SBS stands for short bowel syndrome. With some bowel diseases, it is unavoidable to remove diseased parts of the small intestine. If large parts of the small intestine have to be removed, short bowel syndrome can develop.
What is short bowel syndrome?
The symptoms of short bowel syndrome depend on the cause, the remaining length of the small bowel and the area of the bowel that had to be surgically removed. The shortened intestine and the associated lack of nutrients can cause problems in various organs.
The medical term short bowel syndrome (SBS) summarizes a number of complaints that can lead to considerable loss of bowel length and insufficient digestion and processing of nutrients after surgical interventions. See AbbreviationFinder for abbreviations related to SBS.
If only 60 to 100 centimeters remain in the small intestine, the nutrient processing can no longer be adequately secured, which leads to deficiency symptoms. Normally, the small intestine is five to six meters long, so it is understandable that a loss in length leads to health problems.
Short bowel syndrome occurs most commonly in patients with severe Crohn’s disease, but also as a result of surgery for cancer, radiation, and vascular occlusion.
Causes
The most common cause of short bowel syndrome is severe Crohn’s disease with recurrent inflammation of the small intestine. However, acute vascular occlusions in the small intestine (mesenteric infarction), colon cancer and radiation in the abdomen due to cancer, intestinal injuries, fistulas and intestinal entanglements can also lead to large parts of the intestine having to be removed.
In childhood, a short bowel syndrome usually occurs when there are complications in premature births, congenital malformations or tangles are present. Groin, umbilical and incisional hernias can also be possible causes.
Symptoms, Ailments & Signs
The symptoms of short bowel syndrome depend on the cause, the remaining length of the small bowel and the area of the bowel that had to be surgically removed. The shortened intestine and the associated lack of nutrients can cause problems in various organs. Massive, sticky diarrhea with a strong odor develops, especially when the carbohydrate content is high.
As a result of the disturbed digestion, flatulence and abdominal cramps occur, often also severe weight loss. The lack of vitamins and nutrients that occurs as a result of the shortening can express itself differently, depending on the missing substance. With a vitamin deficiency, the skin is dry, an increased tendency to bleed, and night blindness can be observed.
Likewise, a lack of vitamin B12 and folic acid can lead to anemia, accompanied by a pale skin color, exhaustion and loss of performance. The vitamin deficiency can also affect nerves in the spinal cord and cause abnormal sensations in the hands and feet, such as difficulty walking.
When there is a lack of blood salts such as magnesium and calcium, the muscles cramp and the bones ache. A lack of protein can lead to significant weight loss, and ankles and lower legs can swell from water retention.
Diagnosis & course of disease
The diagnosis of short bowel syndrome is based on the severity of the condition and which parts of the bowel had to be removed. Regular blood counts are important after an operation to determine whether the body is being supplied with sufficient vitamins and nutrients, as are regular weight checks and stool examinations in order to avoid complications in good time.
If necessary, X-ray examinations or computed tomography (CT) can also be useful to monitor the intestine. To a certain extent, the intestine is able to adapt to the new conditions and to compensate for the function of missing sections (medical adaptation). The adjustment phase after the operation can last up to a year and is initially associated with severe diarrhea, especially in the first few weeks after the operation.
As a rule, the intestines recover after a certain period of time and those affected feel an improvement in their symptoms after this adjustment phase. If medication does not help, artificial nutrition can be given temporarily or an artificial anus can be placed.
If the remaining length of the intestine is less than one centimetre, artificial nutrition may be necessary on a permanent basis. If, in severe cases, there is further weight loss despite artificial nutrition, the only solution is often an intestinal transplant.
Complications
Short bowel syndrome can cause various complications. The overproduction of stomach acid can lead to diarrhea and fatty stools. The accompanying lactose intolerance often intensifies the gastrointestinal complaints and contributes to the over-acidification of the organism. The decrease in bile acid concentration can cause gallstones and kidney stones.
This can lead to various complications such as biliary and renal colic, jaundice, urinary retention and inflammation of the ureters. In severe cases, the bile duct can become inflamed, causing fever and chills. In addition, short bowel syndrome increases the risk of oxalate stones, which are also associated with serious complications and severe pain.
In the long term, the system complex in short bowel syndrome leads to a decrease in quality of life and the development of mental problems. Problems can also arise in the treatment of short bowel syndrome. Infusion feeding can lead to infections, venous irritation, edema and long-term damage to both the cardiovascular system and the digestive tract.
In addition, a change in diet can cause pronounced fatty stools and, as a result, hemorrhoids. The preparations used to regulate stomach acid can cause sleep disorders, skin reddening and other side effects. Colestyramine, which is prescribed for kidney and gallstones, can trigger nausea, heartburn, loss of appetite and the like.
