irritable bowel syndrome
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Irritable Bowel Syndrome
Causes and symptoms
Nursing care for the patient with irritable bowel syndrome is essentially the same as that for someone with diarrhea or constipation. Patient teaching should include information about gas-forming foods such as legumes and those in the cabbage family. Milk and milk products are restricted in those patients who have shown an intolerance to milk.
Anxiety can often be mitigated by teaching the patient about the nature of the illness and reassurance that it is not related to malignancy of the bowel and can be managed by relatively simple, noninvasive measures. Ineffective coping patterns are not uncommon in these patients. When there is evidence that the patient is either unable to cope or is using harmful coping mechanisms such as smoking, drinking, or drug abuse, health teaching concerning relaxation techniques, wholesome diet, exercise, and recreation is appropriate.
irritable bowel syndrome (IBS),
irritable bowel syndrome
irritable bowel syndromeIrritable colon GI disease A condition characterized by chronic abdominal pain, bloating, mucus in stools, irregular bowel habits, alternating diarrhea and constipation; IBS may accompany anxiety and panic disorders; Sx tend to wax and wane over yrs; the primary defect appears to be abnormal GI tract contractions–motility, which does not lead to any serious organ problems; it is a diagnosis of exclusion Management Symptomatic–high fiber diet, exercise, relaxation techniques, avoid caffeine, milk products, sweeteners, medications
ir·ri·ta·ble bow·el syn·drome(IBS) , irritable colon (ir'i-tă-bĕl bow'ĕl sin'drōm, kō'lŏn)
Synonym(s): spastic colon.
irritable bowel syndromeA persistent disorder of unknown cause characterized by recurrent abdominal pain, abdominal rumblings (borborygmi), excessive gas production, urgency to empty the bowels and intermittent diarrhoea often alternating with constipation. It most commonly affects women between 20 and 40 especially those of an anxious disposition. After full investigation and reassurance the symptoms will often settle on simple treatment. There is no consensus of opinion and no hard evidence as to the cause of this common disorder. Also known as spastic colon, mucous colitis, colonic spasm or nervous diarrhoea.
Irritable Bowel Syndrome
|Mean LOS:||5.1 days|
|Description:||MEDICAL: Esophagitis, Gastroenteritis, and Miscellaneous Digestive Disorders With Major CC|
Irritable bowel syndrome (IBS), sometimes called spastic colon, is the most common digestive disorder in the United States with a prevalence as high as 10% to 20% of the population. It is a poorly understood syndrome of diarrhea, constipation, flatus, and abdominal pain that causes a great deal of stress and embarrassment to its victims. People often suffer with it for years before seeking medical attention.
Although people with IBS have a gastrointestinal (GI) tract that appears normal, colonic smooth muscle function is often abnormal. The autonomic nervous system, which innervates the large bowel, fails to provide the normal contractions interspaced with relaxations that propel stool smoothly forward. Excessive spasm and peristalsis lead to constipation or diarrhea, or both. Generally, patients with IBS have either diarrhea- or constipation-predominant syndrome. Although complications are unusual, they include diverticulitis, colon cancer, and chronic inflammatory bowel disease; IBS, however, does not increase mortality or the risk of inflammatory bowel disease or cancer.
IBS is a disorder of GI motility. Its exact cause remains unknown, although there is a familial link in about one-third of cases. 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 and lactose intolerance seem to play roles for many individuals. The course of the disease is usually specific to the patient, who can identify the individual precipitating factors for exacerbations.
IBS appears to run in families, but the exact mechanism is unclear. It is most likely a complex disorder with contributions from several genes and environmental factors. Serotonin transporter gene polymorphism has been associated with IBS.
Gender, ethnic/racial, and life span considerations
Most newly diagnosed patients are young women in their 20s or early 30s. Some recall at the time of diagnosis that as children they experienced abdominal pain or changes in bowel habits. The incidence of newly diagnosed IBS is rare over age 50. Fewer than one-third of the cases of IBS are in men. The disorder is more common in people with white/European ancestry, especially Jews, than in other groups such as Asian Americans and Hispanics/Latinos.
Global health considerations
Western Europe and the United States have similar prevalence statistics. The prevalence of IBS in developed nations is likely higher than in developing nations. These differences are likely because of sociocultural issues, eating patterns, and strategies of healthcare management.
The Rome II criteria are used to diagnose IBS in patients who have the following symptoms for at least 3 months of the year: (1) Abdominal pain or discomfort that is relieved by defecation, associated with a change in stool frequency, and associated with a change in stool consistency; and (2) supporting symptoms including altered stool frequency, altered stool form, altered stool passage, mucorrhea, abdominal bloating, or subjective distension.
Symptoms that are reported most often are pain in the left lower quadrant, abdominal distention, diarrhea, and constipation, especially alternating bouts of the latter two. The pain may increase after eating and be relieved after a bowel movement. Pain is often cramping in nature and may be accompanied by nausea, belching, flatus, bloating, and sometimes anorexia. As the disease progresses, the patient may suffer fatigue and anxiety related to the many attempts to control the symptoms and lead a normal life. For some individuals with this disorder, the lifestyle is dictated by the need to remain close to a bathroom, which limits both occupation and social life.
With auscultation of the abdomen, normal bowel sounds may be heard, although they may be quiet during constipation. Tympanic sounds may be heard over loops of filled bowel. Although palpation often discloses a relaxed abdomen, it may reveal diffuse tenderness, which becomes worse if the sigmoid colon is palpable. The patient may have pain on rectal examination but does not usually experience rectal bleeding.
