| Irritable Bowel Syndrome (IBS) is the most common GI problem affecting 8 to 14% of population occurs more commonly in women than in men. It is a functional bowel disorder characterized by abdominal pain and changes in bowel habits which are not associated that is any abnormalities seen on routine, clinical testing. It is fairly common and make up 20-50% of visits to Gastroenterologist. |
Etiology:
Initially, Irritable Bowel Syndrome (IBS) was considered an psychosomatic illness and the involvement of biological and pathogenic factors was not verified until 1990s, a process common in the history of emergency infectious diseases. The risk of developing IBS increases six folds after acute gastrointestinal infection. Post infection further risk factors are young age, prolonged fever, anxiety and depression.
Although no anatomic or bio-chemical abnormalities have been found that explain the common symptoms, various factors are associated
- Heredity
- Psychological stress
- A diet high in fat & stimulating or irritating foods
- Alcohol consumption
- smoking
Nursing Management of Irritable Bowel Syndrome (IBS)
- Emphasize teaching and reinforces good dietary habits which culminate in medical weight loss.
- Encourage to eat at regular times and to chew food slowly and thoroughly.
- Alcohol use and cigarette smoking are discouraged.
- Fluids should not be taken in meals because this results in abnormal distention.
Medical Management of Irritable Bowel Syndrome (IBS)
Goals of Rx are aimed at relieving abdominal pain, controlling the diarrhea or constipation and reducing stress. Restriction and gradual reintroduction of foods that are possibly irritating amy help determine what type of food are acting as irritants (e.g.. bean, caffeinated products, fred foods, alcohol and spicy foods).
Dietary modification to prevent the over action of the gastrocolic reflex and lesser pain, discomfort and bowel dysfunction, having soluble fiber foods and supplements, substituting milk products with roy or rice products, being careful i fresh fruits and vegetables that are high in soluble fiber and eating small frequent meals of small amounts of food, can all help to loosen the symptoms of IBS.
Food and beverages to be avoided or minimized include, red meat, oily or fatty and fried products, milk products (even when there is no lactose intolerance), solid chocolate, coffee (regular and decaffeinated), alcohol, carbonated beverages especially those containing sorbitol or other artificial sweeteners.
- A healthy high fiber diet is prescribed to help control the diarrhea and constipation.
- Exercise can assist in reducing anxiety and increasing intentinal motility often find it helpful to participate in a stress reduction or behaviour modification program.
- Psychotherapy or Hypnotherapy self hypnosis or hypnotherapy is one of the most promising areas of IBS Rx symptom reduction of elimination from IBS, hypnotherapy can last at least five years. Relaxation therapy is also useful. There was a greater involvement in the psychotherapy groups of patients.
- Hydrophilic colloids (i.e. bulk) and anti-diarrhea agents (e.g. loperamide ) may be given to control the diarrhea and decal urgency.
- Antispasmodic drugs (hysocyamine) and calcium channel blockers to decrease smooth muscle spasm, decreasing cramping and constipation and diarrhea.
- Antidepressants can assist in treating underlying anxiety and depression. Antidepressant include both tricyclic antidepressant and the newer selective serotonin reputate inhibitosis.
- Rifaximin can be used as an effective Rs for abdominal bloating and flatulence, giving more credibility to the potential role of bacterial over growth.
- Aloevera juice has an extremely positive effect on the problems associated with digestion such as IBS (spartic colon), colitis, diverticulitis and chron’s disease. It helps to break down the impacted matter, repair leaking colon and bring relief from the build upto toxins to increase the health of the digestive system.
- Acupuncture.
Assessment and Diagnostic Findings for Irritable Bowel Syndrome (IBS)
The underlying biochemical cause of IBS is not well established. So there is no specific laboratory test w! can be performed to diagnosis this condition. Dx of IBS excluding condition w! produce i.e. IBS like symptoms and then following a procedure to categorize the patients symptoms.
- Stool studies.
- Contrast x-ray studies.
- Proctoscopy to rule out colon disease
- Barium enema and colonoscopy (may reveal spasm, distention, mucus accumulation in the intestine)
- Manometry and electromyography (used to study intra/ uminla pressure chages generated by sparticity)
Clinical manifestations of Irritable Bowel Syndrome (IBS)
Wide variability in symptom presentations symptoms range in intensity and duration from mild and infrequent to server and continuous.
Primary symptom is on alteration in bowel patterns.
- constipation
- Diarrhoea
- or a combination of both
- Abdominal pain
- Change in bowel habit
- Bloating (Abdominal fullness/ detention)
- Abdominal discomfort relieved
- Fever, vomiting, positive stool culture
- Acute diarrhea occur after an acute infectious illness.
- Headache, fibromyalgia, depression
Pathophysiology for Irritable Bowel Syndrome (IBS)
Results from functional disorder of intestinal motility. The change in motility may be related to the
- Neurologic regulatory system
- Infection
- Irritation
- Vascular or metabolic disturbances
The peristaltic waves are affected at specific segments of the intestine & in the intensity with w! they propel the fecal matter forward. There is no evidence of inflammation or tissue. There is the intestinal mucosa.
