Reccurent diarrhoea, an irritable bowel syndrome

Many persons suffer from recurrent diarrhoea but no definite cause is found. Investigation results are non-conclusive and the problem continues, in spite of treatment.

Many persons suffer from recurrent diarrhoea but no definite cause is found. Investigation results are non-conclusive and the problem continues, in spite of treatment. 

This condition is technically called, ‘Irritable bowel syndrome.’ Like the name implies, those with an irritable temperament are more prone to develop irritable bowel syndrome (IBS).

It is characterised by altered bowel habits, commonly diarrhea, but sometimes constipation may occur. There may be associated abdominal cramp like pain and or sense of bloating of abdomen.
It is a common condition for patients seeking consultation for frequent abdominal pain and diarrhoea. IBS commonly occurs due to stress in people.

Due to the high adrenergic levels produced due to stress these affected persons develop increased motility of the gut and also stretching which causes the painful distension. There is frequency of passing stools with profuse mucous. At times, the person may also have nausea and or vomiting, thus mimicking acute gastroenteritis.

IBS can occur in any individual but is more common in young adults around 30 years of age.

Females are more prone to IBS, perhaps because they are more emotional. Apart from bowel disturbances, there may be associated symptoms of depression, hysteria or anxiety. These usually manifest as palpitations, restlessness, sweating, unexplained gloominess, and sleep disturbances.

Individuals having long-standing IBS often also suffer from nutritional disturbances due to the frequent diarrhea. The anxiety can give rise to other diseases such as hypertension, diabetes, among others.
The chronic diarrhea often is confused with chronic diseases of the large bowel like tuberculosis, cancer, HIV, inflammatory bowel disease, etc.

Diagnosis of IBS is a diagnosis of exclusion, that is, it is established by excluding other organic or infectious causes for the frequent or prolonged diarrhea.

These persons spend a lot of time and money in going around hospitals, seeking consultations and getting tested and treated. Sometimes the condition may be diagnosed late or remain undiagnosed because the affected person may keep on changing doctors and hospitals.

Thus, every new doctor will review the patient as a fresh case and investigate for umpteenth time.
This person is also inadvertently given many anti-infective drugs for the presumed infection. Thus they become susceptible to the side effects of the drugs.

They also are at risk of developing oral ulcers due to deficiency of Vitamin B complex in the body. This develops because frequent use of antibiotics tends to deplete the useful bacteria of the bowels.

Reassurance and good counselling are important for the good and sustained recovery of the patient. They should be explained to patiently that there is nothing wrong with their system and all they need is to relax.

Anti-motility drugs (used to reduce diarrhoea by suppressing intestinal motility) or laxatives are also useful for a short time but may damage the bowel movements permanently.

The best treatment for individuals suffering from irritable bowel syndrome lies in learning to relax mind and body. Then only will they be rid of this condition.

Dr Pande is a specialist ininternal medicine at Ruhengeri Hospital

 

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