| Irritable bowel syndrome (IBS) is a functional disorder characterized by poorly localized, occasionally intense, cramp-like abdominal pain, as well as changes in bowel function. Movement (motility) of the intestine may be either increased or decreased, resulting in either loose stools (diarrhea) or constipation. Increased gas formation may result in bloating or distention of the abdomen. Although usually a chronic disorder, symptoms may disappear for long periods of time only to recur without warning.
No specific causes or biological markers for IBS have been identified nor any association with organic disease, although abnormalities of the sigmoid colon (prediverticular disease) may be involved. Especially low levels of certain chemicals in the intestines, the spinal cord, or brain, are also thought to be a factor. IBS is considered a functional disorder (functional bowel) because either the muscles or the nerves of the intestinal tract are not working properly. Spasms of the pyloric sphincter between the stomach and the small intestine is a condition that sometimes occurs in conjunction with typical IBS symptoms. Pylorospasm, which can occur without any other IBS symptoms being present, occurs when the pyloric sphincter contracts spasmodically, preventing partially digested food from the stomach from entering the small intestine (duodenum) where it will be digested further. The backup of partially digested material can result in regurgitation of the stomach contents back into the esophagus, vomiting, and abdominal pain. This condition is often mistaken for IBS. Chronic dyspepsia, a functional condition of the upper gastrointestinal area, also has symptoms similar to IBS. An analysis of hundreds of studies of IBS cases has determined that it is a stable, symptom-based diagnosis.
Although the precise dysfunction of IBS is not understood, it is often thought to be related to psycho-social symptoms such as anxiety or depression. While other diseases of the digestive tract can be detected microscopically or through specific tests, it is typical in IBS for symptoms to be present while laboratory tests show negative results and imaging studies (such as CT scan, MRI, or x-ray with barium enema) reveal no abnormalities.
IBS may also be a symptom of another disease such as an inflamed bowel (diverticulitis), pouch formation in the sigmoid colon (diverticulosis), or colon cancer. IBS is also associated with fibromyalgia.Risk: IBS is often associated with a history of mental, sexual, or physical abuse and psychiatric conditions such as anxiety, depression, and inability to handle stress. The ingestion of certain types of foods such as coffee or milk (lactose), a diet low in fiber (low-residue), or the overuse of medications such as laxatives are believed to either cause or aggravate IBS symptoms in some individuals. Incidence and Prevalence: IBS is a common gastrointestinal condition, affecting from 10% to 20% of adults in the US (Lucak). More women are diagnosed than men, though this is believed to be related to differences in healthcare-seeking behavior. More prevalent in lower socioeconomic groups, IBS is equally common among blacks and whites in the US. |
Source: Medical Disability Advisor
| History: Individuals may report constipation and/or diarrhea, as well as abdominal pain that may be relieved by a bowel movement. The number of bowel movements and the consistency of stools may often be different from what is normally experienced. Pain is often reported in more than one site in the abdomen or in different sites at different times. Individuals may also experience abdominal distention, bloating, and other nonintestinal symptoms such as headache, backache, fatigue, or urinary symptoms. Physical exam: The exam may reveal an anxious or depressed but otherwise healthy individual. Although some distention and tenderness may be found, abdominal organs are not enlarged. The diagnosis of IBS is symptom-based, requiring at least 3 months of continuous or recurring abdominal pain that is relieved with defecation, or associated with a change in the frequency of bowel movements or consistency of the stool. Tests: No specific tests give a definitive diagnosis for IBS. Consequently, a fairly standard workup of diagnostic tests and procedures is performed primarily to rule out other disease states. These tests may also help reassure the individual that a more serious condition does not exist. A reasonable evaluation includes a complete blood count (CBC) and stool examination to rule out disease-causing (pathogenic) bacteria, parasites, parasite eggs, or intestinal bleeding (occult blood). A blood chemistry panel including thyroid (TSH) and amylase tests helps rule out thyroid dysfunction and pancreatic problems. A urinalysis is usually sufficient to rule out urinary tract problems.
Examination of the sigmoid colon (sigmoidoscopy) using a flexible optic instrument (endoscope) may reveal abnormal spasms and mucus within the large intestine. Other diagnostic tests, more typically performed on individuals over age 50, include an endoscope (full colonoscopy) to visualize the entire colon, a radiographic procedure to visualize the colon (barium enema), or sampling a small piece of the colon for microscopic analysis (colonic biopsy). These diagnostic procedures may only be performed when IBS symptoms are accompanied by unexplained weight loss; a family history of inflammatory bowel disease, colon cancer, or celiac disease; or the presence of anemia, bowel obstruction, enlarged liver, or thyroid disorder. Anorectal motility studies may be indicated for individuals over 50 who present with IBS symptoms. |
Source: Medical Disability Advisor
| Once organic disease is ruled out, treatment consists of educating the individual and providing reassurance. Supportive encouragement may help moderate the intensity of the condition. The individual is instructed on the relationship between stress, anxiousness, and/or nervousness and IBS. Behavioral modification and relaxation techniques are often beneficial. Psychiatric consultation may be warranted for diagnosing or treating depression, chronic anxiety, or obsessive-compulsive disorders. Antidepressant drugs may be effective in some individuals with IBS. A drug that modifies serotonin activity (tegaserod maleate) may help to treat a possible underlying chemical cause of IBS, as serotonin is believed to influence abnormal contractions of the intestinal muscles and to increase intestinal sensitivity to pain. Tegaserod maleate has been shown to reduce sensitivity of the nerves to pain and increase muscle contractions in the intestines to help relieve constipation-predominant IBS; its use is contraindicated for diarrhea-predominant IBS.
