Diagnosis of Irritable Bowel Syndrome.

Copyright 2006 Dr. Phil Hariram
Irritable Bowel Syndrome (IBS) belongs to a group of conditions called Medically Unexplained Diseases or Disorders (MUD). Fibromyalgia Syndrome is also in this group. IBS is a functional disorder. In other words, you have symptoms but there is no structural abnormality. It is the most common condition seen by Gastroenterologists and the most common gastrointestinal condition seen by the family doctor.
Diagnosis is easier since the introduction of the Manning Criteria and more recently the Rome Criteria. The Rome 11 Criteria gives family physicians the confidence to diagnose Irritable Bowel Syndrome without invasive tests. This is very useful especially in the very young.
IBS is a very common condition and, as a large percent of sufferers do not see their GP, the incidence could be as high as 20% globally. It is more common in women. It is also a heavy burden not only to the sufferer but to the health professionals and health providers.
Abdominal pain is an important symptom in the diagnosis of Irritable Bowel Syndrome. A patient attended my surgery and said she had IBS. Her only symptom was bloating. She had a flat tummy when she woke up but by the end of the day, she looked like she was nine months pregnant. She had no pain or altered bowel habit or form. This is not Irritable Bowel syndrome but one of the many functional disorders that affect the gut. Thompson and Heaton produced a long list of functional gastrointestinal disorders. Quite a few overlap with IBS.
For the diagnosis of IBS, according to the Rome 11 Criteria, you must have abdominal pain or discomfort for at least 12 weeks in a year plus two of the following in the absence of structural or metabolic abnormalities to explain the symptoms. Relief of pain with defecation. Pain associated with change in frequency of bowel movement. Pain associated with a change in form of stools.
IBS sufferers also have rectal symptoms such as urgency and incomplete emptying. Urgency can cause faecal incontinence. Although this is uncommon, it is a source of severe embarrassment. Bloating is common in Irritable Bowel Syndrome. IBS sufferers are aware of their rumbling tummy and wind. Mucus was a common feature in the past but is not a significant feature today.
Non colonic symptoms of IBS include tiredness and lethargy, urgency and frequency to micturate, backache, pain during intercourse and painful periods in women.
Statistics show that a large percent of Irritable Bowel Syndrome patients wait years before seeing a doctor. These individuals are making their own diagnoses. IBS patients should have a diagnosis established by a health professional. Some serious illnesses have similar symptoms as IBS. Subclinical Ulcerative Colitis can mimic Irritable Bowel Syndrome.
Patients who suspect they have Irritable Bowel Syndrome must see their doctor if they have any of the following symptoms. Unexpected weight loss, loss of appetite (anorexia), bleeding from the rectum and symptoms first appearing after the age of 50. See your family doctor if you have IBS symptoms and you have a family history of colon cancer or polyp. There is a higher incident of haemorrhoids (piles) in Irritable Bowel Syndrome and haemorrhoids can cause bleeding from the rectum. Bleeding from the rectum is, however, a red flag symptom and can point to serious underlying disease. Check it out.