Irritable Bowel Syndrome In The Emergency Department
P J Whorwell / Editor: Charlotte Davies / Codes:CAP1, CAP2, HAP1, ACCS LO 2, GC4, GP1, MHC6, MHP3, PC1, PC2, SLO1, SuP1 / 10/09/2019
Toni is a 35 year old lady who attends the emergency department regularly with chest pain. Nothing seems to make it better, and her troponin is always normal. You wonder if there is a potential cause. Read on to find out that there is more to IBS than abdominal pain.
The characteristic symptoms of irritable bowel syndrome are abdominal pain, abdominal bloating or distension coupled with a disordered bowel habit in the form or constipation, diarrhoea or an alternation between the two. In addition, many patients also suffer from a range of non-colonic symptoms such as low backache, constant lethargy, chest pain, urinary frequency or urgency and in females, gynaecological symptoms.
All investigations in patients with IBS will inevitably be negative as it is a disorder of function of the whole length of the gastrointestinal system rather than being a structural problem. Consequently, investigations should be limited to ruling out realistic alternatives for the cause of a particular patients symptoms rather than being exhaustive. Nothing disillusions a patient more than being told that all the tests are normal with the implication that there is nothing wrong with them.
The Usual Ibs Pain Locations And Characters:
IBS pain is usually located at the umbilicus and lower abdomen. The most common locations are:
- At the belly button ,
- At the upper central part of the abdomen
- At lower abdomen .
But IBS pain can occur anywhere all over the abdomen. And it can even occur in locations outside your abdomen!
The diagram below is acquired with modification from the Journal of Gastroenterology and Hepatology explaining the common typical IBS pain locations.
The numbers below will give you an idea about common IBS pain areas.
1- Around the umbilicus : the most common in 39% of patients.
2- In the upper central part of the abdomen: 2nd most common, 33%
3- In the lower central abdomen: 13%
4- in the lower left abdomen: about 7%
5, 6, and 7 are less common locations.
These numbers are approximate. And other studies showed slightly different distributions of IBS pain.
Ibs Pain Under The Ribs In The Left Side :
IBS pain occurring on the left side is more commonly present in the left lower part of your abdomen. Less commonly, IBS pain occurs under the ribs of your left side. This area overlies the stomach, spleen and the pancreas.
IBS pain in this area can be confused with:
- Functional dyspepsia: a sense of fullness and bloating for hours starting after meals. Unlike IBS, It is more like discomfort, not colics. Functional dyspepsia is associated with nausea and maybe vomiting.
- Pain from Gastritis or stomach ulcers:
- Pancreatitis: severe agonizing pain associated with vomiting. The most common causes of pancreatitis are obstruction of its duct by stone or tumor and alcoholism. The pain from pancreatitis usually becomes relieved when you lean forward.
IBS pain in the kidney areas :
IBS colics can occur all over your abdomen the kidney areas are not exceptions.
IBS pain in the kidney area can be confused with:
- Kidney stones: renal colic is different from IBS pain.
The renal colic resulting from a Kidney stone is:
- Colicy in nature but usually confined to the kidney area.
- Not related to meals.
- The pain is usually very intense and may be associated with vomiting.
- May become associated with turbid or bloody urine.
- Inflammatory bowel disease: Crohns disease or Ulcerative colitis.
- Chronic constipation.
- Muscular pain : Usually, it is related to movement.
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What Treatments Are Available For Non
The most common and effective treatment for other health problems that cause non-cardiac chest pain is a medicine that blocks the pain signals. Tricyclic antidepressants , used in a low dose, are the most commonly used medicines. A low dose of other types of anti-depression medicine can be used if the patient has side effects from the TCAs.
When non-cardiac chest pain is caused by a muscle problem, simple treatments, such as a heating pad, stretching exercises, or over-the-counter pain relievers like ibuprofen, can relieve the pain.
Non-cardiac chest pain can be due to stress, anxiety, or depression. A psychologist can help patients with these problems work through them so they do not cause chest pain. Talk therapy that teaches the patient how to change or eliminate thought patterns that cause stress can reduce the frequency of chest pain episodes.
Food Sensitivity And Intolerances
Sometimes food intolerances are to blame for gas pain in the chest. Eating dairy if youre lactose intolerant can cause a buildup of excess gas, causing chest pain. Similarly, if youre sensitive to gluten or have celiac disease, eating food contaminated with even a trace amount of wheat can cause similar symptoms. Gluten contamination can also cause inflammation in the intestines that can take up to six months to fully heal, negatively affecting digestion long term.
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A Pain That Is Related To Movement:
The movement-related pain is the pain that:
- Greatly increases with a tiny movement like sitting or leaning forward, and
- Nearly relieved when you obtain a fixed position and stop moving.
The IBS pain is usually the same whether you are moving or in a fixed position. Movement-related pain occurs with other conditions like inflamed organs, bone, and joint pain.
