Bakgrund   Irritable Bowel Syndrome (IBS) är en mag- och tarmsjukdom som drabbar cirka 18 procent av den svenska befolkningen och som medför en lägre livskvalitet. Irritable bowel syndrome är en komplex sjukdom med en multifaktoriell etiologi där vanliga symtom är exempelvis magsmärtor, förstoppning och diarré. I vården blir personer med IBS ofta felaktigt bemötta och det finns ett ökat behov av kunskap hos sjuksköterskor kring IBS för att kunna erbjuda en god och personcentrerad vård. Syfte Syftet med litteraturöversikten var att beskriva vuxna personers erfarenhet att leva med irritable bowel syndrome. Metod En icke-systematisk litteraturöversikt valdes som metod för att besvara studiens syfte där 12 vetenskapliga artiklar av både kvantitativ och kvalitativ metodansats inkluderades. Sökningen av artiklar genomfördes i databaserna PubMed och CINAHL där valda artiklar kvalitetsgranskades i enlighet med Sophiahemmet Högskolas bedömningsunderlag. Resultatet sammanställdes genom en integrerad dataanalys. Resultat Två huvudkategorier framkom i resultatet; Utmaningar i det dagliga livet och Mötet med hälso- och sjukvården. Personer upplevde att IBS påverkade negativt den fysiska och psykiska hälsan, yrkes- och privatlivet samt att det fanns brister i sjukvården. Sjukdoms påverkan över det dagliga livet är dubbelriktad där psykosociala faktorer samspelar med symtomen. Personer som sökt vård för IBS besvär upplever att de inte får tillräckligt med stöd och att de inte blir tagna på allvar. Resultatet diskuterades sedan med stöd av Erikssons teori om lidande så kallad Caritativ vårdande. Slutsats Denna litteraturöversikt belyste vuxna personers erfarenheter av att leva med IBS. Resultatet påvisade att IBS har en komplex påverkan på personernas dagliga liv och brister i mötet med sjukvårdspersonal. Genom ökad kunskap kring detta skulle sjuksköterskor kunna arbeta mer personcentrerat för att kunna bemöta och stötta personer med IBS. / Background Irritable Bowel Syndrome (IBS) is a gastrointestinal disorder that affects approximately 18 percent of the Swedish population and leads to a lower quality of life. Irritable bowel syndrome is a complex disease with multifactorial etiology, where common symptoms include abdominal pain, constipation, and diarrhea. People with IBS are often wrongly treated in the healthcare system, where there is an increased need for knowledge among nurses about IBS in order to offer good and person-centered care.  Aim The aim of the literature review was to describe adults’ experiences of living with irritable bowel syndrome. Method  A non-systematic literature review was chosen as the method to answer the purpose of the study where 12 scientific articles with a quantitative and qualitative approach were included. The search for articles was carried out in the databases PubMed and CINAHL and selected articles were quality checked in accordance with Sophiahemmet University’s assessment document. The results were compiled through an integrated data analysis.  Results Two main categories emerged in the results: Challenges in their daily lives and The encounter with healthcare. People experienced that IBS negatively affected their physical and mental health, work and personal life, and that there were shortcomings in healthcare. The impact of the disease on daily life is bidirectional, where psychosocial factors interact with the symptoms. People seeking care for IBS problems often feel that they do not receive enough support and that they are not taken seriously. The result was discussed with the support of Eriksson´s theory about suffering, known as Caritative caring.   Conclusions This literature review emphasizes adult’s experiences of living with IBS. The results showed that IBS has a complex impact on a person’s daily life and can create challenges when interacting with healthcare professionals. By increasing knowledge about this, nurses could work more patient-centered in order to meet and support people with IBS.

