Modern problems of science and education. Treatment of IBS - irritable bowel syndrome Results and discussion

Is irritable bowel syndrome treated by a psychotherapist?

Here I would like to dwell separately on such a problem as irritable bowel syndrome (IBS) . This complex disorder is psychosomatic. The medical understanding of the term "psychosomatics" implies such a disorder when there is physical discomfort and a change in the functioning of the organs, but the reason for this is a violation of the nervous regulation.

IBS develops, as a rule, in close connection with gastrointestinal disorders. But these violations are not a disease of the intestine, but a violation of its nervous stimulation, irritation. And this brings great suffering to a person.

Usually, in the vast majority of cases, an infectious problem or dysfunction with intestinal dysbiosis is present at the very beginning of the development of this psychosomatic disorder, IBS.

For example, a person was poisoned, and then got an intestinal disorder for long time with which he could not cope for a long time. Or it could be the result of long-term use of antibiotics for some other disease.

But already further, the basis of the mechanism of this chronic disorder is vegetative (sympathetic-adrenal) disorders. They are connected by a combination of intestinal reflexes with unconscious stressful tension. All this causes manifestations of irritable bowel syndrome.

As the disease progresses, phobias arise that are associated with intestinal discomfort, significant life restrictions, and the lack of guaranteed bowel control, which causes increased anxiety.

A person suffering from IBS gets used to experiencing the fear of diarrhea or pain, and adjusts his life in such a way as to avoid the consequences of expected troubles. After all, it is simply impossible to control your intestines, and a person is tied to toilets. And the fear of a terrible shame, "if suddenly ...", increases the stressful expectation of an aggravation, thereby "charging" nerve impulses for this aggravation. That is, the fear of expectation programs the next intestinal irritation. Irritable bowel syndrome is a variant of somatoform neurotic disorder (neurosis).

During gastroenterological examination of significant physical changes bowel is not found. At the same time, patients are tormented by symptoms of one of three forms of irritable bowel syndrome:

1. irritable bowel syndrome with diarrhea (diarrhea);

2. irritable bowel syndrome with spastic pain and bloating;

3. irritable bowel syndrome with constipation.

There are also cases where the predominant forms of IBS change over time.

What is the role of psychotherapy in IBS?

The best effect for irritable bowel syndrome is cognitive behavioral therapy. There are several goals in psychotherapeutic work with a patient.

The first goal is the fear of anticipation of subsequent attacks and the change of "avoidant" behavior. Here, the stage of teaching self-control during the beginning of an exacerbation is very important, techniques are used that help reduce the level of tension and fear. These are special concentration and breathing exercises. Improving self-control allows you to control behavior more, expand your comfort zone when moving around in your life. And as a result, intestinal reflexes, which lie in the IBS reinforcement mechanism, are weakened.

It is also very important to wean yourself from the rituals of protective behavior while improving well-being, because all this allows IBS to be reinforced. It happens that with IBS, the patient gets used to making sure that the intestines are emptied before leaving the house, so that the route of movement is laid only where there are toilets, and where there are none, or there is no way to leave at any time - to exclude movement and being. Human society suffers greatly.

In addition, special attention is paid to the study of personality traits, because such states are characteristic of emotionally unstable and anxious individuals who, throughout their lives, have "learned" to restrain their stress inside the body. The analysis and psychological processing of current life difficulties, past catastrophes in life, expectations of future failures and the impending meaninglessness of life are carried out.

Such an integrated approach to the problem, when a person suffers from irritable bowel syndrome, allows you to cope more reliably and with a stable result for the future.

What is the role of drugs in IBS?

The use of special means that can regulate the nerve impulses of the intestine and the general emotional background is in some cases mandatory. There are also many such cases of IBS. And then we need to smooth out the deformed bowel reflexes at the first stage of treatment, this helps the psychotherapy that has already begun. This is applied in a strictly verified course, under the supervision of a psychotherapist, whom you visit for cognitive-behavioral therapy of irritable bowel syndrome. Modern medicines allow you to feel efficient, and with a qualified approach, they practically do not have side effects and addictive properties.

