Go to the toilet after eating and go to the toilet when you are nervous... These manifestations are nicknamed "rhythmia". Some people say that the "rectal" proves that digestion is good, while others say that the "rectal" is a disease. So is the "rectal" a normal physiological phenomenon or a disease?
In fact, if the above manifestations occur in a single way, most of them are normal physiological phenomena. If you are often accompanied by symptoms such as abdominal pain and/or diarrhea, and you have no parenchymal lesions after various laboratory tests and imaging examinations in the hospital, then you will consider that irritable bowel syndrome (IBS) .
1. Physiological phenomena
. Caused by high sensitivity of viscera
After the human body eats, chyme will stimulate the gastrointestinal tract and promote its peristalsis, which is a normal physiological phenomenon. Because everyone has different sensitivity to the gastrointestinal mucosa and some people have high sensitivity, the gastrointestinal tract will be more rapid and strong after eating, and the phenomenon of "rectal" will appear.
In addition, when the human body is nervous, sympathetic nerve excitation will also stimulate the gastrointestinal peristalsis to accelerate. If the internal organs are more sensitive to it, the above symptoms will occur.
. Food factors
The human body's tolerance and acceptance of each food is different. It is common in people who are lactose intolerant. After eating foods containing lactose , the gastrointestinal tract is intolerant of lactose, which accelerates its peristalsis. Some people may not know what foods tolerate (such as high-fat foods, high-protein foods, etc.), and continue to eat or consume in large quantities, and they will also defecate immediately after eating.
2. Pathological phenomena
In addition to physiological phenomena, if long-term defecation is accompanied by changes in fecal traits, repeated symptoms of abdominal pain, abdominal distension and other discomforts, you need to be vigilant about IBS!
After the promulgation of the Roman IV standard in 2016, my country updated its IBS expert consensus - "2020 China Irritable Bowel Syndrome Expert Consensus", which mentioned that "IBS is mainly symptom of abdominal pain, abdominal distension or abdominal discomfort, and is related to defecation or accompanied by changes in defecation habits such as frequency and/or fecal traits. Through routine clinical examinations, it is not possible to find organic diseases that can explain these symptoms.
. Etiology and pathogenesis
IBS has not been fully elucidated. It is currently believed that it is an abnormal intestinal-brain interaction caused by the combined action of multiple factors .
(1) Dietary factors
Dietary factors can induce or aggravate IBS symptoms. Most studies have shown that food intolerance is the main risk factor for IBS, and the number of foods that induce gastrointestinal symptoms is positively correlated with the severity of IBS symptoms.
(2) Disease factors
Foreign studies meta-analysis showed that intestinal infection is an important pathogenic factor for IBS , and about 10% of intestinal infections will develop into IBS ( OR=7.3, 95% CI 4.8~11.1). Prospective studies in my country have confirmed that the incidence of IBS in patients with a history of intestinal infection is 4 times higher than that in patients without a history of intestinal infection ( OR=2.39).
(3) Mental factors
Mental factors can interact with the surrounding and/or central nervous system, endocrine, and immune system to regulate the severity of symptoms. Therefore, has long-term mental stress, depression, tension, anxiety, etc., which can easily induce or aggravate the symptoms of IBS. Among them, depression and anxiety disorders are significant risk factors for IBS, and the incidence rate in IBS patients is 40% to 60%.
. Diagnosis
At present, the diagnosis of IBS in my country is mainly based on the Roman IV standard, and is formulated in combination with the actual clinical situation in my country. The standards are as follows:
repeated abdominal pain, bloating, and abdominal discomfort, and have any 2 or more of the following:
|Related to defecation
2| with changes in defecation frequency
|Accompanied fecal traits or appearance
symptoms appear at least 6 months before diagnosis, and meet the above diagnostic standards in the past 3 months.
At the same time, excludes alarm signs, includes age >40 years old, blood stool , positive fecal occult blood test, nighttime defecation, anemia, abdominal mass, ascites, fever, non-deliberate weight loss, colorectal cancer and inflammatory bowel disease family history.
. There is no cure for treating
IBS. The main treatment goal of is to improve symptoms and improve quality of life. At the same time, since each patient's personal condition, degree of condition and symptoms are different, needs to adopt an individualized comprehensive treatment strategy .
(1) Drug treatment (Figure 1)
Figure 1 Schematic of drug treatment classification for irritable bowel syndrome
IBS Common drugs include:
① Drugs that act on the peripheral nervous system, including antidiarrhea (such as polyethylene glycol ), GC-C agonists (such as linalide), bile acid regulators (such as geese deoxycholic acid), chloride channel activators (such as rubiprostone), etc.
② Drugs that act on the system include antispasmodic (such as piviton bromide ), antidepressants (such as doxepin hydrochloride), opioids (such as loperamide ), serotonin reuptake inhibitors (such as fluoxetine ), etc.
(2) Non-drug treatment
① Daily Recommended low FODMAP diet , that is, reduce the intake of fermentable oligosaccharide , disaccharide , monosaccharide and polyol . At the same time, avoids factors that induce or aggravate symptoms and adjusts lifestyle (Figure 2), which are both beneficial to improving IBS symptoms.
Figure 2 Adjusting lifestyle
② Psychological cognitive behavioral treatment is a necessary link in IBS treatment. A controlled study of 436 IBS patients included in 436 patients with IBS found that the proportion of standard cognitive behavioral treatment to improve gastrointestinal symptoms was higher than that of psychological education (61% vs.
3%), and the effective absolute risk measurement index was 4 (95% CI 3~9).
In short, the so-called "rectal" in life may be caused by physiological factors or pathological factors. You can first improve your daily routine by adjusting your diet and living habits appropriately. If there is no improvement or worsening of symptoms, and other symptoms are accompanied by other symptoms, it is recommended to actively go to the hospital for examination to avoid delaying the condition and affecting your health and quality of life.
References
[1] Gastrointestinal functional diseases collaboration group of the Chinese Medical Association Gastrointestinal Molecular Diseases, Chinese Medical Association Gastrointestinal Dynamics Group. 2020 Expert Consensus on Experts in China [J]. Chinese Journal of Digestion , 2020, 40 (12): 803-818.
[2] Bonetto Silvia, Fagoonee Sharmila, Battaglia Edda, et al.Recent advances in the treatment of irritable bowel syndrome[J].Polish Archives of Internal Medicine, 2021, 131, (7-8): 709-715.
Text: Feng Xiwen
