1 focus on irritable bowel syndrome (ibs) (relates to chapter 43, “nursing management: lower...

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Focus on Irritable Bowel Syndrome (IBS)

(Relates to Chapter 43, “Nursing Management: Lower Gastrointestinal Problems,” in the textbook)

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

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Description

•Common problem affecting 10% to 15% of Western populations•Affects twice as many women as men•Characterized by intermittent and recurrent abdominal pain and stool pattern irregularities


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Etiology and Pathophysiology•Pain/discomfort from visceral hypersensitivity Stool or gas in GI tract stimulates visceral afferent fibers.

•Neurochemicals involved in bowel symptomsSerotonin


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Etiology and Pathophysiology•Altered motility•Altered intestinal and colonic motility •Altered response to stress •Postinfectious IBS


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Clinical Manifestations

•SymptomsDiarrheaConstipationAlternating diarrhea/constipation

Abdominal distentionExcessive flatulence


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Clinical Manifestations

•Symptoms (cont’d)BloatingContinual defecation urge, urgency

Sensation of incomplete evacuation

FatigueSleep disturbances


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Psychosocial Factors in IBS

•Common in patients with IBSAnxiety, panic disorderDepressionPosttraumatic stress disorderAbuse history


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Psychosocial Factors in IBS

•Stress can exacerbate stress symptoms.•May influence health care–seeking behavior


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Problems Not Associated With IBS•Anemia•Fever•Persistent diarrhea•Rectal bleeding •Severe constipation •Weight loss


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Differential Diagnoses

•Malabsorption (gluten intolerance, lactose intolerance)•Dietary factors•Infection•Colorectal cancer•Inflammatory bowel disease


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Differential Diagnoses

•Psychologic disorders•Gynecologic disorders•Peptic ulcer disease •Celiac disease


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Diagnostic Studies

•No specific physical findings•Diagnosis made on the basis of symptoms and by ruling out other conditions

•Physical examination•Past health history

Psychosocial factors Family history Drug/diet history


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Diagnostic Studies•Standardized symptom-based criteria (Rome III criteria) At least 3 months, with onset at least 6 months previously of recurrent abdominal pain or discomfort associated with two or more of the following: Pain relieved by defecation Onset of pain related to a change in

stool frequency Onset of pain related to a change in

stool appearanceCopyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

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Collaborative Care

•Patients do better with therapy if they haveA trusting relationship with care provider

Coping mechanismsSymptoms that are less severe/frequent


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Collaborative Care

•Based on dominant symptoms and their severity and on psychosocial factorsMedical management DietPsychologic or behavioral options


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Collaborative Care

•Consider predominant symptom pattern.DiarrheaConstipationPain


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Collaborative Care

•Diet modification•Fiber therapy (20 g/day)•Antispasmodics•Antidiarrheals •Laxatives•Serotonergic agents•Antidepressants


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Nonpharmacologic Treatments•Education and reassurance •Relaxation•Stress management techniques•Alternative therapies


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Nutritional Therapy

•Eliminate gas-producing foods.Brown beansBrussel sprouts, cabbage, cauliflower, raw onions

Grapes, plums, raisins


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Nutritional Therapy

•Eliminate fructose, sorbitol.•Determine if lactose intolerant.


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Drug Therapy: Antispasmodics•Anticholinergics

Dicyclomine (Bentyl)Reduce colonic motility after meals.

Take before meals.Side effects

Dry mouth, urinary retention, tachycardia


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Drug Therapy: Antidiarrheals•Loperamide (Imodium)

Decreases intestinal transitEnhances intestinal water absorption and sphincter tone


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Drug Therapy

•Lubiprostone (Amitiza)•For treatment of women with IBS-constipation


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Drug Therapy: Serotonin Agonists•5-HT3 receptor blockers

↓ Urgency, pain, and diarrhea in diarrhea-prominent women

Alosetron (Lotronex) FDA approved for women only Must be monitored because of potential side effects


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Psychologic Therapies

•Cognitive-behavioral therapy•Stress management techniques•Acupuncture•Hypnosis


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Case Study


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Case Study

•31-year-old woman is seen in an outpatient clinic for abdominal pain, discomfort, bloating.


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Case Study

•She has had intermittent abdominal pain for approximately 6 months.

•She often misses work, where she is an administrative assistant, because of her GI symptoms, as well as fatigue.


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Case Study

•She eats irregularly and often in a hurry.

•She is anxious about her symptoms and is worried that she may have colon cancer, because her grandmother died of cancer. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

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Case Study

•She has a very stressful lifestyle.

•She denies any blood in stool or diarrhea.

•No change in body weight is noted, and appetite is good.Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

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Case Study

•She states that abdominal pain and bloating are relieved by having a bowel movement.

•She is often constipated, for which she takes laxatives.


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Case Study

•On examination, bowel sounds are present, and her physical (BP, heart rate, temperature) and laboratory findings (WBC) are normal.


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Discussion Questions

1.What problems do her history and symptoms suggest?

2.What important teaching topics should you discuss with her?

3.What nutritional recommendation could you make?


1 focus on irritable bowel syndrome (ibs) (relates to chapter 43, “nursing management: lower...

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