Example: A pain in the lower right part of your abdomen that greatly increases while you move your right lower limb may suggest appendicitis.
Can Ibs Cause Upper Back Pain
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Stomach Pain After Eating
Stomach pain after eating is a common problem for many people. There are many causes and different types of stomach pain, so it is important to know what type you might be experiencing.
There are a few causes that could be the culprit in your case: acid reflux, inflammation or infection, irritable bowel syndrome , appendicitis, gallstones, lactose intolerance, Crohns disease, ulcerative colitis, and more.
Sometimes all you may need is some over-the-counter medication such as ibuprofen or Tums. However, if this does not help then its time to see a doctor for further diagnosis and treatment. The sooner you can get relief from your symptoms the better!
Other Features Suggesting That The Pain Is Due To Your Ibs:
According to Rome IV criteria, the IBS Pain is:
- Associated with meals: usually, the IBS pain increases after meals. Especially known food triggers like FODMAPs and gas-producing foods.
- Associated with defecation: some IBS patients report relieve of IBS pain with defecation. Others report worsening of IBS pain during or after defecation.
- IBS pain frequency: the IBS pain is chronic, your first time experiencing IBS pain should be 6 months ago or more. The IBS pain occurs at least once per week.
- IBS pain character: IBS is described as cramps or colics. Usually associated with bloating and gas distension.
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The Connection Between Ibs And Panic Disorder
Research has indicated that rates of IBS are high among people diagnosed with anxiety disorders and/or mood disorders.
The frequency of IBS symptoms has been found to be especially high for people diagnosed with anxiety disorders such as panic disorder. Much like panic disorder, IBS poses many distressing symptoms that can be embarrassing and difficult to manage.
Recurrent and often unexpected panic attacks are the main symptom of panic disorder. Similar to IBS, panic attacks are characterized by many uncomfortable physical sensations. Some of the most common symptoms of panic attacks include sweating, trembling, chest pain, accelerated heart rate, and shortness of breath.
Both conditions also share many of the same symptoms, such as anticipatory anxiety and avoidance behaviors. The symptoms of both IBS and panic disorder can be upsetting, embarrassing, and difficult to manage.
Shortness of breath
Symptoms of IBS
It is currently unclear why a significant percentage of panic disorder sufferers also struggle with the symptoms of IBS. It has been hypothesized that both conditions are triggered by the fight or flight stress response. The fight or flight response is prompted by the sympathetic nervous system, causing changes in the body to prepare to fight off or flee from a perceived threat. Common physical reactions include sweating, rapid heart rate, and a slowing down of the digestive system.
I Get Terribly Embarrassed At Work Because I Cant Stop Burping And Farting How Can I Make It Stop
Excess belching can be the result of eating too quickly, drinking too quickly or drinking too many fizzy drinks. It can also be caused by nervousness, which makes people swallow a lot. The bicarbonate in saliva reacts with stomach acid to make CO2, which is then belched.
Excess farting may be due to eating too much fibre , or certain vegetables whose carbohydrate cant be digested by the human gut .
Extra-smelly farts are sometimes due to having too much fat in the diet. Fats may be broken down in the large bowel by bacteria, which produce volatile, unpleasant fatty acids.
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One Symptom That Isnt Ibs
Sometimes people with IBS blame all of their digestive troubles on their disease. But that can be dangerous.
When new symptoms crop up, like weight loss or loss of appetite, always have them evaluated, advises Dr. Baggott.
One symptom that IBS does not cause is bleeding, he notes. If you have rectal bleeding or bloody stools, its not IBS. Get to a doctor.
S To Ensure You Have A Healthy Gut
There are certain steps you can take to ensure your gut is healthy. By making these adjustments to your diet you will see an overall improvement in your digestive system.
Eat fruit and vegetables to ensure you get the required vitamins and nutrients. Drink plenty of water.
Reduce your alcohol intake because drinking too much can lead to a number of health conditions and drinking while eating can cause acidity in your stomach that leads to pain.
Increase your fiber intake by including more beans, peas, legumes, fruits, and whole grains into your diet.
The above steps will help reduce pain in your abdomen after eating or drinking certain foods such as caffeine or fatty foods if consumed too often.
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Can Ibs Cause Back Pain
In addition to bloating and gas, people with IBS often develop extraintestinal symptoms, or symptoms that involve body parts beyond the gut. These may include sleep problems, headaches, urination troubles, fatigue, muscle pain, pain in the pelvis or jawand back pain.
Back pain is common among IBS patients, though the exact incidence is unknown. Studies estimate it affects between 28 and 81 percent of people with the disorder. Some experts believe that it may be referred pain, or pain that originates elsewhere in the body and is felt in the back. In research, gastrointestinal symptoms like gas and bloating have been linked to back pain.
Another possibility: People with IBS often have other health conditions at the same time, which are also frequently associated with backaches. These include interstitial cystitisa chronic illness that causes bladder pressure and painand the pain condition fibromyalgia. Studies have found that about 3 in 10 people diagnosed with IBS meet the criteria for fibromyalgia, as well.
