25 Mar 2023

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  1. Irritable Bowel Syndrome (IBS) Prof.Dr.Chinna Chadayan.N RN.RM., B.Sc (N)., M.Sc (N)., Ph.D (N)., Professor, Adult and Elderly Health Nursing Department, 1st yr M.Sc (N) 2nd batch Unit – 14e AEN Specialty
  2. INTRODUCTION Irritable bowel syndrome (IBS) is a common disorder that affects the stomach and intestines, IBS is also known as spastic colon, irritable colon, mucous colitis, and spastic colitis. It is a separate condition from inflammatory bowel 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 bowel simply does not work as it should. IBS is a common disorder that affects the large intestine (colon). IBS is a group of intestinal symptoms that typically occur together. The symptoms vary in severity and duration
  3. DEFINITION Irritable bowel syndrome (IBS) is a chronic functional disorder characterized by recurrent abdominal pain associated with disordered bowel movements, which may include diarrhea, constipation or both. (Lacy et 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. Mechanism of colon in Irritable bowel syndrome The contraction of the colon muscles and the movement of its contents is controlled by nerves, . hormones, and impulses in the colon muscles These contractions move the contents inside the .colon toward the rectum During this passage, water and nutrients are absorbed int o the body , and what is left over is . stool
  6. C ONT.. A few times each day contractions push the stool down t he colon, resulting in a bowel . movement However, if the muscles of the colon do not contract in the ri ght way, the contents inside the .colon do not move correctly resulting in abdominal pain, cramps,- constipation , a sense of incomplete stool movement, or diarrhea
  7. 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
  8. •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
  9. •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
  10. 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.
  12. PATHOPHYSIOLOGY 𝗈 IBS pathophysiology is not clear 𝗈 Many theories have been put forward , but the exact caus e of IBS is still uncertain 1. Alteration in GI motility : alteration in frequency and irreg ularity of luminal contractions 2. Visceral hypersensitivity : increased sensation in response t o stimuli 3. Brain gut axis : alteration in communications between e nteric nervous system and CNS 4. Post infectious :about 10% of IBS cases are triggered by an acute gastroenteritis infection 5. Genetics
  14. RED FLAG Signs and Symptoms 1. Unintentional and unexplained wt. loss 2. Rectal bleeding 3. Family h/o bowel/ovarian cancer 4. A change in bowel habit to loose and/or more frequent stools persisting for more than 6 wks in a person aged over 60yrs. 5. Anemia 6. Abdominal masses 7. Rectal masses 8. Inflammatory markers for IBD
  15. CLINICAL MANIFESTATION Other manifestation Includes 1) Abdominal (stomach) pain and cramps, which may be relieve d by passing stools 2) A change in your bowel habits – such as diarrhoea, constipati on, or sometimes both 3) Bloating and swelling of your stomach 4) Excessive wind or gas 5) Experiencing an urgent need to go to the toilet 6) A feeling that you have not fully emptied your bowels after g oing to the toilet. 7) Passing mucus or slime with your stools.
  16. 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
  17. Investigations of IBS ROME SYMPTOM DIAGNOSTIC CRITERIA IS DEPICTED BELOW A. At least 3 months of continuous or recurrent abdominal pain that is: • Relived with defecation, and/or, • Associated with change in frequency of stool, and/or, • Associated with a change in consistency of stool B. Two or more of the followings at least on one –fourth of occasions or days: • Altered stool frequency(˃3 bowel movements daily or ˂ 3 bowel moveme nts weekly) • Altered stool consistency (lumpy/hard or loose/watery stools) • Altered stool passage (straining, urgency or feelings of incomplete evacuati on) • Passage of mucus • Abdominal bloating or distension
  18. 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
  19. COMPLICATION Complication of IBS Impacted bowel Hemorrhoids Malnourishmen t Food Intolerance Depression and Anxie ty Poor Quality of Life
  21. 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.
  22. Nursing Diagnosis 1.Diarrhea related to irritated bowel and intestinal hyperactivity 2.Anxiety related to possible social embarrassment, diagnostic tests, and tre atments 3.Imbalanced Nutrition: Less than Body Requirements related to decrease d intake, decreased absorption, and increased nutrient loss through diarrhea 4.Impaired Skin Integrity related to diarrhea and altered nutritional status 5.Ineffective Coping related to chronic disease, lifestyle changes, stress and pain 6.Ineffective Therapeutic Regimen Management related to lack of knowle dge of disease course, lifestyle adjustments, nutritional and drugtherapy
  23. Nursing Role The nurse’s role is to provide patient and family education. The nurse emphasizes teaching and reinforces good dietary habits. The patient is encouraged to eat at regular times and to chew food slowly and thoroughly. The patient should understand that, al-though adequate fluid intake is necessary, fluid should not be taken with meals because this results in abdominal distention. Alcohol use and cigarette smoking are discouraged.
  24. MANAGEMENT HEALTH EDUCATION  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
  25. Prevention Enough fiber in diet Stop smoking ,avoid excessive amounts of caffeine Yoga, relaxation technique Regular exercise Reduce the stress