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Which Specialist should I see for IBS Irritable Bowel Syndrome

Posted Jul 31 2013 9:55am

The symptoms of Irritable Bowel Syndrome (IBS) are often mild but for many the condition is a long term burden. In some cases a more serious underlying problem might be the cause. This concern can often be reduced by a simple professional assessment without the need for invasive tests.  Tests to exclude serious disease are important when appropriate and, in older patients, may help to reduce the risk of future colonic malignancy.  Management of IBS should start with carefully listening to the patient’s clinical history, performing appropriate examination and investigation and then starting treatment, preferably based on diet and non-pharmaceutical therapy.  Many patients can be managed by their family doctor and pharmacist.  For those with more significant symptoms a gastroenterologistA doctor who specialises in the digestive system and its disorders. and dietician are often the best team to help the patient manage the condition.

As Consultant Gastroenterologist, Mr Andrew Millar explains in his excellent article for totalhealth -

"Irritable Bowel Syndrome (IBS) is very common, affecting one out of 6 adults.  Although the symptoms of IBS vary there are typical features which can help doctors make an accurate diagnosisThe process of determining which condition a patient may have. without using invasive investigations.  A diagnosis of IBS also relies on checking for worrying symptoms, which doctors call ‘warning’ or ‘red flag’ signs."

When these symptoms appear more thorough investigation is needed.  

IBS Step One - is to exclude serious disease; often with as little intervention as possible.  

IBS Step Two -  is to treat the condition as effectively as possible.  

IBS Step Three - it is important to provide explanation and support to minimise the impact of remaining symptoms and to allow the patient to manage the condition in the long term, themselves.

Many serious bowel disorders can mimic IBS but almost always have other features that should raise concern and lead to investigation.  

Duration of the symptoms – IBS is a long-term condition.  It can start with a bowel infectionInvasion by organisms that may be harmful, for example bacteria or parasites., an operation or traumaA physical injury or emotionally painful event. to the intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus. but the starting point in most patients is not obvious.  Anyone with recent symptoms that are not getting better may well have a different problem.  

Rectal bleeding - The passage of bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. is NOT a feature of IBS and should always be fully assessed. 

A lump in the abdomenThe part of the body that contains the stomach, intestines, liver, gallbladder and other organs. or rectumThe last part of the large intestine, where faeces are stored before being passed. – Anyone feeling a lump in the abdomen that does not pass on opening their bowels or any in the anusThe external opening of the back passage, the rectum. or rectum should see a doctor for a full examination

Continuing IBS symptoms over the age of 50 could be a sign of bowel cancer

Age – The main concern here is bowel cancer.  Although this can occur at almost any age, it is incredibly rare under 20, very rare under 30 and rare under 50.  

The ‘Red Flag’ or ‘Warning’ features – Those features listed below should always be investigated, as should lesser symptoms, or those in younger people, that are started fairly recently and are worsening over days, weeks or months.  The ages are not given as a single figure as there is no absolute cut off above which we should become concerned.  The red flag features are:

  • The passage of dark blood, or blood mixed in with the stoolFaeces., particularly if the stool has become looser or more frequent
  • New onset of any blood in the stool in a patient over 40–45
  • Recent onset of stools looser than normal for more than 3 weeks, in those over 40–50 and 6 weeks if less than 40-50
  • Unexplained significant weight loss with altered bowel habit at any age
  • Iron deficiency anaemiaA reduced level of haemoglobin, which carries oxygen in the blood. Anaemia causes tiredness, breathlessness and abnormally pale skin. in any male and any female who does not have significant menstrual blood loss
  • Anyone with a mass in the abdomen, anus or rectum
  • Any person with very severe bowel symptoms, at any age


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