Irritable bowel syndrome is a collection of symptoms, commonly including chronic abdominal pain, bloating, flatulence and altered bowel habits. It is a functional disorder of the intestines, occurring in the absence of visible structural abnormality.
Medications:
If diarrhea is the dominant feature-
- Tab. Roko (Loperamide 2 mg) 1 tablet after each unformed stool (maximum dose of 16 mg per day).
- Cap. Rinifol (Folic acid, Pyridoxine, Lactobacillus, Niacinamide) 1 capsule at night.
If constipation is the dominant feature-
- Isogel granules 2 teaspoons at bedtime with water for 2 days.
- If no relief – Syrup Aqualac (Lactitol monohydrate 10 gm/15 ml) 2 teaspoons at bedtime for 2 days.
- If no relief – Cap. Lubowel (Lubiprostone 8 mcg) 1 capsule twice a day.
- Cap. Rinifol (Folic acid, Pyridoxine, Lactobacillus, Niacinamide) 1 capsule at night.
If pain is the dominant feature-
- Susp. Cyclopam (Dicyclomine 10 mg, Simethicone 40 mg) – 10 ml thrice a day (15 minutes before meals) for 3 days.
- Tab. Tryptomer 10mg (Amitriptyline 10 mg) 1 tablet at bedtime – for chronic abdominal pain.
- Cap. Rinifol (Folic acid, Pyridoxine, Lactobacillus, Niacinamide) 1 capsule at night.
General advice:
- Keep a diary of food intake to identify intolerance to any food items.
- Ensure adequate nutrition and hydration.
- Advice about reducing emotional stress.
- Patients may benefit from cognitive behavioural therapy.
Investigations:
- Complete blood count – to rule out macrocytosis and/or anaemia.
- Erythrocyte sedimentation rate – to assess inflammatory activity.
- Serum electrolytes – to rule out electrolyte disturbances due to excessive laxatives.
- TSH – to rule out hypothyroidism.
- Stool ova and parasites – to rule out enteral infections.
Referral:
Consider referral to gastroenterologist with patient fails to respond to the above treatments or presents with additional complications.