Lived Experience: Irritiable Bowel Syndrome
Submitted By ber07d
Lived Experience Paper
Irritable Bowel Syndrome
Florida State University
College of Nursing
NUR3125 – Fall ‘09
November 10, 2009
Introduction Irritable Bowel Syndrome (IBS) is recorded to be the most common intestinal complaint and reasoning for a patient’s direct referral to a gastroenterologist (Medline Plus Organization, 2009). This paper will give a summarized desciption of the characterisitics of IBS, as well as a glimpse into the life experience of a patient whom deals with the symptoms of irritable bowel on a daily basis. My hopes would be for people to get a more cathartic understanding of the effects that these constant symptoms have on a regular person. Description IBS is described as, a functional gastrointestinal disorder in which the patient experiences periods of abdominal pain and discomfort, along with changes in their normal bowel movement habits (Longstreth, 2006). However, unlike more serious gastrointestinal diseases, IBS does not bring about bowel inflammation or permanent alterations in bowel tissue; therefore, it does not contribute either to irreversible damage of the colon, or an increased risk of colorectal cancer. (Mayo Clinic Staff, 2009). Epidemiology and Populations at Risk Studies suggest that genetic susceptibility plays a role in IBS. Patients with a first-degree relative diagnosed with IBS have an increased risk of this disorder. Approximately 1 in every 5 people in the world suffers from IBS, and it is seen twice as often in women then in men. These statistics infer that hormonal changes play may play a role in this condition (Huether & McCane, 2008). It is common for IBS first be discovered in adolescents and young adults between the ages of 15 and 25 (Schneider PhD & Fletcher PhD, 2008). Pathophysiology Although the pathophysiology of IBS is extremely complex, there are a number of mechanisms that lead to the clinical manifestations associated with this disorder. The peristaltic contractions of the smooth muscle walls in the gastrointestinal tract are uncoordinated, and may contract at a much stronger and longer pace, or at a slower and weaker pace then normal bowels (Mayo Clinic Staff, 2009.) This can result in “rapid colonic transit times,” for those with a hyperactive intestinal wall, causing diarrhea, and “delayed transit time” for those with a hypoactive intestinal wall, causing constipation and bloating. This abnormal peristaltic activity can also be related to, “Dysregulation of the brain-gut axis, or the role of serotonin in the function of the enteric nervous system” (Huether & McCane, 2008, p. 955). Bacterial enteritis can cause postinfectious IBS, which seems to be linked to, “low grade inflammation and abnormal response in gut tissues.” The proliferation of intestinal flora may also worsen symptoms. (Huether & McCane, 2008, p. 955). Clinical Manifestations Since there is no identified etiology with this disorder, the Rome III Diagnostic Criteria was developed to assist in the seperation of irritable bowel syndrome from the other functional bowel disorders. This criteria states that, “Recurrent abdominal pain and discomfort for at least three days per month in the last three months with a symptom onset of at least six months prior to diagnosis, associated with two or more of the following; improvement with defecation, onset associated with a change in frequency of stool, and onset associated with a change in form (appearance) of stool” (Longstreth, 2006). Although this is the fastest and least expensive way to diagnose, some patients may need further testing. These tests include, a colonoscopy, flexible sigmoidoscopy, CT scan. Lactose intolerance and blood tests are often given to ensure the symptoms do not stem from other disorders with similar symptoms. In addition to the diagnostic criteria of Rome III, IBS encompasses a wide range of abdominal symptoms ranging from mild to extremely severe. Common symptoms include: abdominal distension, gas or bloating, abdominal pain that is reduced or goes away after a bowel movement, colicky pain that comes and goes, and usually occurs after meals; chronic and frequent diarrhea and/or constipation (sometimes alternating); and mucus in the stool. Some people experience emotional distress, depression and loss of appetite due to their symptoms (Medline Plus Organization, 2009). Since IBS is classified as a chronic condition, there are often periods of exacerbation with debilitating symptoms, as well as periods of remission when the patient may be able to dismiss the diagnosis completely. (Mayo Clinic Staff, 2009). IBS is a functional bowel disorder because of its ability to be controlled in most people by lifestyle modification. Whether its diet alteration, a steady exercise routine, a reliable way to manage possible stressors, or a combination of these, it is extremely important for patients to be consistent and realize exactly which noxious stimulus trigger an exacerbation of their IBS. In particular, stress and anxiety related to the patients disorder are often referred to as the “Cascade of impact,” because it is hard for the patient to discern whether the exacerbation of IBS precedes or follows the feelings of stress and anxiety (Schneider PhD & Fletcher PhD, 2008). Keeping a journal of daily activites with food intake, and the direct effect this has on the bowel, can be very helpful in teaching the patient to manage and control their unpleasant symptoms. Lived Experience R. R. was first diagnosed with Irritable Bowel Syndrome at the age of 20, her first year as a student nurse. Her symptoms initiated rather abruptly, and would greatly