Quality of Life with IBS
Irritable bowel syndrome (IBS) is a functional disorder affecting the gastrointestinal tract and is characterized by pain in the abdomen, accompanied by constipation or diarrhea. Gastrointestinal diseases are a common disorder of the general population. IBS affects close to 10% to 20% of the general population; however, only 35% seek medical advice because of its symptoms (Bonn, Dickey & Humphreys, 2018). IBS should be diagnosed based on the patient’s clinical history, minimal laboratory tests and physical examination. Due to the complicated and unknown pathomechanism of the disorder, no medical intervention or radical treatment is set to relieve the disease symptoms. While the disease is not life-threatening, for most people, it has a significant influence on mental health and the quality of life. This paper aims to explore the quality of life with irritable bowel syndrome, specifically the experience of IBS during IBD remission, analysis of literature regarding the concept, how the concept can be applied and its implications on nursing.
Concept Definition and Analysis
Irritable bowel syndrome is a chronic disease characterized by four main symptoms, including incomplete defecation, bloating, changes in bowel habits such as (constipation and diarrhea) and abdominal pain. Most of the patients also report concurrent vomiting with abdominal cramping and nausea. IBS is classified further as alternating, constipation dominant and diarrhea-predominant (Ford et al. 2018). The symptoms of the disease are recurrent and differs in severity. Diarrhea and bloating are the significant negative impacts of the disease, making most patients stay close to a toilet. IBS is also known as a Gastrointestinal (GI) disorder. Doctors call the disease a gut-brain interaction disorder because it is a functional disease that interferes with how the brain and the gut of a patient work together. The problems or interferences caused by the disease can make a patient’s gut more sensitive and change the way the bowel muscle contract. If the gut is highly sensitive, then the patient may feel more bloating and abdominal pain. The variations in how the bowel muscles contract may lead to constipation or diarrhea, or both. The other similar terms or names related to IBS include spastic bowel, nervous colon, spastic colon, mucous colitis and IBS colitis (Zargar et al. 2019). IBS and IBD possess overlapping symptoms. The patients suffering from IBD in clinical remission suffer from symptoms resembling those of IBS. IBD is characterized by chronic inflammation of the intestinal mucosa and the difficulty in regulating the immune response of the inflammation once it is activated. IBD comprises Crohn’s disease (CD) and ulcerative colitis (UC).
Remission is defined as the disappearance or the decrease of inflammatory bowel disease symptoms (IBD). Remission holds different meanings for the individuals living with IBD. Patients experiencing remission equates it to the peace, heaven, energy, comfort, happiness and freedom they get due to the decrease or disappearance of the IBD. The IBD remission patients always feel like they have gone back to their normal life. Remissions also mean the situation when the test of an IBD patient shows no active inflammatory bowel disorder. The comprehensive definition of remission is the disappearance or reduction of signs and symptoms of a disease. A remission can either be partial or complete remission. Remission is often measured by the use of CRP blood test, endoscopy and fecal calprotectin. The main goal of ulcerative colitis or Crohn’s disease is the treatment to achieve and maintain remission when the symptoms disappear entirely or improve. Remission means different things based on the parameters that are used to describe it. The types of remission include clinical remission, which means symptoms of IBD have gone away or improved. However, you may still be having inflammation in the GI tract. Endoscopic remission means no inflammation evidence is found upon doing sigmoidoscopy or colonoscopy tests (Swaminath et al. 2017). This remission means that the GI tract damage has ceased. Radiographic remission means no inflammation sign on an MRI scan of the GI tract or other imaging scans. The last type of remission is histological remission; this refers to healing or reduced inflammation in the GI tract lining.
The development of IBS and IBD in human beings is mostly associated with genetic factors. Environmental factors also play a part in the distribution of UC and CD. Some of the predominant impacts of IBD and IBS include fatigue, malnutrition, weight loss, gastrointestinal bleeding, abdominal pain and diarrhea (Teruel, Garrido & Mesonero, 2016). These symptoms substantially impact the quality of lives (QoL) of patients living with these diseases, majorly due to the psychological impacts of the symptoms. The UC and CD symptoms of IBS and IBD that cause a negative impact on the QoL are feeling smelly or dirty, production of unpleasant smell, lack of bowel control and constraints in sexual relationships. The disease mostly attacks individuals between the ages of 15 to 30 years. The second peak of IBD occurs between the ages of 50 and 70 years. The patients of UC and CD undergo a process of exacerbation followed by periods of remission. However, approximately 25% to 50% of IBS and IBD relapse within a year.