<p>Denna uppsats behandlar den dolda folksjukdomen IBS och dess konsekvenser för individens sociala delaktighet. Syftet med studien är att studera individens upplevelse av delaktighet och erfarenhet av att leva med sjukdomen. IBS är en så kallad funktionell mag- och tarmsjukdom och står för Irritable Bowel Syndrome (Colon/Kolon irritabile), Irriterad tarm i svenskt tal och kännetecknas av återkommande eller kroniska symtom från mag- tarmkanalen. Medicinskt sett anses IBS vara en godartad sjukdom, men den kan vara besvärlig att leva med och ibland ge nästintill handlingsförlamande konsekvenser för individen och dennes sociala livsvärld. Forskarna vet inte orsaken bakom IBS och det finns inget medicinskt test som visar att det är IBS som en patient lider av, men man vet att individens sjukdomshistoria ofta är typisk och att sjukdomen är vanligast bland kvinnor. Av världens alla invånare lever det många människor med sjukdomen IBS, som kommit att bli en ny folksjukdom, då man beräknar att närmare 10-20 procent av den vuxna befolkningen har IBS. Individens upplevelse av vad som är normalt kontra avvikande när det gäller det friska och det sjuka visar en bild av hur samhället tycks vara skapat. Individens hälsotillstånd påverkar livskvaliteten och diagnosen bidrar till en förändrad identitet, och för varje individ som lever med IBS har begreppet delaktighet; att vara social med andra och i samhället i stort, fått en helt ny mening i och med deras sjukdom. <strong> </strong></p><p>Min förhoppning är att denna studie ska uppmärksamma läsaren kring den nya folksjukdomen IBS och hur den påverkar individens sociala liv.</p><p> </p> / <p>This essay deals with the new widespread disease IBS and its consequences for the social participation of the individual. The purpose of the study is to look at the experience of social participation of the individual and her experience of living with this disease. IBS is a so-called dynamic/functional belly- and intestinal disease, which stands for Irritable Bowel Syndrome, and is symbolized by recurrent or chronical symptom from the belly- and intestinal canal. From a medical view IBS is considered as a benign disease, but it can be tricky to live with and sometimes give heavy problems for the individual and its social life. The scientists doesn`t know what the cause is behind the disease and it doesn`t exist any medical test who can prove that a patient is suffering by IBS, but they do know that the case-history of the individual is very typical and that the disease is more common among women. From a social view studies show that the social life of the individual is strongly affected, and that the identity and how she look at normalcy/variation is no longer the same as it was when she was healthy. For every individual whos is living with this disease has also the concept of participation; to be social with other people and in society at large, got a whole new meaning as a result of their disease.</p>

Denna uppsats behandlar den dolda folksjukdomen IBS och dess konsekvenser för individens sociala delaktighet. Syftet med studien är att studera individens upplevelse av delaktighet och erfarenhet av att leva med sjukdomen. IBS är en så kallad funktionell mag- och tarmsjukdom och står för Irritable Bowel Syndrome (Colon/Kolon irritabile), Irriterad tarm i svenskt tal och kännetecknas av återkommande eller kroniska symtom från mag- tarmkanalen. Medicinskt sett anses IBS vara en godartad sjukdom, men den kan vara besvärlig att leva med och ibland ge nästintill handlingsförlamande konsekvenser för individen och dennes sociala livsvärld. Forskarna vet inte orsaken bakom IBS och det finns inget medicinskt test som visar att det är IBS som en patient lider av, men man vet att individens sjukdomshistoria ofta är typisk och att sjukdomen är vanligast bland kvinnor. Av världens alla invånare lever det många människor med sjukdomen IBS, som kommit att bli en ny folksjukdom, då man beräknar att närmare 10-20 procent av den vuxna befolkningen har IBS. Individens upplevelse av vad som är normalt kontra avvikande när det gäller det friska och det sjuka visar en bild av hur samhället tycks vara skapat. Individens hälsotillstånd påverkar livskvaliteten och diagnosen bidrar till en förändrad identitet, och för varje individ som lever med IBS har begreppet delaktighet; att vara social med andra och i samhället i stort, fått en helt ny mening i och med deras sjukdom.   Min förhoppning är att denna studie ska uppmärksamma läsaren kring den nya folksjukdomen IBS och hur den påverkar individens sociala liv. / This essay deals with the new widespread disease IBS and its consequences for the social participation of the individual. The purpose of the study is to look at the experience of social participation of the individual and her experience of living with this disease. IBS is a so-called dynamic/functional belly- and intestinal disease, which stands for Irritable Bowel Syndrome, and is symbolized by recurrent or chronical symptom from the belly- and intestinal canal. From a medical view IBS is considered as a benign disease, but it can be tricky to live with and sometimes give heavy problems for the individual and its social life. The scientists doesn`t know what the cause is behind the disease and it doesn`t exist any medical test who can prove that a patient is suffering by IBS, but they do know that the case-history of the individual is very typical and that the disease is more common among women. From a social view studies show that the social life of the individual is strongly affected, and that the identity and how she look at normalcy/variation is no longer the same as it was when she was healthy. For every individual whos is living with this disease has also the concept of participation; to be social with other people and in society at large, got a whole new meaning as a result of their disease.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2006. / Härtill 5 uppsatser. NB: Rätt ISBN från spikblad.

