no anatomical reason can be found. Emotional factors, diet, drugs or hormones can all promote or aggravate this high-tension gastrointestinal movement. Some patients have anxiety. Adult depression and somatic symptoms disorder. However, stress and emotional distress are not always accompanied by the onset and recurrence of symptoms. Some IBS patients show acquired abnormal pathological behavior. For example, they tend to take mental pain as the chief complaint of digestive tract, usually abdominal pain. Doctors should know whether there are unsolvable psychological problems when evaluating IBS, especially patients with intractable symptoms. Including sexual and physical abuse. Pathophysiology In IBS patients, the annular and longitudinal muscles of the small intestine and sigmoid colon are particularly sensitive to abnormal movements. The proximal small intestine seems to be highly responsive to food and parasympathetic drugs. In patients with IBS, small intestinal transport is varied. Moreover, the change of intestinal transit time is usually unrelated to symptoms. The measurement of intraluminal pressure of sigmoid colon shows that functional constipation can occur when the motility reactivity of cystic segment of colon is high (such as the increase of contraction frequency and amplitude), and conversely, diarrhea is related to the decline of motor function. Patients with IBS often have mucus hypersecretion, which has nothing to do with mucosal injury and the reason is unknown. However, it is related to the high activity of cholinergic nerves, just as patients tend to feel pain when there is normal amount and quality of gas in intestinal cavity. The pain of IBS seems to be caused by abnormal contraction of small intestinal smooth muscle or excessive sensitivity to small intestinal cavity expansion. It may also be highly sensitive to gastrin and cholecystokinin. However, the fluctuation of hormones is not consistent with clinical symptoms. The increase of food calorie intake can increase the amplitude and frequency of myoelectric activity and gastric activity. Fat intake may delay the appearance of power peak, which is more obvious in IBS patients. The first few days of menstruation may lead to a temporary increase in prostaglandin E2, which may lead to aggravation of pain and diarrhea. This is not caused by estrogen or progesterone. It is caused by the release of prostaglandin. The symptoms and signs of IBS are mostly at the age of 20-30, which leads to the onset of symptoms and irregular recurrence. It rarely occurs in the middle, late and early stages. Symptoms are common in awake patients, but rarely in sleeping patients. Stress or food intake can cause symptoms. IBS is characterized by pain relief during defecation, alternating defecation habits, abdominal distension, mucus in stool and endless defecation, and more symptoms. The more likely you are to have irritable bowel syndrome. Usually, the characteristics and location, trigger factors and defecation types of patients with abdominal pain are different. Changes or deviations from common symptoms suggest that organic diseases exist at the same time and should be thoroughly examined. Patients with IBS may also have parenteral symptoms (such as fibromyalgia, headache, dyspareunia, temporomandibular joint syndrome). There are two main clinical types of IBS. Constipated IBS is often constipation. But the habit of defecation is different. Most patients have at least part of colon pain, accompanied by periodic constipation and frequent normal defecation. The stool often contains clean or white mucus, and the pain is strangulation, paroxysmal or persistent dull pain, which can be relieved after defecation. Eating often will lead to symptoms, and there will be symptoms such as bloating, flatulence, nausea, indigestion and heartburn. Diarrhea-type irritable bowel syndrome, especially sudden diarrhea at the beginning, during or after eating. Diarrhea at night is rare. There are often pain, abdominal distension and urgency of rectal urination, and fecal incontinence can also occur. Painless diarrhea is atypical, and doctors should consider the possibility of other diagnoses (such as indigestion and osmotic diarrhea). The diagnosis of IBS is based on stool characteristics, pain time and characteristics. The standardized diagnostic criteria of IBS have been determined. Rome criteria of IBS include relief of abdominal pain after defecation, change of defecation frequency or nature, abdominal distension or mucus. The key to diagnosis is the effective acquisition of medical history, and attention should be paid to the direct and involuntary symptoms, medical history, previous treatment history, family history and family member relationship. Describe the history of medicine and diet. For patients, explaining personal problems is as important as the patient's overall emotional state. The relationship between doctors and patients is the key to determine the effect of diagnosis and treatment. IBS