Database of diseases - Pain treatment clinic

Differentiation of abdominal pain in the irritable bowel syndrome

For a more accurate differentiation between functional and organic gastrointestinal disorders, the following table can be used.
 
 

differentiation:
between functional and organic gastrointestinal diseases

 

functional

organic

 

 

 

 

neoplastic

inflammatory

symptoms:

 

Weight loss

Absent

Often

Sometimes

Diarrhea

Only during the day

In the night

Day and night

Loss of blood

 

Absent

Often

Often

Fever

Absent

Rarely

Often

Ache

Stinky, it gently weakens after emptying

From weak to strong

It can be located,

to acute inclusive

The rhythm of bowel movements (diarrhea or constipation)

Alternating diarrhea and constipation

Bean stools

Constipation (rarely diarrhea)

Pencil stools

Diarrhea or normal

Laboratory tests:

 

hematocrit

Standard

Often below the norm

It may be below the norm

leukocytes

Standard

Usually the norm

Often above the norm

erythrocytes

Standard

Usually below the norm

Usually below the norm

The pain that lasts hours or days, and these are generally somatic pain, requires a thorough assessment of the specialist.

Undoubtedly, such a procedure is indicated when the patient has an intense abdominal pain, which interrupts sleep because it usually occurs at night. "Smoker", acute pain is characteristic of duodenal ulceration and occurs immediately before eating a meal.An intense paroxysmal abdominal pain accompanied by nausea and vomiting is often caused by cholelithiasis. Pain associated with acute pancreatitis is very strong and usually develops after ingesting a rich a meal or more alcohol.


The location of abdominal pain is one of the main clinical components of the differential diagnosis of the disease.

Pain located in the upper parts of the abdominal cavity (abdomen) is usually caused by disease processes in the stomach, bile ducts, liver, pancreas. The pain resulting from gallstones or liver diseases can be located in the upper right part of the abdominal cavity (it can also radiate under the right shoulder blade). The pain accompanying gastric or duodenal ulcers and pancreatitis usually radiates in a "diffuse" way to the back area. The pain caused by disturbances of small intestine functions is usually located around the navel, pain in the intestine and beneath the umbilicus. Pain localized and origin from the pelvis, they are usually perceived as oppression and malaise after adopting a vertical position.


Specialists will recognize that with a positive answer, although one of the following questions, the patient should consult a physician:

Do you often suffer from stomach pains?
Does the pain occurring affect your everyday life and your job duties?
Do you have any weight loss or loss of appetite?
Do you feel nausea and vomiting?
Are there any changes in bowel function (diarrhea / constipation)?
Do you feel pain during the night?
Have you had any previous diseases such as: peptic ulcer of the stomach or duodenum, gallstones, intestinal inflammatory diseases, diseases of the pancreas or abdominal surgery?
Do you take medications that may adversely affect the gastrointestinal tract (eg: aspirin, non-steroidal anti-inflammatory drugs)?




 
 
 
 
Abdominal pain in the irritable bowel syndrome may be differently located and may have different severity, but they have some common features that facilitate the diagnosis of the disease.

Most often they are located in the right or left abdomen. They often intensify within an hour and a half after eating and in stressful situations, but they disappear after passing the stool. They never wake the patient out of sleep or prevent them from falling asleep. The progressive nature of abdominal pain excludes the diagnosis of irritable bowel syndrome.
Together with abdominal pains or irrespective of them in patients with irritable bowel syndrome, there are often abdominal bloating, which intensifies with the passage of the day. We are talking about the form of pain and bloating disease, which is particularly difficult to treat. Patients suffer from the disease sometimes described and the disease can disorganize their whole life.



Let the following account testify to it:

I have been suffering from a sensitive gut for ten years. I usually have constipation and abdominal pain. Besides, I'm probably a "book case". It is true that some foods are more harmful to me. However, I can not fully determine my own list of "hostile foods". Nutrition specialist warned me about food containing wheat and yeast because I did not tolerate both of these ingredients. However, when browsing the composition of individual products in stores, it is difficult to find bread without these ingredients.

When pain comes to me, I can not think about anything else. I am completely helpless and lost then. My friend always tries to help me, but he realizes that he is convinced that this illness is in my head and I "invented it" myself. To be honest, I would not wish to experience such agonies even to the worst enemy.

