I. Drug therapy

1, pain relief and diarrhea: compound phenethylpiperidine is effective in abdominal pain, diarrhea-based colonic dysfunction. If the number of stools is not high, 1 tablet can be taken 3 times a day at the beginning, and after improvement, 1~2 tablets can be taken every day, 1 tablet in the morning and 1 tablet in the evening; after the number of stools is normal, it can be stopped.

2、Improve intestinal mucosal function: Compound glutamine enteric-coated capsule, 2 to 3 capsules at a time, 3 times a day, taking 4 weeks for a course of treatment. This drug is a new type of Chinese and western medicine compound preparation for the treatment of intestinal diseases, the main function is to protect and promote the repair of intestinal mucosa, enhance the intestinal immune barrier function, regulate the function of the digestive system.

3, the regulation of intestinal flora: lactobacillus tablets, rectum, Rejuveno, etc. can regulate intestinal flora, treatment of indigestion, gastrointestinal dysfunction caused by diarrhea.

4, traditional Chinese medicine: can choose to replenish the spleen and intestinal pills, colitis pills and so on. Gastrointestinal cold, can be served with the medicinal pill. 5, local hot compresses: a catty of coarse salt, fried hot, into a cloth bag hot compresses abdomen, once a day, 10 times a course of treatment, can improve intestinal blood circulation, enhance intestinal function, effective in the treatment of abdominal cold-type chronic intestinal disease.

II. Conditioning and precautions

1, relax the spirit: this disease is often associated with mental factors, so we must relax the spirit, eliminate worries, pay attention to the regularity of life, ensure sleep. Appropriate increase in exercise, enhance physical fitness, in order to accelerate the recovery of gastrointestinal nerve function.

2, pay attention to diet: diet should be low-fat, less fiber. Cooking methods to steam, boiled, stewed, braised mainly; digestion and absorption function is poor, it is appropriate to use easy to digest diet, a meal should not be too much.

3, eat less gas-producing food and sweets. Exhaustion, bowel sounds too strong, should eat less sucrose and easy to produce gas fermentation food, such as soybeans, sweet potatoes, white radish, pumpkin, soybeans and so on.

4. Pay attention to dietary hygiene. Do not eat raw and cold, hard and spoiled food, prohibit alcohol and spicy, stimulating condiments.

Dr. Clove is here to answer that question.

Daily Life Management: 6 Tips to Cope

Literature reports that the incidence of the disease in Beijing and Guangzhou is 7.3% and 5.6%, respectively. In Europe and the United States, it is as high as 10-20%. Irritable bowel syndrome is no longer a rare disease, so it is necessary to explain the daily management of this chronic disease:

1. Removal or circumvention of contributing factors

For example, as summarized by the banker in the case, the contributing factors to his onset of illness were stress, anger, meeting leaders, socializing, etc., and ways should be found to avoid these events.

2. Proactive adjustment of emotions and mindset

Secondly, many contributing factors cannot be avoided, so you have to adjust your mindset yourself. First of all, don't be overly anxious about this chronic disease and face it openly. You should know that the human gastrointestinal tract is "thinking", most people have encountered distressing things, and feel "tea do not think of food do not want to" time; also have encountered a good thing, instantly and "appetite" time. For example, many cab drivers have stomach problems because they are always in the traffic, the mental tension is higher than the general workplace, and the gastrointestinal tract is also stimulated by the secretion of more gastric acid along with this tension.

Long-term in such a psychological, mental state is certainly not good for the gastrointestinal tract, if necessary, you should see a psychiatrist, or read some soothing books, listen to some relaxing music, find ways to adjust the mind, emotions to a calm state.

3. Adequate exercise

For example, brisk walking, jogging, yoga, Tai Chi and so on. Exercise itself can promote gastrointestinal activity, in abdominal surgery after the doctor always want to rush the patient as soon as possible to get down to the ground activities, do not allow them to lie in bed, is to promote the gastrointestinal tract through the activities to restore function. In addition, exercise can also adjust the mood and improve sleep.

4. Drug-assisted

There is no treatment drug for irritable bowel syndrome per se, but it can be prescribed based on symptoms. For example, the professor in the case prescribed pivacurium bromide, which can selectively act on the smooth muscle of the gastrointestinal tract to relieve abdominal pain and thus improve diarrhea symptoms. In addition, if the patient also has symptoms such as anxiety, depression, insomnia, etc., the drug should also be used. Otherwise, it is easy to fall into the "poor sleep - poor mood - irritable bowel - worse mood - more poor sleep" Vicious cycle.

5. Attention to diet

Yes, western medicine also talks about avoiding food. Irritable bowel syndrome should try to avoid tobacco, alcohol, spicy, cold, oily and hard, these things are more or less a little bit of stimulation of the gastrointestinal tract, the average person ate it's okay, but who makes your gastrointestinal tract so irritable? Eat more food rich in crude fiber, easy to digest, in addition to some good yogurt supplement.

6. Vigilance against other diseases

Although irritable bowel syndrome is not accompanied by organic lesions, it is possible to get other organic gastrointestinal diseases as the patient gets older, and the possibility of lesions should not be ignored just because you know you have irritable bowel syndrome. If the following symptoms occur, it is necessary to check again: weight loss, diarrhea of a different character, blood in the feces, anemia, and low-grade fever, especially if the patient is over 50 years of age. These are called "warning signs", and when they occur, they may indicate other problems and need to be taken seriously.

