腸躁症的防治

腸躁症的防治

楊惟婷整理

 

腸躁症是最常見的腸胃症狀之一,但也是最常被誤解的疾病之一。

據統計,歐美國家因為腸躁症不舒服請假的天數,多到跟感冒一樣。

 

大部分人會以為「腸躁症」就是「腸子」的問題,甚至會因為擔心肚子長瘤,到醫院做了許多沒必要的檢查,浪費時間,結果症狀也沒改善。

 

其實,腸躁症是個複雜、但不會要人命的症候群,很難「藥到病除」,需要長期調養。以下整理一些腸躁症的防治方法:

 

一、腸躁症的特色

 

腸躁症的特色如下﹕

  • 工業國家成年人隨時有20%會受腸躁症所苦
  • 到腸胃科看診的腸躁病人,有15%有憂鬱症狀、甚至自殺意念
  • 憂鬱常惡化便秘,焦慮會加快腹瀉
  • 腸躁症體質的人,日常生活的壓力就有可能誘發腸躁症
  • 腸躁症常因為半年前頻繁的壓力事件而爆發
  • 男女性罹患腸躁症的機率均等,但女性看診次數比男性多一倍
  • 腸躁症病人有50%在35歲之前發病,90%在50歲前發病
  • 40%的腸躁症病人會因此減少社交活動
  • 在嚴重的腸胃炎之後一段時間,病人出現腸躁症的機率會增加,這是因為腸胃炎讓病人腸道神經系統功能變差了。不過這類的腸躁症「預後」最好,能夠完全治癒的比率最高。

 

腸躁症常見附屬症狀﹕

  • 腹部腫脹與腸子脹氣
  • 不規則、可能每天都不一樣的腸子蠕動
  • 消化不良
  • 頭痛、背痛、肌肉痛、疲倦、頻尿
  • 女性常見性交後疼痛

 

二、「神經失調」是腸躁症重要原因之一

 

人的腸道肌肉夾層裡的感覺受器對食物通過膨脹、與腸道肌肉攣縮的感覺往往是很靈敏。尤其腸躁症的人,對這些正常的感覺更是過度敏感,會引發疼痛、脹氣的感覺。而這過度敏感往往是因為神經失調。

 

腸躁症跟三個神經系統有關:交感神經、副交感神經或腸道神經系統的失衡,造成排便習慣改便,或對腸道脹氣、膨脹的感覺異常敏感。

 

三、每個人的腸躁症狀都不太一樣

 

腸躁症的英文是irritable bowel syndrome,syndrome就是「症候群」,意思是許多常見症狀的組合,但沒有確定的病因、以及確定診斷的病名。腸躁症無法以任何醫學檢查來確認,醫師只能從病人描述的症狀來判斷。

 

原本腸躁症有一套很複雜的診斷準則,但後來臨床醫師的標準越來越寬鬆,因為每個人的表現症狀都不太一樣,但從結果來看都是腸躁症。現在只要有「慢性、反覆的腹痛與不適,加上排便習慣改變」,然後又找不到其他腸道器官的損傷,臨床上就會當做是「腸躁症」。

 

四、腸躁症可能會長期存在

 

腸躁症通常跟個人體質與長期壓力有關,一旦出現腸躁症,這些症狀可能會長期出現,就算用藥物硬壓症狀,也可能會從另一個地方跑出來。病人應學習改善體質、減輕症狀的方法,但也得習慣跟腸躁症和平相處。想辦法讓症狀緩和下來、學習漸漸別太在意症狀,腸躁症的負面影響就會越來越小。

 

五、不用過度擔心腸躁症

 

腸躁症的症狀不會劇烈起伏,有腸躁症的人,平均壽命也不會縮短。

亦即腸躁症不會自己突然惡化成嚴重的癌症或腫瘤,變成致命疾病或重大傷害的機率也幾乎等於零。

 

