Diagnosis

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Irritable bowel syndrome (IBS) is a common medical disorder that is characterized by chronic abdominal discomfort or pain, bloating and changes in bowel habits. An IBS diagnosis is based on a pattern of symptoms that fit established criteria in conjunction with physical examination and tests that rule out other conditions with similar symptoms.

Health care professionals use a symptom checklist called the Rome III Diagnostic Criteria to diagnose IBS. It requires that people have least three months of recurrent abdominal pain or discomfort associated with two or more of the following:

Abdominal pain or discomfort that is:

• relieved with defecation and/or

• associated with a change in frequency of stool; and/or

• associated with a change in form (appearance) of stool

Other symptoms include:

• altered stool frequency (often defined in research studies as more than three bowel movements per day or fewer than three bowel movements per week);

• altered stool form (lumpy/hard or loose/watery stool);

• altered stool passage (straining, urgency or feeling of incomplete evacuation);

• passage of mucus; and/or

• bloating or feeling of abdominal distension.

While most people with IBS meet these criteria for symptoms, some don't. That doesn't mean they don't have IBS. Also, some people with other gastrointestinal illness may meet the Rome III Criteria but not have IBS. So you can't diagnose yourself simply with a list of symptoms. You must work closely with your doctor, who should also take a complete medical history and conduct a full physical exam along with necessary tests to determine your diagnosis.

It's important to remember, however, that everyone suffers from an occasional bowel disturbance. A normal bowel movement is one that is formed but not hard, contains no blood and is passed without cramps or pain. Changes in bowel habits can occur with changes in diet or activity and don't necessarily indicate IBS. If you have IBS, such disturbances are chronic and recurrent.

IBS symptoms cause more than just physical distress. You may also suffer stress, depression, anxiety and frustration, at least in part because IBS can be embarrassing and not easy to talk about. A common source of anxiety relates to the need to be near a toilet when the feeling of urgency develops. Some people with moderate to severe symptoms (including unpredictable pain, urgency and perhaps even bowel incontinence) find that IBS can affect many aspects of their lives, from the most public (including the ability to work, attend social events and travel) to the most private (relationships with friends, family and sexual partners).

Moreover, IBS symptoms are an example of what researchers call the "mind-gut" connection. That is, having IBS often causes stress and stress often triggers more symptoms. That's because the colon is partly controlled by the nervous system. When areas of the brain that are influenced by stress are overwhelmed, the gastrointestinal tract is affected, causing pain and other symptoms. Then increased pain can cause further anxiety.

A psychological evaluation and possible treatment may be recommended, particularly when symptoms are severe enough to affect your quality of life. Questionnaires that detect anxiety, depression or other psychological problems may be used to supplement your health care provider's evaluation of your symptoms. Psychological treatment, in addition to medical treatment, can break the vicious IBS symptom cycle.

In addition to taking a complete medical history that includes a careful description of symptoms, your health care professional may do one or more of the following:

• Order lab tests. (There is no lab test specifically for IBS, but thyroid, blood and urine tests may be able to eliminate other conditions that cause similar symptoms.)

• Order a flexible sigmoidoscopy or, for older patients, a colonoscopy. These procedures involve viewing the colon through a flexible tube inserted through the anus. (For instance, during flexible sigmoidoscopy, the rectum, sigmoid colon and descending colon are directly viewed using flexible tube with a light on the end. A similar procedure includes colonoscopy, which also involves viewing the entire colon through a flexible tube inserted through the anus.) The point is to look for signs of other disease but the test may not be necessary in all patients.

• Conduct a pelvic exam to rule out ovarian tumors and cysts or endometriosis, which may cause symptoms similar to IBS.

• Test for lactose intolerance. Lactose is a sugar found in dairy products that causes gastrointestinal distress in some people. To test for this, your health care professional may ask you to eliminate milk products from your diet for two weeks; if your symptoms improve, you may be lactose intolerant, and not have IBS. A lactose hydrogen breath test may also be used to indicate lactose intolerance.

• Test a stool sample for evidence of bleeding. Your health care professional may take a sample during a rectal exam, or you may be asked to take a sample yourself. How you do this depends on the on the type of kit you receive. One kit supplies a special paper you use to collect the sample. You then return it to the lab in the container provided. Be sure to get complete instructions from your health care professional.

• Order a barium enema. This is a radiological (x-ray) examination of the large intestine that is performed by taking x-ray pictures of the bowel after it has been distended with a barium-containing liquid and air.