Background - Irritable bowel syndrome (IBS) is a poorly understood functional gastrointestinal disorder and is a major cause of abdominal discomfort and gut dysfunction. IBS symptoms encompass abdominal pain, bloating, flatulence and irregular bowel movements such as constipation, diarrhoea and alternating bowels, bloating, flatulence and irregular bowel movements. Physiological studies have shown that manipulation of the intestinal microbiota by antibiotics, prebiotics or probiotics can affect intestinal functions in the pathogenesis of IBS. The probiotic concept suggests that supplementation of the intestinal microbiota with the right type and number of live microorganisms can improve gut microbiota composition and promote health in IBS sufferers. Aim - The aim of the main clinical trial is to determine whether ingestion of fermented milk containing Bifidobacterium animalis DN-173010 is associated with improved defecation frequency, stool consistency and quality of life in black South African females with constipation-predominant IBS (IBS-C). Methods - A pilot and process evaluation approach was employed during the current study to examine and understand the feasibility of implementing the study and to explore the facilitating implementation of the main clinical trial. Twenty black female participants, aged 18-60, with IBS-C were recruited from the practices of gastroenterologists, specialist physicians and medical doctors in Soweto. Participants fulfilling the Rome III criteria for IBS-C and inclusion criteria were randomized into two groups to participate in a 4-week, double blind, placebo controlled study. The placebo group received unflavoured sweetened, white base yoghurt and the intervention group received similar yoghurt with the probiotic, Bifidobacterium animalis DN-173010 [>3,4X10⁷ CFU/g]. Participants were required to record their bowel movements daily and IBS symptoms weekly in questionnaires during the four-week study period. Quality of life was assessed at baseline and at the end of the treatment period. Participants visited the study unit weekly to collect the placebo or probiotic study products and return the completed questionnaires during the study period. Results - Seventeen participants completed the study (eight intervention and nine placebo). There were not significant differences in IBS symptoms between the two groups, but differences were observed overtime within groups. The severity of abdominal pain score within both groups was statistically significant (p=0.004), and the number of days with pain was also statistically significant (p=0.00001). The frequency of normal stools reported was statistically significant different compared to all the other stool types (constipation and loose stools) throughout the four-week study period in both the intervention and placebo group. There was no significant difference in the quality of life between the intervention group compared to the placebo group. Conclusion - Process evaluation allows for the monitoring of a programme and corrections of problems as they occur. The intervention is feasible to implement, acceptable and safe to participants. The study indicates that consumption of the probiotic Bifidobacterium animalis DN-173010 for four weeks is not superior to the placebo in relieving IBS symptoms. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2014

Background - Irritable bowel syndrome (IBS) is a poorly understood functional gastrointestinal disorder and is a major cause of abdominal discomfort and gut dysfunction. IBS symptoms encompass abdominal pain, bloating, flatulence and irregular bowel movements such as constipation, diarrhoea and alternating bowels, bloating, flatulence and irregular bowel movements. Physiological studies have shown that manipulation of the intestinal microbiota by antibiotics, prebiotics or probiotics can affect intestinal functions in the pathogenesis of IBS. The probiotic concept suggests that supplementation of the intestinal microbiota with the right type and number of live microorganisms can improve gut microbiota composition and promote health in IBS sufferers. Aim - The aim of the main clinical trial is to determine whether ingestion of fermented milk containing Bifidobacterium animalis DN-173010 is associated with improved defecation frequency, stool