In addition, IBS can be associated with other inflammatory conditions, including rheumatoid arthritis, which could lead to back pain. IBS symptoms with back pain should prompt you to head to the doctor so you can be sure your symptoms arent caused by any other underlying medical conditions.
Ibs Headache And Migraine Pain
How can an irritable gut make your head irritable too? Head pain and gut pain may seem like an unlikely pair, but science shows that people with IBS also commonly experience migraines and headaches.
A study published in the Polish Journal of Neurology and Neurosurgery showed that between 23 to 53 percent of people with IBS experienced frequent headaches. Additional research, published in the Journal of BMC Gastroenterology, reported that people with IBS were around 60% percent more likely to experience migraines than people without IBS.
The connection between the gut and the head works both ways. Just as people with IBS often have headaches, people with migraines often experience gastrointestinal symptoms associated with IBS during a migraine attack.
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Can You Eat Popcorn If You Have Ibs
Irritable bowel syndrome is a fairly common disorder of the digestive system.
The exact causes are not known, and there is no cure for it. With the proper diet and medicines, it is possible to manage IBS symptoms.
IBS has several triggers, like stress or drugs, but probably the most common triggers are certain foods.
If you still want to eat popcorn with IBS, we recommend eating only small amounts and see how your body reacts.
Is Pain Under The Left Rib Cage Typical For Ibs And How Common
IBS pain can be generalized or localized at any part of your abdomen, it is not common for IBS to localize in the upper left abdomen under the rib cage. According to the journal of Hepatology and gastroenterology, upper left abdominal pain occurs only in 6% of IBS patients.
The most common IBS pain locations are around the umbilicus and the upper part of the abdomen in the middle. Here is a break down of the frequency of abdominal pain according to the site :
- IBS can affect more than one location in your abdomen. Some have IBS pain or discomfort allover their abdomen.
- The above percentages are based on a small study in the journal of gastroenterology and hepatology.Although it is not a large scale clinical study, it can give you an idea about the common IBS pain locations.
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What Is Causing My Abdominal Pain
Abdominal pain is pain that you feel anywhere between your chest and pelvic region and can range from a minor problem to one needing urgent attention. Dr. Indran Indrakrishnan at Gwinnett Digestive Clinic in Lawrenceville, GA, offers the latest treatments for gastrointestinal conditions.
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What Kind Of Doctor Treats Non
The first time a person has non-cardiac chest pain, he or she usually goes to the emergency room, thinking he or she is having a heart attack. The first thing the emergency room doctor will do is make sure the pain is not a heart attack or due to heart disease.
If it truly is non-cardiac chest pain, the emergency room doctor usually refers the patient to a gastroenterologist, a doctor who specializes in digestive system disorders, for more testing and treatment.
Some people who have had several episodes of non-cardiac chest pain go to their primary care physician or a heart doctor instead of the emergency room. The doctor will follow the same steps to make sure the pain is not heart-related, then refer the person to a gastroenterologist.
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Ibs Pain Around The Umbilicus :
IBS pain is commonest in the lower abdomen, especially around the umbilicus. IBS Pain located around the umbilicus retains the typical IBS characters:
- Colicky in nature: with waves of colon contractions followed by waves of partial relief.
- Associated with gas distension and bloating.
- Usually increases after meals.
- Related to defecation: may become relieved or increased during or after you poop.
- Recurrent, but not progressive: this means that you experience IBS at least once per week for at least the previous 3 months. Usually, there are periods of remissions and flare-ups .
But if the pain becomes progressive you should consult your doctor.
Other conditions causing pain around the umbilicus :
- Early appendicitis.
Healing Irritable Bowel Syndrome With Diaphragmatic Breathing
After having constant abdominal pain, severe cramps, and losing 15 pounds from IBS, I found myself in the hospital bed where all the doctors could offer me was morphine to reduce the pain. I searched on my smart phone for other options. I saw that abdominal breathing could help. I put my hands on my stomach and tried to expand it while I inhaled. All that happened was that my chest expanded and my stomach did not move. I practiced and practiced and finally, I could breathe lower. Within a few hours, my pain was reduced. I continued breathing this way many times. Now, two years later, I no longer have IBS and have regained 20 pounds. 21-year old woman who previously had severe IBS
Generally, standard medical treatments are often ineffective in reducing abdominal IBS and other abdominal symptoms , while complementary and alternative approaches such as relaxation and cognitive therapy are more effective than traditional medical treatment . More recently, heart rate variability training to enhance sympathetic/ parasympathetic balance appears to be a successful strategy to treat functional abdominal pain in children . Sympathetic/parasympathetic balance can be enhanced by increasing heart rate variability , which occurs when a person breathes at their resonant frequency which is usually between 5-7 breaths per minute. For most people, it means breathing much slower, as slow abdominal breathing appears to be a self-control strategy to reduce symptoms of IBS, RAP and FAP.
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