Irritable Bowel Syndrome and Anemia


Anemia and irritable bowel syndrome: what is the relationship?

A few words about what is IBS syndrome. What are the consequences of this disease? Tell that one of the consequences is anemia.

Why? A step-by-step instruction on what to do if anemia is diagnosed because of IBS.

Irritable bowel syndrome is one of the most problematic diseases in gastroenterology. According to different estimates, this condition has about 10 percent of the population, that is, every 10 of us.

At the same time, the symptoms are painful enough and really cause people to suffer. Fortunately, recently, new standards for diagnosis and treatment of this disease have been developed, which have been waiting for 10 years!

Suspect irritable bowel syndrome is possible if there are abdominal pain associated with a stool disorder. The chair can be liquid or solid, or sometimes liquid, or sometimes hard, or sometimes such, and at other times other.

That is, if there are stomach pains more than once a week and changes in the stool, one can think

of irritable bowel syndrome.

The first thing to do if you have these symptoms and persists for a month or longer is to see a doctor for a survey. Examination is prescribed depending on the condition of the abdomen, may be minimal (some general tests) or complete enough, including a colonoscopy.

In principle, depending on the condition, different methods can be used - irrigoscopy, computer tomography with double contrasting, capsular endoscopy and others, everything is solved individually. However, many patients do not even need an additional examination.

Most importantly, with irritable bowel syndrome, almost all tests are normal and do not have abnormalities, but the stomach continues to ache and problems with stool persist!

If you have anemia or a decrease in hemoglobin, or a decrease in the level of iron in the irritable bowel syndrome, then it's bad. Hence, the ailment that troubles you is not irritable bowel syndrome, but one of the inflammatory bowel diseases!

It can be ulcerative colitis, Crohn's disease, diverticular disease, intestinal polyposis or other diseases. In such a situation, examination and additional examination are necessary, because the disease can be serious.

For the treatment of inflammatory bowel diseases, it is important to understand which inflammation arose. This will determine the way and duration of treatment. In any case, it will be quite a special medicine that the doctor will appoint.

For the treatment of anemia in inflammatory bowel diseases, not all drugs are suitable, or rather, only one is suitable - Sideral Forte. Because unlike any other iron preparation, it has no side effect on the intestines and even if there is a violation of absorption of food in the intestine, iron from it will enter the body.

To treat irritable bowel syndrome, it is important to be sure that there are no other bowel diseases. After this, you can proceed and to treatment. Depending on the type of pain, frequency and consistency of the stool, different treatment options are used.

For pains and constipation, correction of nutrition, a special diet is used. Then proceed to the fibers and osmotic laxative. With pain and diarrhea, remedies are used that slow the contraction of the intestine. If the diarrhea persisted for a long time, more than a month, it is necessary to remove excess bacterial growth from the intestine and restore intestinal motility.

Irritable bowel syndrome also affects the sensitivity of nerve fibers located in the intestine. That is why pain can be perceived and felt much stronger than the situation in the intestines actually. The most difficult thing in the treatment -

For this, various drugs are used that act on special receptors.

Irritable bowel syndrome is not fatal, but very painful.

Author. Sergey Vyalov, a gastroenterologist in GMS Clinic, Ph.D. A member of the American Gastroenterological Association (AGA) and the Russian Gastroenterological Association (RGA)

Irritable bowel syndrome (cipher K 58)

Definition. Irritable bowel syndrome - violations of motor and secretory function, mainly of the large intestine, not associated with organic pathology, lasting at least 3 months.

Statistics. Pathological affection is 14-48% of the adult population. The most common disease in people aged 20-50 years, women are sick 2 times more often than men.

Etiology, pathogenesis. The importance of the following factors is proved:

• Dietary habits of the patient (refined food with a low amount of ballast substances);

• suppression of normal gastrointestinal reflex (nutrition "on the go lack of a full breakfast, antihygienic maintenance of toilets, etc.);

• violations of the ovarian-menstrual cycle in women, chronic urogenital pathology ("silent" prostateziculitis) in men;

• congenital hypersensitivity of the colon receptors with the formation of a low threshold of pain sensitivity when the organ is stretched;

• personal characteristics of patients (anxiety, poor tolerance of frustrating situations, subdepression, sleep disorders, poor quality of life, etc.).

Probably the role of increased production of cholecystokinin, which leads to spastic reduction of the colon, acceleration of the passage of intestinal contents, diarrhea.

Roman criteria for the diagnosis of "irritable bowel syndrome" Symptoms persisting or recurring for at least three months: Pain or discomfort in the abdomen:

• relieved after defecation;

• depend on changes in stool frequency;

• Depends on the change in the consistency of the stool. Two symptoms or more, disturbing the patient for at least 1/4 of the time of complaints:

• Changing the frequency of the stool (more than three times a day or less than three times a week);

• change in the consistency of the stool ("sheep feces dense, unformed or watery);

• changing the act of defecation (difficult, imperative urges, feeling of incomplete bowel movement);

• bloating, feeling of overflow of the abdomen.