Those who suffer from irritable bowel syndrome are likely to undergo similar tortures like me, especially those who have constipation at the same time. Two years ago I finally graduated from my university and now I know that, despite some of the stress, this disease will probably endlessly endure. Perhaps I will have to say goodbye to my work because of it. Every day I go to sleep with a bottle of hot water, without the certainty that she will help me. I dream about the day when I can live a normal life and my stomach will work regular, and not as it is in a given moment of fantasy.
 
The development of irritable bowel syndrome is often attributed to colonic motor dysfunction, because the characteristic symptoms are associated with abnormal bowel function, and abdominal pain localizes mainly in the colon.

Some patients have some abnormalities of colonic motility, but these changes are not convincingly related to the pathogenesis of the disease. It is worth adding that the techniques of continuous recording have identified motor disorders that also affect the small intestine, but their significance in the described syndrome is still unclear. The most frequent phenomenon is visceral sensation disorder.

It is generally accepted that stimulation of the intestinal wall receptors through stretching (gas, high amplitude of contractions) is responsible for the occurrence of pain.

This was confirmed by the Holdstock and Misiewicz studies, who showed a relationship between the occurrence of pain and a manometrically monitored pressure increase in the colon or small intestine. Lynn and Friedmen believe that irritable bowel syndrome is probably a heterogeneous group of conditions. On the basis of many works, motor dysfunction or sensation within the gastrointestinal tract was found. However, no type of disorder affects all patients or explains a complex set of symptoms. Some of them may characterize a given subgroup of ill people. Research on motility and intestinal sensation is usually performed in patients who are idle or undergoing stimulation, not during episodes of spontaneous pain that is typical for this condition.

Wiklund and his team examined 234 patients with irritable bowel syndrome. There were as many as 77% of women in this group. The studies used the Gastrointestinal Symptom Rating Scale with its special modification for patients with this diagnosis. (GSRS-IBS).Most patients gave the most common symptoms known from previous descriptions of this syndrome (feeling of abdominal fullness - 0.85 and pain - 0.74).

Patients with their statements and complaints usually confirm the observations of these authors:

Every evening (possibly late in the afternoon) I feel that my stomach swells, swells (I feel like "inflated" all the time).) In the morning after waking up without troubles I fasten my belt from trousers, but in the evening I have to loosen it.

My symptoms are intensified during stressful situations. I belong to hypersensitive people. Regarding ailments, abdominal pain, bloating, piercing stings, these symptoms have recently been around the navel. Constipation, alternate bitterness and hyperacidity in the mouth, pain in the lower part of the esophagus. My problem is that my body can not tolerate certain medications. Recently, the symptoms have intensified very much.

Stretching the balloon of the rectum, sigmoid or small intestine with the balloon already causes pain at the volume of the balloon that does not normally cause such a reaction in healthy people.

However, little is known about the mechanism of abnormal pain sensation. It is not determined whether the basic defect concerns the sensory receptors and neurons of the intestinal wall or central nervous system, in which the sensation of pain is processed and made aware. It is an indisputable fact that the high threshold of pain excitability in people with irritable bowel syndrome is found in many parts of the intestines, which suggests that this disease relies on a generalized disorder of visceral pain. Mertz believes that in addition, the intestinal hyperactivity may increase in periods of increased psychological stress to which sometimes sick persons are subjected.

Thus, the undoubted basis of the disease is visceral hypersensitivity, lowering of the pain threshold and volume threshold in the intestines.

It may be responsible for feeling pressured and the impression of incomplete bowel movement, hypersensitivity to the normal amount of intestinal gas. This feeling can be projected on lumbar and thoracolumbar dermatoses. There is hyperactivity of the spinal cord (the phenomenon of memory of pain at the level of the central nervous system).
If the colonic segmental spasms are more frequent, the motility of the rectal-esophageal space increases with them. There is also an increased excitability of the large intestine in response to various stimuli, eg stress, rectal stretching, cholecystokinin, cholinergic drugs, meal. As a result, the activity increases and the amplitude of the contractions of the large intestine increases.
 

Author dr n. Med. Janusz Krzyżowski - psychiatrist

References: U of the author

From the Author:
CONTENTS presented on the website are for educational purposes only.

CONTACT:
Private Medical Cabinet: Treatment of Irritable Bowel Syndrome - conditioned by stress and psychogenic background, anxiety, depression, neuroses.
Warsaw Ul. Dolna 4/15 Registration tel. 022 833 18 68

Table of contents of a monograph of the subject by dr n. Med. Janusz Krzyżowski:
- Irritable bowel syndrome - psychogenic aspect
1. Introduction
2. Characteristics of symptoms in the irritable bowel syndrome
3. Other symptoms of cha