Irritable Bowel Syndrome
Intro
Irritable bowel syndrome is the most common gastrointestinal disorder in Western society and accounts for 50% of subspecialty referrals. It is referred to as the "common cold of the stomach" and is most common in women in early adulthood. IBS is a functional disorder of motility in the small and large intestines diagnosed according to specific bowel symptom clusters. It is classified as a “functional” disorder because the abnormal muscle contraction cannot be credited to any identifiable abnormality of the bowel. Individuals affected by this perceive unpleasant or inappropriate sensory experiences in the absence of physiologic or pathophysiologic event. This syndrome is commonly linked with psychosocial factors.
Signs and Symptoms
Referred Patterns
The typical pain pattern is lower left quadrant abdominal pain, constipation, and diarrhea. The pain may be steady or intermittent. The individual may experience discomfort with sharp cramps in the morning or after eating. Abdominal pain or discomfort may be relieved by defecation. Individuals who have IBS with constipation have more symptoms and more severe symptoms that those with IBS with either diarrhea or alternating constipation and diarrhea.
Differential Diagnosis
Red Flags
Irritable bowel syndrome is the most common gastrointestinal disorder in Western society and accounts for 50% of subspecialty referrals. It is referred to as the "common cold of the stomach" and is most common in women in early adulthood. IBS is a functional disorder of motility in the small and large intestines diagnosed according to specific bowel symptom clusters. It is classified as a “functional” disorder because the abnormal muscle contraction cannot be credited to any identifiable abnormality of the bowel. Individuals affected by this perceive unpleasant or inappropriate sensory experiences in the absence of physiologic or pathophysiologic event. This syndrome is commonly linked with psychosocial factors.
Signs and Symptoms
- Abdominal pain or discomfort (required for diagnosis)
- Bloating
- Mucus in stool
- Incomplete evacuation
- Constipation
- Diarrhea
- Nausea and vomiting
- Foul breath
- Dull, deep discomfort with sharp cramps in the morning or after eating
Referred Patterns
The typical pain pattern is lower left quadrant abdominal pain, constipation, and diarrhea. The pain may be steady or intermittent. The individual may experience discomfort with sharp cramps in the morning or after eating. Abdominal pain or discomfort may be relieved by defecation. Individuals who have IBS with constipation have more symptoms and more severe symptoms that those with IBS with either diarrhea or alternating constipation and diarrhea.
Differential Diagnosis
- Careful questioning about the location of abdominal pain and bowel habits helps distinguish IBS from functional dyspepsia or GERD.
- Altered bowel function is a key symptom of IBS, not found in functional dyspepsia or GERD
- The abdominal pain in IBS is in lower abdomen, not upper abdomen in functional dyspepsia and GERD
Red Flags
- A patient with a known history of IBS is now experiencing unexplained weight loss or persistent, severe diarrhea
- Family history of colon cancer
- Anemia
- Persistent fever
- Symptoms of IBS tend to go away at night. Nocturnal diarrhea, awakening the patient from a sound sleep, is more often a result of organic disease of the bowel.
- A sudden return of symptoms after age 50 following prolonged remission should be evaluated medically, especially if there is blood in the stool
References:
Ehrenpreis, E. D. (2004, August). Characterizing Patients with IBS: How to make a confident diagnosis. Biomedical, 26(8), 53-59.
Goodman, MBA, PT, C. C., & Snyder, MN, RN, OCN, T. E. (2007). Differential Diagnosis PHYSICAL THERAPISTS Screening for Referral (4thth ed.). St. Louis, MO: Saunders Elsevier
Lembo, T J., and R N. Fink. "Clinical Assessment of Irritable Bowel Syndrome." J Clin Gastroenterol 35 (2002): 531-36.
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