conditions irritable-bowel-syndrome

RECND4772

Irritable Bowel Syndrome

Condition:Irritable Bowel Syndrome (IBS)
Other:Spastic colon
ICD-10 Codes:K58

Naturopathic Treatments

Lifestyle & Diet
• physical exercise
• IgG food testing & elimination diet
• avoid lactose, sorbitol, fructose, refined sugars
• decrease fats and fast foods
• eat a bland diet
• increase soluble fiber
• increase bitter greens - promotes digestion

Specific foods
• ground flax (Linum usitatissimum)

Botanicals (antispasmodics, to decrease colic and gas)
peppermint (Mentha piperita)
ginger (Zingiber officinale)
greater celandine (Chelidonium majus)
lemon balm (Melissa officinalis)
chamomile tea (Matricaria recutita)

Botanicals (antimicrobials, if dysbiosis is suspected)
goldenseal (Hydrastis canadensis)
pau d'arco (Tabebuia spp.)
wormwood (Artemisia absinthium)
turmeric (Curcumin longa)

Physical therapies
• heat applications (hot water bottle)
• acupuncture

Supplements
• probiotics
peppermint oil capsules
melatonin
• digestive enzymes
• 5-hydroxytryptophan (5-HTP)

Lifestyle
• regular exercise
• yoga

Other
St. John's Wort (Hypericum perforlatum)

Conventional Treatments

anticholinergics
- hyoscyamine
- dicyclomine
• tricyclic antidepressants (TCA)
• selective serotonin reuptake inhibitor anti-depressants (SSRIs)
• serotonin agonists
- tegaserod
• antibiotics

Signs & Symptoms

• abdominal pain relieved with defecation
• change in frequency or appearance of stool
Diarrhea-predominant
> 3 BM/day, with loose or watery stools, urgency
Constipation-predominant:
< 3 BM/week, hard or lumpy stools, straining, may have rectocele, rectal prolapse, or internal/external hemorrhoids
• alternating diarrhea and constipation
• aggravated by stress

Other
• mucus
• incontinence
• tenesmus
• abdominal distension

DDx

• ulcerative colitis
• Crohn's disease
• infectious diarrhea
• diverticulitis
• colorectal adenocarcinoma
• lactose intolerance
• celiac disease
• gluten sensitivity
• food sensitivities

Pathogenesis

Multifactorial cause
• visceral hypersensitivity
• neuroendocrine dysfunction
• psychosocial factors
• stress
• enteric infection
• dysbiosis
• food sensitivities/allergies
• immune dysregulation
• visceral hypersensitivity:
• higher postprandial serotonin level leading to:
- altered gastric emptying
- increased bowel contractions
- shortened transit time
- altered pain perception

Diagnostics

Rule-out and treat the primary cause:
• Dysbiosis
• Diet and/or food sensitivity
• Stress
Hypochlorhydria
• Drink adequate water

ROME III criteria:
- Recurrent abdominal pain or discomfort occurring at least 3 days in a month for the past 3 months and symptom onset must be at least 6 months before diagnosis with 2 or more of the following:
- pain is improved upon defecation
- onset associated with change in bowel movement frequency
- onset associated with change in appearance of stool

Although not part of diagnostic criteria, these can help support diagnosis of IBS:
• abnormal stool frequency, either > 3/day or < 3/week
• abnormal stool form, appearance
• straining, urgency, feeling of incomplete evacuation
• mucus in stools
• boating and abdominal distension

References

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