Irritable bowel syndrome

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Irritable bowel syndrome is a gastrointestinal system problem that affects 20% of the general population and accounts for 50% of GI outpatient referrals. The etiology is unclear, but is suspected to be multifactorial, taking into account visceral hypersensitivity, motility disorders, and psychosocial issues. Diagnosis happens when there are continuous or recurrent symptoms for at least three months of abdominal pain related to bowel movements and altered bowel function (diarrhea and maybe constipation). On closer examination, there should be nothing to suggest "organic" disease on history, physical examination or initial investigations. The disease is usually found in females more than males in Western society.


Patients may present with abdominal pain, which is usually crampy, lower abdominal pain but may be anywhere. Often, it is relieved by defecation or passing gas. Altered bowel habits (diarrhea, constipation, mucus, urgency, or sense of incomplete emptying, though there is usually no nocturnal diarrhea). Abdominal bloating and psychosocial problems (40-50%) may also be present. Physically, patients are generally normal, and appear healthy, though they may report left lower quadrant tenderness (e.g., "ropey" tender sigmoid colon).


Management and investigations should be kept to a minimum, as they are only needed to exclude diagnoses suggested by the history and physical and that are needed to reassure the patient. Ultimately, management primarily consists of a "therapeutic" doctor-patient relationship in which there is regular follow up, reassurance, patient education, simple, sympathetic explanation and psychological intervention if necessary. Dietary modification to increase fibre may also be handy, as well as stress management and symptomatic drug therapy.