Irritable bowel syndrome has these symptoms such as decreased sleep at night, depression, musculoskeletal pain or fibromyalgia, decreased sexual performance, and inadequate attention. IBS can be diarrhea-predominant or constipation predominant or mixed.
In the case of diarrhea-predominant IBS, it is better to avoid eating vegetables, flour containing products and other foods containing FODMAP (Fermented foods containing oligosaccharides, monosaccharides, and polyols). It is helpful for some patients. After having repeated counseling, they need pharmacotherapy. I advise taking Chlordiazepoxide with Clidinium bromide and a probiotic combination trial. It helps for some persons.
In the case of constipation-predominant IBS, I advise stool bulking agents like psyllium husk or lactulose to the patient. For the depression and musculoskeletal pain, I usually prescribe Duloxetine which works better than SSRI (selective serotonin reuptake inhibitors). But in cases when the musculoskeletal pain is not severe, I advise SSRI. If any further doubts consult a gastroenterologist.
Hyperacidity is a common problem seen in these type of patients. Treat with a short course of PPI (proton pump inhibitors) first and then downgrade to Ranitidine after the symptoms get controlled. In some patients, counseling plays an essential role in the treatment of IBS.
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