Many patients have consulted physicians who fail to take IBS seriously, telling them to eat a high-fiber diet and relax. Unfortunately, a high-fiber diet, which is good for ordinary constipation, often makes the irritable bowel worse. As the person suffers more frequent bouts of diarrhea and constipation, any attempts to relax become futile. Anxiety over control of symptoms makes the symptoms of IBS worse, creating a vicious circle that becomes hard to break. Depression over the inability to control one’s bodily functions or lead a normal life sometimes becomes a serious problem.
|Test||Normal Result||Abnormality With Condition||Explanation|
|Flexible sigmoidoscopy or colonoscopy||Visualization of normal sigmoid and colon||Intense spastic contractions; mucosa appears normal (smooth and pink)||Flexible sigmoidoscopy in adults younger than 40; colonoscopy in adults older than 40 years|
|Barium enema||Normal abdominal structures||Colonic spasms may occur during procedure; may have a normal examination||Identifies colonic spasms and rules out other pathology|
Other Tests: Often diagnostic testing will not occur unless the patient has weight loss, iron deficiency anemia, or a family history of gastrointestinal illness. Additional tests are complete blood count, serological tests, serum albumin, stool for guaiac (occult blood), and abdominal x-ray.
Primary nursing diagnosis
DiagnosisPain (acute) related to abdominal cramping
OutcomesComfort level; Pain control behavior; Pain level; Symptom severity
InterventionsMedication management; Anxiety reduction; Environmental management; Comfort; Pain management
Planning and implementation
As the symptoms worsen during the stress of other physical illnesses or trauma, fluid volume deficit may become a serious problem. It is usually treated by hypotonic intravenous solutions such as half-strength normal saline, sometimes with a potassium supplement. The nurse monitors the patient’s state of hydration and intake and output. If the diarrhea continues to be severe, antidiarrheal and anti-anxiety agents may be prescribed for a short period. Diarrhea, constipation, and abdominal pain are treated by a combination of drugs, diet, and attempts to establish an exercise routine that promotes normal bowel function.
The diet used most often for changes in GI motility is high in fiber and bulk. Bran may be added to increase dietary bulk and control diarrhea. A high-fiber diet may control symptoms and establish regular bowel movements in some; for others, a low-fiber, low-fat diet may be more effective. Some patients have fewer symptoms on a gluten-free diet. Lactose or sorbitol intolerance may require treatment, and hypersensitivity to particular foods may be found by eliminating wheat, citrus foods, and fatty foods.
|Medication or Drug Class||Dosage||Description||Rationale|
|Bulk-forming laxatives||Varies with drug||Psyllium hydrophilic mucilloid (Metamucil); calcium polycarbophil (Mitrolan)||Facilitate defecation and enhance comfort|
|Antidiarrheal agents||Varies with drug||Diphenoxylate hydrochloride with atropine sulfate (Lomotil); loperamide (Imodium)||Decrease cramping and diarrhea; used only during an acute episode because they have a narcotic base and could easily lead to dependency|
|Antispasmodic agents||Varies with drug||Dicyclomine hydrochloride (Bentyl); propantheline bromide (Pro-Banthine); hyoscyamine (Levsin, Levbid)||Relieve abdominal cramping and spasms|
The patient with IBS needs encouragement to eat meals at regular intervals, to chew the food slowly to help promote normal bowel function, and to drink eight glasses of water daily. Diet should include 30 to 40 g of fiber each day. Most of the fluid intake should be at times other than mealtime. Foods to avoid include alcohol, caffeine, and anything that may irritate the GI tract. For example, if milk or milk products cause cramping or discomfort, they should be avoided.
Incorporating regular exercise in the daily routine may be helpful in controlling GI motility, but strenuous exercise is not desirable. Reassure the patient that stress does not cause the illness, even though it may be a major factor in its severity. Refer patients to a counselor if anxiety and stress management might help manage the condition.
Evidence-Based Practice and Health Policy
Moayyedi, P., Ford, A.C., Talley, N.J., Cremonini, F., Foxx-Orenstein, A.E., Brandt, L.J., & Quigley, E.M. (2010). The efficacy of probiotics in the treatment of irritable bowel syndrome: A systematic review. Gut, 59(3), 325–332.
- Investigators conducted a meta-analysis of 19 randomized controlled trials, which included 1,650 patients with IBS, to determine the beneficial effects of probiotics on IBS symptoms.
- When compared to the placebo, probiotics significantly reduced pain scores (mean difference, 0.51; 95% CI, 0.09 to 0.91; p = 0.016) and flatulence (mean difference, 0.22; 95% CI, 0.01 to 0.42; p = 0.04).
- Overall, the relative risk of IBS improvement increased 29% with probiotics use compared to the placebo (95% CI, 0.57 to 0.88; p < 0.001).
- Physical response: Hydration, GI assessment, frequency and consistency of bowel movements, level of discomfort
- Emotional response: Level of stress, mood and affect, coping ability
- Response to medications
- Nutritional status: Tolerance to food, body weight, appetite
Discharge and home healthcare guidelines
Help the patient set a long-term goal to regain control of elimination patterns with manageable short-term goals to reduce stress. Progressive muscle relaxation helps relieve the tension that often stimulates stress-related diarrhea. Explain that as the patient experiences less frequent diarrhea, he or she begins to relax even more. Teach the patient about the disease, the treatment, and how to control the symptoms. Explain that the prognosis for control of the disease depends largely on the establishment of normal bowel habits and a plan for stress management. Explain all medications, including the dosage, action, route, and possible side effects. Explore the patient’s dietary patterns and provide a dietary consultation if it is appropriate.
Patient discussion about irritable bowel syndrome
Q. What percentages of fibromyalgia patients have IBS. My cousin with fibromyalgia aka FMS have also been diagnosed with IBS. Is it a usual happening? What percentages of fibromyalgia patients have IBS?