OTC - IBS

Question 1

IBS symptoms?

Answer 1

• lower abdominal pains
• bloating
• alternating constipation and diarrhoea

*Aggravated by stress, depression, anxiety and lack of dietary fibre. Commonly affects young adult women

Question 2

Referral criteria?

Answer 2

• children (rare)
• over 45 yrs and first time symptoms (bowel cancer)
• blood in stools (IBD, gastric ulcer or carcinoma)
• bowel obstruction (severe abdominal bloating, colic, vomiting, constipation)
• unexplained weight loss, appetite loss (cancer)
• fever, nausea, vomiting and severe abdo pain (IBD?)
• pregnant women (not recommended OTC)
• suspected depression (antidepressant? psychological factors aggravate IBS)

Question 3

OTC products?

Answer 3

• antispasmodics (mebeverive etc)
• antimuscarinics (hyoscine etc)
• laxatives
• loperamide

Question 4

Antispasmodics?

Answer 4

• mebeverine 18+ (colofac IBS)
• alverine 12+ (spasmonal)
• peppermint oil 15+ (colpermin IBS relief)

Works by relaxing smooth muscle to reduce abdominal spasms

*peppermint oil: swallow capsules whole; irritates mouth and oesophagus (common side effect = heartburn)

Question 5

Antimuscarinics?

Answer 5

• hyoscine 12+ (buscopan IBS relief)
• dicycloverine 12+ (kolanticon gel)

Has an anticholinergic effect, relaxing gut smooth muscle

Interaction: additive anticholinergic effect = antihistamines, TCAs, antipsychotics, avoid in glaucoma and BPH

Question 6

Treating other symptoms like constipation and diarrhoea?

Answer 6

CONSTIPATION; bulk forming laxatives

DIARRHOEA; loperamide 18+ (imodium IBS relief) for previously diagnosed IBS

Question 7

Advice?

Answer 7

• limit to 3 portions of fruit and veg
• increase soluble fibre intake (ispaghula husk, oats)
• avoid insoluble fibres = bloating
• eat regularly and avoid missing meals
• drink 8 glasses of water
• limit stress
• take probiotics