Constipation and irritable bowel syndrome


Constipation is a widespread phenomenon, but under all circumstances it turns into a sad heavy burdensome harm to the patient. There are no grounds for suppressing problems associated with constipation: the problems of defecation exist, they are burdensome and reduce the quality of life.

Constipation is a rather vague term used by patients and physicians in various meanings. It is believed that constipation developed within a few hours, days or weeks is defined as acute constipation, and constipation lasting more than three months, according to clinical experience, is chronic.

In medicine, normal (according to previous studies of patients without gastroenterological diseases) is considered a frequency of bowel movements from three times a day to three times a week. Among the population, the frequency of defecation once a day is usually considered a norm. However, only 1/3 of the population has such a frequency of defecation, and 3/4 have regular bowel movement once every two days. It is noted that the freq

uency of defecation is less often in women than in men, while in more men than women, defecation occurs more often than 1 time per day.

For a long time constipation was interpreted as a prolonged retention of intestinal contents in the digestive tract or a delay in the evacuation of solid feces. However, the frequency of evacuation of stool masses has individual variations. Defecation does not necessarily correlate with the diagnosis of constipation, but symptoms such as pain, straining during defecation or Other difficulties associated with the act of defecation are more important than hard stools or feelings of incomplete emptying.

The next characteristic feature of any constipation is the decrease in the water content in the stool due to the prolonged stay of the contents in the large intestine. The weight and amount of water in the stool, as well as the gastrointestinal transit time, are taken into account to determine constipation and to diagnose it.

In 1988 and again in 1998. The international group of experts examined in detail the symptoms of functional gastrointestinal diseases (Roman criteria). The expert group concluded that the diagnosis of chronic constipation should be made with at least two of the following symptoms:

  • The absence of defecation for at least 25% of the normal stool time
  • presence of constipation for at least 12 months without the use of laxatives
  • there is a need for straining
  • hard or cloddy stool
  • feeling of incomplete emptying
  • Two and less bowel movements per week

If we summarize the various opinions, chronic constipation is a chronic blockade of feces with a delay in stool in the large intestine for a long time (colonostasis), decrease in the frequency of defecation (less than 3 times a week), decrease in the number of stools (less than 35 grams per day), and difficult, irregular and often painful defecation with a hard feces. Thus, the symptoms of constipation are also associated with the frequency of the stool (not often enough), the amount of stool ( very little), the consistency of the stool (very hard) and the symptoms of defecation (very difficult, very painful ).

With constipation, you should not joke, it requires a certain diagnosis, for this you need a phased examination.

Constant straining during defecation can damage the nerve endings of the pelvic floor and contribute to constipation.

Constipation can lead to a disease that is defined as constipation.

Treatment of constipation is based on the application of general measures to activate physical activity, changes in eating habits and the intake of laxatives. Household habits should contribute to the gastrointestinal reflex, and it is also advisable to use the method of toilet training.

Laxatives should be combined with non-medical measures to regulate the act of defecation.

It is necessary to take into account the side effects of laxatives and their interaction with other medicines.

Irritable Bowel Syndrome (IBS)

In addition to functional constipation. chronic constipation may be a manifestation of irritable bowel syndrome (IBS). The latter is one of the most common conditions encountered in modern medicine. Surveys conducted in Western Europe and North America show that the prevalence of IBS among adults is 10%. It should be noted that IBS is distributed throughout the world, regardless of geographic location or socio-economic status. There is no one specific diagnostic test for the detection of IBS. Its diagnosis, respectively, is based either on the exclusion of diseases that may have all or part of a similar symptomatology, or on the application of the Rome criteria for IBS. The cardinal symptoms of IBS are abdominal pain / discomfort and bowel dysfunction. As a rule, these complaints are interrelated. For example, a patient can report that his (or, more often, her) condition deteriorates with constipation, and is relieved only after bowel movement.

Irritable Bowel Syndrome (IBS)# 8212; relapsing pain or discomfort (an unpleasant sensation not described as pain) in the abdomen that were observed for at least 3 days per month during the last 3 months and are associated with the following two or more signs:

  1. Reducing pain after the act of defecation.
  2. The onset of pain / discomfort is accompanied by a change in the frequency of the stool.
  3. The onset of pain / discomfort is accompanied by a change in the consistency (appearance) of the stool.

These signs should be observed over the past three months, and the onset of symptoms should precede the diagnosis at least 6 months. IBS is further classified into subtypes based on the prevalent bowel function disorder at the time of symptoms:

  • IBS-D (with diarrhea) - in this subtype of IBS, diarrhea is the predominant disorder of the intestine;
  • IBS-Z (with constipation) - with a subtype of hard or cloddy stool (type 1 or 2 according to the Bristol scale of feces) at 25% stool, and an unformed or loose stool (type 6 or 7 according to the Bristol scale of stool form) at 25% defecations;
  • SRK-C (mixed) - this subtype is characterized by both diarrhea and constipation;
  • IBS-H (nonspecific) - stool disorders and symptoms do not correspond to any of the above categories.

Since the individual symptoms of IBS are very nonspecific, even when assessing the complex of symptoms, for example, according to the Roman criteria, the possibility of diagnostic coincidence is maintained until the criteria become much more stringent, which is especially important for differential diagnosis of SRK-3 and functional constipation. Despite the detailed study of various pathological electromyographic and motor characteristics of bowel function in different departments, their specificity remains unclear. Recently violations of the axis "brain-intestine" are actively studied in the pathogenesis of functional constipation and irritable bowel syndrome with constipation.

Thus, both functional constipation and IBS-3, the determination of which is based exclusively on interpretations of symptoms, tend to embrace a heterogeneous population of patients, sometimes with different etiologies of these symptoms. It is not surprising that attempts to develop a single hypothesis explaining all the symptoms of these two conditions turned out to be fruitless. A number of disorders certainly contribute to the development of symptoms, including intestinal spasm, visceral hypersensitivity or hyperalgesia in IBS, decreased sensitivity of the intestine in some patients with functional constipation, a change in the cerebral control of bowel functions, stressful environmental effects, as well as individual psychopathological characteristics patient. Recently, the interest of scientists has shifted from studying the role of colorectal dysfunction to axis disturbances "The brain-intestine" in the pathogenesis of functional constipation and irritable bowel syndrome with constipation.
Where does the border between CPM-3 and functional constipation really go? At the moment, this is determined subjectively, based on how the intensity of pain and the level of discomfort in a patient with constipation is assessed. Every physician can face the fact that many patients with constipation complain of flatulence, swelling and discomfort in the abdomen are the main symptoms of IBS. In our opinion, only the severity of these symptoms distinguishes CPC-3 from functional constipation. In clinical practice, differential diagnosis between these states is often difficult or impossible.



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