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A Common Condition
Irritable Bowel Syndrome (IBS) is a common functional disorder of the large intestine encountered frequently in daily life. The prevalence of this condition is quite high in European and North American countries, reaching 10-20%. In Asian countries, the rates vary significantly; for example, in Japan, it is 25%, while in Iran, it is 3.4%. In Vietnam, although there are no official statistics, our experience suggests that this condition is quite prevalent.
IBS typically affects individuals aged 20 to 50, with female patients outnumbering male patients by four times. While it is not life-threatening, the condition causes significant discomfort and feelings of frustration for patients, especially when they have a close relationship with their doctor. This syndrome has been documented in medical literature for a long time, but it was not until 1978 that Manning provided a comprehensive description.
Main Symptoms of the Condition
– Alternating diarrhea and constipation: Diarrhea often intensifies in the morning, during or after breakfast. After having 3-4 loose stools with mucus, patients generally feel better for the remainder of the day. Diarrhea rarely lasts all day or at night. It can persist for weeks or months and then resolve on its own without treatment. However, the symptoms may recur, with irregular intervals between episodes, sometimes quick, sometimes slow. Some individuals may not experience diarrhea but instead have soft stools resembling a pencil. Others may suffer from constipation along with chronic abdominal pain, typically in the lower abdomen and left iliac area over the sigmoid colon. Abdominal pain often alleviates after passing gas or having a bowel movement.
– Bloating and other digestive disturbances: Some patients may not experience diarrhea or constipation but frequently feel bloated, experience heartburn, back pain, fatigue, or palpitations. These symptoms can easily be mistaken for other conditions such as autonomic nervous system disorders, peptic ulcers, or biliary diseases. To avoid missing potentially serious conditions like ulcerative colitis, colon cancer, or intestinal tuberculosis, patients need thorough clinical examinations, including detailed medical history, identifying any warning signs of malignancy such as blood in stools, or palpable masses in the abdomen. Diagnostic tests may include ultrasound, colonoscopy, stool tests for blood, and X-rays of the colon with contrast.
Causes of the Condition
One primary cause of IBS, highlighted by many pathologists, is the disruption of gastrointestinal motility due to dysfunctions in both the central nervous system and the autonomic nervous system within the intestinal wall. This phenomenon increases peristaltic waves, mixing food, and enhances small intestinal motility, resulting in decreased transit time of feces in the intestine. Meanwhile, the motility of the large intestine may vary, leading to either prolonged or shortened transit time, causing constipation or diarrhea.
Other potential causes include altered sensitivity in the large intestine or rectum, diminishing the bowel movement reflex. Patients may experience psychological disturbances, stress, hysteria, or in some cases, a history of childhood sexual abuse, depression, etc. IBS may also develop after an acute infection, most commonly following acute gastroenteritis. According to some authors, 24-32% of patients may develop IBS within three months after such infections. Interestingly, some patients report that their IBS symptoms diminish or disappear when their doctor reassures them that they are not suffering from any serious disease.
Treating the Condition – A Challenging Task
Overall, treating IBS is complex and requires maximum patience from both healthcare providers and patients. The primary steps in the treatment process include psychological counseling, dietary modifications, medication, and other non-pharmacological therapies.
Psychological counseling for patients is crucial; the outcome largely depends on the skills and experience of the healthcare provider. It is essential to clearly explain to patients that IBS is not serious, does not pose a life threat, and, importantly, does not lead to cancer. Ideally, patients should identify specific foods that trigger their symptoms to avoid them in their diet. It is advisable to avoid raw foods and those high in fat, as well as alcohol and carbonated beverages.
Associate Professor, Doctor Nguyen Hoai Nam (Lecturer at the University of Medicine and Pharmacy in Ho Chi Minh City)