patients are generally in a healthy state at the time of physical examination. Abdominal palpation can have tenderness, especially in the left lower abdomen, and sometimes the sigmoid colon can also have tenderness. All patients need anal digital examination. For women, pelvic examination should be performed. A fecal occult blood test should be performed (preferably for 3 consecutive days). Without the support of related travel or symptoms (such as fever, bloody diarrhea, acute attack of severe diarrhea), routine egg or parasite examination or stool culture is rarely needed. Fibrorectal sigmoidoscopy should be performed. Colonoscopy and gas injection often induce intestinal spasm and pain. The mucosa and blood vessels of IBS patients are often normal. Patients with chronic diarrhea, especially elderly women, can be excluded from microscopic colitis by mucosal biopsy. There are two types: collagen colon, and 3-color staining shows submucosal collagen deposition; Lymphocytic colitis is characterized by an increase in the number of mucosal lymphocytes. The average age of these patients is 60-65 years old, which is more common in women. Like IBS, it is characterized by non-bloody watery diarrhea and can be diagnosed by rectal mucosal biopsy. Laboratory tests should include a full blood cell count. ESR6 or 12 biochemical spectrum, including serum amylase, urine analysis and thyroid stimulating hormone determination. Abdominal ultrasound, barium enema, esophagogastrostomy or colonoscopy should be selected according to the patient's basic medical history, physical examination, age and follow-up evaluation results. However, these inspections are only carried out when the inspection with light damage and low cost is abnormal. The diagnosis of IBS should not exclude the suspicion of accompanying diseases. Changes in symptoms may indicate the existence of another disease, such as changes in the location, form and intensity of pain, changes in stool habits, constipation or diarrhea, and vice versa. New symptoms or chief complaints (such as diarrhea at night) may have clinical significance. Other symptoms that need to be examined include fresh blood in feces, weight loss, severe abdominal pain or abnormal abdominal distension, fatty diarrhea or obviously disgusting white feces, fever or chills, persistent vomiting and hematemesis. Symptoms (such as pain or urgency of defecation) or symptoms that prompt patients to wake up from deep sleep continue to deteriorate. Patients over 40 years old are more likely to be mixed with organic diseases than young people. Common diseases that may be confused with IBS in differential diagnosis include lactose intolerance, diverticulosis, "drug-induced diarrhea", biliary tract diseases, laxative abuse, parasitic diseases, bacterial enteritis, eosinophilic gastritis or enteritis. Microscopic (collagen) colitis and early inflammatory bowel disease. The age distribution of patients with inflammatory bowel disease is bimodal, so these conditions must be considered in the evaluation of young and old patients. For people over 40 years old, especially those who have no history of IBS symptoms before, colon polyps and tumors must be excluded through colonoscopy if their bowel habits change. For patients over 60, the possibility of ischemic bowel disease should be considered. Pelvic examination in women is helpful to exclude ovarian tumors and cysts or uterine fibroids, because the symptoms of these diseases may be similar to IBS. For patients with diarrhea, the possibility of hyperthyroidism, carcinoid syndrome, medullary thyroid cancer, VIP tumor and Zolinger-Ellison syndrome should be considered. Patients with constipation and no anatomical lesions should be considered. Then we should consider the possibility of hypothyroidism or hyperparathyroidism. If the patient's medical history and laboratory examination indicate malabsorption, absorption should be determined to exclude tropical stomatitis, diarrhea, celiac disease and Whipple's disease. Finally, for all constipation patients who need to exert excessive force during defecation, other diseases (such as pelvic floor muscle disharmony) should be considered. Treatment is supportive and symptomatic. It is very important for doctors to have compassionate understanding and guidance. Doctors must explain the nature of basic diseases. And convincingly prove to the patient that there is no organic disease. It takes time to listen to patients' complaints and explain to them the normal intestinal physiology and the high sensitivity of the intestine to stressed foods or drugs. These explanations give us a basis to try to re-establish the normal law of intestinal movement and choose the specific therapy suitable for patients. We should emphasize the prevalence, long-term nature and the necessity of continuous treatment of IBS. We should find, evaluate and treat psychological stress. Anxiety and emotional disorders (see sections 187 and 189). Regular physical activity is helpful