IRRITABLE BOWEL SYNDROME (IBS)
DISEASE CONDITION
Irritable bowel syndrome (IBS) is a category of conditions that develop together
including repeated stomach pain and changes in the motions of the bowel that may include
diarrhea, constipation, or both. For IBS, you get these effects in the digestive tract without any
clear evidence of injury or infection.
IBS is a gastrointestinal (GI) disease that is functional. Functional GI disorders, now
referred to by clinicians as gut-brain interface disorders, are linked to complications about how
the brain and gut function together. These issues will make your stomach more vulnerable and
modify how your bowel muscles contract. More abdominal pain and bloating can be noticed if
the stomach is more sensitive. Changes in the way the muscles react to diarrhea, constipation, or
both in the bowel contract.
There are four types of the disease. IBS with constipation (IBS-C) and IBS with diarrhea
are found (IBS-D). There is an alternating cycle of constipation and diarrhea in some individuals.
This is called IBS Blended (IBS-M). The disease is called unsub typed IBS, or IBS-U, for
persons who do not readily fall into these groups.
CAUSES
Abdominal gastrointestinal (GI) tract movements
A change in in the nervous system communication between GI and brain
Sensory and motor disorders of the colon
Dietary allergies or food sensitivities
Neurotransmitter imbalance (decrease serotonin levels)
Stress
SIGNS AND SYMPTOMS
1. Pain and Cramping – lower abdominal pain, which is less severe after bowel
movement, is the most frequent symptom of IBS. Dietary improvements, treatments that
relieve depression and some drugs may help reduce discomfort.
2. Diarrhea – frequent, loose stools are common in IBS, and are a symptom of the diarrhea-
predominant type. Stools may also contain mucus.
3. Constipation – in IBS, regular, loose stools are normal, and are a symptom of the form
prevalent in diarrhea. Stools can contain mucus as well.
4. Alternating Constipation and Diarrhea – about 20% of patients with IBS experience
alternating periods of diarrhea and constipation. Throughout each phase, they continue to
experience pain relieved by bowel movements.
5. Changes in Bowel Movement – IBS changes the time stool remains in your intestines.
This changes the amount of water in stool, giving it a range from loose and watery to
hard and dry.
6. Gas and Bloating – four of the most frequent and irritating indicators of IBS are gas and
bloating. It can help minimize bloating by adopting a low-FODMAPs diet.
7. Food Intolerance – many people with IBS report specific trigger foods. Some common
triggers include FODMAPs and stimulants, such as caffeine.
8. Fatigue and Difficulty Sleeping – in comparison to those without it, those with IBS are
more fatigued and report less refreshing sleep. More severe gastrointestinal symptoms are
also related to fatigue and poor quality of sleep.
9. Anxiety and Depression - IBS can produce a vicious cycle of digestive symptoms that
increase anxiety and anxiety that increases digestive symptoms. Tackling anxiety can
help reduce other symptoms.
MANAGEMENT
a. Medical Management
Treatment and management of IBS involves a combination of drugs, dietary
modifications and psychosocial interventions. Medications specific for IBS includes:
Alosetron (Lotronex) – the aim of Alosetron is to stimulate the colon and
delay the flow of waste through the lower intestine.
Eluxadoline (Viberzi) – can ease diarrhea by reducing muscle
contractions and fluid secretion in the intestine and increasing muscle tone
in the rectum.
Rifaximin (Xifaxa) – this antibiotic can decrease bacterial overgrowth
and diarrhea.
Lubiprostone (Amitiza) – can increase fluid secretion in your small
intestine to help with the passage of stool.
Linaclotide (Linzess) – also can increase fluid secretion in your small
intestine to help you pass stool. Linaclotide can cause diarrhea but taking
the medication 30 to 60 minutes before eating might help.
Depending on the severity of the condition and the signs as symptoms manifested
by client/patient there are a variety of medications that can be prescribed such as:
Fiber supplements – taking a supplement such as psyllium (Metamucil)
with fluids may help control constipation.
Laxatives – if fiber does not help constipation, your doctor may
recommend over-the-counter laxatives, such as magnesium hydroxide oral
(Phillips' Milk of Magnesia) or polyethylene glycol (Miralax).
Anti-diarrheal medications – over-the-counter medications, such as
loperamide (Imodium A-D), can help control diarrhea.
Anticholinergic medications – medications such as dicyclomine (Bentyl)
can help relieve painful bowel spasms. They are sometimes prescribed for
people who have bouts of diarrhea.
Tricyclic antidepressants – this type of medication can help relieve
depression as well as inhibit the activity of neurons that control the
intestines to help reduce pain.
SSRI antidepressants – selective serotonin reuptake inhibitor (SSRI)
antidepressants, such as fluoxetine (Prozac, Sarafem) or paroxetine
(Paxil), may help if you are depressed and have pain and constipation.
Pain medications – Pregabalin (Lyrica) or gabapentin (Neurontin) might
ease severe pain or bloating.
b. Nursing Management
Mild signs and symptoms can often be controlled by managing stress and by
making changes in your diet and lifestyle. Avoid foods that trigger symptoms (gases
forming foods such as lentils, legumes, and beans); low FODMAP diet or Fermentable
Oligo Di-Monosaccharides and Polyols – are short chain carbohydrates that are poorly
stored in the small intestines; fiber supplementation which improve symptoms of
constipation and diarrhea; avoid caffeine, tea and soda; and limit lactose intake or food
with milk contents. Advice patient to exercise regularly, avoid alcohol intake and
smoking and reduce or avoid stress.
SCHEMATIC DIAGRAM
© Magdy El Saphy, MD, PhD (2016)