The importance of having a regular schedule, nourishing meals, adequate sleep, and recreational activities should be emphasized. The individual is encouraged to establish a regular bowel routine. Regular exercise to relieve stress and anxiety may help moderate IBS symptoms. Any aerobic exercise such as walking, jogging, or swimming may be beneficial. It is important that the individual enjoys the exercise program so it will be done on a regular basis.
Certain foods may precipitate IBS symptoms. In general, foods to be avoided include those that are gas-producing or irritating, nondigestible carbohydrates, milk and milk-products, caffeinated beverages, and alcohol. Increased fiber in the diet may help control IBS-associated diarrhea or constipation by producing bulkier stools and reducing tension in the walls of the colon. Sources of dietary fiber include bran, whole grains such as brown rice and whole wheat, and raw and dried fruits and green leafy vegetables. Individuals should be encouraged to drink 6 to 8 glasses of water a day to regulate stool consistency and frequency. When IBS is related to chronic laxative abuse, bowel training may be necessary to correct the condition and alleviate symptoms.
Rest and heat applied to the abdomen may help alleviate cramping. Fiber supplements and stool softeners may help those who have constipation and anti-diarrheal drugs may help those with diarrhea. In some cases, sedatives and anti-gas or anti-spasmodic drugs may also provide relief. Care must be taken to avoid dependence on these medications. |
Source: Medical Disability Advisor
| Individuals with IBS may experience intermittent or chronic symptoms throughout their lifetime; 2% to 18% will experience worse symptoms, while 30% to 50% will have no noticeable change in symptoms, and still others will have symptoms subside almost completely (El-Serag). Symptoms that are more of an annoyance than a disability may be moderated with education, stress reduction, exercise, and dietary modifications. Only a small number of individuals with IBS (0.7% to 6.5%) are typically diagnosed with organic disease later in life (Lucak). |
Source: Medical Disability Advisor
| Hard stools, inflammation, and irritation from frequent loose stools may cause crack-like tears in the anus (anal fissures). Constipation may produce a sense of fullness along with nausea, belching, stomach distention, or abdominal discomfort. Long-term, untreated constipation may produce headache, dizziness, vertigo, generalized weakness and discomfort (malaise), loss of appetite (anorexia), or a bad taste in the mouth. Although rare, severe diarrhea can cause dehydration and subsequent chemical imbalances. Diarrhea may interfere with daily activities or prevent individuals from venturing far from toilet facilities, causing social isolation. |
Source: Medical Disability Advisor
| Work restrictions are not required, although ready access to toilet facilities may be necessary if diarrhea occurs. Symptoms are rarely severe enough to warrant time off from work other than for doctor visit. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual complain of poorly localized, occasionally intense, cramp-like lower abdominal pain?
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Does individual report bloating or abdominal distension?
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Does individual report constipation and/or diarrhea, as well as abdominal pain that may be that is relieved by a bowel movement?
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Does individual report that the number or consistency of stools is different from what is normally experienced?
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Does individual also complain of headache, backache, fatigue, or urinary symptoms?
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Has individual experienced symptoms for at least 3 month continually or recurring?
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Have the symptoms been absent for an extended period of time only to return?
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Does individual have prediverticular disease, anxiety, depression, or inability to handle stress? Does the individual have diverticulitis or diverticulosis?
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Do the symptoms seem to be related to the ingestion of certain types of foods such as coffee or milk or medications such as laxatives?
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On physical exam, did the individual appear anxious but otherwise healthy?
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Did individual have any abdominal distention and tenderness?
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Has individual had a CBC, urinalysis, comprehensive stool testing, blood chemistry panel including a TSH and amylase test?
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Has individual had a sigmoidoscopy, colonoscopy, barium enema, or a colon biopsy?
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Have conditions with similar symptoms been ruled out?
Regarding treatment:
- Has individual received education about IBS and control of the condition?
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If necessary, has the individual sought psychiatric consultation?
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Has individual addressed correctable causes of symptoms?
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Is individual being treated with any medications?
Regarding prognosis:
- Does individual exercise regularly?
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Is individual's employer able to accommodate any necessary restrictions?
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Does individual have any conditions that may affect the ability to recover?
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Does individual have any complications such as anal fissures, headache, vertigo, malaise, anorexia, a bad taste in the mouth, or dehydration and subsequent chemical imbalances? Does the diarrhea may interfere with daily activities or prevent the individual from venturing far from toilet facilities, causing social isolation?
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Source: Medical Disability Advisor
| El-Serag, H. B., P. Pilgrim, and P. Schoenfeld. "Systematic Review: Natural History of Irritable Bowel Syndrome." Alimentary Pharmacology & Therapeutics 19 8 (2004): 861-870.Lucak, S. "Diagnosing Irritable Bowel Syndrome: What's Too Much, What's Enough?" Medscape General Medicine 6 1 (2004): 17. |
Source: Medical Disability Advisor
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