Irritable Bowel Syndrome: Symptoms and Management Tips

Is it irritable bowel syndrome?

Approximately last year, after giving birth, I experienced long-term sleep disruptions while caring for my child.
In early 2018, I had stomach discomfort that lasted nearly a month (I consulted a doctor and took medication).
Later, feeling uneasy, I underwent an endoscopy, and the doctor diagnosed me with superficial gastritis.
My stomach improved, but due to ongoing poor sleep, my gastrointestinal tract began to behave strangely.
Initially, I felt a sour discomfort and bloating when pressing on the left side of my abdomen near the navel, which sometimes triggered a bowel movement leading to diarrhea.
Concerned, I underwent a comprehensive health check-up (including colonoscopy, abdominal ultrasound, stool bacterial examination, and gynecological examination).
The doctor indicated that there were no issues with my colon and diagnosed me with irritable bowel syndrome (IBS).
I took medications prescribed by a gastroenterologist for IBS and probiotics, but the symptoms continued to recur.
Now, I often experience cramping pain in the lower left abdomen upon waking, followed by diarrhea (the stool is usually golden yellow, likely due to the probiotics).
Sometimes the cramping stops after a bowel movement, but other times, even after one bowel movement, pressing on the left side near the navel still causes discomfort.
I massage the area around my navel (the entire area around the navel feels bloated and sometimes produces a gurgling sound), and then I feel the urge to use the restroom again, resulting in more diarrhea.
Eventually, the discomfort subsides.
The area of discomfort is primarily from the navel to the lower left abdomen.
I have seen a gynecologist several times to rule out any gynecological issues, but I have not fully recovered (I did not have these problems before pregnancy).
This recurring issue has made me somewhat anxious, even leading to health anxiety.
Some have suggested I consult a psychiatrist, stating that part of IBS may be related to autonomic nervous system dysregulation.
I would like to ask the doctor how I should proceed from here.
Thank you.

Miss Zhang, 30~39 year old female. Ask Date: 2019/04/26

Dr. Chen Qifeng reply Gastroenterology and Hepatology

A diet low in oil, dairy, and刺激 foods is fundamental; medication management comes next.

Reply Date: 2019/04/26

More Info

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder characterized by a combination of symptoms, including abdominal pain, bloating, and changes in bowel habits such as diarrhea and constipation. Your situation, particularly following childbirth and the associated stress and sleep disruptions, aligns with many of the factors that can contribute to the onset of IBS.

Symptoms and Diagnosis
From your description, it seems that you are experiencing several hallmark symptoms of IBS. The left-sided abdominal pain, urgency to defecate, and diarrhea, particularly after meals, are indicative of this condition. The fact that you have undergone extensive testing, including endoscopy and colonoscopy, which have ruled out organic diseases, further supports the diagnosis of IBS. The Rome IV criteria, which are used to diagnose IBS, suggest that symptoms must be present for at least 12 weeks over the past year, with abdominal pain related to bowel movements and changes in stool frequency or form.

Potential Triggers
Several factors can exacerbate IBS symptoms, including:
1. Diet: Certain foods can trigger symptoms. Common culprits include dairy products, high-fat foods, caffeine, and artificial sweeteners. Keeping a food diary may help identify specific triggers.

2. Stress and Anxiety: Psychological factors play a significant role in IBS. Stress can lead to changes in gut motility and sensitivity, which may explain the exacerbation of your symptoms during periods of anxiety or sleep disruption.

3. Sleep Disruption: As you mentioned, your sleep has been affected since childbirth. Poor sleep can impact gut health and exacerbate IBS symptoms.

Management Strategies
1. Dietary Modifications: Consider adopting a low-FODMAP diet, which involves reducing certain carbohydrates that are poorly absorbed in the small intestine. This diet has been shown to alleviate symptoms in many IBS patients. Consulting with a dietitian can provide personalized guidance.

2. Probiotics: While you mentioned taking probiotics, it’s important to note that their effectiveness can vary. Some strains may be more beneficial for IBS symptoms than others. It may be worth trying different formulations or dosages.

3. Stress Management: Techniques such as cognitive-behavioral therapy (CBT), mindfulness, and relaxation exercises can be beneficial. Since you mentioned the possibility of autonomic nervous system dysregulation, addressing stress through these methods may help improve your symptoms.

4. Regular Exercise: Physical activity can help regulate bowel function and reduce stress. Aim for regular, moderate exercise, which can also improve sleep quality.

5. Medication: If dietary changes and lifestyle modifications do not provide relief, medications may be necessary. Antispasmodics can help with abdominal pain, while medications that target diarrhea or constipation may also be considered.

6. Follow-Up Care: Since your symptoms are persistent, regular follow-up with your healthcare provider is essential. They can monitor your condition and adjust your treatment plan as needed. If anxiety or stress continues to be a significant issue, a referral to a mental health professional may be beneficial.

Conclusion
IBS can be a frustrating and challenging condition, particularly when it disrupts daily life and causes anxiety. However, with a comprehensive approach that includes dietary changes, stress management, and possibly medication, many individuals find significant relief from their symptoms. It’s important to remain proactive in managing your health and to communicate openly with your healthcare providers about your concerns and progress.

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