Irritable bowel syndrome and hypochondriac development

In some cases IBS symptoms are connected with pathological dynamics of personal features which are known as hypochondriac development. It is characterized by premorbid personal features such as rigidity, scrupulousness, excessive inclination for order, anxiety in case of changes in traditional way of life, sticking on troubles.

In such a way, manifestation of irritable bowel syndrome is connected with psychotraumatic situation. However when the situation is settled IBS symptoms don't disappear or abate. On the contrary, manifestation of irritable bowel syndrome remains steadily over several years. It all tells on patient's consciousness and his look on the disease. As a result, the patient becomes hypochondriac.

Abdominal pains that are strong, long lasting and have strict localization are exacerbated periodically in connection with psychotraumatic influences. Consequently, patients focus themselves on their pains and quite often become phobic about their health problems.

Such hypochondriac patients often study corresponding popular scientific literature carefully and practice non-medical ways of treatment. They try to diet and gradually exclude more and more products from their daily ration. And if at the initial stages of the disease the diet is composed in accordance with recommendations of the doctor, in the course of time the chose of foods becomes more independent but less and less rational. This choice is based mainly on scanty information from some medical encyclopedias and the nature of pains and physical discomfort after consuming various products. Such patients refuse to follow doctor's advice and change their diet saying that even a slight deviation from current nutritional behaviour will definitely lead to exacerbation of abdominal pains, swelling, meteorism, negative change in stool pattern. Similar selectivity is observed in case of medications. Thus, hypochondriac behaviour causes additional problems in treatment of irritable bowel syndrome.

Irritable bowel syndrome and neurotic disorders

In case of IBS patients suffering from neurotic disorders (anxious, somatoform, algic, vegetative) irritable bowel syndrome develops more favorably according to the clinical course of organic neurosises, for example, such as a cardioneurosis.

One of the peculiarities of such patients is that abdominal pains usually can't be localized for sure. They tend to migrate and change their intensity and the area of irradiation. The character of pains is also labile - from burning to long-lasting, spastic or shooting pains. More than that, they are accompanied by the feeling of abdominal distension, frequent sudden urges to defecate with the subsequent feeling of uncompleted rectal expulsionin. Patients often link occurrence IBS symptoms with wrong diet, unhealthy lifestyle, change of the place of living, psychotraumatic circumstances.

In most cases the spectrum of pathological sensations also include headaches, heartaches, giddiness, unsteady step, faint, numbness of hands and feet. They are often combined with phobias and anxiety disorders. Exacerbations of pains and change of stool pattern take place in case of panic attacks (incidental spontaneous or situationally conditioned attacks of fear with heavy vegetative disorders). It often leads to protective behavior when the patient tries to refuse from public transport, go to the lavatory frequently right before going out, study locations of public lavatories that lies on the route, etc.

Another typical feature of irritable bowel syndrome developing together with organic neurosis is excessive attention of the patient to "pathological processes" that take place in the gastrointestinal tract. Dissatisfaction of negative results of treatment and state of one's health results in attempts to diagnose oneself independently and to resort to self-treatment.

In case of long-lasting (about several years) treatment patients get used to cope with irritable bowel syndrome in stressful conditions and resort to the doctor only when symptoms are exacerbated. Even in case of persistent protective behavior most patients preserve social activity and working capacity.

Irritable bowel syndrome and mental pathology

The link between functional disorders of gastrointestinal tract of IBS patients with mental pathology was already determined in the beginning of XX century. It was established that abdominal attack-like pains accompanied by diarrhea were connected with pathological fears, social phobia, anxiety and excessive excitement.

Quite a lot of studies have confirmed irritable bowel syndrome to be a complicated psychosomatic complex of symptoms that covers both structural derangements of the colon and psychopathological disorders. According to various scholars, 70-90 % of IBS patients have some mental disorders. Moreover, in more than half of these cases gastrointestinal disorders occurred and developed against the background of already present mental pathology. On the other hand, more than 50 % of patients with irritable bowel syndrome have their gastrointestinal and psychopathological symptoms aggravated in stressful situations.

In case of IBS patients with mental pathology there is prevalence of the neurotic (anxious) and affective (depressive) disorders with expressed algic and vegetative derangements (weakness, excessive fatigability, nervousness, dizziness, headaches, tremor, pains in the back, sleeping disorders).

As a matter of fact, patients suffering from irritable bowel syndrome differ according to clinical presentations (both psychopathological and those connected with disorders of gastrointestinal functioning) and dynamics of the disease.

What causes irritable bowel syndrome?

Irritable bowel syndrome is mostly prevalent in the Western society, but notwithstanding the fact that there are many theories about its occurrence and development clear causes have not yet been established. There is a lot of speculation about them but, generally speaking, it turns out that irritable bowel syndrome is a conglomeration of disorders with similar symptoms but various root causes. Let’s consider these disorders in succession.

Food allergies and sensitivities.
According to recent studies, irritable bowel syndrome symptoms are sometimes caused by immune response to foods. Exclusion of those foods to which the immune system is responding results in reduction or elimination of irritable bowel symptoms.

Stress.
It is scientifically proved that stress may definitely trigger symptoms in people with irritable bowel syndrome. There are different ways that stress may interact with irritable bowel syndrome. The colon has a vast supply of nerves that connect it to the brain which control the normal rhythmic contractions of the colon and cause abdominal discomfort at stressful times. Also, some physician say that irritable bowel syndrome is affected by the immune system which fights infection in the body. Consequently, stress also affects the immune system. Moreover, socially stressful situations may make the mind more tuned to the sensations that arise in the colon and make the stressed person perceive these sensations as unpleasant.

