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    Suggest treatment for symptoms of irritable bowel syndrome

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Posted on Mon, 24 Jul 2017 in Digestion and Bowels
Question: I have extreme diarrhea at least 3 or 4 times each week. I have had this for over 10 years. I have had many doctors but no one has come up with any answers. I also have to go to the hospital once a week because my magnesium is below l and my coumadin level is also very low. We have tried many medicines ordered by the doctors, but nothing works to stop this aggravating problem. I am 79 years old, have had 2 heart attacks 30 yrs ago and cannot do much exercise because both knees have severe damage. I also have diabetes . My name is XXXX, YYYY@YYYY . I would very much appreciate any suggestions you may have. Thank you very much.
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Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Irritable bowel syndrome.

Detailed Answer:
Hi XXXXXXX
Thanks for choosing HealthcareMagic for your query.
I am a Gastroenterologist and would be answering your query.
Have gone through your details and i appreciate your concerns.
You are suffering from irritable bowel syndrome.

Firstly small briefing for Irritable bowel syndrome and why every patient is a unique case when we deal with IBS.
In IBS there is some problem in the functional ability of the gut that leads to the symptoms of irritable bowel syndrome. The structure of the intestines is normal, only functional abnormality occurs in this condition.So frankly speaking (IBS) represents a functional disorder of gastrointestinal tract without the presence of an anatomic defect.

Recent studies by French scientists have indicated that the most important mechanisms include visceral sensitivity, abnormal gut motility and autonomous nervous system dysfunction. The interactions between these three mechanisms make bowel's function susceptible to many exogenous and endogenous factors like gastrointestinal flora, feeding and psychosocial factors.

Further data indicate that according to the above mechanisms, the influence of genetic factors and polymorphisms of human DNA in the development of IBS is equally important.

So in lay mans language till date we are not sure whats the exact cause of this problem.So the million dollar question is how to repair a system when you don't know which part of it is faulty(Some says it can be brain other says it can be hormone anxiety age etc etc).

Some patients have symptoms of unformed stools some have bloating and some may have severe constipation. Some patients have occasional symptoms whereas others may have symptoms for a long period of time.So as seen above every patient is different.Intensity of symptoms in every patient is different as so is the response to medicines and life style change.A patient may respond good to one medication while other patient is totally unresponsive to the same.

Our goal-
Every drug is not effective in every patient so we have to try different therapies till we find the drug which suits best our patient.All the below mentioned drugs slows down motility of intestines hence will decrease both frequency of motions as well as will increase your power to control them.


Dicyclomine is an anticholinergic drug.An anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system. Anticholinergics inhibit parasympathetic nerve impulses by selectively blocking the binding of the neurotransmitter acetylcholine to its receptor in nerve cells.

Mebeverine is an antispasmodic medicine and is very useful in IBS and is well tolerated by patient with minimal side effects. Mebeverine works on certain muscles in the wall of your intestines, causing them to relax.

Clidinium bromide is an anticholinergic (specifically a muscarinic antagonist) drug. It may help symptoms of frequent stools.

Chlordiazepoxide works by increasing the action of GABA, a chemical messenger which suppresses the abnormal and excessive activity of the nerve cells in the brain.Can be used in combination with above mentioned medicines.


Ask your Gastroenterologist to start you initially on clidinium bromide and mebeverine (tablet cibis 8mg thrice daily) combination with loperamide 2mg twice daily initially for 21 days.

Along with it take a probiotic twice daily like VSL#3.Why?
The bacteria in our gut (mostly in the large intestine) in considered beneficial, helping us digest all kinds of food. The team of scientists, the bacteria inside our gut influences our maturation, immune system development, metabolism, and production of essential biocompounds. Moreover, it has been proven that a number of diseases are associated with changes in our gut bacteria, he gastrointestinal tract is a complex system that allows the body to digest and absorb food while moving wastes for excretion. For the intestinal tract to function properly, normal flora must be present. Intestinal flora are types of microorganisms known as probiotics that live normally as part of the intestinal tract. These organisms have several functions that help the body, but also gain benefits from their hosts. For example, these microbes reside in the intestinal tract, where they receive nutrients for growth. Intestinal flora are found in both the large and small intestines. Intestinal flora might aid in food digestion to form other components. For example, Lactobacillus acidophilus creates lactic acid and hydrogen peroxide in the intestine during the digestive process as it breaks down food, according to the University of Maryland Medical Center. The resulting products might serve other purposes as well, such as for immunity. Additionally, some intestinal flora might help with digestion by breaking down proteins or helping the body digest dairy products.In patients with long term IBS this flora is severely hampered hence a probiotic should be taken regularly to restore it.

Follow up after 21 days.
Al these medicines are safe for diabetic and cardiac patients.

Thanks.




Above answer was peer-reviewed by : Dr. Kampana
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Answered by
Dr.
Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2435 Questions

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