Download IBD and IBS Handout

Isaac Levinsky
Page 1
Irritable Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS)
Irritable Bowel Disease (IBD) definition: Inflammatory bowel disease (IBD) refers is a chronic
conditions that cause inflammation in some part of the intestines. Inflammation leads to ulcers,
serious digestive problems, strictures (narrowing), possible blockages and the need for surgery
and or medication.
There are two types of IBD, including Crohn’s disease and Ulcerative Colitis: Crohn's
disease is a form of IBD and it can occur anywhere along the digestive tract – from the mouth to
the anus. It affects the deeper layers of the digestive lining and diseased areas can be present
anywhere in the digestive system. Strictures, narrowing of the intestine can lead to blockages,
pain, and the need the surgery in Crohn’s. Unlike Crohn's disease, Ulcerative colitis only
involves the colon and rectum. Inflammation and ulcers typically affect only the innermost lining
in these areas, compared with the deeper lesions seen in Crohn's disease.
Irritable Bowel Syndrome (IBS) definition: Irritable bowel syndrome is not a disease; it is a
syndrome or group of symptoms. IBS affects the colon (large intestine). IBS is a functional
disorder, which means that the functioning of the bowel is incorrect, yet the tissue remains
undamaged.
IBD and IBS are not the same condition: Unlike IBD (Crohn’s and Ulcerative colitis), IBS
does not involve inflammation, and it does not damage the digestive system or cause ulcers. IBD
often leads to serious complications such as surgery or even intestinal blockage.
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66% to 75% of persons with Crohn’s disease will require one or more surgeries to
remove diseased tissue, and remove strictures or blockages in the small or large intestine
most often.
20% of persons with Ulcerative colitis will require surgery on the large intestine.
IBS does not require surgery because it is not structural.
Symptoms of Irritable Bowel Disease: Symptoms are similar for Crohn’s and Ulcerative
colitis, but vary depending on severity and where there is actively diseased tissue.
 Abdominal pain or cramping
 Diarrhea multiple times per day
 Bloody stools
 Weight loss
IBD can cause problems outside of the digestive system:
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Mouth sores and skin problems
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Arthritis
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Eye problems that affect vision
Symptoms of Irritable Bowel Syndrome: The main symptoms of IBS are
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abdominal pain or discomfort, usually relieved or related to
bowel movements
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chronic diarrhea, constipation, or a combination of both
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Isaac Levinsky
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Medication Issues: IBD Treatment has two goals including achieving remission and
maintaining remission. Medications are targeted to reduce inflammation of the intestine as
inflammation causes symptoms.
Types: IBD: Aminosalicylates, Corticosteroids, Immunomodulators, Antibiotics, Biologic
therapies.
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Aminosalicylates: mesalamine, balsalazide, balsalazide
Corticosteroids: prednisone, methylprednisolone, hydrocortisone, Budesonide (specific
to Crohn’s)
Immunomodulators: Azathioprine, 6-mercaptopurine (6-MP), Cyclosporine A,
tacrolimus, Methotrexate
Antibiotics: Metronidazole, Ciprofloxacin
Biologic Therapies: Anti-TNF: Infliximab, Adalimumab, Certolizumab pegol, Integrin
Receptor Antagonist: Natalizumab
IBS: Medications for diarrhea, for constipation, for pain and cramping, and for anxiety or
depression
Diarrhea: diphenoxylate and loperamide, Bile acid binding agents (cholestyramine),
Alosetron
Constipation: Lubiprostone, Osmotic laxatives, Polyethylene glycol, Stimulant laxatives
Pain and Cramping: Anticholinergics (antispasmodics), antidepressants
Anxiety or Depression: antidepressants, anti-anxiety (including benzodiazepines)
Adherence: Medications have side effects and may have to be taken for long periods of time.
Some medications have serious, potentially fatal side effects. Adherence is problematic due to
side effects, high cost, and chronic need for symptom relief.
Effect of noncompliance: Noncompliance can be serious for IBD and can lead to serious
complications. Long term consequences of noncompliance in IBD can be disability, pain,
functional impairment, increased need for surgery and hospitalizations or death. Noncompliance
for IBS is less serious but leads to the symptoms of IBS going untreated.
Other Management Issues: Diet and stress play a role in IBS and persons with IBS should learn
to avoid their trigger foods. IBD (Crohn’s and Ulcerative colitis) are not caused or exacerbated
by a person’s diet. If inflammation is severe and causes strictures or narrowing, caution should
be taken with foods that could become lodged behind the stricture.
Health Behavior Change Areas
Assess relevance
Assess patient’s perception of importance of change in area
Assess prior efforts to change
Emotional Regulation
Assess relevance, skill level, need for training
Tracking Form - explain
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Isaac Levinsky
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Intervention/Technique Handout
Eliminating or Reducing Environmental Stressors:
 Plan ahead: Bring medication to manage symptoms, be careful with your diet, find out
where the bathrooms are located, bring emergency supplies when you travel (toilet paper,
medication).
Reducing Vulnerabilities & Risk Factors:
 Diet and nutrition: Avoid foods that cause an increase in symptoms. Speak to your
Doctor about specific dietary plans or nutritional needs. Also, do not take NSAIDs if you
have IBD as they irritate the digestive system.
 Alcohol moderation: Alcohol increases the motility of the digestive tract. Limit alcohol to
improve IBS and IBD symptoms.
 Increase activity levels and exercise: Low impact aerobic exercise can improve mood and
aid digestion.
Increasing Coping Skills:
Problem-Solving: If you do not feel well, listen to your body.
Generating options
Goal setting / means-end thinking
Reducing/eliminating cognitive errors: Pay attention to automatic negative thoughts
Assertiveness training: Communicate your needs and learn to set boundaries
Increasing pleasurable activities: Participate in activities you enjoy.
Increasing social interaction: Do not isolate, participate socially.
Acceptance and commitment techniques: Dealing with a chronic illness is tough, be easy
on yourself.
Values clarification: Remember that before you can take care of others, you must take
care of yourself first.
Reducing Perceived Stress:
Alternate response to stress - relaxation / mindfulness: Stress is the enemy, learn to relax.
Stress management techniques: Deep breathing, yoga, tai chi, progressive muscle
relaxation
Anger management techniques: Count to ten. Take a deep breath. Getting angry will only
add to your stress level.
Communication training: Communicate your needs and make others aware of what your
condition involves and when you are not feeling well.
Cognitive reappraisal of perceived stress level: A positive attitude and remembering a
situation is not “the end of the world”
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Keeping Track
IBS and IBD
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
Your Symptoms
Rate on a scale of 0 = no
symptoms whatsoever;
10= unbearable symptoms
Stressful Events
Rate how stressful the day
was for you, with 0 = not
stressful, and 10 = extremely
stressful
Deep. Breathing
Whether or not you practiced
Yes or No
Medication
Whether or not you took your
medication - Yes or No
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