Irritable Bowel Syndrome (IBS)

C) Symptoms of IBS typically occur during young adulthood and continue throughout life. Ref: Iggy 5th Edition p.1312

A) Abdominal pain relieved by defacation or changes in the frequency or consistency of stoolB) Abdominal distentionC) Sensation of incomplete evacuation of stoolD) The presence of mucous with stool passageE) Pt.'s often c/o abdominal discomfort or pain, belching, sense of gaseousness, bloating, anorexia, and change in bowel habits (diarrhea, constipation or alternating episodes of the two)Ref: Iggy 5th Edition p. 1313-1314

Pt.'s usually experience pain in the left lower quadrant of the abdomen.Ref: Iggy 5th Edition p. 1313

Bulk-forming laxatives-(Ex. Metamucil) usually taken with taken at mealtimes with water to help prevent dry and hard stools or liquid stools Anticholinergics-(Ex. Dicyclomine (Bentyl)- Affects nerves cells or fibers to calm muscle spasms in the intestine and can help reduce the amount of stomach acid produced, relieving the cramping pain and diarrhea experienced by IBS pt.'s. Antidiarrheal agents-(Ex. Diphenoxylate/atropine(Lomotil) Diphenoxylate treats the diarrhea and atropine relieves muscle spams in the gut. (Only for short -term use)
Tricyclic antidepressants-(Ex. Amitriptyline) effects may be r/t the antidepressant effects or the anticholinergic effects of the antidepressants 5-HT4 Agonists-(Ex. Tegaserod (Zelnorm))-helps move stool through the intestine and is used to treat women with the constipation problems associated with IBS-is usually used for treatment for 4-6 weeks

Other drug options:

Belladonna/Phenobarbitol- (Ex. Hyoscyamine)Combination of alkaloids and barbituates help relax the muscles in the bladder and intestines and reduce stomach acid

Alosetron hydrochloride (Lotronex)-used only to treat women suffering from the severe diarrheal effects of IBS and works by disrupting the action of serotonin that aids in causing intestinal movement and pain Chlordiazepoxide/clidinium (Librax)-prevents spasms in the gut and bladder.

http://ibdcrohns.about.com/cs/faqsibs/a/ibsfaq_3.htm
• Iggy 5th Edition p.1314

Some of the common "trigger" foods are:

Alcohol, artificial sweeteners or substitutes, carbonated beverages, dairy products especially if lactose intolerant, coconut milk, coffee (including decaffeinated), egg yolks, poultry skin and dark meats, red meat (hamburgers, hot dogs, pepperoni, pork chops, etc), fried Foods (Batterfried, Deep fried, Skillet Fried), solid chocolate, nuts and nut butter, olives, oils, shortening, margarine, mayonnaise, salad dressings, and artificial fats like Olestra.

Ref: Iggy 5th Edition p.1314

/diet/trigger2.asp

CBCSerologic TestsSerum AlbuminErythrocyte Sedimentation Rate (ESR)Stools for occult bloodFlexible Sigmoidoscopy (for adults younger than 40)Colonoscopy (for adults older than 40)-often demonstrates intense spastic contractions that often stimulate painful secretions during the procedure Ref: Iggy 5th Edition p. 1314

Always eat soluble fiber first especially when your stomach is completely empty and make it the largest part of all meals.Foods that are high in soluble fiber are recommended and include:Barley, Oatmeal and Oat Bran, Brown rice, Dried Beans, Pasta, Fresh Peas, Raisins, Rice, Prunes, Soy, French bread and Sourdough BreadMinimize the fat intake ex.-Focus on using monosaturated oils when cooking.Never eat high fat foods, especially without eating a source of soluble fiber first.Eliminate all food triggersNever eat insoluble fiber without a soluble fiber source and definately not on an empty stomach. Eat small portions at a slow rate to aid in digestion.If you don't know if the food will trigger an attack, avoid it.Be creative with food choices and meals-use 2 egg whites instead of the yolk, eat soy burgers in place of hamburgers, use cocoa powder instead of solid chocolate when baking etc.

• Ref:
• http://ibdcrohns.about.com/cs/faqsibs/a/ibsfaq_4.htm
• Heather's Tummy Care: IBS Diet Cheat Sheet

May be caused by impairment of motor or sensory function of the GI tract which causes the muscles to become overreactive, often when stimulated by "trigger" foods or other stimuli such as stress or depression that causes a strong response in the colon leading to either constipation/diarrhea or the combination of the two. The mucosal lining of the bowel remains the same even though episodes of constipation and diarrhea or a mix of the two occur. IBS also has bouts of remission and exacerbations.Iggy 5th Edition p.1312http://ibdcrohns.about.com/cs/faqsibs/a/ibsfaq.htm

There are no major known complications associated with IBS, but may affect the overall quality of life for the patient. I have listed some of the potential problems that IBS sufferers deal with below:Diarrhea can happen at anytime, so the person is always looking for a bathroom in case an episode occurs-the person may just avoid going out for that reason, causing social isolation Hemorrhoids may occur from straining during a bowel movement in people suffering from constipation r/t IBS. Sexual experiences may be painful because of the symptoms of IBS-bloating, abdominal discomfort etc. May lead to depression because of isolation, social inadequacies, IBS sort of controlling the way of life for the pt. Some nutritional issues may also occur d/t eliminating some important foods like milk which can reduce the major source of calcium intake on a daily basis. /health/irritable-bowel-syndrome/DS00106/DSECTION=complications

The pt. will state that the drug/treatments are effective and that there are fewer episodes of constipation and/or diarrhea. The pt. will remain pain-free or state a noticeable reduction in pain that is tolerable. The pt. will participate in stress managment, exercise programs, alternative therapies and report fewer or no symptoms of IBS. The pt. will be able to identify "trigger" foods by using a food diary and avoiding those foods-eliminating or reducing flare-ups of IBSIggy 5th Edition p.1314-1315

1) Educate-med teaching, avoiding food triggers, exercise 2) Dietary modification3) Drug Therapy-antidiarrheals, anticholinergics, tricyclic antidepressants, muscarinic receptor antagonists, 5HT4 agonists, 4)Stress Management-counseling, exercise, yoga, meditation5)Complimentary /Alternative Therapies-Accupuncture, Hypnosis, Chamomile, Evening Primrose, Peppermint and Caraway Oil combination Iggy 5th Edition p. 1314-1315

A) Usually a person suffering from IBS appears healthy, with a stable wt., and normal/adequate fluid and nutritional status. Upon assessment the pt. may have normal bowels sounds unless constipation is present and then they would be quiet, there may be widespread tenderness upon palpitation that is worse if the sigmoid colon is palpable.Ref: Iggy 5th Edition p.

A,B,CAll of these options can cause spasms and irritation of the bowel creating IBS symptoms to flare-up.Iggy 5th Edition p.1312

Eat 30-40g of soluble fiber per day to help with regularity of bowel movements Avoid food triggers like milk, especially if lactose intolerant and limit caffeine Avoid alcohol and beverages that contain sorbitol (fake sugar) fructose (sugars naturally found in fresh fruits) or other gastric irritants Create a diary containing the effects of new foods if needed to either keep or eliminate them from the diet Chew foods slowly and puree, chop or cut insoluble fiber foods into smaller pieces to help tolerate those foods better and promote normal bowel function/diet/trigger2.asp

Signals between the brain and nerves of the small and large intestines a.k.a. "the gut", control how the intestines work and when the brain-gut signals don't work properly, IBS symptoms could occur. Ref: /site/about-ibs/intro-to-ibs/