Clinic. The main symptoms of the disease: abdominal pain, diminishing after bowel movement, combined with flatulence, rumbling; constipation; diarrhea; alternation of diarrhea and constipation. For every third patient, these symptoms are combined with nausea, belching, epigastric pain (non-ulcerative syndrome dyspepsia); headaches, cardialgia, respiratory disorders, weakness, vasospastic reactions (autonomic syndrome dystonia). From an anamnesis it is possible to find out, that the disease proceeds for a long time, with spontaneous remissions. Deterioration is associated with stressful situations, frustration. At night, there are no abdominal pains, no diarrhea. Despite the long, often long-term course of the disease, the general condition of the patient does not suffer. There are no signs of malabsorption, weight loss, etc. The abundance of complaints does not correspond to scanty physical data. The abdomen is soft, hyperalgegia is often detected with superficial and comparative palpation. The departments of the colon at palpation can be moderately painful, spasmodically reduced, rumbling. The blood counts are normal. Irrigography: uneven gaustration, alternation of enlarged and spasms of the intestine. With sigmoidoscopy, colonoscopy: enhanced vascular pattern, mucus overlay ("catarrhal proctosigmoiditis"). There are no signs of inflammation in the biopsy. Coprogram: mucus, muscle fibers of varying degrees of digestion.

Classification. The leading clinical syndrome identified:

• irritable bowel syndrome with a predominance of diarrhea;

• irritable bowel syndrome with constipation predominance;

• irritable bowel syndrome with predominance of abdominal pain and flatulence.

• Irritable bowel syndrome with constipation predominance.

Astheno-neurotic syndrome, measured. Anxious type of attitude towards the disease.

• Irritable bowel syndrome with predominant diarrhea. Astheno-hypochondriacal syndrome.

• Cider of irritable bowel with predominance of pain, flatulence. Asthenic-vegetative syndrome. Ergopathic type of attitude towards the disease.

Social status is formulated in accordance with general principles.

• Colon cancer flows with rectal bleeding, abdominal pain, difficulty with defecation, persistent diarrhea or constipation, anemia. The diagnosis is specified for rectal examination, sigmoidoscopy, colonoscopy.

• Crohn's disease, ulcerative colitis is excluded on the basis of the absence of cardinal symptoms of these diseases: nocturnal diarrhea with an admixture of blood, fever, nemia, weight loss. In irritable bowel syndrome, there are no characteristic of Crohn's disease, no specific ulcerative colitis changes with irrigogra

• Diverticulosis of the large intestine. Clinical manifestations are caused, as a rule, by diverticulitis, provoked by the use of rough food, nuts, corn flakes. Acute pains appear in the abdomen, more often in the left hypogastrium, worse with walking, physical activity, fever. The diagnosis is verified by colonoscopy, irrigography. The described signs of diverticulitis are completely not typical for irritable bowel syndrome.

The diagnostic algorithm for the leading symptom "constipation" consists of 2 stages (EP Yakovenko):

Exclusion of organic pathology of the colon and anorectal area - tumor, Crohn's disease, diverticula, anatomical abnormalities. Resolving methods: irrigography, colonoscopy.

Determination of the level of stasis of intestinal contents (thick, rectum), determination of the type of motor disorders (hyper hypomotor dyskinesia), primary or systemic nature of suffering.

• Mechanical constipation (with a tumor). The age of the patients is usually older than 50 years. Pain history is short, characterized by weakness, weight loss, rectal examination of the ampoule is empty. In the analysis of blood anemia (with a tumor of the right hemikolon), increased ESR. The reaction to the embryospecific antigen in the blood serum is positive.

• Functional constipation is more common in young and middle-aged people. Not characterized by severe pain in the abdomen, weakness, poor overall health, weight loss. There is no blood in the feces and anemia, an increase in ESR. When finger examination of the rectum, the ampoule is filled with feces.

Reflex closure is caused by gastroduodenal ulcer, pancreatitis, hepatitis.

• Hypodynamic constipation occurs in elderly people and those who have long-term adherence to bed rest.

• Constipation due to abnormalities of the large intestine is met with megacolon, splanchnoptosis. The diagnosis is specified in the course of irrigography.

• Toxic constipation is a symptom of lead poisoning, mercury, thallium.

• Medication constipation is caused by ganglion blockers, drugs, M-anticholinergics, psychotropic and anticonvulsant drugs, barium sulfate, cholestyramine.

• Endocrine constipation is a symptom of myxedema, hyper pairs of athereoza, and diabetes mellitus.

• Alimentary constipation is caused by a long observance of a sparing diet.

Irritable Bowel Syndrome

Nursing help with bowel disease.