BE HEALTHY!!!

What is the duration of the course of psychotherapy and psychoanalysis?

Currently, there are several forms of psychotherapy using classical psychoanalytic theory and technique and taking different time. By duration (in descending order) they can be arranged as follows:

• Classical psychoanalysis is the most rigorous model for the study of the human psyche. It is for those who can use it, the most effective way treatment, opening new ways of development. Work in psychoanalysis is focused on the study and elaboration of unconscious conflicts underlying a particular symptom or psychological problem, and this careful study makes possible the structural restructuring of the deep foundations of the Self, the personality as a whole. Classical psychoanalysis is applicable only to a limited number of people. Sometimes the patient does not want to resort to it, sometimes he cannot, because the peculiarities of his mental functioning, or the social context in which he finds himself, preclude analysis and make it practically impossible.
• Psychoanalytic psychotherapy. If in psychoanalysis the goal is the study of the personality as a whole, then in psychoanalytic psychotherapy the goal is more modest, but more specific - the resolution of certain specific problems. Psychoanalytic psychotherapy has a wider range of applications. This type of treatment can help not only people with neurotic problems, but also more serious problems: character neuroses, personality disorders, and in some cases (with mandatory drug treatment) and in the treatment of psychoses and severe psychosomatic illnesses. Psychoanalytic therapy provides unique opportunity relive your personal history, take a fresh look at it and find a connection between events in the past and conflicts in the present and thereby prevent their occurrence in the future.
• Focus therapy is a limited form of psychotherapy in which one specific problem is identified and therapy is focused on it.
• Psychoanalytic counseling is usually work with a specific life situation that has arisen.

Thus, the duration of psychotherapy, depending on the stated problem and the personality of the patient, can range from one meeting to several years. A person who wants to receive psychoanalytic help can choose the duration of treatment depending on the goals and objectives that he sets for himself. The duration and frequency of meetings is determined by him together with the psychoanalyst and does not necessarily amount to a long time.

When talking about psychoanalytic psychotherapy and psychoanalysis, they are never limited to a specific time or course of treatment. Everything is determined by how much time it takes to re-examine all the complex (or rather, complicated) layers of your feelings, understand all the unique nuances of your individual history, and only then determine the real causes of certain personal or interpersonal problems, as well as form adequate ways to resolve them. You may find "side" issues of great importance or obstacles that will slow you down. In some cases, you will have to stop or even retreat. But it will always be your decision.

In some cases, the analysis can last several months and even years, in others - several weeks. You should always be aware that you determine the duration of the analysis yourself. But! Often the desire to interrupt the analysis is dictated by the fear of change, an indication that the psychic conflict has been "plucked". A neurosis can be steadfastly "guarded" by the psyche. In this case, the analyst must point out this circumstance to you. A sharp abandonment of psychotherapy leads to the fact that everything done before is practically crossed out. Therefore, it is common for the patient and analyst to agree that if the person decides to leave, then a few more sessions will take place to understand the patient's motives and consolidate the results of the work.

If you feel that you have achieved what you wanted, or solved the issues that you yourself have set, you can always determine with your analyst the end date of the analysis. And yet, if we talk about the "average" terms of psychoanalytic psychotherapy, then after 2-3 months certain changes occur, and after six months these changes begin to become persistent. Further, it all depends on whether the person is satisfied with the fulfillment of the initially set tasks, or there is a desire to move on and set new ones.

Moreover, women are 2 times more likely than men. The treatment of the disease is carried out not only by gastroenterologists, but also by psychotherapists.

Our expert - Doctor of Medical Sciences, Gastroenterologist, City Clinical Hospital No. 31, Professor Svetlana Chernyakevich.

