IRRITABLE BOWEL SYNDROME. Pathophysiology Nursing Melba Sahaya Sweety Chinna Chadayan Comprehensive Nursing Pediatric Nursing Child Health Nursing

1. IRRITABLE
BOWEL
SYNDROME
Mrs. D. Melba Sahaya Sweety RN,RM
PhD Nursing , MSc (Pediatric Nursing),BSc Nursing
Associate Professor
Department of Pediatric Nursing
Enam Nursing College, Savar,
Bangladesh.

2. INTRODUCTION
Irritable bowel syndrome(IBS) is a commondisorder that aff
ectsthe stomach and intestines, IBSis also known as spastic
colon, irritablecolon, mucous colitis, and spastic colitis. It is
a separate condition frominflammatorybowel disease and
isn’t related to other bowel conditions. Irritable Bowel
Syndrome is not a disease,It's a functional disorder, which
means that the bowelsimplydoes not work as it should. IBS
is a common disorder that affects the large intestine (colon).
IBSis a group of intestinal symptoms that typically occur
together. The symptomsvary in severityand duration from
person to person.

3. DEFINITION
Irritable bowel syndrome (IBS) is
a chronicfunctional disorder
characterizedby recurrent
abdominal painassociated with
disordered bowel movements,
whichmay include diarrhea,
constipationor both.
(Lacyet al., 2016)

4. INCIDENCE
 Prevalence 3 - 22% world-wide Reason for 20 - 50%
of gastroenterology visits.
 IBS is less among Asian population with 6.5 – 11% p
revalence rate.
 26%prevalence among children with recurrent
abdominal pain.
 40% onset before age 35.
 50% onset age 35 – 50.
 Female > Male (3:1)

5. ETIOLOGY
 Abnormal gastrointestinal (GI) tract
movements like bowel muscles spasm.
 A change in the nervous system
communication between the GI and brain
 Sensory and motor disorders of the colon.
 Dietary allergies or food sensitivities.
 Neurotransmitter imbalance“(Decrease sero
tonin levels that control nerve signals bet
ween the brain and digestive tract.).
 Stress

6. •Gender - About twice as many women as men hav
e the condition. It’s not clear why, but some researc
hers think the changing hormones in the menstrual c
ycle may have something to do with it.
•Age - IBS can affect people of all ages, but it's mor
e likely for people in their teens through their 40s.
•Family history - The condition seems to run in f
amilies. Some studies have shown that the genes ma
y play a role.
•Medications - Studies have shown a link betwee
RISK FACTORS

7. •Mental health— anxiety, depression, personality
disorder, and history of abuse are all associated risk
factors
•Food sensitivities - Foods like dairy, wheat, a s
ugar in fruits called fructose, or the sug
ar substitute sorbitol. Fatty foods, carbonated drink
s, and alcohol can also upset digestion and they ma
y trigger symptoms.
•Other digestive problems, like stomach fl
u, traveler’s diarrhea, or food
RISK FACTORS

8. TYPES OF IBS
There are four subcategories of IBS, each with
equal prevalence:
 IBS-C: IBS with constipation;
 IBS-D: IBS with diarrhea;
 IBS-M: IBS with constipation/diarrhea;
 IBS-U: IBS unclassifiable.

9. PATHOPHYSIOLOGY

10. CLINICAL MANIFESTATION

11. CLINICAL MANIFESTATION
Other manifestation Includes
 Abdominal distension
 Bloating
 Change in appearance of stool
 A feeling of incomplete emptying of the bowel
 A feeling of urgency
 Fatigue
 Back pain
 Nausea vomiting
 Symptoms made worse by eating
 Poor appetite
 Heartburn

12. DIAGNOSTIC EVALUATION
There are currently no definitive tests for diagnosi
s Therefore, diagnosis is usually based o
n patient history , Rome criteria and Lacy
et al., Category of IBS
 The Rome III classification for IBS subtypes required that t
he proportion of total stools using the Bristol Stool Form Scal
e be used to classify
 IBS with predominant diarrhea (>25% loose/watery, <25% hard/
lumpy),
 IBS with predominant constipation (>25% hard/lumpy, <25% loose/
watery),
 Mixed-type IBS (>25% loose/watery, >25% hard/lumpy), and IBS un

13. DIAGNOSTIC EVALUATION
 Rome IV criteria -
This criteria require the
patient to have abdominal
pain lasting at least three
days a month in the last
three months, associated
with two or more of the
following:
1.Improved pain with defecatio
n
2.Altered frequency of defecati
on
3.Altered consistency of stool

14. Lacy et al., Category of IBS Based o
n BSFS
DIAGNOSTIC EVALUATION

15. Additional Diagnosis
•Flexible sigmoidoscopy or colonoscopy to look for signs of blo
ckage or inflammation in your intestines
•Upper endoscopy if you have heartburn or indigestion
•X-rays and CT scan Tests to look for problems with your bowe
l muscles
•Blood tests to look for anemia (too few red blood cells), thyroi
d problems, and signs of infection
•Stool tests for blood or infections
• Lactose intolerance Test, to detect gluten allergy, or celiac di
ease
DIAGNOSTIC EVALUATION

16. COMPLICATION
Complication
of IBS
Impacted bowel Hemorrhoids Malnourishmen
t
Food Intolerance Depression and Anxie
ty
Poor Quality of Life

17. MANAGEMENT
MEDICAL AND PHARMACHOLOGICAL MANAGEMENT

18. MANAGEMENT
MEDICAL MANAGEMENT
Diet and lifestyle changes
Usually, with a few basic changes in diet and activities, IBS will improve over time.
 Avoid caffeine (in coffee, tea, and soda).
 Add fiber to your diet with foods like fruits, vegetables, whole grains, and nuts
 Drink at least three to four glasses of water per day.
 Don't smoke.
 Learn to relax, either by getting more exercise or by reducing stress in your life
 Limit milk or cheese .
 Eat smaller meals more often instead of big meals.
 Keep a record of the foods you eat so you can figure out which foods bring on bouts of
IBS.

19. MANAGEMENT
NURSING MANAGEMENT
 Patient and family Education – Give educa
tion regarding use of Bowel habits diary, Bristo
l Stool Form Scale, Avoidance of food triggers .
 Encourage self activities
 Educate the stress management techniques like
relaxation techniques, cognitive behavioral ther
apy, Yoga and exercise.
 Reassurance and psychological support