1. Irritable bowel syndrome.

2. Chronic enteritis and colitis: causes, risk factors, clinical manifestations.

3. Methods of diagnosis, principles of treatment, nursing process.

4. Pharmacotherapy, prevention.

Irritable Bowel Syndrome

By irritable bowel syndrome (IBS) is understood a stable set of functional disorders (motor and secretory functions of the intestine), predominantly large intestine without structural its changes.

According to the diagnostic "Roman criteria the disease lasts at least 12 weeks (3 months) during the year and is accompanied by pain and / or discomfort in stomach associated with bowel movements and stool disorders (pain relieved after defecation, combined with changes in frequency and shape of stool), flatulence. There are no alarming symptoms ("red flags"): weight loss, anemia, blood in the feces, etc.

Previously, the disease was called dyskinesia of the intestine, spastic colitis.

Prevalence of IBS in most countries of the world is on average 20%. Women are more often ill at the reproductive age.

Causes of IBSare not known, but more and more materials testify to the association of IBS with stress, inflammatory pathology, and infectious diseases of the intestine. Significant role played by violation of the regime and the rhythm of nutrition. Refusal of a full breakfast or other meals, rush while eating, various distractions (reading, watching telecasts, etc.) lead to the suppression of a normal gastrointestinal reflex or by a complete extinction (with a missed reception food), or a significant decrease (in the presence of various distractions), eventually there are constipation and the syndrome is formed irritated bowel.

As a result of abnormalities in IBS, dyskinesia develops (more often hyperkinesis, less often hypokinesia or a mixed character). Dysmotorics give a painful syndrome, mostly spastic.

Clinic.The main symptom of IBS is abdominal pain caused by a spasm, which is based on an involuntary contraction of the smooth muscles of the intestine. The pain of a pressing, bursting character, accompanied by bloating, cramping, dull, burning, sometimes beyond description. The localization of pain can be varied. Most often the pain is localized in the lower abdomen, more to the left, it often migrates. It can vary in intensity from mild discomfort to colic attacks, simulating an "acute abdomen". The duration of pain is from several minutes to several hours. "Painful periods" can be interrupted by "light" intervals.

An important distinguishing feature of IBS is the absence of pain and other symptoms at night. Most often, when you fall asleep, the pain disappears and gradually reappears upon awakening. About a third of patients, it appears or increases after eating, but it is not related to the nature of the food. Strong emotions and stress often cause increased pain. In some patients, there is a link between pain and exercise.

Patients also note bloating, accompanied by some loud rumbling. The meteorism is predominantly local in nature, when the gas accumulates in one or another part of the intestine.

Stool disorders occur in almost all patients with IBS:

• violation of stool frequency (more than 3 times a day or less 3 times a day). Diarrhea is usually 2-4 times a day, mainly in the morning hours, after breakfast, sometimes with an admixture of mucus;

• abnormal stool form (hard, dry lumps, like "sheep stool or unformed, mushy or watery), sometimes mucus secretion with feces;

• difficulty in the act of defecation (difficulty, or mandatory urges, additional efforts during defecation, a feeling of incomplete emptying of the rectum, unfinished defecation).

Very often in IBS, there is not only a relationship between impairment and psychoemotional factors, but alsopsychoneurologicalsyndromes of varying severity: hysterical aggressive reactions, depression, carcinophobia, feeling fear, pathological anxiety, obsessive states, hypochondriacal manifestations and even suicidal attempts. Patients complain of headache and migraines, increased fatigue, often on a bad mood, drowsiness, sleep and appetite disorders.

Patients with IBS often complain of a sensation of a coma when swallowing, dissatisfaction with inhalation, vasospastic reactions, disorders of urination, pain in the sacrum.

When examining a patient with IBS, there is a discrepancy between abundance and sometimes color presented complaints and good general condition of the patient, no signs of progression disease.

Depending on the leading clinical symptom, it is common to distinguish between the three main variants of IBS:

1. With the prevalence of diarrhea.

2. With the predominance of constipation.

3. With the predominance of abdominal pain and flatulence - an algic form.

The diagnosis of IBScan be delivered after a careful examination of the patient and exclusion of a number of diseases with similar manifestations. With IBS there are no pathological changes from laboratory and instrumental methods of research.

The first stage of diagnosis of IBS is a preliminary diagnosis. At this stage, the analysis of anamnestic data is carried out, explicit organic violations are excluded.

At the second stage, the dominant symptom from the clinical form of the syndrome is identified.

In the third stage, the "symptoms of anxiety" are excluded: fever, fever, discoloration of feces, admixture of blood in the feces, unexplained weight loss, bleeding, anemia, persistent, for a long time, abdominal pain. Such signs are not symptoms of IBS, but indicate other, more serious diseases. The presence of only a loose stool is considered as functional diarrhea and does not indicate irritable bowel syndrome.

The fourth stage is the most complicated, since it is necessary to conduct differential diagnosis of IBS with various organic bowel lesions or diseases of other organs of the gastrointestinal tract: chronic non-ulcerative colitis, nonspecific ulcerative colitis, Crohn's disease, colon tumors, intestinal infections, etc.



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