Extraordinary "concert"

Irritable bowel syndrome is characterized by a whole "bouquet" of unpleasant symptoms, among which the main place is occupied by rumbling and pain in the abdomen (especially in the evenings), feeling permanent bloating, flatulence, unstable stool (constipation or, conversely, diarrhea). Pain can increase after suffering stress or eating certain foods (milk, black bread, fresh vegetables and fruits). But after going to the toilet discomfort usually subside.

At the same time, there are practically no organic changes in the large intestine with IBS, and yet this is not a harmless "sore" at all, since over time a functional disorder threatens to turn into a serious pathology. In addition, poor bowel function is often combined with dysbiosis - an imbalance of "good" and "bad" bacteria, which inevitably leads to a deterioration in immunity.

To the exit!

Fighting this disease on your own is not only useless, but also dangerous - you can overlook more serious problems. Therefore, you first need to undergo a diagnosis, the purpose of which is to exclude organic disorders in the small and large intestines. Which one diagnostic method to choose, the doctor decides, based on the patient's complaints.

Sigmoidoscopy - a study using a special apparatus of the last 15-20 cm of the rectum - helps to identify most diseases (including cancer) at an early stage.

Colonoscopy is an endoscopic examination of the inner lining of the large intestine along its entire length: from the rectum to the caecum. A flexible endoscopic light guide tube is inserted into the patient's anus, and an image of his " inner peace". The procedure is not the most pleasant, but tolerable, besides, it takes place under premedication (relieving spasms and analgesic intramuscular injection).

Irrigoscopy - X-ray of the colon with a contrast suspension. Allows you to see the organ in its unchanged form (during colonoscopy, the colon is inflated from the inside).

Find a provocateur

It is advisable to perform an ultrasound of the organs abdominal cavity. According to the results of a blood test and ultrasound, the doctor will conclude whether the patient has a concomitant pathology of the gastrointestinal tract. Alas, as a rule, it is. Often, IBS occurs along with gastroesophageal reflux, a disease in which acidic contents are thrown from the stomach into the esophagus.

Other problems can also be associated with irritable bowel syndrome. In this case, you will first have to treat the main disease, and only then - its consequence.

Treatment of IBS is symptomatic, meaning it depends on the specific symptoms. With pain and cramps in the abdomen, a four-week course of antispasmodics (drugs that relieve intestinal spasms) is prescribed, with diarrhea - “fixing” the stool, with constipation - laxatives, with bloating - carminative.

Away with anxiety!

Often, psychotherapists also take part in the treatment of patients suffering from irritable bowel syndrome. It has long been noticed that irritable, suspicious and depressed people often have problems with the intestines. Why? It turns out that in the wall of the colon, in the nervous system and brain structures, the same neurotransmitters are present - special cells that provide all the most important regulatory processes.

Prolonged irritation, chronic stress, accompanied by a sense of anxiety, often lead to pain and rumbling in the abdomen. By suppressing these emotions, we aggravate our ill health, and by coping with them, we can forget about the disease. If necessary, in stressful situations, doctors advise patients with IBS to resort to the help of anti-anxiety drugs. And, of course, you can not do without a diet, which should depend on the nature of the problems with the stool.

Eating with frequent stools

Nutrition with a tendency to constipation (a fractional diet is recommended - 5-6 times a day. Steamed food, boiled.)

Irritable Bowel Syndrome, or IBS in other words, is a persistent functional disorders in the work of the intestines, expressed in chronic discomfort, pain and cramps in the abdomen and accompanied by a change in the frequency and consistency of the stool in the absence of organic causes. This is even more likely not a disease, but a syndrome that has a psychological basis and arises as a result of the reaction of an overly sensitive intestine to stress and other adverse life situations.

