IRRITABLE BOWEL SYNDROME (IBS)

IRRITABLE BOWEL SYNDROME (IBS) – Etiology and Risk Factors, Pathophysiology, Signs and Symptoms, Diagnostic Evaluation and Management (medical and nursing)

Irritable bowel syndrome (IBS) is a common disorder that affects large intestine, characterized by cramping, abdominal pain, bloating gas, diarrhea and constipation.

ETIOLOGY AND RISK FACTORS

• Foods: carbonated beverages and some fruits and vegetables may lead to bloating and discomfort in some people with IBS
• Stress: signs and symptoms are worse or more frequent during stressful events.
• Hormones: because women are more likely to have IBS, many women find that signs and symptoms are worse during or around their menstrual periods.
• IBS symptoms first appear before the age of 35 for about half of those with  the disorder
• More women than men are diagnosed with this condition
• Have a family history of IBS

PATHOPHYSIOLOGY

Lesions typically develop in several separated segments of bowel. Examination of the bowel tissue by endoscopy reveals edematous, heavy, reddish purple area ——-

Enlarged lymph nodes appear in the submucosa and Peyer’s patches are seen in the intestinal mucous membrane —–

These areas undergo small superficial ulcerations with granulomas and fissures ——

Fissures may completely penetrate the bowel wall, leading to fistulas and abscesses ——

Fistulae, in turn, release toxic substances from the intestine into the bloodstream, the abdominal cavity and other organs —–

Collection of lymphocytes throughout the mucosa, submucosa and serosa —–

The small bowel becomes congested and thickened, narrowing the lumen

SIGNS AND SYMPTOMS

• Abdominal pain or cramping
• A bloated feeling
• Gas (flatulence)
• Diarrhea or constipation
• Mucus in the stool

DIAGNOSTIC EVALUATION

• Flexible sigmoidoscopy: this test examines the lower part of the colon with a flexible, lighted tube (sigmoidoscope)
• Colonoscopy: in this, a small, flexible tube is used to examine the entire length of the colon
• Computerized tomography (CT): CT scans produce cross-sectional X-ray images of internal organs
• Lactose intolerance tests: Lactase is an enzyme required to digest the sugar (lactose) found in dairy products
• Blood tests: celiac disease (nontropical sprue) is sensitivity to wheat protein that also may cause signs and symptoms like those of irritable bowel syndrome

MANAGEMENT

• Fiber supplements: Taking fiber supplements, such as psyllium or methylcellulose with fluids may help control constipation
• Anti-diarrheal medications: over-the-counter medications, such as loperamide can help control diarrhea
• Eliminating high-gas foods, especially cabbage, broccoli, and cauliflower
• Anticholinergic medications: some people need medications that affect certain activities of the autonomic nervous system (anticholinergics) to relieve painful bowel spasms
• Antidepressant medications, such as tricyclic antidepressant or a selective serotonin reuptake inhibitor (SSRI). These medications help relieve depression as well as inhibit the activity of neurons that control the intestines.
• Alosetron: alosetron is a nerve receptor antagonist that is designed to relax the colon and slow the movement of waste through the lower bowel
• Lubiprostone: lubiprostone is approved for adult women and men who have IBS with constipation

Nursing Management

Nursing Diagnosis

• Activity intolerance related to fatigue and weakness
• Constipation related to immobility, pain, medication, and decreased GI motility
• Diarrhea related to acute infectious process
• Disturbed body image related to presence of feeding tube.
• Imbalanced nutrition: less than body requirements related to enteral feeding problems
• Ineffective therapeutic regimen management related to lack of knowledge of long-term management of disease and consequences of not following treatment plan and unwillingness to modify lifestyle.

Interventions

• Change in bowel habit
• Lethargy, nausea, backache and bladder symptoms may be used to support diagnosis
• Provide information about self-help covering lifestyle, physical activity, diet, and symptom-targeted medication
• Encourage people to identify and make the most of their leisure time and to create relaxation time
• Assess physical activity levels, ideally using the general practice physical activity
• Assess diet nutrition and give general advice
• Review the person’s fiber intake and adjust (usually reduce) according to symptoms. Discourage intake of insoluble fiber (bran). If more fiber is needed, recommend soluble fiber such as ispaghula powder, or foods high in soluble fiber (oats)
• If the person wants to try probiotics, advise it to take the dose recommended by the manufacturer for at least 4 weeks while monitoring the effect
• Discourage use of aloe vera for IBS
• Ensuring patients are properly nourished and hydrated will be priority of nursing care and includes monitoring weight, I and O, provision for adequate fluid intake, monitoring BP, tachycardia
• Administration and management of alternative forms of nutrition (TPN, enteral feedings)
• Assess self-feeding abilities and assist as needed, and administer medications as ordered (appetite stimulants, antiemetic, antidiarrheals, laxatives, stool softeners, antacids, proton pump inhibitors, H₂ blockers)
• Monitoring critical lab values will be ongoing and include potassium, sodium, magnesium, albumin and CBC with differential WBCs and BUN/creatinine
• Patient education will include instruction in appropriate fluid intake, appropriate balance of foods, diet planning