Brief Answer:
Detailed answer follows.

Detailed Answer:
Hello,
Thanks for asking query on this forum.
I am a Gastroenterologist and would be answering your query.

As per you query answers are-

Firstly for Irritable bowel syndrome.
Irritable bowel syndrome is a common intestinal disorder. There is some problem in the functional ability of the gut that leads to the symptoms of irritable bowel syndrome. The structure of the intestines is normal, only functional abnormality occurs in this condition.So frankly speaking (IBS) represents a functional disorder of gastrointestinal tract without the presence of an anatomic defect.

Recent studies by French scientists have indicated that the most important mechanisms include visceral sensitivity, abnormal gut motility and autonomous nervous system dysfunction. The interactions between these three mechanisms make bowel's function susceptible to many exogenous and endogenous factors like gastrointestinal flora, feeding and psychosocial factors.

Further data indicate that according to the above mechanisms, the influence of genetic factors and polymorphisms of human DNA in the development of IBS is equally important.

So in lay mans language till date we don't know the exact cause of this problem.So the million dollar question is how to repair a system when you don't know which part of it is faulty(Some says it can be brain other syas it can be hormone anxiety age etc etc).

Some patients have attacks of diarrhea and bloating and some may have constipation. Other symptoms that may be present in irritable bowel syndrome include nausea, vomiting, headache, loss of appetite, muscular pains, heartburn, and weakness. Some patients have occasional symptoms whereas others may have symptoms for a long period of time.

So as seen above every patient is different.Intensity of symptoms in every patient is different as so is the response to medicines and life style change.

Every drug is not effective in every patient so we have to try different therapies till we find the drug which suits best our patient.

Dicyclomine 20mg four times a day is to heavy a dose for 80 year old women.
Dicyclomine ios an anticholinergic drug.An anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system. Anticholinergics inhibit parasympathetic nerve impulses by selectively blocking the binding of the neurotransmitter acetylcholine to its receptor in nerve cells(In simple words it messes up with both your peripheral and central nervous system)


Mebeverine is an antispasmodic medicine and is very useful in IBS and is well tolerated by patient with minimal side effects.Mebeverine works on certain muscles in the wall of your intestines, causing them to relax.

Clidinium bromide is an anticholinergic (specifically a muscarinic antagonist) drug. It may help symptoms of frequent stools.

Chlordiazepoxide works by increasing the action of GABA, a chemical messenger which suppresses the abnormal and excessive activity of the nerve cells in the brain.Can be used in combination with above mentioned medicines.

Another OTC medication is Bismuth sub-salicylate. It belongs to a class of medications called antacids and adsorbents marketed by name of Pepto Bismol. Doses up to 1gram can be taken daily to provide symptomatic relief.

Loperamide can be used but should be avoided.



Diphenoxylate and Atropine combination(Lomotil)-Atropine/diphenoxylate is an antidiarrheal and anticholinergic combination. .

For bloating and gas take Tab Nexium 40mg twice daily.Take a probiotic daily with food as proper digestion of food will prevent excess gas formation.
Food pattern recommended is-
Eat simple and natural home cooked food.
If possible try detox diet(Raw vegans) for atleast 3 month. Take normal food in lunch while in supper take uncooked raw natural form of food.This can play wonders.
Avoid taking excessive fibres.A total fiber intake of about 20-30 grram per day would be good for you. Any thing in excess is good for nothing.
No pizza,Burger,Red meat,and dairies for few weeks.
No alcohol or smoking.

Take natural food rich in probiotics like Yoghurt,Kimchi,etc.This doesnot mean that you have to take them as much as you can.Follow your body increase their uptake gradually.
Drink lots of juices and fresh water daily.
Avoid over spicy and heavy food.

If possible go for a detox diet but again don't force your body rather let your body adopt gradually to things.


Anal fissure and fistula-

An anal fissure is a small tear or crack in the lining of the anus so in lay mans language its an internal wound.Certain treatments can promote healing and help relieve discomfort, including stool softeners(you already have soft stools) and topical pain relievers. If an anal fissure doesn’t improve with these treatments, surgery may be required.

Salts adviced for trial before going for surgery are-
A broad spectrum antibiotic like Cefuroxime to prevent bacterial infection of site.
Combination of trypsinogen with serratiopeptidase( Wound healer).
Dicofenac as an anti inflammatory.
Ointment containing broad spectrum antibiotic to be applied locally over fissures.
Vitamin C( wound healer).
Folic acid and zinc supplement.

However initially an anoscopy should be done by a Rectal surgeon to see the extent of fissure.

Best surgical option is
Video-assisted anal fistula treatment (VAAFT) is a novel minimally invasive and sphincter-saving technique for treating complex fistulas.

As per the standard data of NCBI(National centre of biotechnological information) a facility funded by XXXXXXX govt data's are-
"
From May 2006 to May 2011, 136 patients were operated using VAAFT. Ninety-eight patients were followed up for a minimum of 6 months.
1)No major complications occurred. In most cases, both short-term and long-term postoperative pain was acceptable.
2)Primary healing was achieved in 72 patients (73.5%) within 2–3 months of the operation.
3)Sixty-two patients were followed up for more than 1 year. The percentage of the patients healed after 1 year was 87.1%.


Hermorrhoids-

1)Sitz bath-Sit in about 3 inches of warm water for 15 minutes or so, several times a day. This helps reduce swelling in the area and relaxes your clenching sphincter muscle.


2)A 1% hydrocortisone cream on the skin outside the anus can relieve itching and pain.

3)With an electric probe, a laser beam, or an infrared light, a tiny burn will be made to remove tissue and painlessly seal the end of the hemorrhoid, causing it to close off and shrink.
4Rubber band ligation is a procedure in which the hemorrhoid is tied off at its base with rubber bands, cutting off the blood flow to the hemorrhoid. This treatment is only for internal hemorrhoids.

Hope i answered your query in detail,However in case you have any other query feel free to question.I would be happy to answer you.

Regards.

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