IBS is considered one of the most common diseases in the world, it affects up to 20% of the adult population of the Earth. Doctors note that the syndrome often manifests itself between the ages of 25 and 40, although it often begins in childhood and adolescence. In the fairer sex, this pathology is observed twice as often as in men. It is noted that in most cases people with irritable bowel syndrome do not seek medical help on time, as they consider the malaise to be the result of malnutrition or physiological characteristics organism.

Today, most physicians believe that main reason that causes IBS is stress and psycho-emotional overstrain. Permanent negative emotions, depression, anxiety, panic disorders adversely affect the state of the nervous system, constantly maintaining it in an excited state.

This leads to impaired intestinal motility and excessive sensitivity of its inner lining to any adverse effects. In such circumstances, even minor errors in the usual diet or the consumption of a particular food can cause IBS symptoms. In addition, there are a number of possible causes causing pain and discomfort. It:

The more of the above factors that cause IBS, the more its symptoms will manifest.

Symptoms of the disease

Symptoms of irritable bowel usually appear after eating and are paroxysmal in nature. Discomfort and pain last from two to four days, after which they disappear without a trace. About availability this disease they say in the case when the symptoms persist for a long time (more than a month) or unpleasant and painful manifestations recur within the last three months, and every month lasts 2-3 days in a row.

Main symptoms:

• Cramps and pain in the abdomen that go away after a bowel movement. The nature of the pain is wandering, the patient cannot accurately determine the place of its localization
• Constipation (stools less than three times a week) or, in some cases, these conditions may alternate
• Excessive gas formation (flatulence)
• Swelling and bloating
• Sudden and intense urge to defecate
• Feeling incomplete emptying bowel after stool
• The appearance of mucus in the stool

In addition to these symptoms, there are general signs of the disease that are not related to intestinal symptoms:

• Anxious and depressive states, headache
• Pain in the lumbar region, cardiac arrhythmias
• Decreased libido
• Frequent urge and discomfort when urinating
• Autonomic disorders
  a (chilliness, lump in throat, shortness of breath)

Signs of intestinal irritation may appear immediately after eating, or in a stressful situation. In women, symptoms of IBS may occur before menstruation.

Classification of irritable bowel syndrome

Depending on which symptom is the leading one, intestinal irritation is divided into three types:

1. IBS with diarrhea
2. IBS with a predominance of constipation
3. IBS with crampy abdominal pain and flatulence

How is IBS diagnosed?

Since this disease does not cause pathological changes in the gastrointestinal tract, there is no single test to determine the disease. To diagnose an ailment, an experienced doctor must exclude other possible diseases with similar symptoms. If at least two of the following symptoms are present, the specialist may suspect that the patient has IBS:

• The patient complains of constipation or diarrhea, pain or bloating that disappears after a bowel movement
• Frequent sudden urge to defecate, feeling of incomplete emptying of the bowels after it, the appearance of mucus in the feces
• Unpleasant symptoms are most pronounced after eating.

Having identified these symptoms, the doctor may prescribe a series of studies that help confirm the diagnosis. General and biochemical analysis blood. The study will determine the number of blood elements such as leukocytes, erythrocytes, platelets. The erythrocyte sedimentation rate (ESR) and the number of leukocytes will indicate whether there is an infectious process in the body.

Analysis for celiac disease. It will help to eliminate such diseases of the digestive tract as celiac disease. A blood test is done to check immune response body for gluten. This reaction causes damage. small intestine and causes frequent bouts of diarrhea and indigestion.

Colonoscopy and sigmoidoscopy. for the study of the rectum and colon, and sigmoidoscopy will allow you to examine the rectum and sigmoid colon. Such examinations are carried out after special preparation of the patient, the procedures are performed in medical institution experienced professionals.

MRI and CT scan . Appointed in order to exclude such serious illness, fecal stones, inflammation of appendicitis or cancer.

Treatment of IBS (irritable bowel syndrome): drugs and folk remedies

Complex therapy in the treatment of irritable bowel syndrome includes the use of medications in combination with the correction of psycho-emotional states and adherence to a certain diet.

