Inflammatory Bowel Syndrome (IBS)

Inflammatory Bowel Syndrome (IBS) 

Image obtained from Google search 

It is defined as an on-going GI disorder with episodes of either constipation or diarrhoea or both, accompanied with abdominal discomfort, triggered by certain factors, from time to time. Most of the time, IBS symptoms disturb your daily life rather than causing serious complications or problems.

It is one of the most common GI disorder diagnosed in healthcare. Yet, it is very hard to determine if you are having IBS since there is no specific laboratory tests for it. Usually, the doctor will exclude other possible causes such as IBD, coeliac disease and lactse intolerance before coming to a diagnosis that you have IBS. Exclusion of the possible risk of colorectal cancer is also important. One thing is there is no physical damages or obvious phsiochemical changes to your guts if you are diagnosed with IBS.

Your IBS symptoms could be predominatly constipation-prone or diarrhoea prone or both. Usually, abdominal cramps, distension or discomfort is relieved after passing the motions.

The causes of GI is not fully understood. However, it is believed that it is highly associated with stress, gut motility, emotional factor or weather changes, food ( eg fatty or spicy or preserved food.

Symptoms

-       abdominal discomfort or pain or cramps

-       bloating/flatulence/abdominal distension

-       changes in bowel habit eg. bouts of constipation or diarrhoea

-       feel of not complete defaecation

-       nausea and vomiting

-       back pain

-       fatigue/ lethargy

-       mood changes – anxiety or depression

Red flags

-       Unexplained, sudden decrease in weight

-       Blood stools

-       Wake up at night due to abdominal pain or urge to go toilet

-       Family history of colorectal cancer or other GI disease eg IBS or coeliac disease

-       Abdominal mass or lump

Recommended products

 1. Probiotics eg Inner health IBS

-       it is believed that with the restoration of the gut microbiota with the good bacteria, it may reduce or dampen the symptoms of IBS especially bloating and flatulence.

Inner Health IBS support
Image obtained from Google search 

22.   Antispasmodic medicines

-       Hyoscine butylbromide eg Buscopan or Gastrosoothe that can be obtained from your pharmacist or doctors to treat abdominal spasm or cramps.

-       mebeverine can be prescribed by doctors to reduce the abdominal cramps or pain or discomfort. (1 tablet TDS 20 minutes before meals)

-       Peppermint oil eg Mintec can be used to treat abdominal distention or bloating. (1-2 capsules TDS  30-60 minutes before meals)

-       Low dose Nortriptyline (or amitriptyline) could be considered to relieve abdominal pain (and also diarrhoea)

hyoscine butyl bromide
Image obtained from Google search

Peppermint oil
Image obtained from Google search

Meberverine 

33. Antinauseatic and anti-vomitign medicine

-       Domperidone can be used for nausea or vomiting. ( take 15 -20 minutes before meals)

-       Ondansetron could also be prescribed for nausea and vomiting (may also reduce diarrheo frequency)

For those with IBS-constipation

44. Increase Soluble Fibre intake ( Psyllium husk eg Metamucil)

55. Laxatives

-       Softener (docusate), stimulant (bisacodyl or senna) or osmotive laxatives (eg macrogol or lactulose)  could be considered. Refer to constipation.

-       Should only be used when non-pharmacological treatments such as diet and exercise does not work well.

-       Should not on prolonged use.

For those with IBS-diarrheoa

66. Antidirreal medicines

-       loperamide or diphenoxylate + atropine sulfate can be used to treat diarrhea.

-       For loperamide, take 2 capsules initially then 1 capsile after each loose bowel motion. Maximum of 8 capsules in 24 hours.

-       For diphenoxylate + atropine sulfate, take 2 tablets 3-4 times daily. Maximum of 8 tablets in 24 hours.

Loperamide. Maximum 8 capsules in 24 hours
Image obtained from Google search 

77.Rehydration salts

-       rehydration is the most improtant thing to do when you are experiencing diarrhoea.

-       ORS eg Enerlyte can be taken to replenish the water and salt balance in your body.

