Counseling and Irritable Bowel Syndrome by Tony Astro

Irritable bowel syndrome is one of the most common chronic gastrointestinal disorders since almost half of the patients reporting to gastroenterologists with gastrointestinal symptoms. It is not a major life threatening disease.

IBS is defined by the presence of abdominal pain or discomfort in association with disordered defecation (that is, either constipation or diarrhea or both). The sensation of abdominal pain or discomfort is a key part of the definition of IBS. Other typical symptoms of IBS include: bloating, gassiness, abdominal distention, feelings of extreme urgency to use the bathroom, excessive straining while having a bowel movement, feelings of incomplete evacuation after having had a bowel movement, and the passage of mucus during evacuation (Lacy, 2006)

Client must be totally aware of the symptoms and how it can be pacify through medication in order that other psychological and social issues during counseling will not deviate. These pain and discomfort and inflate other issues psychologically to the patient and hence counseling cannot be effective.

The symptoms of IBS usually come and go, so that people can have long-lasting periods when they hardly notice they have it. In one study, fewer than a third of people were free of symptoms after 2 years, and in another, 1 in 20 people were free of symptoms after 5 years. IBS occurring after a bout of gastroenteritis (post-infectious IBS) may have a better prognosis – about 40% of
people with this appear to recover after 5– 6 years (Shmueli, 2007)

The social implications of IBS should also be considered during the counseling. When a client shows discomfort of IBS in public many issues arise: embarrassment, time wasted, prolong unplanned events, and even relationship with other people including friends and relatives may be affected. The main thing is IBS have social and psychological implications and must be treated with proper diet.

Time should be taken to explain carefully and sympathetically the possible mechanisms of symptom production and to reassure the patient of the lack of serious underlying disease (many patients being concerned that they may have cancer). Patients should be made aware that symptoms usually resolve (perhaps after months or years) and that, although there is no cure, symptoms can be relieved. Between 40 and 70% of patients respond to placebo (Anderson, 1998)

Here are some findings from Dr. Anderson on some treatment for IBS:
1. Dietary modification. Although no specific diet helps all patients, almost half of patients experience some relief with an exclusion diet consisting of one meat, one source of carbohydrate and one fruit. Such patients are able to identify several agents (most commonly sorbitol, caffeine or wheat products) which exacerbate the symptoms when reintroduced into the diet. A small subgroup of patients have a defined food sensitivity, usually lactose intolerance.
2. End-organ treatment Medical therapy can be useful for the short-term amelioration of symptoms, although many patients would prefer to manage without. It is often necessary to try several different preparations, as the response may be unpredictable and vary with time, possibly due to a high placebo response rate in patients with IBS.
3. Central treatment. An underlying affective disorder may or may not be the cause of IBS; however, it is often a reason why a patient seeks medical advice. Psychotherapy and hypnosis (and to a lesser extent, antidepressants) do benefit those with severe symptoms. Although antidepressants do not work in non-depressed patients, they do alter small-bowel motility (imipramine slows intestinal transit whereas paroxetine accelerates motility).




References

Anderson, Simon H. C. Key Topics in Gastroenterology. Oxford, GBR: BIOS Scientific Publishers Ltd, 1998. p 178. Retrieved on 13 November 2008 http://site.ebrary.com/lib/capella/Doc?id=5000295&ppg=188

Lacy, Brian E. Making Sense of IBS : A Physician Answers Your Questions about Irritable Bowel Syndrome. Baltimore, MD, USA: The Johns Hopkins University Press, 2006. p 29-30. Retrieved on 13 November 2008 at: http://site.ebrary.com/lib/capella/Doc?id=10188462&ppg=44

Shmueli, Udi. Irritable Bowel Syndrome : Answers at Your Fingertips.
London, , GBR: Class Publishing, 2007. p 28.
http://site.ebrary.com/lib/capella/Doc?id=10173818&ppg=43