Some individuals visit the hospital due to frequent diarrhea. They may be practically passing stool after every meal.

This may continue for weeks to months with no improvement. During all this time they may or may not look sick. This condition is called as, "irritable bowel syndrome”.

Irritable bowel syndrome commonly occurs due to stress in people who remain very anxious. The name itself implies that it occurs in people with irritable temperament.  Those who remain anxious and stressed are prone to develop this condition. 

Due to stress, they have increased adrenaline levels, which cause increased motility of the gut and increased stretching. 

This causes painful distension of the abdomen. There is increased frequency of passing stools with profuse mucous. At times, the person may also have nausea and or vomiting, thus mimicking acute gastroenteritis.

 Though diarrhea is a common manifestation of irritable bowel syndrome, some persons may have chronic constipation.

Those having chronic diarrhea may also have constipation sometimes. There may be associated cramp like pain and or a sense of bloating of the abdomen.

Irritable bowel syndrome can occur in any individual but is more common in young adults before 30 years of age.  Females are more affected than males, perhaps because they are more emotional.

Apart from bowel disturbances, there may be associated symptoms of depression, hysteria or anxiety. These usually manifest as palpitations, restlessness, sweating, unexplained gloominess, and sleep disturbances, e.t.c.

Individuals having long standing irritable bowel syndrome can suffer from nutritional disturbances also, due to the frequent diarrhea. 

High levels of anxiety can give rise to other diseases associated with anxiety such as hypertension, diabetes, e.t.c. The chronic diarrhea often is confused with chronic diseases of the large bowel like tuberculosis, cancer, H.I.V. infections, inflammatory bowel disease, e.t.c.

Diagnosis of irritable bowel syndrome is a diagnosis of exclusion, i.e. it is established by excluding other organic or infectious causes for frequent or prolonged diarrhea.   Results of all the relevant tests done for diarrhea are usually negative. 

These persons spend a lot of time and money visiting different hospitals and doctors for their chronic ailment.  They are also given many antibiotics empirically for the diarrhea on the presumption that it may be due to infection.

Thus he/she becomes susceptible to the side effects of the drugs.  They can develop ulcers in the mouth, superadded fungal infections and worse still can have diarrhea induced by antibiotics.

This occurs because antibiotics deplete the intestines of useful protective bacteria, thus, increasing the number of infectious germs   present in the bowels.

Reassurance and good counseling are very important for the good and sustained recovery of the patient.

He should be explained to patiently and sympathetically that there is really nothing wrong with his system and all he needs is just to relax mentally.

In no way should he get the feeling that he is being ignored or criticized, otherwise the counseling will be ignored.  His doctor and family members should give him the confidence that they are all his well wishers and support him in every way. 

Thus in this way he will be more responsive to their counseling and other steps undertaken for his management

Tranquilizers and sedatives can be used temporarily to calm the mind of the patient and cure sleep disturbances but long term use carries the risk of addiction and adverse effects.

Anti motility drugs, used to reduce diarrhea by suppressing intestinal motility, like loperamide can be used in severe cases for a short time. But their long term use is not safe. One can develop paralytic ilieus and severe bloating of the abdomen due to these drugs.

The best treatment for individuals suffering from irritable bowel syndrome lies in learning to relax the mind and body. Then only will one be rid of this condition.

Pande is a Specialist –Internal medicine Ruhengeri Hospital
rachna212002@yahoo.co.uk