to relieve stress and promote intestinal function, especially for constipation patients. Generally speaking, patients with abdominal distension and flatulence should return to normal diet. It is advisable to eat less foods containing fermentable carbohydrates such as beans and cabbage, and eat less apples, grape juice and bananas. Various nuts and raisins can also reduce flatulence. Patients with lactose intolerance should reduce their intake of milk or dairy products. Ingestion of sorbitol, mannitol, fructose or simultaneous intake of sorbitol and fructose can also lead to intestinal dysfunction. Sorbitol and mannitol are artificial sweeteners used for nutrition or as drug carriers, while fructose is fruit. Basic ingredients of berries and plants. Patients with postprandial abdominal pain can try a low-fat and high-protein diet. Increasing dietary fiber is beneficial to many IBS patients, especially constipation patients. Foods with little irritation, such as bran, can be given at the beginning of each meal 15ml( 1 tablespoon), which will increase with the increase of liquid intake. Or, take psyllium hydrophilic mucilage and take two cups of hydrating clothes at a time. This method can often stabilize the water in the intestine and increase the volume. These preparations are helpful to the retention of water in the intestine and can prevent constipation. They can also reduce the transit time of the colon, and can also be used as shock absorbers to prevent spasms between intestinal walls. Adding a small amount of fiber can also help reduce diarrhea in IBS by absorbing water and hardening feces. However, excessive application of fiber can lead to abdominal distension and diarrhea. Therefore, the application of fiber should follow the principle of individualization. Anticholinergic drugs (such as scopolamine 0. 125mg, 30 ~ 60min before meals) can be used in combination with fiber. It is not recommended to use narcotics, sedatives, hypnotics and other drugs that can produce dependence. For diarrhea patients, phenethyl piperidine 2.5 ~ 5mg( 1 ~ 2 tablets) or loperamide 2 ~ 4mg( 1 ~ 2 tablets) can be given before meals. Long-term use of antidiarrheal drugs and antidepressants (such as norimipramine, imipramine and amitriptyline) is not recommended because of their tolerance to antidiarrheal effects. 50~ 100mg daily) is helpful for two types of IBS patients. Besides constipation and diarrhea, antidepressants can also relieve abdominal pain and bloating. These drugs relieve pain by down-regulating the activity of afferent nerves in spinal cord and intestinal cortex. Finally, containing some aromatic oils (painkillers) can relieve spasmodic pain in some patients by relaxing smooth muscles. Chili oil is the most commonly used preparation for these patients. Prevention knowledge: Irritable bowel syndrome (IBS) is the most common intestinal functional disease, and its etiology and pathogenesis are still unclear, which may be related to drugs, emotional stress, food intolerance, abnormal colon motility, intestinal dysfunction, and abnormal esophageal and gallbladder motility. Among them, the change of intestinal function plays an important role in the pathogenesis of irritable bowel syndrome. The clinical manifestations are diverse and lack specificity. No organic intestinal lesions were found in stool routine and culture, barium enema and colonoscopy, and no abnormality was found in pathological examination. After excluding malabsorption syndrome, diagnosis can only be made after organic diseases such as schistosomiasis infection, intestinal tumor, ulcerative colitis, Crohn's disease, lactase deficiency, gastrointestinal hormone tumor, endocrine disease and pelvic disease. Irritable bowel syndrome is a benign disease and will not endanger normal life and health. Although the prognosis is good, it can gradually improve or even disappear after proper treatment. Patients with chronic diseases complain about covering up new intestinal malignant diseases and should be vigilant at any time. Be good at identifying the early discovery of organic diseases in functional complaints and making necessary inspections. In terms of treatment, it is very important to relieve tension, eliminate psychological burden and enhance confidence. Live a regular life, get enough sleep, strengthen exercise, improve physical fitness, eat less and eat more meals, avoid irritating food and overheated diet, and quit smoking and drinking. Diarrhea patients should eat food with less residue and easy digestion. Constipation patients should not only drink more water, but also develop the habit of regular defecation and increase foods containing more cellulose. Drug treatment is mainly symptomatic, and the daily drug dosage is adjusted according to abdominal pain, bloating and defecation. Constipation patients should try to avoid using all kinds of laxatives. Physical therapy such as hot water bottle, massage, sunbathing, warm water bath and frequency spectrum has certain effects.