The quality of life of patients suffering from IBD and IBS due to the impacts of these diseases can be classified by the use of concepts of enumerative, relational and statistical. The concept can be classified as enumerative because it gives the number of people impacted by IBS and IBD in terms of age ranges to identify the ages highly susceptible to the disease. It is relational because the concept provides the relationship between the disease and genetic factors. It also relates the disease to the environmental factors that help to distribute the disease. The concept is statistical because it gives the percentages of patients who relapse annually due to UC and CD types of IBS and IBD. In the nursing realm, the concept of naturalistic is identified because it can be put in practice now to make a scientific inquiry about the diseases and the nature of remission. It is also a research-based concept because the data of the research is evidence-based, practical and observable. There is evidence of the data provided, and it is also observable from the signs and symptoms of those experiencing the disease. However, the differences in the timings of research might cause differences in the statistical evidence. That is, data collected at different times will depend on the efforts placed by the nurses and doctors to enhance the remission rate of the patients and the data provided by the patients on how they have been impacted by IBS and IBD diseases. To determine the variances and the relationship of the statistical evidence found by different researches, it is prudent to use the correlation coefficient to enhance the precision of data.
Since the evidence of the concept involves pain, fatigue, bleeding and diarrhea, among other symptoms, it is difficult to measure the extent of the impact of IBS and IBD on the patient. The evidence is not also constant truth that can be extrapolated to give the right information on the concept at all times. Therefore the concept is a more abstract and not concrete concept that requires absolute truths only found on constant evidence. The quality of life pegged on IBS and IBD impacts is immeasurable because we cannot measure an impact like the degree of pain a patient is undergoing. It is only the patient who can tell you about the pain which you try to estimate as a medical professional as at the time of the research. Fatigue and diarrhea due to IBS and IBD are also abstract concepts that cannot be easily measured and extrapolated.
Several studies have been done pertaining to the concept of the quality of life in IBS and the experience of IBS during IBD remission. The studies have translated into many articles written to corroborate the concept. The articles revolve around the symptoms of the concept, the impacts and a few cases of studies to support them. However, the studies are not so detailed to capture all the facets of the concept to find the best-selected treatment and faster methods of remission of UC and CD. For that reason, the conceptuality of the concept is not well mature to enhance evidence-based decision making in the nursing field. Therefore, there is a need to enhance the maturity of the concept through research to provide accurate and comprehensive evidence in nursing.
One of the most recent articles completed on the concept is Ozer et al. (2020) article, which aimed at defining the prevalence of IBS-like symptoms in inactive patients of IBD by employing the use of Rome IV criteria and also to evaluate the effect of IBS-like symptoms on QOL. 137 inactive IBD patients were enrolled in the study. Fifty-six patients had UC, while 81 were with CD. The study also used 123 participants as controls. The control group had a mean age of the participants was 49.3 plus or minus 18.2 years. The research was done in four groups, including the control group, a group with IBS-like symptoms, inactive IBD patients with IBS-like symptoms and inactive IBD patients without IBS-like symptoms. The study used tools like ROME IV diagnostic criteria, SPSS17 statistical package program and Shapiro Wilk test for the statistical test. The study started by use of the Harvey-Bradshaw index to measure abdominal pain, bowel habits and abdominal mass. The study was mediated accordingly; however, some weaknesses existed. The use of questionnaires for every group was biased because individuals groups might have consulted each other or written what they felt like. The other weakness was the mean age of those participating in the study. The age difference did not cater to the age of 15 to 20 and 65-70 who are prevalent in the disease (Ozer et al. 2020). The first strength of the study is the use of Rome IV diagnostic criteria, which is a more accurate and modern tool for the diagnosis of IBD and IBS patients. The use of a large control population was another advantage because it enhanced the detailed check-up of the population.
The other study was done by Zargar et al. (2019) to study the effect of IBS on Sleep Quality and Quality of Life of IBD in Clinical Remission. 115 IBD patients aged 14 to 70 were enrolled for the study. The study took nine years to accomplish. Patients were put in four group’s those with IBD and those without. Rome III criteria were used to diagnose IBS patients. Pittsburgh Sleep Quality Index questionnaire and health-related QOL questionnaire was used to get information from the patients. The study was well monitored, and from the results, sleep quality was affected by life quality due to IBD. From the study, one of the weaknesses was the longer period of the study. The longer time most probably contributed to inaccurate results because other patients with IBD and IBS had undergone remission. The use of Rome III criteria was used to diagnose IBS is a weakness because it was outdated by the year the diagnosis was done. The strength noted is the use of an inclusive and a good range of age groups most susceptible to the disease.
In comparing the two studies, they used more or less the same methods because they both used questionnaires for data collection and Rome diagnostic criteria. Both of them carried out interviews in groups. However, Zargar et al. (2019) used an inclusive age group for IBD, which helped in finding better results. On the other hand, Ozer et al. (2020) used Rome IV diagnostic criteria, an accurate and modern tool that also tried to enhance their results.
