1. IRRITABLE BOWEL
SYNDROME
By
Wisam Gatea Hani
1

2. Colon structure and function
𝗈Colon is the part of the large intestine , the last
portion of the human gastrointestinal tract is
approximately 5 to 5.5 feet long with a diameter of
about 2.5 inches, is located between the cecum
and rectum.
,It is divided into four sections
ascending, transverse
descending and sigmoid colon,
2

3. Function
. 2
r
The organ for storing waste products by .
1 elimination of toxic waste material in the
form of stool
Reabsorbing water from wastes and
maintaining water balance in the
body.
Serves at the site for the growth of
beneficial bacteria and to
the microorganisms
3

4. Irritable bowel syndrome
𝗈 Irritable Bowel Syndrome is not a disease. It's a
functional disorder, which means that the bowel
simply does not work as it should.
𝗈 (IBS) is a common disorder that affects the large
intestine (colon).
𝗈 (IBS) commonly causes cramping, abdominal
pain, bloating, gas, diarrhea and constipation
4

5. Epidemiology
Prevalence 3 - 22% world-wide
. Reason for 20 - 50% of gastroenterology visits
prevalence among children with recurrent 26%
.abdominal pain
.onset before age 35 40%
.onset age 35 – 50 50%
( Female > Male (3:1
5

6. 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 into the body , and what is left over is
. stool
6

7. C ONT..
A few times each day contractions push the
stool down the colon, resulting in a bowel
. movement
However, if the muscles of the colon do not
contract in the right 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

8. 8

10. PATHOPHYSIOLOGY
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5. Genetics
𝗈 IBS pathophysiology is not clear
𝗈 Many theories have been put forward , but the
exact cause of IBS is still uncertain
1. Alteration in GI motility : alteration in frequency
and irregularity of luminal contractions
2. Visceral hypersensitivity : increased sensation in
response to stimuli
3. Brain gut axis : alteration in communications
between enteric nervous system and CNS
4. Post infectious :about 10% of IBS cases are
triggered by an acute gastroenteritis infection

11. Symptoms of IBS
1) Abdominal (stomach) pain and cramps, which
may be relieved by passing stools
2) A change in your bowel habits – such as
diarrhoea, constipation, 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 going to the toilet.
7) Passing mucus or slime with your stools.
11

12. RED FLAG Signs and
Symptoms
Unintentional and unexplained wt. loss
Rectal bleeding
Family h/o bowel/ovarian cancer
A change in bowel habit to loose and/or more
frequent stools persisting for more than 6 wks in a
person aged over 60yrs.
Anemia
Abdominal masses
Rectal masses
Inflammatory markers for IBD

13. Types of IBS
-2
:IBS can be subdivided into
• Constipation-predominant :the person tends to
alternate constipation with normal stools.
Symptoms of abdominal cramping or aching are
commonly triggered by eating
• Diarrhea-predominant : the person tends to
experience diarrhea first thing in the morning or
after eating. The need to go to the toilet is typically.
urgent and cannot be delayed
• (Alternating constipation and diarrhea(IBS-A or
(IBS-M) mixed IBS 14

14. 14

15. Investigations of IBS
15
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
movements weekly)
• Altered stool consistency (lumpy/hard or loose/watery stools)
• Altered stool passage (straining, urgency or feelings of incomplete
evacuation)
• Passage of mucus
• Abdominal bloating or distension

16. Diagnostic tests
1.Flexible sigmoidoscopy
This test examines the lower part of the colon (sigmoid) with a
flexible, lighted tube (sigmoidoscope)
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17. 2- Computerized tomography (CT) scan :-
𝗈CT scans produce cross-sectional X-ray images of
internal organs
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18. 3- Colonoscopy :-
𝗈In some cases, your doctor may perform this
diagnostic test, in which a small, flexible tube is
used to examine the entire length of the colon.
18

19. 4- Lactose intolerance tests :-
Lactase is an enzyme you need to digest the sugar -
. found in dairy products
If you don't produce this enzyme, you may have -
problems including abdominal pain, gas and
. diarrhea
,To find out if this is the cause of your symptoms-
your doctor may order a breath test
or ask you to exclude milk
and milk products from your
.diet for several weeks
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20. TREATMENT
S TRATE G IE S
𝗈 Treatment involves a mix of drug , diet ,and
psychosocial interventions .
20

21. A-DIETARY MODIFICATION
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➢Avoid food that trigger symptoms (such as
gases forming foods as lentils , legumes ,
and beans )
➢Low FODMAP diet (Fermentable Oligo Di
Mono-saccharides And Polyols) :- are short
chain carbohydrates that are poorly
absorbed in small intestine .
➢Fiber supplementation :- may improve
symptoms of constipation and diarrhea

22. B- PHARMACOLOGICAL
THERAPIES
1 Antispasmodics :-
dicyclomine, hyoscine N-butylbromide,
clidinium ,peppermint oil, mebeverine ,and
pinaverium
2 Tricyclic antidepressants : -
imipramine , amitriptyline , nortriptyline
3- selective serotonin reuptake inhibitors
(SSRIS):-
fluoxetine, sertraline , paroxetine , citalopram
,
escitalopram
4- probiotics :- improvement in global symptoms ,
24

23. ❖ Drugs for IBS-C :-
𝗈 Laxatives :- psyllium
𝗈 C hloride channel activators:- lubiprostone
𝗈 Serotonin agonists:- tegaserod , mosapride
𝗈 G uanylate cyclase -C agonists :- linaclotide
❖ Drugs for IBS-D:-
o Antibiotics :- Rifaximin
o Antimotility agents :- loperamide ,
diphenoxylate
o Serotonin antagonists :- alosetron , cilansetron
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24. Prevention
Enough fiber in diet
Stop smoking ,avoid excessive
amounts of caffeine
Yoga, relaxation technique
Regular exercise
Reduce the stress

25. Nursing Management
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.

26. Nursing Diagnosis
1. Diarrhea related to irritated bowel and intestinal hyperactivity
2. Anxiety related to possible social embarrassment, diagnostic
tests, and treatments
3. Imbalanced Nutrition: Less than Body Requirements related to
decreased 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 knowledge of disease course, lifestyle adjustments,
nutritional and drugtherapy

27. References
Anonymous (2010), Irritable bowel syndrome (English). Medical Subject- 1
.Headings. U.S. National Library of Medicine
Article:Amanda Chan Date: 06 January 2011 Time: 10:11 AM ET- 2
March 9, 2011 | Author: Kristie Brehant | Posted in Disease and Illness-3
/http://mdhba.com/disease-and-illness/ibs-help
http://www.naturalnews.com/IBS.html- 4
Friday, October 08, 2010 by: Tony Isaacs
Alan Jensen EzineArticles.com Expert Author- 5
Joined December 13, 2010
State Government of Victoria 2010-© 6
Irritable bowel syndrome. The National Digestive Diseases Information- 7
Clearinghouse. http://digestive.niddk.nih.gov/ddiseases/pubs/ibs/. Accessed
.June 2, 2009
Clinical Therapeutics, Volume 30, Issue 5, May 2008, 8Pages 884-901-8-8
Roja Rahimi, Shekoufeh Nikfar, Mohammad Abdollah
Gastrointestinal Endoscopy, Volume 70, Issue 5, November 2009, Pages 942-946-9
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