Irritable Bowel Syndrome

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Irritable  bowel  syndrome  (IBS)  is  a  functional  GI  disorder  characterized  by  abdominal  pain  and  altered bowel habits in the absence of specific and unique organic pathology. 

Four bowel patterns may be seen with IBS; 

  1. IBS-D (diarrhea predominant)
  2. IBS-C (constipation predominant)
  3. IBS-M (mixed diarrhea and constipation)
  4. IBS-U (unclassified;  the  symptoms  cannot  be  categorized  into  one  of  the  above  three subtypes)

Clinical presentation 

  • Recurrent abdominal pains or discomfort at least 3 days per month in the last 3 months associated with two or more of the following
  • Improvement with defecation
  • Onset associated with a change in frequency of stools
  • Onset associated with a change in form of stool
  • Bloating or feeling of abdominal fullness

Non-pharmacological Treatment 

  • Counseling  on  compelling  psycho  –social  factors,  lifestyle  modification,  avoidance  of trigger factors, and reassurance are corner stone of long-term management strategy. Plus, supportive therapies such as:
  • High fiber diet and eating a healthy diet.

Pharmacological Treatment 

A: hyoscine butyl bromide (PO) 10mg 6hourly when required 

OR    

D: mebeverine (PO) 135mg 8hourly when required 

AND  

A: amitriptyline (PO) 25mg nocte for one week then 50mg nocte week 2-4. 

AND 

C: lactulose (PO) 20mls 12hourly (when required for constipation) 

OR  

A: bisacodyl (PO) 5-15mg when required for constipation 

For diarrheal predominant IBS 

B:  loperamide  (PO)  4mg  stat,  for  diarrhoea  followed  by  2mg  8hourly  or  after  each 

unformed stool until diarrhoea is controlled.