Visceral hyperalgesia.
Increased sensitivity to noxious stimuli in the gut or visceral hyperalgesia makes patients perceive pain from distention of a rectal balloon at smaller volumes than normal people do. Though, somatic sensitivity testing shows that people with irritable bowel syndrome have greater pain tolerance than normal people.

Post-infectious or post-antibiotic disorders.
In course of investigations onset of irritable bowel syndrome after episodes of enteritis or antibiotics have been evidenced. In these cases, a prolonged immune reaction may be the cause.

Irritable bowel syndrome and hormones.
Actually it’s difficult to say that the role of hormones in occurrence and development of irritable bowel syndrome is fully understood. Studies showed that menstruation frequently triggers or exacerbates irritable bowel syndrome symptoms. In fact, pregnancy and menopause can either worsen or improve symptoms. Obviously, hormone replacement therapy is associated with an increased risk of developing irritable bowel syndrome.

Parasites.
The part of the immune system, which parasites stimulate does not strengthen the organism to resist serious infection and contributes to allergic reactions. Thus, parasitic infection increases allergic tendencies. There are two general categories of parasites: 1) protozoa - one-celled organisms like the amoeba; 2) intestinal worms attaching themselves to the lining of the small intestine and causing internal bleeding and loss of nutrients. Such parasited destroy vitamings and produce toxins.

Bacterial overgrowth.
Studies showed that the majority of IBS patients had bacterial overgrowth. As a matter of fact, antibiotic treatments lead to substantial reduction in IBS symptoms.

Symptoms of irritable bowel syndrome

Impairment of motor function of the colon is commonly considered the basic symptom of irritable bowel syndrome. Generally, it is associated with derangement of stool pattern. Constipation-predominant stool pattern is the most common one - half of all the patients suffering from irritable bowel disorder has it. Diarrhea-predominant and alternating stool patterns are almost equally prevalent.

The second basic symptom of irritable bowel syndrome is abdominal pains. Most often pains are spastic and are localized in the abdominal area, but and their intensity and localization may be different depending on the patient. Painful sensations may occur not in the area of the colon and have extra-abdominal localization. Usually pains are aggravated right before defecation and are relieved after it.

At present several diagnostic criteria of irritable bowel syndrome are developed. The most popular are the so called Rome criteria, based on the symptomatologic approach to the classification of functional disorders of the gastrointestinal tract. Irritable bowel syndrome can be diagnosed based on at least 12 weeks, which need not be consecutive, if there was abdominal discomfort or pain:

- relieved with defecation; and/or
- onset associated with a change in frequency of stool; and/or
- onset associated with a change in form (appearance) of stool.

The symptoms that cumulatively support the diagnosis of irritable bowel syndrome are:

- abnormal stool frequency (“abnormal” may be defined as greater than 3 bowel movements per day and less than 3 bowel movements per week);
- abnormal stool form (lumpy/hard or loose/watery stool);
- abnormal stool passage (straining, urgency, or feeling of incomplete evacuation);
passage of mucus;
- bloating or feeling of abdominal distention.

It is necessary to note, that in recent years the look on the essence of irritable bowel syndrome has considerably changed due to expansion of knowledge in etiology, pathogenesis and clinical features of IBS. First of all, the connection of gastrointestinal tract disorders with pathological processes in the central nervous system is emphasized. Thus, irritable bowel syndrome is considered to be the clinical manifestation of neurotransmitter system disbalance, and the notion of functional disorder is being reconsidered.

Modern etiopathogenetic concepts of irritable bowel syndrome are based on the interaction of genetic and psychogenic (i.e. connected with psychotraumatic influences) pathophisiological, psychopathological and personal disorders.

Introduction to irritable bowel syndrome

Irritable bowel syndrome, a functional gastrointestinal disease has been studied by medical specialists since the end of XIX century. The first descriptions of irritable bowel syndrome in the context of "mucosic enteritis" were given by J. Da Costa in 1871. The term "irritable bowel syndrome" was offered by H. Bockus in 1929 and became popular among gastrointestinal medical specialists. Also such synonyms as spasmodic colon, irritable colon, spastic colitis, colon neurosis, colon dyskinesia, mucus colitis, functional diarrhea, nervous stomach, functional enterocolonopathy and nervous diarrhea are used.

Irritable bowel syndrome belongs to the most widespread psychosomatic disorders. According to epidemiological researches, approximately one fifth of the whole population suffers from this disorder in various periouds of life and 8-19% of the whole population reveal its symptoms to this or that extent. However, not in all cases symptoms of irritable bowel syndrome are serious enough to resort to medical aid. Only 5 % of all people with infringements of colon functioning suffer from clinically completed forms of irritable bowel syndrome.

Irritable bowel syndrome is the most common form of pathology in gastrointestine medical practice - it makes up 11 % of all gastrointestine diagnoses. Moreover, 50 % of patients that apply for a gastroenterologist have symptoms of the disorder.

In most cases irritable bowel syndrome develops at late teenage and early adult age. People that are more than 60 fall victim to it quite rarely. As a matter of fact, women suffer from it as twice as often than man. Generally, irritable bowel disorder manifests itself with monosymptoms, most typical of which are abdominal pain and feeling of overflow, epigastria, nausea, borborygmus, loss of appetite and abnormal stool pattern.