The document discusses Irritable Bowel Syndrome (IBS), a functional gastrointestinal disorder characterized by abdominal pain and changes in bowel habits without identifiable structural causes. Key points include its pathophysiology, symptoms, diagnostic evaluations, and treatment options, emphasizing that IBS is distinct from inflammatory bowel disease. The management involves dietary modifications, medications, and nursing care to alleviate symptoms and improve patient well-being.

1. IRRITABLE BOWEL
SYNDROME(IBS)
Prepared by
Ms. Maira Shaheen

2. Learning Objectives
At the end of this lecture, students will be able
to:
• Explain the pathophysiology of IBS and its
clinical picture.
• Describe assessment and diagnostic evaluation
of IBS.
• Discuss the management of IBS.
• Discuss the nursing process for the care of a
patient with IBS.

4. Irritable Bowel Syndrome(IBS)
• A group of functional bowel disorders
• Chronic abdominal complaints without a
structural or biochemical cause
• Constitutes a major health problem with
gastrointestinal (GI) symptoms
• The cause of IBS is unknown.
• Affects up to ~20 % adults in the industrialized
world
• The condition is more frequent in women.
• The direct medical costs of IBS are ~ $ US 8
billion in the US each year.

5. Irritable Bowel Syndrome (IBS) (spastic
bowel, functional colitis)
Definition
• Functional GI tract disorder without
identifiable cause characterized by abdominal
pain and constipation, diarrhea, or both

7. Irritable Bowel Syndrome (IBS) (spastic
bowel, functional colitis)
Pathophysiology
• a. Appears there is altered CNS regulation of
motor and sensory functions of bowel
1.Increased bowel activity in response to food
intake, hormones, stress
2.Increased sensations of chyme movement
through gut
3.Hypersecretion of colonic mucus
• b. Lower visceral pain threshold causing
abdominal pain and bloating with normal levels
of gas
• c. Some linkage of depression and anxiety

8. Causes of IBS
The exact cause of IBS is idiopathic
 But it’s likely due to a variety of factors,
including genetics. A history of anxiety or
depression has been linked to IBS, but not all
patients with IBS have these risk factors.
Genetics

9. Symptoms of IBS
• Abdominal discomfort and pain
• Bloating, mucous in stools, diarrhea, constipation,
or alternating diarrhea and constipation
• Depression, anxiety or stress
• IBS can be subdivided into
– Diarrhea-predominant (IBS-D)
– Constipation-predominant (IBS-C)
– Alternating diarrhea and constipation

11. Is IBS the same as inflammatory
bowel disease(IBD)?
No. Inflammatory bowel disease, or IBD, is a disease
involving the immune system, and there is overt
inflammation of the intestine. In an IBS case, if you were
to perform an endoscopy or colonoscopy, it would look
normal, but the symptoms are driven by changes in the
way the bowel is functioning. For example, the pain from
IBS can be from “visceral hypersensitivity,” which means
the nerves of the gut are extremely sensitive to normal
things like gas, movement, contraction, and secretion.
These normal functions of the gut can trigger pain in
someone with IBS but might not trigger pain in someone
without IBS.

12. Subclassification of patients
• Supportive symptoms of IBS
1. Fewer than 3 bowel movements a week
2. More than 3 bowel movements a day
3. Hard or lumpy stools
4. Loose or watery stools
5. Urgency
6. Feeling of incomplete bowel movement
7. Passing mucus during a bowel movement
8. Abdominal fullness, bloating or swelling

13. Serotonin is important in gut function
• GI disorders may be related to
– an imbalance of serotonin in the gut
– an improper reaction of the digestive system to
serotonin
– a faulty communication network between
serotonin in the gut and the brain and spinal
cord.
• Serotonin plays a major role in modulating
intestinal movement and perception of pain.
Helps to soften stools by releasing water.

14. Irritable Bowel Syndrome (IBS) (spastic
bowel, functional colitis)
Diagnostic Tests: to find a cause for client’s
abdominal pain, changes in feces elimination
• Stool examination for occult blood, ova and
parasites, culture
• CBC with differential, Erythrocyte Sedimentation
Rate (ESR): to determine if anemia, bacterial
infection, or inflammatory process.

15. Irritable Bowel Syndrome (IBS) (spastic
bowel, functional colitis)
c. Sigmoidoscopy or colonoscopy
1.Visualize bowel mucosa, measure
intraluminal pressures, obtain biopsies if indicated
2.Findings with IBS: normal appearance
increased mucus, intraluminal pressures, marked
spasms, possible hyperemia without lesions
d. Small bowel series (Upper GI series with small
bowel-follow through) and barium enema:
examination of entire GI tract; IBS: increased
motility.

16. Irritable Bowel Syndrome (IBS) (spastic
bowel, functional colitis)
Collaborative Care
• a. Management of distressing symptoms
• b. Elimination of precipitating factors, stress
reduction

17. Irritable Bowel Syndrome (IBS) (spastic
bowel, functional colitis)
Medications
• a. Purpose: to manage symptoms
• b. Bulk-forming laxatives: reduce bowel spasm,
normalize bowel movement in number and form
• c. Anticholinergic drugs (dicyclomine (Bentyl),
hyoscyamine) to inhibit bowel motility and
prevent spasms; given before meals
• d. Antidiarrheal medications (loperamide
(Imodium), diphenoxylate (Lomotil): prevent
diarrhea prophylactically
• e. Antidepressant medications
• f. Research: medications altering serotonin
receptors in GI tract to stimulate peristalsis of the
GI tract

18. Irritable Bowel Syndrome (IBS) (spastic
bowel, functional colitis)
Dietary Management
• a. Often benefit from additional dietary fiber:
adds bulk and water content to stool reducing
diarrhea and constipation
• b. Some benefit from elimination of lactose,
fructose, sorbitol
• c. Limiting intake of gas-forming foods,
caffeinated beverages

19. Irritable Bowel Syndrome (IBS) (spastic
bowel, functional colitis)
Nursing Care
• a. Contact in health environments outside acute
care
• b. Home care focus on improving symptoms
with changes of diet, stress management,
medications; seek medical attention if serious
changes occur

21. REFERENCE
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., &
Cheever, K. H. (2010). Brunner and Suddarth’s
textbook of medical-surgical nursing (12th ed.).
Philadelphia:Lippincott Williams & Wilkins.