Irritable bowel syndrome, or IBS, constitutes a functional disorder of the colon characterized by recurrent episodes of abdominal pain or discomfort accompanied by diarrhea, constipation or both. Many patients develop IBS for the first time after an insult to the gastrointestinal tract, such as surgery. Patients with pre-existing IBS may find that their symptoms get worse after surgery.
Causes of Post-Operative IBS
Surgery, particularly gastrointestinal surgery, sets the stage for IBS by mechanically severing the connection between nerves in the bowel and nerves in the brain. This triggers the influx of inflammatory mediators into the gastrointestinal tract and disrupts the balance of beneficial bacteria that live there--as a result of antibiotic prophylaxis, bowel cleansing regimens, disruption in nutrition or all three. Post-operative infections of the gastrointestinal tract, such as clostridium difficile, increase the risk.
Diagnosis
Doctors usually diagnose IBS "clinically," which means on the basis of history and physical examination findings. For patients who have undergone surgery, a doctor will usually order diagnostic tests such as X-ray, CT scan, blood tests and/or colonoscopy to exclude complications of surgery or exacerbation of the initial disease as possible causes of new symptoms or symptoms that get worse.
Course
According to Dr. Chung Owyang, chief of gastroenterology for the University of Michigan health care system, patients with IBS typically experience a chronic course with symptoms that wax and wane over time. Some patients with IBS also develop other functional disorders such as fibromyalgia, back pain, headaches, and genital or urinary problems.
Lifestyle Change
Treatment for all patients with IBS begins with lifestyle change including a high fiber diet, increased physical activity and stress management. Patients with pre-existing IBS should ask their surgeons for specific recommendations on diet and activity for the first few weeks after surgery.
Medication
Medications used to treat IBS include stool bulking agents, antispasmodics, anti-diarrheals, antidepressants, chloride channel activators, probiotics and antibiotics. Medication choice depends on the type of symptoms the patient experiences--mostly diarrhea, mostly constipation or both. Patients with pre-operative IBS which responded to lifestyle change may find that they require medications post-operatively.
References
- Irritable Bowel Syndrome (chapter); C. Owyang; In: "Harrison's Principles of Internal Medicine, 19th edition;" A.S. Fauci et al. (eds.); 2008
- "The American Journal of Gastroenterology;" An Evidence-Based Systematic Review on the Management of Irritable Bowel Syndrome
- American College of Gastroenterology: Understanding Irritable Bowel Syndrome
- National Institutes of Health: What I Need to Know about Irritable Bowel Syndrome