Drug therapy for IBS includes the use of the following drugs:

Considering the fact that stress factors play an important role in the event of a disease, psychotherapeutic measures will help to significantly improve well-being and reduce the intensity of IBS manifestations. Patients with a similar diagnosis are advised to consult a psychotherapist. Psychological techniques will help reduce the level of anxiety, help to avoid panic attacks learn how to deal with stressful situations and respond appropriately to problems.

Hypnotherapy successfully reduces the influence of the subconscious mind on the appearance of certain clinical symptoms diseases. Psychological trainings with the use of relaxation techniques allow you to calm and strengthen nervous system. Yoga classes, special breathing exercises and meditation will teach you how to quickly and properly relax. And physical education and therapeutic gymnastics help to strengthen the body and improve the nervous system.

Diet for IBS: Proper nutrition

With irritable bowel syndrome, a very important factor is the observance of a certain diet. It should contribute to the normal operation digestive system, be balanced, rich in vitamins and essential nutrients. With constipation, the right diet performs a cleansing function, with diarrhea it reduces indigestion. It is necessary to eat fractionally, in small portions, every three to four hours, the daily caloric content of the diet should not exceed 2500-2800 Kcal.

With IBS, it is necessary to exclude from the diet products that cause putrefactive and fermentation processes in the body, nausea and bloating. Give preference to foods high in protein and dietary fiber, and discard those that the body does not tolerate well.

If the syndrome is accompanied by constipation, include foods that improve motor function intestines:

With constipation, flour and confectionery products from pastry dough, kissels, mucous soups, pureed cereals, chocolate, strong coffee, and tea are excluded from the diet. If flatulence torments during constipation, whole milk is removed from the diet, Rye bread, legumes, grapes, cabbage, potatoes.

Nutritionists advise eating beets, prunes, freshly squeezed vegetables and fruit juices, carrot, pumpkin. Refuse hot dishes, they should be served warm. If IBS occurs with diarrhea, the products included in the daily menu should reduce intestinal motility. You can not eat foods that provoke liquefaction of the stool and stimulate bowel movements. Products recommended for use:

Sausages, sugar, salt, spices, seasonings, sauces, spicy and pickled dishes are removed from the diet. Exclude from the menu fruits, vegetables, fatty fish and meat, whole milk and fresh dairy products, bread with bran, flour products from pastry, carbonated drinks. Food is taken in small portions, as often as possible, up to six times a day. Such a low-calorie diet is not prescribed for a long time, as it can cause vitamin and protein starvation and lead to depletion of the body.

Treatment of IBS (Irritable Bowel Syndrome) with folk methods

Before using funds traditional medicine it is necessary to consult with a gastroenterologist and the attending physician and avoid factors that provoke the occurrence of the syndrome. Try during treatment to refrain from alcohol, smoking, eat right and avoid physical activity and nervous tension.

These are good for diarrhea medicinal plants like sage, white cinquefoil, serpentine, blueberry. From medicinal herbs you can prepare decoctions and infusions, and brew strong tea with blueberries. Take off pain herbs such as fennel, mint, valerian will help. With severe flatulence, anise, cumin and chamomile help perfectly.

As preventive measures with irritable bowel syndrome, doctors advise quitting smoking and alcohol, leading an active lifestyle, not overeating, including foods rich in fiber in the diet, playing sports and avoiding stressful situations.

It is necessary to refuse products, irritating intestines, eat whole grain bread, dairy products with bifidobacteria, drink up to one and a half liters of fluid daily. This will help to achieve normal bowel function and avoid unpleasant symptoms.

In any case, patients with IBS should not start the disease, take into account their individual characteristics when compiling the menu, do not look for recommendations and folk remedies on Internet forums, and in time to seek help from specialists. The doctors will necessary examination, will help adjust the menu and prescribe all the necessary medications. Only by joint efforts can we achieve an improvement in well-being and defeat the disease.