IRRITABLE BOWEL SYNDROME

INTRODUCTION Irritable bowel syndrome is a disorder characterized most commonly by cramping,abdominal pain, bloating, constipation,and diarrhea. IBS causes a great deal of discomfort and distress, but it does not per-manently harm the intestines and does notlead to a serious disease, such as cancer.Most people can control their symptoms with diet, stress management, and pre-scribed medications. For some people,however, IBS can be disabling. They may be unable to work, attend social events,or even travel short distances Irritable bowel syndrome DEFINITION  (IBS) is an intestinal disorder that causes abdominal pain or discomfort, cramping or bloating, and diarrhea or constipation. Irritable bowel syndrome is a long-term but manageable condition irritable bowel syndrome is defined as a chronic, relapsing functional disorder of the gut characterised by: abdominal pain abdominal distension abnormality in bowel habit

INCIDENCE  It is estimated that between 10% and 15% of the population of North America, or approximately 45 million people, have irritable bowel syndrome, yet only about 30% of them will consult a doctor about their symptoms. IBS tends to be more common in: Half of the people who have IBS develop symptoms before age 35, and 40% develop symptoms between the ages of 35 and 50. In women, IBS is 2 to 3 times more common than in men.

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CAUSES         IBS is a disorder of GI motility. Its exact cause remains unknown, although there is a familial link It is not caused by nerves or poor diet. Both stress and intolerance for some foods, however, can precipitate attacks. Other triggers include some types of abdominal surgery, acute illness that has disrupted bowel function , prolonged use of antibiotics, exposure to toxins, and emotional trauma. Ingestion of caffeine, alcohol, and other gastric stimulants Lactose intolerance seem to play roles for many individuals.

Distension o Change in bowel habit o Abnormal stool passage o Change in stool form Urinary Symptoms o Frequency o Urgency o Nocturia Gynaecological symptoms o Dysmenorrhoea o Dyspareunia o Premenstrual Tension  Non-specific symptoms o Back Pain o Headaches o Bad breath o Poor Sleep .. SUB TYPES     IBS with constipation (hard/lumpy stools predominant) IBS with diarrhea (loose/watery stools predominant) Mixed IBS (neither predominates) Unsubtyped IBS (insufficient stool abnormality to meet the above subtypes CLINICAL MANIFESTATIONS Gastrointestinal Symptoms o Abdominal discomfort o Bloating.

Endometriosis. stool for guaiac(occult blood). Diverticulosis. COMPLICATIONS . abdominal x-ray erythrocyte sedimentation rate abdominal ultrasound endoscopy hydrogen breath testing rectal biopsy lactose intolerance test DIFFERENTIAL DIAGNOSIS     Inflammatory bowel disease. Cancer.o Fatigue DIAGNOSTIC CRITERIA  ROME II Criteria (1999) In the preceding 12 months there should be at least 12 weeks (consecutive) of abdominal discomfort or pain that has two of three of the following features: Relieved with defecation Onset associated with a change in frequency of stool Onset associated with a change in form of stool The following symptoms cumulatively support the diagnosis of IBS: Abnormal stool frequency (‘abnormal ‘ may be defined as >three/day and <three /week Abnormal stool form Abnormal stool passage (straining urgency or feeling of incomplete evacuation Passage of mucous Bloating or feeling abdominal distension         OTHER TEST              Flexiblesigmoidoscopyor colonoscopy Barium enema Complete blood count serologic tests serum albumin.

which may relieve abdominal pain. Hypnosis can help some people relax. should exclude gas-producing foods. fatty foods.  Treatment is focused on relieving symptoms. leading to sx and increased intestinal permeability.  Biofeedback. atropine.min of moderate to vigorous activity 3-5x/w – showed improvement in severity of IBS compared with control group  Psychosocial therapies: behavioral treatments for those who associate sx with stressors – the goal being to reduce anxiety. and scopolamine (Donnatal) or chlordiazepoxide and clidinium bromide (Librax) are second-line agents . carbohydrates (sx may be related to impaired absorption of carbohydrates: FODMAPs enter distal small bowel and colon when they are fermented. Increase fiber intake (say most studies. although keep in mind that might be an issue for diarrhea-predominant IBS  Patient-physician relationship is important!  Physical activity: in a randomized trial. this was examined .Physical activity comprised of 20-6.yoga. although there have been few studies to demonstrate this). coffee. should be used only for limited periods such as during a flare-up o Combination agents: phenobarbital.  Treating the patient's most predominant symptoms determines the most successful therapy. It also may help improve bowel movement control in people who have severe diarrhea.  This disorder is associated with: o Psychological distress o Sexual dysfunction o Interference with work and sleep o Decreased quality of life Unnecessary surgery due to misdiagnosis appendectomy. Biofeedback training may help relieve pain from intestinal spasms. or partial colectomy (such as cholecystectomy.  Relaxation or meditation.acupuncture  Stress relief excercises  Antispasmodic and peppermint oil  PAIN AS A”PREDOMINANT SYMPTOM o Anticholinergic drugs: dicyclomine (Bentyl) or hyoscyamine (Levsin) taken before meals. MANAGEMENT MEDICAL MANAGEMENT Dietary modification: Patient may have food allergies. among other things  Hypnosis.  Stress relieving measures. Relaxation training and meditation may be helpful in reducing generalized muscle tension and abdominal pain. hycosamine.