consistency and quality of life in black South African females with constipation-predominant IBS (IBS-C). Methods - A pilot and process evaluation approach was employed during the current study to examine and understand the feasibility of implementing the study and to explore the facilitating implementation of the main clinical trial. Twenty black female participants, aged 18-60, with IBS-C were recruited from the practices of gastroenterologists, specialist physicians and medical doctors in Soweto. Participants fulfilling the Rome III criteria for IBS-C and inclusion criteria were randomized into two groups to participate in a 4-week, double blind, placebo controlled study. The placebo group received unflavoured sweetened, white base yoghurt and the intervention group received similar yoghurt with the probiotic, Bifidobacterium animalis DN-173010 [>3,4X10⁷ CFU/g]. Participants were required to record their bowel movements daily and IBS symptoms weekly in questionnaires during the four-week study period. Quality of life was assessed at baseline and at the end of the treatment period. Participants visited the study unit weekly to collect the placebo or probiotic study products and return the completed questionnaires during the study period. Results - Seventeen participants completed the study (eight intervention and nine placebo). There were not significant differences in IBS symptoms between the two groups, but differences were observed overtime within groups. The severity of abdominal pain score within both groups was statistically significant (p=0.004), and the number of days with pain was also statistically significant (p=0.00001). The frequency of normal stools reported was statistically significant different compared to all the other stool types (constipation and loose stools) throughout the four-week study period in both the intervention and placebo group. There was no significant difference in the quality of life between the intervention group compared to the placebo group. Conclusion - Process evaluation allows for the monitoring of a programme and corrections of problems as they occur. The intervention is feasible to implement, acceptable and safe to participants. The study indicates that consumption of the probiotic Bifidobacterium animalis DN-173010 for four weeks is not superior to the placebo in relieving IBS symptoms. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2014

Irritable bowel syndrome (IBS) är en sjukdom som leder till en funktionell motorisk störning i mag-tarmkanalen och symtom som förstoppning, diarré, gasbesvär, buksmärta och uppspänd buk är vanligt förekommande. Symtomen leder ofta till stress, depression, ångest vilket kan medföra ett begränsat vardagsliv. Individens livskvalitet påverkas av vad symtomen orsakar för individen i vardagslivet vilket kan leda till lidande. Syftet med litteraturstudien var att granska och sammanställa vårdvetenskaplig forskning som belyser patienters upplevelser av att leva med IBS. Metoden är en litteraturstudie utifrån Fribergs modell. Sex kvalitativa artiklar och tre kvantitativa artiklar har analyserats. Resultatet visade att kroppen var opålitlig då sjukdomen orsakade fysiska symtom och gav oönskade symtom som gasbesvär, smärta i buken, diarré, förstoppning och uppspändhet. Patienter upplevde begränsningar i vardagen i form av symtom som ökade gasbesvär, uppspändhet, diarré. Patienter hade ständigt uppsikt efter toaletter då de gick hemifrån vilket ofta skapade en ökad oro. Symtom som gasbildningar och diarré innebar att patienter ofta behövde gå på toaletten vilket var besvärligt i samband med möte, arbete, skola. Detta upplevde patienter vara skamligt. Sjukdomen bidrog i längden till ökad stress, ångest, depression och isolering hos patienterna. Detta har orsakat minskat förtroende till vården, patienterna upplevde sig missförstådda och välbefinnandet minskade. Strategier och planering bidrog till bekräftelse, medvetenhet, kunskap och förståelse. Patienter upplevde sig ha bättre koll på symtomen och kunde agera tills värken släppte. Sjuksköterskan har en viktig roll där hen kan hjälpa patienten att känna välbefinnande, hopp, livslust och ökad självkänsla genom bekräftelse av att bli sedd och hörd samt ge nyttig kunskap för att patienter ska kunna hantera sin sjukdom med bra planering och strategier.