Concept Application
Many studies have been done on QoL with IBS and experience of IBS during IBD remission. Kopczyńska et al. (2018) did research on the QoL and depression in patients with irritable bowel syndrome. In the study, he found that IBS and IBD have significant effects on QoL and mental health. Another study on QoL IBS and experience of IBS during IBD remission was done to diagnose how to manage functional symptoms in IBD in remission (Teruel, Garrido & Mesonero, 2016). Ozer et al. (2020) focused on the prevalence of IBS-like symptoms in patients with inactive IBD and its relation to the quality of life. He found that QoL reduces in patients with IBD and that symptoms of IBS are common in the long-standing phase of remission. Perera and her colleagues conducted a study focused on associating a high rate of anxiety and depression with the presence of IBS Symptoms in Quiescent IBD (Perera et al. 2019). Another study, as mentioned above, concentrated on the effect of IBS on Sleep Quality and QoL of IBD in clinical remission (Zargar et al. 2019). Another study related to QoL with IBS and experience of IBS during IBD remission focused on social and psychological factors associated with pain in IBD. The study found that IBS patients presented significantly lower QOL in all the groups except the control group (Sierżantowicz, Lewko & Jurkowska, 2020). In the above studies, each group studied using different parameters, age group range populations to elucidate the concept. They also used different methods and circumstances to research IBS and IBD in relation to QoL.
All the studies above are practical and functional in the practice and field of nursing. Each of the studies above investigates distinctive populations on a broader of a narrower scale to find a specific result related to the concept. However, the most effective study among the studies listed above is the one done by Ali Zargar (2019). It focuses on the effects of quality of IBS on sleep quality and quality of life of the patients suffering from IBD in clinical remission. This study is important because it employs the best range of individuals who are all susceptible to IBS and IBD. The study also employed one of the accurate tools ROME III diagnostic criteria for diagnosing IBS and IBD. Combining these two significant aspects of the study makes the study more applicable to nursing practice than the others mentioned. Though it also uses questionnaires, the two types of questionnaires of the PSQI questionnaire and health-related QoL questionnaire were precisely chosen for determining the QoL rather than the use of general questionnaires, as seen in other studies.
On a detailed examination of the studies analyzed above, all the six studies affirm that the quality of life is indeed negatively affected by IBS during IBD remission. This is seen in all the groups suffering from IBS and BD, whether in the active or passive form. They all agree that the age group between 15 and 70 years is most affected by the different types of IBS and IBD diseases (Dumic et al. 2019). The studies also confirm that IBD and IBS’s predominant symptoms are similar, including fatigue, malnutrition, weight loss, gastrointestinal bleeding, abdominal pain and diarrhea, among other effects. Most of these studies have also recognized that a negative impact on the QoL concept is feeling dirty, producing unpleasant smell, lack of bowel control and constraints in sexual relationships.
Model Case
James, a 20-year-old African American, went to the hospital for medical attention. He was diagnosed with Irritable bowel syndrome (IBS). Upon examination, the doctor recognized the James had the following symptoms; malnutrition, gastrointestinal bleeding, fatigue. The doctor inquired about his status in the past one week, and he told the doctor that he was experiencing abdominal pain, and he has been diarrhearing for the past three days, making him feel so tired. He also insinuated that of late, he has been finding difficulty in controlling his bowels. The physician also realized that he was producing some strange smell that increased in intensity as he examines him.
Implications and Discussion
In the model, symptoms such as diarrhea by IBS patients’ may originate from the stronger and longer contraction of intestinal muscles or the surplus of bacteria in the intestines. Fatigue may be caused by stressful events that the patient may be undergoing. Abdominal pain could be resulting from the poor coordination of the intestinal and brain signals (Dimidi, 2017). As a nurse being aware of the possible causes of IBS, I can play a big role in helping the patient manage the situation. A nurse can discuss eating well balanced high fiber diet and avoiding foodstuff, forming gas in the stomach. Advice the patient to participate in regular exercises to help him increase intestinal motility. A discussion about adhering to a regular eating schedule and drinking six to eight glasses of water to prevent constipation.
One of the limitations of this concept is that when advising the patient, the nurse may not understand the patient’s psychological and economic status. Maybe a patient has been psychologically tortured by the disease to an extent where they may not take any more advice. Alternatively, some patients lack even a single dollar to purchase the balanced diet a nurse is advising them to take.
This concept can be used to teach nurses the nursing management skills they can use to handle both critical and stressed up IBS and IBD patients comprehensively. The concept can also enable nurses’ advise patients on lifestyle and dietary changes that may reduce the IBS symptoms and improve the patient’s quality of life. Due to the increasing number of individuals being diagnosed with IBS and IBD, it is prudent for nurses to undertake in-depth research in this concept to help patients prevent exasperation of IBS and IBD in remission.
the predominant symptoms of