What is Irritable Bowel

Syndrome(IBS) ?
“A functional bowel disorder in which
abdominal pain is associated with defecation
or a change in bowel habit, with features of
disordered defecation and distention.”
 Effects of Irritable Bowel
Syndrome
• Muscles do not contract in normal way
resulting in spasms.i.e. PAIN

• If movement of food is slower then the

person is constipated.

• If movement is rapid, then the person

gets diarrhea.
 IBS Patients
Categorization

• Abdominal Pain- Diarrhea-predominant

(IBS-D)
• Constipation - Constipation-predominant
(IBS-C)
• Alternating stool pattern (IBS-A)
HOW ARE
FEACES
FORMED?
INTRODUCTION TO LARGE
INTESTINE
 LARGE INTESTINE
• Last part of digestive system: the final stage of
the alimentary canal in vertebrate animals.
• Most liquids and minerals are absorbed from
digested food, as well as a few remaining
nutrients.
• The colon is about 1.5 meters long, which is
about one-fifth of the whole length of the
intestinal canal.
• The colon ends at the anus.
 PARTS OF LARGE
INTESTINE
• Cecum- The cecum is a pouch connected to the
ascending colon of the large intestine and the ileum
• Colon- Part of the intestine from the cecum to the
rectum.

• Rectum-The rectum is the final straight portion of

the large intestine in some mammals, and the gut in
others, terminating in the anus.
• Anal Canal- The anal canal is the terminal part of
the large intestine.It is situated between the rectum
and anus, below the level of the pelvic diaphragm.
 What does colon do?
• Absorb water, nutrients, and salts from
the partially digested food.
• Colon motility -controlled by nerves,
hormones, and impulses in the colon
muscles.
• Contractions move the contents inside
the colon
 Pathophysiology
• IBS is not an organic disorder.

• Three main physiologic abnormalities:

1.Altered GI motility
2.Altered intestinal secretion
3.Enhanced visceral sensitivity.
PERISTALSIS MOVEMENT
IN COLON
 Serotonin (5-HT) appears to be the common link involved in
motility, intestinal secretion, and perception of pain.

 Serotonin, which is produced and stored mainly in the gut (95%)

 Serotonin has been responsible for the symptoms of IBS.

 Among 5HT receptor:

---5HT3 & 5HT4 receptor are responsible for GI
motility
 SYMPTOMS OF IBS

Primary IBS Symptoms Secondary Non-GI

Symptoms Supportive of GI Symptoms
IBS Diagnosis Symptom

Abdominal pain Hard/lumpy stools Heartburn Dysmenorhea

Altered bowel Loose watery stools Dyspepsia Backache
habits Straining during bowel Indigestion Fatigue
(constipation or movements Nausea Headache
diarrhea) Bloating Vomiting, early Difficulty
Sensations of urgency satiety falling/staying
asleep
Urinary urgency
Taste alterations
Muscle stiffness
and aching

IBS = Irritable bowel syndrome; GI = gastrointestinal

ALSO INCLUDES:

 Fewer than three bowel movements a week

 More than three bowel movements a day

 Urgency (having to rush to have a bowel

movement)

 Feeling of incomplete bowel movement

 Passing mucus (white material) during a

bowel movement
 CAUSES OF IBS
• STILL INCOMPLETELY KNOWN.
• BOTH CENTRAL AND PERIPHERAL
FACTORS INCLUIDNG PSYCHO-
SOCIAL FACTORS, ABNORMAL GI
MOTILITY AND SECRETION, AND
VISCERAL HYPERSENSITIVITY ARE
THOUGHT TO CONTRIBUTE TO
THE SYMPTOMS.
 DIAGNOSIS

