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

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

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)

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)

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

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

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

•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

•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

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.

PATHOPHYSIOLOGY

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

CLINICAL MANIFESTATION

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

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.

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

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

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

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

MANAGEMENT
MEDICAL AND PHARMACHOLOGICAL MANAGEMENT

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.

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

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.

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

Prevention
Enough fiber in diet
Stop smoking ,avoid excessive amounts of caffeine
Yoga, relaxation technique
Regular exercise
Reduce the stress