Oral rehydration salts
Image obtained from Google search 

Advice

-       try to identify the possible triggers egg stress, foods (eg spicy foods) or emotional changes

-       try on low-FODMAP diet

-       increase soluble fibre intake ( especially for IBS with constipation) and drink plenty of fluid

-       manage your stress eg yoga , meditation , gardening etc

-       exercise more

References

1.     http://www.bpac.org.nz/BPJ/2014/February/ibs.aspx

2.     http://www.healthyfood.co.nz/sites/default/files/articlepdf/2776.pdf

3.     http://www.healthnavigator.org.nz/health-a-z/i/irritable-bowel-syndrome/?tab=9201

Constipation

Constipation is very common in our normal life. In fact, most of us will experience it at some stages of our lives. One thing to note that is constipation is not a disease, it is a symptom. There might be an underlying cause if your constipation is chronic.

One more misconception in our society is that we must have bowel motion everyday. Otherwise, we may consider ourselves as constipated. This is absolutely wrong. Some people may only pass their motions on alternate or even a few days - it is totally normal if that's your bowel habit. So, it is important to know about your own bowel habit. 

Questions to ask before recommending laxative for the patients or customers. 

WWHAM template

Who ? Is it for children or elderly people ?

What are the symptoms ? Is the stool soft or hard ? Any other symptoms - abdominal pain, flatulence/bloating , pain while passing the motion , bleeding ? 

How long have you experience constipation? Few days ? Often experience this ?  Is this a sudden change (especially for those aged > 4o years) 

Action taken ? have you tried anything already ? 

Medication or any medical condition ? Pregnant or breastfeeding? Taking any medicines such as opioids e.g. codeine? 

Red flags 

- blood in stool 

-severe abdominal pain , bloating 

- unexplained sudden change in bowel habit (especially those who aged more than 40)

- constipated for more than 2-weeks without any obvious cause

Recommend a product 

Depend on patient's preference and formulation ( oral, enema, suppository) 

1. Bulk forming laxative eg psyllium 

- to bulk up the stool 

- take up to few days to work 

2. Osmotic laxative eg lactulose

- retain the water in the guts and soften the stools 

- take up to 1-day or so 

3. Softener laxative eg docusate 

- soften the stool and make it easier to pass 

- take up to 1-3 days to work ( usually within 8-12 hours) 

4. Stimulant laxative eg senna , bisacodyl 

-stimulate the guts movement

-take up to 6-8 hours 

5. Enemas or suppositories e.g. Fleet , Microlax, Glycerol suppositories, Bosacodyl suppositories 

- different functions, act locally to stimulate bowel motions 

- fast ( usually works within 15- 20 minutes) [ therefore, make sure the assess to toilet] 

dulcolax suppository 

OTC recommendations

1. Senokot (senna) 

- take 2-4 tablets at night 

Image sourced from Google search 

2. Coloxyl with senna (decussate + sennoside B) 

- take 1-2 tablets at night 

Image sourced from Google search 

3. Dulcolax (bisacodyl) 

- take 1-2 tablets at night 

- >4 years old ( 1-2 tablets at night) 

Image sourced from Google search 

For children 

1. Coloxyl drop 

- is a stool softener 

-for infant and up to 3-years-old 

- based on the directions on the box or as directed by the doctors or pharmacists. ( usually TDS in feeding bottle or fruit juice ) 

Image sourced from Google search 

2. Lactulose 

- to soften the stools 

- based on prescriber's or pharmacist's direction 

Image sourced from Google search 

Advice 

- eat more fibre in diet e.g. vegetables and fruits 

- drink plenty of water ( especially when you are taking bulking agents, or it will make the stools harder)
- Reduce coffee or tea intake ( as they cause you pass urine more and may make the stools harder) 

- exercise 

-do not resist the natural urge to toilet 

One of the common misconceptions about laxatives is that it can be used to slim down the body. This is Wrong ! Do not try this ever. Talk the pharmacist or doctors if you want to tackle obesity problems. 

Laxative should not be used for prolonged period unless you have other medical conditions or taking other medications such as opioid that the use of laxatives may be needed. 

Always to talk to the pharmacist and prescribers if you are concerned about the use of laxatives.

References 

1. Pharmacy Today healthcare book 

2. http://www.medicalnewstoday.com/info/oic/causes-of-opioid-induced-constipation.php