Content reference to Dr. Clove's scientific article: "TheDaily life management of irritable bowel syndrome》

Author / Wang Xiaoman丨Hepatobiliary Surgeon

Editor / Lee Bad

Irritable bowel syndrome (IBS) is a functional disorder in which the normal activity of the intestinal tract is disturbed, characterized by abdominal pain or abdominal discomfort, accompanied by changes in bowel habits (constipation or diarrhea), and there is no organic pathology in colonoscopy and fecal laboratory tests. The occurrence of young people is more common, the first onset of the elderly is relatively rare, according to the characteristics of defecation and the nature of feces are divided into three types of diarrhea, constipation and mixed type. The common clinical type is diarrhea type irritable bowel syndrome.

The cause and pathogenesis of irritable bowel syndrome is not well understood, and it is certain that it is the result of a combination of factors and multiple pathogenic mechanisms, including:

1. Abnormal gastrointestinal dynamics: the frequency of intestinal electrophysiological activity is significantly weakened in people with constipation and abdominal pain predominantly in irritable bowel syndrome, and intestinal electrophysiological activity is significantly increased in diarrheal type of irritable bowel syndrome. The kinetic response to various physiological and non-physiological stimuli (feeding, intestinal lumen dilation, intestinal contents, and certain gastrointestinal hormones) is too strong and manifests itself in a recurrent process.

2. Abnormal visceral sensation: the pain threshold of patients with irritable bowel syndrome is significantly lower than that of normal people during rectal insufflation test. It indicates that patients with irritable bowel syndrome have increased sensitivity to physiological phenomena such as gastrointestinal filling and dilation and intestinal smooth muscle contraction, and are prone to abdominal distension, abdominal pain and diarrhea symptoms.

3. Irritable bowel syndrome can easily occur after the cure of intestinal infections, and the onset of the disease is related to the severity of the infection and the application of antibiotics for a certain period of time.

4. Gastrointestinal hormones: Increases in some gastrointestinal peptide hormones, such as cholecystokinin, can precipitate the onset of irritable bowel syndrome symptoms.

5. Spiritual and psychological factors: patients with irritable bowel syndrome often have anxiety, depression, insomnia, dizziness, emotional instability and other phenomena, especially obvious when receiving sudden stimuli.

The symptoms of abdominal pain and diarrhea in irritable bowel syndrome can be recurrent or chronic, and the duration of the disease can last for years or even decades, but it has little effect on the general health status. Symptoms often recur or worsen due to mental stimulation, poor diet, and other triggers.

The diagnosis of irritable bowel syndrome can be established by the presence of abdominal discomfort or abdominal pain that has persisted for more than 6 months during the onset of the syndrome and has been present for the past 3 months with more than 2 of the following features:

1. Abdominal pain symptoms improve after defecation.

2. Symptoms are accompanied by a change in the frequency of bowel movements. 3. Symptoms are accompanied by a change in the character of the feces. The greater the number of the following symptoms, the more supportive the diagnosis of irritable bowel syndrome:

1. Abnormal frequency of bowel movements: >3 times per day or <3 times per week.

2. Abnormal fecal character: lumpy/hard stools or thin watery stools.

3. Abnormalities in the process of fecal elimination: straining to defecate, feeling of urgency, feeling of incomplete defecation.

4. Mucus stools.

5. Flatulence or a feeling of abdominal distension.

For the first occurrence of abdominal pain, diarrhea or with weight loss, persistent diarrhea, nocturnal diarrhea, blood in feces, intractable bloating, anemia, and low-grade fever over the age of 40, colonoscopy is needed to carefully differentiate the symptoms, and the diagnosis of irritable bowel syndrome should be made only after the discharge of organic pathology.

The treatment of irritable bowel syndrome is mainly aimed at eliminating patients' concerns, improving symptoms, and improving quality of life. The treatment method is mainly to actively find and remove the promoting factors and symptomatic treatment, and according to the actual situation of comprehensive treatment and individualized treatment.

1. Try to find out the contributing factors such as diet, climate change, emotional influence, etc., and avoid and remove them as much as possible. Relieve unnecessary worries, develop good living habits, don't drink alcohol, don't eat chili, garlic, fat meat and other foods that can easily trigger symptoms, and eat more foods containing more fiber to help improve the symptoms of constipation. For people with insomnia, anxiety, depression symptoms, appropriate application of sedative drugs to assist in the treatment.

2. Symptomatic medications include the following:

1) Antispasmodics: commonly used are scopolamine or pivobromine, of which pivobromine is also effective for abdominal pain symptoms and has fewer adverse effects, and the usual dosage is 50mg orally three times a day.

2) antidiarrheal drugs: loperamide or difenocoumarol have good antidiarrheal effects and are suitable for people with severe diarrhea symptoms, but should not be used for a long time. For mild cases, adsorbent antidiarrheal drugs such as montmorillonite and medicinal charcoal should be used.

(3) laxatives for constipated patients can be used as appropriate, and more choose the role of mild light laxatives, commonly used osmotic light laxatives such as polyethylene glycol, lactulose or sorbitol, volumetric laxatives such as methylcellulose.

(4) Antidepressants are mostly used for people with severe abdominal pain symptoms who have not responded to the above treatments and who have significant psychiatric symptoms. They can also be used as an adjunctive treatment for people who do not have significant psychiatric symptoms.

(5) Intestinal microecological preparations such as Bifidobacterium, Lactobacillus, Typhimurium and other preparations, have the effect of correcting the intestinal flora imbalance, and have a certain alleviation of diarrhea and bloating symptoms.

3. When the symptoms are severe and persistent, and the general treatment and medication are not effective, psychotherapy, cognitive therapy and other psychological interventions can be conducted to enhance the efficacy, relieve symptoms and reduce recurrence.

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