Irritable bowel syndrome

Irritable bowel syndrome (IBS), also called spastic colon and spastic colitis, is a common condition marked by chronic or periodic diarrhea, alternating with constipation, and accompanied by straining and abdominal cramps. The prognosis is good. Supportive treatment or avoidance of a known irritant usually relieves symptoms.

Causes and incidence

This functional disorder is generally associated with psychological stress; however, it may result from physical factors, such as diverticular disease, ingestion of irritants (coffee, raw fruits or vegetables), lactose intolerance, laxative abuse, food poisoning, or colon cancer. Some patients may experience a disturbance in the movement of the intestine or a lower tolerance for stretching and movement of the intestine.

IBS affects 10% to 20% of U.S. residents and has a yearly incidence rate of 1% to 2%. The condition occurs most commonly in women ages 20 to 30.

Signs and symptoms

IBS characteristically produces lower abdominal pain (usually relieved by defecation or passage of gas) and diarrhea that typically occurs during the day. These symptoms alternate with constipation or normal bowel function. Stools are commonly small and contain visible mucus. Dyspepsia and abdominal distention may occur.

Diagnosis

Diagnosis of IBS requires a careful history to determine contributing psychological factors such as a recent stressful life change. Diagnosis must also rule out other disorders, such as amebiasis, diverticulitis, colon cancer, and lactose intolerance. Appropriate diagnostic procedures include sigmoidoscopy, colonoscopy, barium enema, rectal biopsy, and stool examination for blood, parasites, and bacteria.

Treatment

Therapy aims to relieve symptoms and includes counseling to help the patient understand the relationship between stress and his illness. Strict dietary restrictions aren’t beneficial, but food irritants should be investigated and the patient should be instructed to avoid them. Rest and heat applied to the abdomen are helpful, as is judicious use of sedatives and antispasmodics. However, with chronic use, the patient may become dependent on these drugs. If the cause of IBS is chronic laxative abuse, bowel training may help correct the condition. Tegaserad may be prescribed for the patient with constipation-predominant IBS.

Special considerations

Because the patient with IBS isn’t hospitalized, focus your care on patient teaching.

❑ Tell the patient to avoid irritating foods, and encourage him to develop regular bowel habits.

❑ Help the patient deal with stress, and warn against dependence on sedatives or antispasmodics.

❑ Encourage regular checkups because IBS is associated with a higher-than-normal incidence of diverticulitis and colon cancer. For patients older than age 40, emphasize the need for an annual sigmoidoscopy and rectal examination.

Book Source Details

• Book Title: Professional Guide to Diseases (Eighth Edition)
• Author(s): Springhouse
• Year of Publication: 2005
• Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.

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Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X

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