Gastrointestinal

Irritable Bowel Syndrome (IBS)

آئی بی ایس

Recurrent abdominal pain with constipation-predominant or diarrhoea-predominant bowel habit, triggered by stress and meals, with unremarkable examination.

ICD-10: —
Source: OPD handbook pp.92–99
Status: Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

Constipation-predominant: off and on constipation, triggered by stress and meals, pain abdomen (examination unremarkable)
Diarrhoea-predominant: loose stools off and on, exaggerated by stress; no weight loss

Diagnosis

Examination unremarkable in both types

Treatment

Step 1 of 4

1. Reassurance (both types)

Urdu note: reassure that this is not a dangerous disease; stress or some foods can worsen it

Step 2 of 4

2. Constipation-predominant IBS

Isphagol husk 2 teaspoons in curd or juice
Antispasmodic: Tab Spasler-Neo 135 mg (mebeverine) 1+1
TCA: Tab Tryptanol 10 mg (amitriptyline) at night
Sodium picosulphate (Laxoberon) is the drug of choice for constipation (Tab Laxoberon 5 mg, 2 tabs if constipated)

Prescription

Ispaghula (Isabgol) huskBulk-forming laxative

Dose2 teaspoons in curd or juice

Brand Isphagol husk

MebeverineAntispasmodic (IBS)

Dose1+1

Brand Tab Spasler-Neo 135 mg

Also sold as Spasler-Neo, Zeespa, Mebever, Colofac

AmitriptylineTricyclic antidepressant

Dose1 at night

Brand Tab Tryptanol 10 mg

Sodium picosulphateStimulant laxative

Dose2 tabs if constipated

Brand Tab Laxoberon 5 mg

Also sold as Laxoberon, Skilax

Step 3 of 4

3. Diarrhoea-predominant IBS

Antispasmodic: Tab Spasler-Neo 135 mg 1+1
Antidiarrhoeal: loperamide, Cap Imodium 2 mg BD
Second line: TCA, Tab Tryptanol 10 mg 1+0 at night
Refer to a consultant if not controlled

Prescription

MebeverineAntispasmodic (IBS)

Dose1+1

Brand Tab Spasler-Neo 135 mg

Also sold as Spasler-Neo, Zeespa, Mebever, Colofac

LoperamideAntidiarrhoeal

DoseBD

Brand Cap Imodium 2 mg

AmitriptylineTricyclic antidepressant

Dose1+0 at night

Brand Tab Tryptanol 10 mg

Second line

Step 4 of 4

4. Counselling (constipation sample, Urdu notes)

Use isphagol husk
Avoid beef (bara gosht), rice and oily things
Fix meal times and the quantity of food
Increase fruit and vegetables
Create a stress-free (tension-free) environment

Sample prescriptions from the book (patient details removed)

Female, 40 y, IBS (constipation): constipation for 25 years off and on with headache and abdominal cramps, exaggerated by tension and stress: Tab Spasler-Neo 135 mg 1+1; Tab Tryptanol 10 mg 1+0 at night, continue; Tab Laxoberon 5 mg 2 tabs in case of constipation; isphagol husk; avoid beef, rice, oily things; fix mealtimes; more fruit and vegetables; stress-free environment.
Male, 26 y, IBS (diarrhoea-predominant): loose stools exaggerated by stress, with abdominal cramps: Cap Imodium 2 mg 1+1 morning/evening; Tab Spasler-Neo 135 mg 1+1 (when abdominal pain, per the Urdu note); Tab Tryptanol 10 mg 1 at night.