Irritable bowel syndrome (IBS)

• Spastic colon
• Irritable colon
• Mucous colitis
• Spastic colitis

• 564.1 Irritable bowel syndrome

• 315.4 Developmental coordination disorder
• 718.45 Contracture of joint, pelvic region and thigh
• 719.70 Difficulty in walking
• 728.2 Muscular wasting and disuse atrophy
• 728.89 Disorders of muscle, ligament, and fascia
• 729.9 Other disorders of soft tissue
• 780.7 Malaise and fatigue
• 782.3 Edema
• 786.0 Dyspnea and respiratory abnormalities

• K58.9 Irritable bowel syndrome without diarrhea

• As of January 2013, the APTA Guide to Physical Therapist Practice does not include practice patterns for organ system pathology; therefore, the associated or secondary musculoskeletal, cardiovascular/pulmonary, or potential neuromuscular patterns would be indicated.

Description

• There is a broad array of GI disorders that may be encountered by physical therapists
• While physical therapists may not manage GI disorders specifically, many clients may have GI pathology and be receiving care as a result of secondary problems such as weakness, gait abnormalities and limited aerobic endurance
• They may be acute, post-operative, chronic, viral, bacterially related, or congenital/hereditary1
• Abdominal pain and altered bowel habits without pathology
• Considered a disorder and not a disease
• Complaints often include changes in bowel habits such as constipation, diarrhea, bowel urgency, bloating, incontinence, and cramping
• Pain is frequently referred to the low back
• Does not result in permanent damage to colon and is not inflammatory
• Symptoms may come and go or, in some cases, disappear

Essentials of Diagnosis

• Abdominal pain; constant or intermittent history
• ROME Criteria
  • Abdominal pain over course of 12 weeks, not necessarily continuous weeks
  • At least 2 of the following:
    • A change in the frequency or consistency of the bowels
    • Straining, urgency or a feeling that the bowels will not completely empty
    • Mucus in the stool
    • Bloating or abdominal distension
• Diarrhea or constipation
• Bloating
• Possible rectal bleeding
• Rectal/anal irritation
• Acute falls in blood pressure, which may result in decrease blood flow to intestines
• Inability to swallow
• Lack of appetite
• Unexplained weight loss
• Abdominal pain related to ingesting food
• Possible joint pains
• Dark stool or bright red blood in stool
• Malaise/fatigue
• Cramping

General Considerations

• Diagnosis for more occult problems may take time and require intensive medical diagnostic testing
• GI disorders occur cross the lifespan; birth through geriatric
• May result in secondary problems such as aerobic capacity and muscle endurance impairment, sarcopenia, weakness/impaired muscle performance, musculoskeletal problems, neuromuscular problems, weight loss or weight gain, indicating the need for physical therapy intervention depending on severity
• Because GI disorders frequently refer pain to other body areas, individuals may get referred to PT inappropriately, such as when referred to the low back
• GI problems may be commonly related to stress or constipation, more serious problems such as autoimmune conditions like Crohn’s, or acute pain indicative of appendicitis
• In adults females, GI complaints may actually be related or indicative of cancer or tumors in the reproductive organs, ...