Irritable bowel syndrome Flashcards
What is IBS?
Affects large intestine
Associated with pain/discomfort which may be with defecation with/without change in bowel habit
Causes of IBS
Irregular muscle contractions in intestines Nervous system abnormalities Inflammation In the intestines Severe infection Changes in gut microflora Stress Family history
Painful peristalsis
Intestine squeezes contents from small and large intestines to anus through peristalsis which is usually a painless process
In IBS, the intestine is sensitised and the peristalsis process is painful
IBS symptoms reported
If symptoms persist for more than 6 months: Cramping Pain/Discomfort Bloating Flatulence Constipation Diarrhoea Sense of incomplete defecation Passage of mucus Nausea Lethargy Insomnia Headaches Back pains Urinary incontinence
Red flag symptoms
Unexplained/unintentional weight loss Rectal bleeding Family history of bowel or ovarian cancer Anaemia – raised inflammatory markers Persistent back pain Recent altered bowel habit in over 60’s
Non-pharmacological treatments
- Dietary advice – healthy balanced diet
- Regular exercise
- Reduce stress levels
Dietary advice
- Regular meals – take time for those meals and avoid long gaps
- 8 cups of fluid
- Restrict tea/coffee to 3 or less
- Reduce alcohol/fizzy drinks
- Reduce resistant starch – processed foods
- Balance amount of fibre/fruit intake
- Should be soluble fibre not insoluble
- Probiotics for at least 4 weeks
Abdominal discomfort treatments
First line
Antispasmodics: Mebeverine/Alverine citrate
Mebeverine:
- Directly relaxes intestinal smooth muscles
- Doesn’t impact gut motibility
- Immediate release over 12 years or sustained release over 18 years
- Contraindicated in paralytic ileus
- 135mg TDS, 20 mins before food
Alverine citrate:
- Directly relaxes intestinal smooth muscles
- Over 12 years
- 60-120mg OD-TDS
Hyoscine butyl bromide (Buscopan)
- Antimuscarinic – Reduces intestinal motility
- Contraindicated in myasthenia gravis, megacolon and narrow angle glaucoma
Peppermint oil
- Relaxes intestinal smooth muscle
- Reduces intestinal motility
- Over 12 years
- Contraindicated in IBD or GI obstruction
Constipation & Diarrhoea
Avoid osmotic and stimulant
Use bulk forming laxatives
Loperamide for diarrhoea
Tricyclic antidepressants
Reduce pain perception
Slow gastric transit so beneficial in diarrhoea-predominant IBS
Amitriptyline, imipramine, nortriptyline
Take 3-4 weeks to experience benefits
Linaclotide
Moderate to severe IBS with constipation Guanylate cyclase-C receptor agonist Reduces visceral pain Increased intestinal fluid secretion Accelerated intestinal transit Contraindicated in IBD
