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
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
IBS is a group of intestinal symptoms that typically occur
together. The symptoms vary in severity and duration
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)
Prevalence 3 - 22% world-wide Reason for 20 - 50%
of gastroenterology visits.
IBS is less among Asian population with 6.5 – 11% p
26%prevalence among children with recurrent
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
A few times each day contractions push the stool down t
he colon, resulting in a bowel
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
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.).
•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
•Mental health— anxiety, depression, personality
disorder, and history of abuse are all associated risk
•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
TYPES OF IBS
There are four subcategories of IBS, each with
IBS-C: IBS with constipation;
IBS-D: IBS with diarrhea;
IBS-M: IBS with constipation/diarrhea;
IBS-U: IBS unclassifiable.
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
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
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.
6. Abdominal masses
7. Rectal masses
8. Inflammatory markers for IBD
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.
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/
IBS with predominant constipation (>25% hard/lumpy, <25% loose/
Mixed-type IBS (>25% loose/watery, >25% hard/lumpy), and IBS un
Investigations of IBS
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
• Altered stool consistency (lumpy/hard or loose/watery stools)
• Altered stool passage (straining, urgency or feelings of incomplete evacuati
• Passage of mucus
• Abdominal bloating or distension
•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
•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
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.
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
1.Diarrhea related to irritated bowel and intestinal hyperactivity
2.Anxiety related to possible social embarrassment, diagnostic tests, and tre
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
6.Ineffective Therapeutic Regimen Management related to lack of knowle
dge of disease course, lifestyle adjustments, nutritional and drugtherapy
The nurse’s role is to provide patient and family education.
The nurse emphasizes teaching and reinforces good dietary
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.
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
Enough fiber in diet
Stop smoking ,avoid excessive amounts of caffeine
Yoga, relaxation technique
Reduce the stress