Irritable bowel syndrome

Also referred to as spastic colon or spastic colitis, irritable bowel syndrome is marked by chronic abdominal pain, alternating constipation and diarrhea, and abdominal distention. This disorder is extremely common; 20% of patients, however, never seek medical attention.

gender influence  Symptoms of irritable bowel syndrome are two to three times more common in women than in men, with women comprising 80% of patients who present with a more severe form of the disorder.

Causes

The cause and pathogenesis of this functional disorder remain poorly understood. Generally associated with psychological stress, the disorder may result from physical factors, such as diverticular disease, ingestion of irritants (coffee or raw fruits or vegetables), lactose intolerance, abuse of laxatives, food poisoning, or colon cancer. Contributing factors include abnormal gut motor and sensory activity, central neural dysfunction, and luminal factors.

Signs and symptoms

Irritable bowel syndrome characteristically produces intermittent, crampy lower abdominal pain. The pain is usually relieved by defecation or passage of flatus. It typically occurs during the day. Pain intensifies with stress or 1 to 2 hours after meals. The patient may experience constipation alternating with diarrhea, with one being the dominant problem. Mucus is usually passed through the rectum. Abdominal distention and bloating are common.

Diagnosis

A history and physical examination should be performed. A careful patient history is required to determine contributing psychological factors such as a recent stressful life change. The 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 relation between stress and her illness. Strict dietary restrictions aren’t beneficial, but food irritants should be investigated and the patient instructed to avoid them. Rest and heat applied to the abdomen are helpful, as is judicious use of sedatives (phenobarbital) and antispasmodics (propantheline or diphenoxylate with atropine sulfate). However, with chronic use, the patient may become dependent on these drugs. Increasing bulk in the diet and administering psyllium and an antidiarrheal, such as loperamide, also helps. If the cause of irritable bowel syndrome is chronic laxative abuse, bowel training may help correct the condition.

UNDER STUDY: Researchers have found that treatment with tageserod activates the serotonin 4 receptor. It has been found effective in increasing frequency of stools, relieving abdominal pain and discomfort, and decreasing bloating sensations.

Special considerations

Clinical tip  Because a patient with irritable bowel syndrome isn’t hospitalized, focus your care on patient teaching.

❑ Instruct the patient to avoid irritating foods, and encourage her to develop regular bowel habits.

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

❑ Encourage regular checkups because irritable bowel syndrome is associated with a higher-than-normal incidence of diverticulitis and colon cancer. For the patient older than age 40, emphasize the need for a yearly flexible sigmoidoscopy and rectal examination.

Book Source Details

• Book Title: Handbook of Diseases
• Author(s): Springhouse
• Year of Publication: 2003
• Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Handbook of Diseases, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5

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