The syndrome irritable bowel ( IBS ) is a common disorder that affects the functions of the large intestine , characterized by alterations in the pattern evacuatorio abdominal pain associated with chronic, relapsing appearance. In recent years its incidence has increased, both in the adult population and in children, impacting their development at work and in their places of study.

Although it is estimated that this condition affects at least 10% of the world population, it is believed that only 40% of that affected population consult a doctor for treatment.

The syndrome of irritable colon is related to other conditions such as chronic stress and other diseases such as anxiety, depression, chronic fatigue syndrome, fibromyalgia and some allergies.

The SII can be confused with other diseases, so should be a correct differential diagnosis based on symptoms of the patient, laboratories and discarding other gastrointestinal diseases.

Irritable bowel symptoms

Most patients describe gastrointestinal symptoms related to bowel movements. Many patients present abdominal pain that improves after evacuation, however, others report that the pain is exacerbated after evacuation. Likewise, they report alterations in their stool pattern (diarrhea that alternates with periods of constipation or periods of pasty stools that change to very compact stools). Most patients report the following symptoms:

  • Abdominal pain, which varies in intensity, colicky, generalized or localized in the lower hemiabdomen (lower part of the abdomen).
  • Feeling of abdominal cramps.
  • Abdominal distention .
  • Belching and flatulence .
  • Burning in the stomach .
  • Diarrhea.
  • Constipation .
  • Alternation of diarrhea with constipation.
  • Rectal tenesmus (persistent desire to evacuate).
  • Rectal pain
  • Mucus stools

If you have any of these symptoms repeatedly (in at least three months) or if these symptoms cause limitations in your daily life, you should see a doctor to rule out the presence of IBS .

How is irritable bowel syndrome diagnosed?

Worldwide, guides have been created on irritable bowel , defining criteria for its correct diagnosis.

It is important that the evaluation of the patient is carried out by a doctor who specializes in internal medicine or gastroenterology, since IBS is a disease that affects functionalism, but not the structure of the intestine, so organic pathologies must be ruled out in the first instance.

Among the diagnostic criteria for IBS are:

Recurrent abdominal pain, at least once a week in the last three months, associated with any of these symptoms:

  • Related to defecation: appears before or after evacuation.
  • Associated with a change in the frequency of bowel movements: they increase (diarrhea) or decrease (constipation or constipation).
  • Associated with a change in the appearance of the stool (more fluid or more compact).

Other criteria are:

  • Very soft or fluid and hard or very compact stools.
  • Pushing or straining to evacuate.
  • Rectal tenesmus or sensation of incomplete bowel movements .
  • Rectal obstruction sensation.
  • Need to use manual maneuvers or suppositories to allow evacuation.

In addition to these symptomatic criteria, complementary laboratory studies should be carried out that include a complete hematology, simple stool examination or coproanalysis, calprotectin in stools (which allows to rule out the presence of ulcerative colitis and Crohn’s disease) and serology to rule out intolerance to gluten or celiac disease, as the main differential diagnoses.

When pathology of the intestinal mucosa is suspected, the doctor will order a colonoscopy or lower digestive endoscopy to evaluate the integrity of the colon. In some cases, there are alarm criteria (weight loss, red blood in stools , dark stools, nocturnal diarrhea, marked weight loss) before which the doctor should suspect more serious pathologies.

Differential diagnoses in Irritable Bowel Syndrome

Among the differential diagnoses of IBS, celiac disease or gluten intolerance, lactose intolerance, intestinal parasites, inflammatory bowel disease (including Crohn’s disease) and diarrhea associated with drug use cannot be omitted. , in the event that the predominant IBS symptom is diarrhea.

In the case of constipation and abdominal pain, whatever symptoms stand out, pathologies such as chronic diverticulitis and colon tumors (such as colorectal cancer) should be ruled out, especially if there are alarm symptoms or a history of gastrointestinal cancer in the patient’s family.

The correct diagnosis of the irritable bowel will be in charge of a specialist who emphasizes the medical history of the patient, his symptoms and the discard of organic pathologies of the colon, including some allergies or intolerances. It is important to see your doctor for a timely diagnosis and treatment.

By Dr. Eric Jackson

Dr. Eric Jackson provides primary Internal Medicine care for men and women and treats patients with bone and mineral diseases, diabetes, heart conditions, and other chronic illnesses.He is a Washington University Bone Health Program physician and is a certified Bone Densitometrist. Dr. Avery is consistently recognized in "The Best Doctors in America" list.

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