# Situation: A 29-year-old office worker has had recurrent crampy lower abdominal pain for 7 months. The pain occurs about twice a week, eases after she passes stool, and comes with looser, more frequent stools; she has had no hard or lumpy stools. She has no fever and no night-time symptoms. Her work-up is completed. She asks how fiber could help her bowel symptoms. What should the nurse advise?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630485  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 29-year-old office worker has had recurrent crampy lower abdominal pain for 7 months. The pain occurs about twice a week, eases after she passes stool, and comes with looser, more frequent stools; she has had no hard or lumpy stools. She has no fever and no night-time symptoms.

Her work-up is completed. She asks how fiber could help her bowel symptoms. What should the nurse advise?

## 보기

1. Add wheat bran to every meal to firm the stools
2. Take psyllium, starting low and adding slowly **✔ 정답**
3. Cut back on fiber until the cramps have settled
4. Raise fiber to 50 g a day starting this week

**정답: 2**

## 해설

Soluble fiber such as psyllium improves IBS symptoms, while insoluble fiber such as bran often worsens bloating. Fiber is increased gradually to limit gas.

## 심화 해설

Soluble fiber helps IBS
Dietary fiber is not one substance. Soluble fiber, such as psyllium, dissolves in water to form a gel that regulates stool consistency, firming loose stools and softening hard ones, and it is fermented slowly, producing relatively little gas. Evidence supports soluble fiber for improving overall IBS symptoms. Insoluble fiber, such as wheat bran, adds bulk but is often poorly tolerated in IBS, worsening bloating and abdominal discomfort. For IBS, the advice is soluble fiber such as psyllium, started at a low dose and increased gradually.

Why gradual increase matters
A sudden increase in any fiber can cause gas, bloating, and cramping as colonic bacteria ferment the new load. Starting low and increasing slowly over several weeks lets the gut adapt and improves adherence. Adequate fluid intake is advised with psyllium. Raising fiber to a very high amount such as 50 g a day in one week is far above the usual recommended intake and almost guarantees worsening symptoms.

| Advice | Effect in IBS | Appropriate? |
| --- | --- | --- |
| Wheat bran at every meal | Insoluble; often worsens bloating | No |
| Psyllium, start low and increase slowly | Soluble; improves symptoms with less gas | Yes |
| Cut back on fiber | Removes a helpful option | No |
| 50 g fiber a day from this week | Sudden, excessive increase; gas and bloating | No |

Why the distractors are tempting
Bran is the traditional "high-fiber" food, and the idea that it will firm the stools sounds logical, but in IBS it tends to aggravate symptoms. Cutting back on fiber until cramps settle seems cautious, yet it removes a treatment that helps. The 50-gram target confuses "more fiber" with "better." Watch out! When an IBS question asks about fiber, the type and the pace of increase are what matter.

Exam takeaway
Nursing advice for IBS combines soluble fiber, regular meals, adequate fluids, stress management, and identification of personal trigger foods; a dietitian may guide a structured approach such as a low-FODMAP diet when needed. Key point! Choose soluble fiber such as psyllium, increase it gradually, and avoid relying on insoluble bran.

## 임상 시나리오

Fiber Advice in IBSSoluble versus insoluble fiber
Soluble fiber such as psyllium improves IBS symptoms and normalizes stool consistency. Insoluble fiber such as wheat bran often worsens bloating.

Start with a low dose and increase gradually over weeks with adequate fluids to limit gas and cramping.

Combine with regular meals, stress management, and identification of trigger foods.

CautionA sudden large increase such as 50 g of fiber a day causes gas and bloating and reduces adherence.

## 핵심 개념

- **Soluble fiber** — Fiber that dissolves in water to form a gel, such as psyllium, which regulates stool consistency.
- **Insoluble fiber** — Fiber that does not dissolve in water, such as wheat bran, which adds bulk and may worsen IBS bloating.
- **Psyllium** — A soluble fiber from plantago seed husks used as a bulk-forming agent and recommended for IBS.
- **Bloating** — A sensation of abdominal fullness or distension, often caused by gas from fermentation of fiber.

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