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Chapter: Medical Surgical Nursing: Management of Patients With Intestinal and Rectal Disorders

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Irritable Bowel Syndrome - Abnormalities of Fecal Elimination

IBS is one of the most common GI problems. Approximately one in six otherwise healthy persons report classic symptoms of IBS.

IRRITABLE BOWEL SYNDROME

 

IBS is one of the most common GI problems. Approximately one in six otherwise healthy persons report classic symptoms of IBS (Wolfe, 2000). It occurs more commonly in women than in men, and the cause is still unknown. Although no anatomic or bio-chemical abnormalities have been found that explain the com-mon symptoms, various factors are associated with the syndrome: heredity, psychological stress or conditions such as depression and anxiety, a diet high in fat and stimulating or irritating foods, alcohol consumption, and smoking. The small intestine has be-come a focus of investigation as an additional site of dysmotility in IBS, and cluster contractions in the jejunum and ileum are being studied (Wolfe, 2000). The diagnosis is made only after tests have been completed that prove the absence of structural or other disorders.

Pathophysiology

IBS results from a functional disorder of intestinal motility. The change in motility may be related to the neurologic regulatory system, infection or irritation, or a vascular or metabolic distur-bance. The peristaltic waves are affected at specific segments of the intestine and in the intensity with which they propel the fecal matter forward. There is no evidence of inflammation or tissue changes in the intestinal mucosa.

Clinical Manifestations

 

There is a wide variability in symptom presentation. Symptoms range in intensity and duration from mild and infrequent to se-vere and continuous. The primary symptom is an alteration in bowel patterns—constipation, diarrhea, or a combination of both. Pain, bloating, and abdominal distention often accompany this change in bowel pattern. The abdominal pain is sometimes precipitated by eating and is frequently relieved by defecation.

 

Assessment and Diagnostic Findings

 

A definite diagnosis of IBS requires tests that prove the absence of structural or other disorders. Stool studies, contrast x-ray stud-ies, and proctoscopy may be performed to rule out other colon diseases. Barium enema and colonoscopy may reveal spasm, dis-tention, or mucus accumulation in the intestine (Fig. 38-1). Manometry and electromyography are used to study intralumi-nal pressure changes generated by spasticity.


 

Medical Management

 

The goals of treatment are aimed at relieving abdominal pain, con-trolling the diarrhea or constipation, and reducing stress. Re-striction and then gradual reintroduction of foods that are possibly irritating may help determine what types of food are acting as ir-ritants (eg, beans, caffeinated products, fried foods, alcohol, spicy foods). A healthy, high-fiber diet is prescribed to help control the diarrhea and constipation. Exercise can assist in reducing anxiety and increasing intestinal motility. Patients often find it helpful to participate in a stress reduction or behavior-modification program.

Hydrophilic colloids (ie, bulk) and antidiarrheal agents (eg, lop-eramide) may be given to control the diarrhea and fecal urgency. Antidepressants can assist in treating underlying anxiety and de-pression. Anticholinergics and calcium channel blockers decrease smooth muscle spasm, decreasing cramping and constipation.

 

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.

 

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