vary on a daily basis. After approximately a month of rather severe symptoms including: distracting and colicky-like abdominal cramping, sudden urges to defecate with either uncontrollable diarrhea or extremely painful constipation, and undue emotional distress because of the intense pain, she decided to see a gastroenterologist. R.R. had recently lost her father to colorectal cancer, and her mother had ulcerative colitis. Having a seemingly genetic trait of bowel problems, she realized the need to intervene. Her doctor believed that her described symptoms fit the criteria for Irritable Bowel Syndrome. As the nurse informed her of the degree of this chronic disorder, she handed R.R. a long list of medications to begin. She was told that these medications could help her condition, but she would need to be proactive in discovering exactly what stimuli affected her the worst. This would include keeping a journal to document her daily routine eating habits in order to help pinpoint other possible foods that had a negative effect on her well being. She was also given a strict diet, which seemed to eliminate every food she loved including: salad, chocolate, milk, broccoli and uncooked fruits and vegetables. The physician warned her that most of his patients diagnosed with IBS found stress and anxiety-filled situations to exacerbate their symptoms. Since she had just recently started nursing school, R.R. initially thought this was impossible to avoid. However, trying not to get discouraged she began planning right away. R.R tried to control her stress levels through exercise or some other form of release, rather then internalizing her feelings and allowing them to have a negative impact on her health. After many months of trial and error R.R. states that she was, “Extremely depressed and emotionally overwhelmed,” and that she felt as if she would never be able to enjoy a somewhat normal life. R.R remembered feeling so embarrassed initially, having to, “go to the bathroom every five seconds some days and having to miss class because of my stomach attacks.” It took her over six years to figure out exactly what caused the exacerbations of her bowels, discovering stress to be the number one instigator. The first few years after my diagnosis were absolutely terrible. I was always worried about when I was going to have another attack, if there was a washroom nearby, and how I felt as if everyone knew when I was in the bathroom for so long. Sometimes the pain was so crushing that I would be hurled over in the public bathroom thinking that I was going to die. It took forever to figure out exactly which foods or situations caused these attacks and I felt like not even the doctors could understand the pain I was in. I even found myself cancelling on friends constantly, getting behind with my schoolwork and missing class more and more. The more I isolated myself, the worse my attacks would be. One day I decided that this was going to stop, there had to be something, anything that could control this. After reading a number of books with different theories, R.R. decided to try yoga and meditations to calm her anxiety. After about a month of practicing both daily meditations and weekly yoga, R.R. noticed a drastic difference in her personality, her daily life activities and most importantly, her IBS. Although she still lives with the mild symptoms from day to day, she has limited her exacerbations greatly, and IBS no longer controls her everyday life. Related Research Article Both researchers involved in this article, suffer from Chron’s disease. Due to the seeming lack of research published on living with irritable bowel disorders, they took it upon themselves to show the world, “The negative impact of IBS and IBD upon university-aged women.” These researchers found that the seven women they interviewed with either IBS or IBD had equally debilitating and severe symptoms at least weekly. Not only did their symptoms have a negative impact on their actual physical health, but most importantly, these symptoms seemed to control their daily lives on a psychosocial level. “These attacks were often the result of an anxiety reaction… this influence could best be described as a cascade of impact… leaving them with extreme feelings of helplessness, embarrassment, and guilt” (Schneider PhD & Fletcher PhD, 2008). The researchers felt that interventions by health care providers to supply these women with as much information on their disorders would help them to optimally manage their IBS or IBD. This extra knowledge would infact create a much more positive psychosocial living experience for the patients as well as their concerned friends and family members.
Huether , S. McCance, K. (2008) Understanding Pathophysiology, (4th Edition). St. Louis, MO: Mosby.
Longstreth, G.F. (2006) Functional Bowel Disorders. Journal of American Gastroenterology Association, 20(5) 2006;103:1480-1491
Mayo Clinic Staff. (2009, July 29). Irritable Bowel Syndrome. Retrieved November 08, 2009, from Mayo Foundation for Medical Education and Research (MFMER): http://www.mayoclinic.com/health/irritable-bowel-syndrome/DS00106/METHOD=print
Medline Plus Organization. (2009, July 7). Irritable Bowel Syndrome. Retreived November 10, 2009, from Medline Plus: Trusted Health Information for You: http://www.nlm.nih.gov/medlineplus/ency/article/000246.htm
Schneider PhD, M. A., & Fletcher PhD, P. C. (2008). "I feel as if my IBS is keeping me hostage!" Exploring the negative impact of irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) upon university aged women. International Journal of Nursing Practice, 14, 135-148. Doi: 10.1111/j.1440-172X.2008.00677.x