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Irritating Irritable Bowel Syndrome (Part 2)

Amy Campbell

March 9, 2009

Last week (in “Irritating Irritable Bowel Syndrome [Part 1]“), we started to take a closer look at irritable bowel syndrome, or IBS. And for those of you who contributed your comments and advice, thank you. IBS is really more common than many of us realize, but because of the nature of this condition, it’s not exactly a topic one brings up too readily. Let’s continue with IBS this week.

Diagnosing IBS: Do You Really Have It?
Most of us experience some gastrointestinal (GI) symptoms at one time or another — gassiness, cramps, bloating, diarrhea, constipation. If you have these symptoms, does it mean you have IBS? Not necessarily. Gassiness can occur from eating a tasty dish of beans and rice; bloating can occur after indulging in a fatty meal; and diarrhea and constipation, well, they can occur for a number of reasons, such as gastroenteritis, in the case of diarrhea. And a lack of fiber in the diet can lead to constipation.

When in Rome…
IBS can actually be a pretty frustrating condition for physicians to diagnose. Back in 1978, researchers gave questionnaires to people whom they suspected of having IBS. Based on the data, they were able to ascertain that people with IBS had certain symptoms in common. Almost 20 years later, a team of scientists convened and put together what was called the Rome I Criteria (this sounds like a religious doctrine, doesn’t it?). The Rome I Criteria went through a couple of iterations, and we have today what is called the Rome III Criteria.

IBS can be hard to diagnose and it may take several years before a physician concludes that a person has this condition. IBS is sometimes referred to as a “diagnosis of exclusion.” Physicians always need to make sure that a more serious condition or disease isn’t present, such as inflammatory bowel disease, for example. The tricky aspect of IBS is that, physically, the bowel appears normal. The problem is that it just doesn’t work normally.

First, here are symptoms, or “red flags” (as the Irritable Bowel Syndrome Self Help and Support Group calls them on its Web site), that rule out IBS:

• Pain that interrupts sleep
• Diarrhea that interrupts sleep
• Fever
• Blood in the stool
• Weight loss
• Abnormal physical exam

So, if you were to have any of the above symptoms, you’d likely have something else going on other than IBS.

How, then, does one “qualify” for IBS? According to the Rome criteria, one must have abdominal pain and discomfort for at least 12 weeks (they don’t have to be consecutive weeks) along with two out of three of the following before you can officially be diagnosed with IBS:

• A change in the frequency of your stool (more than three bowel movements per day or less than three per week)
• A change in the form, or appearance, of your stool (hard or loose)
• Passage of mucus in the stool
• Straining, urgency, or a feeling that you can’t completely empty your bowels
• Bloating or abdominal distention

If you pass the test and you don’t have any of the “red flag” symptoms I previously mentioned, your physician may either start you on a course of treatment or decide to do more tests.

Other Diagnostic Tests for IBS
Running additional tests can be costly and can delay you getting treatment for IBS. But if there’s any doubt about whether you have IBS and not, say, an infection or malabsorption issue, your physician may decide to run these tests:

• Flexible sigmoidoscopy or colonoscopy to examine your large intestine
• Lower GI series, which are x-rays of your large intestine
• CT scan, MRI, or ultrasound to rule out other causes of your symptoms
• Lactose intolerance test
• Exam and blood test for celiac disease
• Stool cultures to rule out bacterial or parasite infection

Not a lot of fun, but it’s better to be certain that you don’t have something more serious going on.

If you think you might have IBS but haven’t had a workup based on the criteria above, talk to your physician about your symptoms and about getting a more formal exam.

More on IBS next week.

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