治療腸躁症很重要的是:不要只是聽症狀然後直接給藥。跟病人解釋腸躁症的原理,讓病人了解腸躁症會長期存在,但不會有重大併發症,平常心面對,反而對病情會有幫助。

 

六、腸躁症跟壓力沒有絕對關係

 

雖然腸躁症跟神經失調高度相關,但最原始的病因可能是「體質」,不一定跟什麼很大的「壓力」有關。

 

不過,腸躁症不舒服起來,可是會增加焦慮、煩躁、失眠的症狀,甚至讓一些病人不敢出門、導致心情變差,所以反過來說,腸躁症本身就是一個「壓力」。

 

統計上,一些社會壓力如失業、親人過世、夫妻爭吵、財務困難、人際障礙,還是有可能誘發腸躁症變嚴重。

 

七、腸躁症沒有特效藥

 

有時,腸躁症病人可以藉由消脹氣、止痛、止瀉或軟便的藥物做「症狀治療」,但由於腸躁的主因是「神經失調」、不同人症狀的個別差異很大,所以目前並沒有腸躁症的特效藥,藥物治療的成效往往有限。病人常需要嘗試各種不同的藥物與非藥物的治療方式,或尋求不同醫師的協助。

 

但有研究指出,可多選擇高營養密度的蔬果,其中含有豐富膳食纖維的奇異果,更能有效幫助改善便秘型腸躁症狀。

 

奇異果內含的寡醣、膳食纖維以及特有的奇異酵素,這些都有助於減緩便秘,寡醣為一種「益生質」,有利於腸胃中好菌生長及促進蠕動,而膳食纖維具有高度保水性,能軟化糞便,幫助排便。另外,奇異果所含的奇異酵素(Actinidin)能促進蛋白質分解,幫助胃部排空,並加速消化道蠕動,刺激大腸黏膜,增加排便,

避免壞菌生長,減輕腸胃道的負擔。

 

除了奇異果外,鳳梨、木瓜、無花果都含有酵素,建議有便秘困擾的民眾都可以多多食用。

 

八、改善神經失調,可望減輕腸躁症狀

 

腸躁症主要來自腸道神經系統的過度敏感,而自律神經系統(交感與副交感)又會影響腸道神經系統。所以,只要是可以改善自律神經失調的藥物,或有氧運動、瑜伽、腹式呼吸、氣功、靜坐、催眠等,都有可能改善腸躁症狀。充足的睡眠也很重要。

 

九、腸躁症的飲食禁忌

 

腸躁症病人可能會對某些食物「過敏」,激起強烈胃腸不適,這有時必須靠病人自己察覺。大體來說,高含量的油脂、咖啡因、高纖維的食品,較容易惡化腸躁症。

傳統觀念認為,腸胃不好就是要吃稀飯、牛奶、地瓜、豆漿等對腸胃好的食物,減少消化負擔,但這種想法在醫生眼裡根本適得其反,更容易脹氣拉肚子!

 

胃腸肝膽科醫師張振榕表示,大腸激躁症患者最需注意的是避免脹氣,地瓜、豆漿、大蒜、洋蔥等高產氣食物,絕對不行吃。

 

十、精神科醫師的畫龍點睛

 

改善腸道神經失調的藥物,就是精神科醫師最擅長、最常開的藥物。而腸躁症拖久後,容易併發失眠、焦慮症狀,這也可以讓精神科醫師一併處理。花時間為病人解釋腸躁症,讓病人不會因為腸躁症過度擔憂、慮病,這是精神科醫師的專長。

 

其實不只腸躁症,像胃食道逆流、胃潰瘍等容易受壓力影響的腸胃疾病,同時看精神科往往會好更快。

 

如果腸躁症已經影響到生活品質,除了看胃腸科外,請記得也要到家裡附近的精神科診所聽聽醫師的建議。

 

 

本文主要資料來源:Understanding Irritable Bowel Syndrome。

作者:Dr Kieran J. Moriaty

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