4. MANNING CRITERIA

2. THE ROME PROCESS

DIFFERENTIAL DIAGNOSIS
 Sigmoidoscopy or Colonoscopy
 Esophagogastroduodenoscopy
 Abdominal ultrasound or CT scan
 Blood tests: complete blood count and
Erythrocyte sedimentation rate.
 Stool chemistry , stool microbiology,
fecal fat.
OTHER TREATMENTS:
• YOGA
• HYPNOSIS
• TRADITIONAL CHINESE TREATMENT
- HERBS
- ACUPUNCTURE
• AYURVEDIC MEDICINE
- DOSHAS
• CLEANING OF COLON
- ENEMAS FOR CONSTIPATION
 Yoga Posture Sequence for IBS
1.Corpse Pose 2.Reclining Bound Angle

3. Hero Pose
4. Bound Angle Pose 5. Seated Wide Angle Pose

6. Upward Facing Dog 7.Downward Facing Dog

8.Shoulder Stand (Inversion) 9. Bridge Pose

10.Cobra
 WOMEN AND IBS
• FEMALE PATIENTS ARE SEEN
THREE TIMES AS COMMONLY AS
MEN.
• ABOUT 75-80% ARE THE
CONSULTERS.
• WOMEN ARE MORE SENSITIVE TO
IBS WHICH OBVIOUS BIOLOGICAL
REASON THAT DO NOT APPLY FOR
MEN.
FOR Eg. MENSTRUATION
 HOPE THROUGH
RESEARCH

• EXACT CAUSE IS NOT KNOWN FOR IBS

TILL NOW.
• BRAIN-GUT AXIS HAS PROVED
SOMEWHAT EFFECTIVE FOR
EXPLANATION OF CAUSE OF IBS.
• PROBIOTICS HAVE PROVED EFFECTIVE
IN PREVENTING THE SYMPTOMS OF IBS.
 ROLE OF PHARMACIST
• PHARMACISTS CAN PLAY AN
IMPORTANT ROLE IN IMPROVING THE
LIVES OF PATIENTS WITH IBS.

• PROPER GUIDANCE SHOULD BE GIVEN.

• PROACTIVE QUESTIONING BY
PHARMACISTS WILL ALLOW THEM TO
GIVE APPROPRIATE OTC THERAPIES.

• PATIENTS SHOULD BE WARNED

AGAINST SELF-MEDICATION.
 RESEARCH ARTICLES
1)
Chey WD, Cash BD

Irritable bowel syndrome:

update on colonic neuromuscular
dysfunction and treatment.
 RESEARCH ARTICLES
2)
Camilleri M

Probiotics and irritable bowel syndrome:

rationale, putative mechanisms, and
evidence of clinical efficacy.
 RESEARCH ARTICLES
3)
W Grant Thompson

Tegaserod and IBS:

a perfect match?
 CONCLUSION
 IBS is not a organic disease. IBS is a disorder
 IBS is a common disorder found more often in
women than men.
 IBS is diagnosed by its signs and symptoms and by
the absence of other diseases.
 IBS does not harm the intestines and does not lead to
cancer. It is not related to Crohn’s disease or
ulcerative colitis.
 No screening methods have been established for the
cure of disease.
 Awareness of the true facts of IBS to every
individuals in modern day life holds the key success
for the prevention of IBS.
Sr. no. Name of Book Editon Author Page no.

1 Clinical 9 th P.N.Bennett 648,649

Pharmacology M.J.Brown

2. The 9 th Goodman & 157,159

Pharmacologic Gilman
al Basis of
Therapeutics

3. A Short 5 th Niraj Ahuja 111,112

Textbook of
Psychiatry

4. Davidson’s 18 th Hunter & 668-670

Principles and Boon
Practice of
Medicine
5. Harrison’s 13 th Volume – Wilson and 1342,1421-
Principles of 2 Kasper 1422
Internal
Medicine
6. API Textbook 7 th Siddharth N. 560-1,1397
of Medicine Shah
 WEB SITES
• http://en.wikipedia.org/wiki/Irritabl
e_bowel_syndrome
• http://digestive.niddk.nih.gov/ddis
eases/pubs/ibs_ez/
• http://www.helpforibs.com/yoga/po
ses.asp
• http://www.helpforibs.com/hypnosi
s/
• http://www.ibs-research-
update.org.uk/ibs/woman1ie4.html
• https://secure.pharmacytimes.com/
lessons/200307-01.asp