IRRITABLE BOWEL SYNDROME (IBS): a chronic functional disorder of the colon that is of unknown etiology but is commonly considered to be of psychosomatic origin and that is characterized by the secretion and passage of large amounts of mucus, by constipation alternating with diarrhea, and by cramping abdominal pain -- also called irritable colon, irritable colon syndrome, mucous colitis, spastic colon.
According to the Merck Manual, IBS may be precipitated, aggravated, or heightened by emotional factors, diet, drugs, or hormones. Some patients have anxiety disorders, particularly panic disorder; major depressive disorder; and somatization disorder. However, stress and emotional conflict do not always coincide with symptom onset and recurrence. Irritable bowel syndrome accounts for 20% to 50% of all GI complaints in private and institutional care facilities. Women outnumber men 2:1, and whites outnumber nonwhites. The preponderance of women with this diagnosis may reflect their greater tendency to seek health care rather than the actual incidence. In 50% of patients, symptoms begin before age 35, and 40% of patients are 35 to 50 years of age. Neither the incidence nor prevalence in the elderly has been well defined. Geriatric patients with this condition usually have a long history of bowel dysfunction, often beginning in childhood.
Features of IBS are pain relieved by defecation, an alternating pattern of bowel habits, abdominal distention, mucus in the stool, and sensation of incomplete evacuation after defecation. The more symptoms that are present, the likelier that the patient has IBS. Patients with IBS may also have extraintestinal symptoms (eg, fibromyalgia, headaches, dyspareunia, TMJ syndrome).
IBS is either:
1. constipation-predominant - constipation is common, but bowel habits vary. Most patients have pain over at least one area of the colon. Stool often contains clear or white mucus. The pain is either colicky, coming in bouts, or a continuous dull ache; it may be relieved by a bowel movement. Eating commonly triggers symptoms. Bloating, flatulence, nausea, dyspepsia, and pyrosis can also occur.
2. diarrhea-predominant - is characterized by precipitous diarrhea that occurs on rising or during or immediately after eating. Nocturnal diarrhea is unusual. Pain, bloating, and rectal urgency are common, and incontinence may occur. Painless diarrhea is not typical and should lead the physician to consider other diagnostic possibilities (eg, malabsorption, osmotic diarrhea).
TREATMENT: reduction in stress, proper diet, antispasmodic drugs, antidepressants.
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