27 Jun 2014

Irritable bowel syndrome - understanding clinical features

Irritable bowel syndrome (IBS) is one of the common bowel problems. Other names are spastic colon, nervous bowel, mucous colitis, functional bowel disorder, intestinal hurry. Many persons suffering from this won’t disclose it to others and their doctors because of fear. Even though the symptoms are distressing many of them can be relieved with proper medication. About 20% of general population may be suffering from the disease but only 10% seek medical attention. This can occur at any age majority experience the first attack before 45 yrs. IBS is mainly a disease of young women. Understanding and treating the condition is important because it will affect the quality of life and frequent work absenteeism .This is a functional disorder of bowel without any structural abnormality.

Clinical features of Irritable bowel syndrome
IBS is characterized by recurrent abdominal pain associated with defecation and altered bowel habits. Symptoms vary from person to person . Predominants symptoms are abdominal pain, altered bowel habits, gas and flatulence, upper gastrointestinal symptoms. Even healthy people may  have occasional stomach upset and diarrhea , IBS  patients experience it more frequently.
1. Abdominal pain
It is the most common and key symptom of IBS. It can be colicky or cramp like mainly felt in the lower abdomen and is relieved by medication. Some patients experience a constant ache in the abdomen. Severity of pain varies from patient to patient. Usually pain is present only during wakeful hours and won’t disturb the sleep. Factors that aggravate pain include eating or emotional stress and it is  improved by passage of flatus or stools. In females during premenstrual and menstrual period worsening of symptoms can occur. 
2. Alteration in bowel habits 
One of the most consistent clinical features in IBS is alteration in bowel habit. Patient may experience diarrhea (IBS-D), or constipation (IBS-C) or a mixture of these (IBS-M ).The usual  pattern is constipation alternating with diarrhea,eithr of these symptom can predominate. In constipated patients stools may be hard with narrow caliber described as marble like or pencil thin. Patients also explain incomplete evacuation this will lead to repeated defecation .In some people diarrhea predominates. This is small volume loose stool. Usually there is no diarrhea at night. Emotional stress and eating will worsen the diarrhea. Passage of mucus per rectum can occur. Usualy there is no weight loss or malabsorption. Rectal bleeding is not seen. 
3. Gas and flatulence
Patients also complain of abdominal distension and flatulence, many patients complain of increasing gas, but that need not be present, there is alteration in bowel transit of intestinal gas and intolerance to gas. Those patients with bloating and abdominal distension experience less abdominal pain.
4. Upper gastrointestinal symptoms
About 25-50% of patients with IBS also experience dyspepsia, heartburn, nausea, and vomiting. The prevalence of IBS is more among patients with dyspepsia. 
Other coexisting conditions are fibromyalgia, non ulcer dyspepsia, chronic fatigue syndrome, headache, backache and dysmenorrhea in females. 

Stress  and IBS
Emotional factors are linked to IBS. Anger, anxiety may increase the bowel movements and produce diarrhea. Upto 50% of people may experience anxiety, depression, obsessive-compulsive disorder .Some patients also gives history of prior physical or sexual abuse.

Rome III criteria for diagnosis of irritable bowel syndrome
Recurrent abdominal pain or discomfort at least 3 days/month in the last 3 months, associated with two or more of the following:
• Improvement with defecation.
• Onset associated with a change in frequency of stool.
• Onset associated with a change in form (appearance) of stool.
Features supporting IBS
• Symptoms for more than 6 months.
• Frequent medical visits for non-gastrointestinal problems.
• Prior symptoms which are medically unexplained.
• Worsening of symptoms by stress.

Alarming features of IBS, if present immediately consult physician 
• Age more than 50 yrs.
• Male gender
• Weight loss
• Nocturnal symptoms ( Symptoms at night ) 
• Family history of colon cancer
• Anaemia – Decreased heamoglobin
• Rectal bleeding

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