o NURSING ASSESSMENT    Assess patient for contributing factors that may affect symptoms: diet. sorbitol o 5-HT4 agonist: tegaserod (Zelnorm) mimics the action of serotonin in the gut and treats global symptoms DIARRHEAAS A”PREDOMINANT SYMPTOM o Cloperamide (Imodium)—reduces stool consistency and improves stool consistency o Cholestyramine (Questran)—binds bile salts o 5-HT3 agonist: alosetron (Lotronex)—first neuroenteric modulator to treat severe cases in which standard therapy has failed Eliminate irritating dietary substances. bloating. Record specific symptoms that patient is experiencing in order to determine best treatment options. professional and personal relationships. fatty foods. NURSING DIAGNOSIS Chronic Pain related to functional disorder   Assess and evaluate abdominal pain using a pain scale. Encourage exercise and adequate fluid/fiber intake to promote bowel motility for constipation. bloating. consistency. gabapentin (Neurontin). timing. duration. doxepin (Sinequan). that may cause such symptoms as spasms. and frequency of stool. and/or diarrhea. Review pain medications for proper usage and possibility of adverse effects”drowsiness and dry mouth with anticholinergics. Explore pain characteristics: frequency.    Nonopioid agents: acetaminophen. emotions. A regular exercise routine can improve gastric emptying and relieve constipation and stress. carbamazepine (Tegratol). diarrhea. cramps. tramadol (Ultram). location. and tricyclic antidepressants. ispaghula husk. fructose. . and intensity. or constipation with others. polycarbophil o Osmotic laxatives: lactulose. Constipation or Diarrhea related to change in bowel motility   Monitor amount. abdominal pain. gas. and precipitating events. patient's fears and concerns. such as financial stress or problems at work or home. combination agents. or lactose. such as caffeine. and amitriptyline (Elavil) CONSTIPATION AS A”PREDOMINANT SYMPTOM: o Fiber: psyllium. and anti-inflammatory agents o Tricyclic antidepressants: desipramine (Norpramin).

and music therapy. dosage. St. Introduction to medical surgical nursing. Hawks HI. Linde Williams. Saunders. Understanding medical Surgical Nursing 2nd edition. FA Davis company. 11 th Ed. which accounts for up to 20% of gastroenterology referrals in the UK and approximately 4 million physician office visits in the USA annually . Elsevier. Black MJ. Encourage participation in counseling sessions to deal with anxiety and depression. Brunner and Suddarths. 1st Ed. RN. psychological counseling. Encourage patient to participate in stress-reducing activities. 4 th edition. Refer patient for pain management. stress. India. Instruct patient about all prescribed medications. 2007 Platt D. alongside abnormal function in the enteric. BIBLIOGRAPHY Linton. Louis Missouri. and adverse effects. Suggest ways for patient to learn coping skills and stress management. St Louid. The etiology of IBS is complex and poorly understood. Medical surgical Nursing 7 th ED. PATIENT EDUCATION AND HEALTH MAINTENANCE      Educate patient on the diagnosis and the natural course of IBS. CONCLUSION IBS is a common functional gastrointestinal (GI) disorder. causes symptoms. 2000 Lewis. Medical Surgical Nursing. including purpose. Moss M. such as exercise. 2005. Elsevier. and depression    Validate patient's complaints and express interest in diagnosis. 2006. 2011. 2003. . It may be viewed as a multi-factorial disorder where dysregulation of the so-called brain–gut axis. Medical Surgical Nursing 5th Ed.. Encourage adequate fluid intake to prevent fluid volume deficit and electrolyte imbalance for diarrhea. Philadelphia. LLC Publishers. Adult medical Surgical Nursing. relaxation techniques. or behavior management therapy if indicated. 2008 Ignatavicius DD. Ineffective Coping related to anxiety. Text book of medical Surgical Nursing. Workman ML. Wolters Kluwer Publishing. India. Follow-up and reassess patient's complaints and status of treatment goals. autonomic and/or central nervous systems.

Azpiroz F. Neurogastroenterol Motill 19: 62–88. et al. The burden of disease. Poitras P. Williams JG. Forbes A. GUT 56: 1–113. Roberts SE. et al. Cheung WY. (2000) British Society of Gastroenterology guidelines for the management of the irritable bowel syndrome. and the organisation and delivery of services for gastrointestinal and liver disorders: a review of the evidence. Sandler RS (1990) Epidemiology of irritable bowel syndrome in the United States. Mayer EA. (2007) Gastroenterology services in the UK. Camilleri M. Boorman J. et al. (2007) Mechanisms of hypersensitivity in IBS and functional disorders. Cohen DR. . Gastroenterology99: 409–15. Cann P. Bouin M. GUT 47: 1–19.JOURNAL REFERENCES Jones J. Gornborone J. Ali MF.

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