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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