<p>One hundred haemorrhoid patients were compared with 300 matched control persons. Haemorrhoid symptoms and bowel symptoms were studied. Most common symptom of the patients was bleeding (44%), followed by prolapse (24%), hygiene problem (14%), pain (12%) and itching (5%). Bowel symptoms, as bloating and evacuation difficulties, possibly related to IBS, were frequent among the patients.</p><p>556 patients were operated upon with Milligan-Morgan haemorrhoidectomy. 418 (81%) answered a questionnaire on results, and on disturbances in anal continence. Totally140 (33%) reported recurrence, and 139 (33%) patients reported anal incontinence. Forty of the 139 patients associated this to the surgical procedure. Female gender was associated to increased risk of incontinence.</p><p>The 40 patients who reported incontinence, were invited to undergo ano-rectal manometry, saline infusion test, endo-anal ultrasound, proctoscopy and clinical examination. Altogether 19 patients approved to participate. Matched control subjects and 15 persons previously operated for haemorrhoids, but without symptoms of incontinence, served as two reference groups. Incontinence score and saline infusion test showed significantly poorer continence in the patient group. Endo-anal ultrasound showed injury to the external sphincter in 20% of the patients. Anal pressure was slightly lower in the patient group, but the difference was not significant. </p><p>Totally 225 patients were randomised to Milligan-Morgan or Ferguson haemorrhoidectomy. Primary aim was to study changes in anal continence. Other aims were to study postoperative pain, wound healing, complications, patient satisfaction and recurrence and changes in bowel function. Patients in the Ferguson group reported, slightly quicker wound healing (P=0.06). Postoperative pain was equal, as was rate of complications. After one year the Ferguson group reported lower incontinence score, and more satisfied patients. Recurrence rate was equal, 15-17%. Most bowel symptoms were reduced one year after surgery.</p><p>In conclusion, functional bowel symptoms are common in haemorrhoid patients. Haemorrhoidectomy is associated with risk for incontinence in 5-10% of patients and females are at greater risk. A proportion of the patients who claim postoperative incontinence have physiological signs of sphincter incompetence, and external sphincter injuries are observed in those patients. Ferguson haemorrhoidectomy results in better anal continence and more satisfied patients. </p>

In a population prevalence questionnaire study we demonstrated that constipation and fecal incontinence are common problems in the general Swedish population with a similar magnitude as in other Western countries. 95.6% of the population had between three bowel movements per day and three per week. Constipation was mostly defined by “hard stools” and “the need of using laxatives”. Irritable Bowel Syndrome (IBS) is characterized by abdominal pain/discomfort and abnormal bowel habits. The diagnostic criteria of IBS are based on clinical symptoms. Division of IBS patients into symptom subgroups appears important as their bowel symptoms are characterized by heterogeneity. International criteria to subgroup IBS (Rome II) are based on expert consensus and not on evidence. We investigated the variation of stool consistency and defecatory symptoms in 135 IBS patients by symptom diary cards. Most patients had alternating stool consistency. When subgroups were based on stool consistency, all kinds of defecatory symptoms (straining, urgency, and feeling of incomplete evacuations) were frequently present in all subgroups. Stool frequency was in the normal range in the majority of patients. We propose that IBS subgroups should be based on stool consistency. We suggest that Rome II supportive criteria must be reconsidered as the determination of presence or absence of specific symptoms does not work as an instrument for categorization of IBS patients into diarrhoea- and constipation-predominant. We also propose that abnormal stool frequency should be excluded to define subgroups of IBS. Alternating stool consistency and presence of different defecatory symptoms, regardless of stool consistency should be included as criteria for IBS. Stress is known to play an important role in the onset and modulation of IBS symptoms. From experimental studies there is evidence for a stress-dependent alteration of visceral sensitivity. The