When should you go to the doctor?
Short bowel syndrome occurs when parts of the small intestine have to be removed due to a disease. Due to the shortened small intestine, affected people often suffer from sticky diarrhea. Immediately after the shortening of the intestine, such complaints are completely normal. In this case, there is no need to see a doctor. With appropriate medication, however, an improvement can be brought about.
After a few weeks, the intestines should have adjusted to the new conditions, so that the diarrhea should subside. If this is not the case, a doctor should definitely be consulted. However, if the small intestine has been shortened to less than 2 cm in length, then artificial feeding may be necessary. In such a case, permanent medical observation is necessary. A doctor should also be consulted in the event of long-lasting pain in the intestinal area. This is the only way to detect, treat and eliminate serious complications at an early stage. Anyone who does not undergo subsequent treatment in the case of short bowel syndrome is at risk.
Treatment & Therapy
As a rule, the intestine is switched to artificial nutrition for two weeks immediately after an operation in order to minimize the risk of massive weight loss. During this time, it is administered intravenously via an indwelling vein catheter.
In the first few weeks, severe diarrhea can occur, which must be treated with medication. In addition, fluid and nutrient intake must be monitored and nutrients supplied if necessary. After the diarrhea subsides, a normal diet can slowly be built up and the artificial nutrition gradually reduced.
If a large part of the small intestine had to be removed, this phase can take longer. If symptoms persist, although the remainder of the small intestine is long enough, a piece of the small intestine can be surgically cut out, rotated 180 degrees and sewn on again in the same place.
The intestinal musculature then ensures that the food pulp is transported back in the direction of the stomach in waves. As a result, the food stays longer in the intestine and the absorption of nutrients is promoted.
Outlook & Forecast
Life expectancy in short bowel syndrome is based on the type and severity of the underlying disease and its course. Depending on which parts of the intestine have to be removed and the length of the remaining intestine, parenteral nutrition may be necessary. If the residual bowel length is less than one meter, the patient usually needs constant care. Age, general condition and any concomitant diseases also have an influence on the prognosis. Complications can also occur that worsen the prognosis.
Through a healthy lifestyle and compliance with medical guidelines, patients can now lead a relatively high quality of life. With a mild short bowel syndrome, there are often only a few restrictions. Those affected then only have to consult the doctor regularly so that the symptoms can be monitored and any complications can be recognized at an early stage. The prognosis in this case is very good.
A complete cure for short bowel syndrome is not yet possible. After the patient has undergone surgery, infections can develop, which can be life-threatening. Even with an extremely short remaining length of the intestine, there may be an acute danger to life for the patient. In these cases, constant medical supervision is necessary.
Prevention
In general, no prevention is possible with short bowel syndrome, but those affected can ensure that the residual bowel is spared and the condition does not worsen by following behavioral measures. In order to achieve this, it is important to follow the diet recommended by the doctor, to have regular check-ups, to take the medication as prescribed and to see a doctor immediately if there are any complications.
Aftercare
Aftercare measures are usually very difficult in the case of short bowel syndrome and in many cases are not even possible. Therefore, sufferers of this disease should consult a doctor very early on, so that no further complications arise. If the short bowel syndrome is not treated, there will inevitably be significant limitations in the quality of life of those affected.
In most cases, after the surgical intervention that led to the short bowel syndrome, no special aftercare measures are necessary. The diarrhea usually returns on its own after a few weeks, so there is no need to see a doctor. This should only be done if the diarrhea has not gone away on its own after a few weeks.
In severe cases, however, those affected with short bowel syndrome are dependent on artificial nutrition, so that the help and care of the affected person by their own family has a positive effect on the further course. As a rule, regular check-ups by the doctor are also necessary in order to identify and treat other damage to the intestines at an early stage.
You can do that yourself
What measures short bowel syndrome patients can take to reduce symptoms and support the healing process after surgery depends on the causative disease.
Basically rest and bed rest apply after an operation. The previous diet may be continued, although initially only small portions of easily digestible food should be eaten. Meals should consist of fish and lean meats, eggs, milk and milk products, potatoes, root vegetables and low-acid fruit and are best divided into six to eight small portions. The fat intake can be increased slowly, always accompanied by medical check-ups. Adequate fluid intake is also important, especially if diarrhea has occurred. For example, isotonic drinks, juice spritzers, sweetened tea or water have proven themselves.
In addition to these dietary measures, steps must be taken to alleviate the individual symptoms. Drugstore products help with dry skin, as do natural ointments and lotions made from chamomile, lemon balm and other medicinal plants. Diarrhea, flatulence and anemia should go away on their own after a few days or weeks, provided the diet prescribed by the doctor is followed.
