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When Are Bowel Symptoms A Sign Of IBS?

Posted Aug 24 2008 1:49pm
ANNOUNCER: When it comes to diagnosing irritable bowel syndrome the first step is: go see a doctor.

LIN CHANG, MD: The majority of individuals that have IBS actually don't seek healthcare. About two-thirds of individuals that have IBS actually don't see a doctor or another healthcare provider for their symptoms.

BRIAN LACY, MD: They're scared to see a doctor. They're worried they're going to get bad news; many of these patients are very concerned their symptoms represent cancer. They're embarrassed to talk about their symptoms. They're worried that there won't be any treatment for their symptoms. And so, many of these patients kind of remain hidden and remain undiagnosed.

ANNOUNCER: At the doctor's office, the next step is to confirm the key symptoms of IBS: abdominal pain or discomfort, plus constipation or diarrhea.

LIN CHANG, MD: The main symptom that is used to classify patients with IBS is the patients have to have abdominal pain or discomfort. In other disorders where they may have similar symptoms such as diarrhea, chronic diarrhea or functional constipation, those patients don't typically have pain as a predominant symptom. So they may have an altered bowel habit, but it's not associated with pain.

BRIAN LACY, MD: We then do a good history and we really listen to the patient's story and we look for some things that are called "warning signs" or "red flags."

Finally, we do a very good physical exam and the physical examination should be normal. When the patient fits the definition, we don't hear the story about warning signs or red flags and they have a normal examination, we can actually confidently tell a patient in the office, on that visit, that "You have irritable bowel syndrome."

ANNOUNCER: The so-called "red flags" the doctor asks about are symptoms or a family history that could suggest a diagnosis other than IBS.

SUSAN LUCAK, MD: The alarm symptoms and signs include weight loss, anemia, elevated white blood cell count, elevated sedimentation rate, again, suggesting inflammation or infection. Electrolyte abnormalities in the blood; again, suggesting that in those patients who have diarrhea, that the diarrhea may be more significant, leading to dehydration. Family history of colon cancer, or inflammatory bowel disease, such as Crohn's disease or ulcerative colitis.

Also when patients have nocturnal symptoms. Generally, when people with irritable bowel syndrome go to sleep, their gut goes to sleep and they generally do not have symptoms at night.

ANNOUNCER: When red flags are present, or a patient is 50 or over, doctors will usually examine the colon with an imaging device. But otherwise, research suggests such diagnostic tests are not necessary on a routine basis.

In fact, in diagnosing IBS, doctors have shifted focus in recent years to what IBS is, rather than what IBS is not.

BRIAN LACY, MD: It's been taught for many, many years that irritable bowel syndrome is actually a diagnosis of exclusion. That a patient should have multiple tests, extensive testing, repeated visits before a diagnosis can be made. One of the things we try to teach here is that irritable bowel syndrome is actually a fairly easy thing to diagnose. That when somebody comes to our office and has these complaints, there are no warning symptoms on exam or by history, we should be able to make a diagnosis that day. And really start treatment on that first visit.

ANNOUNCER: Perhaps the most important factor in promoting IBS diagnosis is a good relationship between doctor and patient. In fact, trust and communication can help bring about the best results as newly-diagnosed patients turn toward treatment.

LIN CHANG, MD: You really do need to spend time with patients to get to know them and to understand what their symptoms are, how they cope with it.

I think it's very important to have good communication between a patient and a physician, to build that sense of trust, that bond.

BRIAN LACY, MD: Make an appointment to see a doctor. Don't be squeamish about telling the doctor your symptoms. Tell them what the symptoms are and be very upfront about it; don't hide it. And follow-up with the rule, the question to the doctor saying, "I have these symptoms now, what can we do about it?"

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