biological mechanisms responsible for the causal link between stress and IBS symptoms are not completely understood, but the hypothalamic-pituitary-adrenocortical axis and the autonomous nervous system seem to play a prominent role in the pathophysiology of IBS. We investigated visceral sensitivity and the effect of repeated maximal tolerable rectal distensions on salivary cortisol levels and skin conductance in patients with IBS, chronic constipation and healthy volunteers. We found that the expectancy of the experimental situation per se (provocation of bowel symptoms by rectal distensions) compared to non-experimental days at home measured as salivary cortisol had a high impact on the level of arousal in IBS. IBS patients had higher skin conductance values than controls in the beginning of distension series and lower rectal thresholds for first sensation, urge and discomfort than healthy controls and constipation patients. IBS patients demonstrated habituation to repeated subjective maximal tolerable rectal distensions according to sympathetic activity although patients continued to rate their discomfort as maximal. Constipation patients had lower sympathetic activity than IBS patients before and during repeated rectal distensions. None of the groups demonstrated a significant increase in cortisol after repetitive rectal distensions. We conclude that Rome II supportive criteria for IBS should be reconsidered according to our findings. IBS patients are more sensitive to pre-experimental stress than healthy controls and patients with constipation. This should be considered in the design of experimental IBS studies. IBS patients habituated to subjective maximal tolerable, repetitive rectal distensions with decreasing sympathetic activity. Since responses to repeated stimuli of close-to-pain intensities are resistant to habituation this finding could be caused by psychological influences on perception, that is, perceptual response bias.

One hundred haemorrhoid patients were compared with 300 matched control persons. Haemorrhoid symptoms and bowel symptoms were studied. Most common symptom of the patients was bleeding (44%), followed by prolapse (24%), hygiene problem (14%), pain (12%) and itching (5%). Bowel symptoms, as bloating and evacuation difficulties, possibly related to IBS, were frequent among the patients. 556 patients were operated upon with Milligan-Morgan haemorrhoidectomy. 418 (81%) answered a questionnaire on results, and on disturbances in anal continence. Totally140 (33%) reported recurrence, and 139 (33%) patients reported anal incontinence. Forty of the 139 patients associated this to the surgical procedure. Female gender was associated to increased risk of incontinence. The 40 patients who reported incontinence, were invited to undergo ano-rectal manometry, saline infusion test, endo-anal ultrasound, proctoscopy and clinical examination. Altogether 19 patients approved to participate. Matched control subjects and 15 persons previously operated for haemorrhoids, but without symptoms of incontinence, served as two reference groups. Incontinence score and saline infusion test showed significantly poorer continence in the patient group. Endo-anal ultrasound showed injury to the external sphincter in 20% of the patients. Anal pressure was slightly lower in the patient group, but the difference was not significant. Totally 225 patients were randomised to Milligan-Morgan or Ferguson haemorrhoidectomy. Primary aim was to study changes in anal continence. Other aims were to study postoperative pain, wound healing, complications, patient satisfaction and recurrence and changes in bowel function. Patients in the Ferguson group reported, slightly quicker wound healing (P=0.06). Postoperative pain was equal, as was rate of complications. After one year the Ferguson group reported lower incontinence score, and more satisfied patients. Recurrence rate was equal, 15-17%. Most bowel symptoms were reduced one year after surgery. In conclusion, functional bowel symptoms are common in haemorrhoid patients. Haemorrhoidectomy is associated with risk for incontinence in 5-10% of patients and females are at greater risk. A proportion of the patients who claim postoperative incontinence have physiological signs of sphincter incompetence, and external sphincter injuries are observed in those patients. Ferguson haemorrhoidectomy results in better anal continence and more satisfied patients.