Symptoms in the Pharmacy :Gastrointestinal Tract Problems(16)
Irritable bowel syndrome
IBS is defined as a functional bowel disorder in which abdominal pain
is associated with defecation or a change in bowel habit, with the
additional features of disordered defecation and abdominal distension.
Its cause is unknown. IBS is estimated to affect 20% of adults
in the industrialised world, most of whom (up to three quarters) do
not consult a doctor.
More women with IBS consult a health professional
than do men and the incidence of the condition appears to be
higher in women. Debate has been fierce about whether IBS has a
psychological cause because it is associated with anxiety or depression
in many patients. However, differences in bowel sensitivity have been
shown in IBS patients compared to those without IBS, although the
full picture is not yet clear.
What you need to know
Abdominal pain
The pain can occur anywhere in the abdomen. It is often central or
left-sided and can be severe. When pain occurs in the upper abdomen,
it can be confused with peptic ulcer or gall bladder pain. The site of
pain can vary from person to person and even for an individual.
Sometimes the pain comes on after eating and can be relieved by
defecation.
Bloating
A sensation of bloating is commonly reported. Sometimes it is so
severe that clothes have to be loosened.
Bowel habit
Diarrhoea and constipation may occur; sometimes they alternate.
A morning rush is common, where the patient feels an urgent desire
to defecate several times after getting up in the morning and following
breakfast, after which the bowels may settle. There may be a feeling of
incomplete emptying after a bowel movement. The motion is often
described as loose and semi-formed rather than watery. Sometimes it is
like pellets or rabbit droppings, or pencil-shaped. There may be mucus
present but never blood.
Other symptoms
Nausea sometimes occurs, vomiting is less common.
Patients may also complain of apparently unrelated symptoms such
as backache, feeling lethargic and tired. Urinary symptoms may be
associated with IBS, e.g. frequency, urgency and nocturia (the need to
pass urine during the night). Some women report dyspareunia.
Duration
Patients may present when the first symptoms occur, or may describe a
pattern of symptoms, which has been going on for months or even
years. If an older person is presenting for the first time referral is most
appropriate.
Previous history
You need to know whether the patient has consulted his/her doctor
about the symptoms and, if so, what they were told. A history of travel
abroad and gastroenteritis sometimes appears to trigger an irritable
bowel. Referral is necessary to exclude an unresolved infection. Any
history of previous bowel surgery would suggest a need for referral.
Aggravating factors
Stress appears to play an important role and can precipitate and
exacerbate symptoms.
Caffeine often worsens symptoms and its stimulant effect on the
bowel and irritant effect on the stomach are well known in any case.
The sweeteners sorbitol and fructose have also been reported to
aggravate IBS. Other foods that have been implicated are milk and
dairy products, chocolate, onions, garlic, chives and leeks.
Medication
The patient may already have tried prescribed or OTC medicines to
treat the condition. You need to know what has been tried and
whether it produced any improvement. It is also important to know
what other medicines the patient is taking. IBS is associated with
anxiety and depression in many patients but it is not known whether
this is cause or effect.
When to refer
IBS is defined as a functional bowel disorder in which abdominal pain
is associated with defecation or a change in bowel habit, with the
additional features of disordered defecation and abdominal distension.
Its cause is unknown. IBS is estimated to affect 20% of adults
in the industrialised world, most of whom (up to three quarters) do
not consult a doctor.
More women with IBS consult a health professional
than do men and the incidence of the condition appears to be
higher in women. Debate has been fierce about whether IBS has a
psychological cause because it is associated with anxiety or depression
in many patients. However, differences in bowel sensitivity have been
shown in IBS patients compared to those without IBS, although the
full picture is not yet clear.
What you need to know
- Age
- Child, adult
- Symptoms
- Gastrointestinal
- Abdominal pain
- Abdominal distension/bloating
- Disturbed bowel habit; diarrhoea and/or constipation
- Nausea
- Other
- Urinary symptoms especially frequency
- Dyspareunia (pain during intercourse)
Significance of questions and answers
Age
Because of the difficulties in diagnosis of abdominal pain in children,
it is best to refer.
IBS usually develops in young adult life. If an older adult is presenting
for the first time with no previous history of bowel problems, a
referral should be made.
Symptoms
IBS has three key symptoms: abdominal pain (may ease following a
bowel movement), abdominal distension/bloating and disturbance of
bowel habit.
Age
Because of the difficulties in diagnosis of abdominal pain in children,
it is best to refer.
IBS usually develops in young adult life. If an older adult is presenting
for the first time with no previous history of bowel problems, a
referral should be made.
Symptoms
IBS has three key symptoms: abdominal pain (may ease following a
bowel movement), abdominal distension/bloating and disturbance of
bowel habit.
Abdominal pain
The pain can occur anywhere in the abdomen. It is often central or
left-sided and can be severe. When pain occurs in the upper abdomen,
it can be confused with peptic ulcer or gall bladder pain. The site of
pain can vary from person to person and even for an individual.
Sometimes the pain comes on after eating and can be relieved by
defecation.
Bloating
A sensation of bloating is commonly reported. Sometimes it is so
severe that clothes have to be loosened.
Bowel habit
Diarrhoea and constipation may occur; sometimes they alternate.
A morning rush is common, where the patient feels an urgent desire
to defecate several times after getting up in the morning and following
breakfast, after which the bowels may settle. There may be a feeling of
incomplete emptying after a bowel movement. The motion is often
described as loose and semi-formed rather than watery. Sometimes it is
like pellets or rabbit droppings, or pencil-shaped. There may be mucus
present but never blood.
Other symptoms
Nausea sometimes occurs, vomiting is less common.
Patients may also complain of apparently unrelated symptoms such
as backache, feeling lethargic and tired. Urinary symptoms may be
associated with IBS, e.g. frequency, urgency and nocturia (the need to
pass urine during the night). Some women report dyspareunia.
Duration
Patients may present when the first symptoms occur, or may describe a
pattern of symptoms, which has been going on for months or even
years. If an older person is presenting for the first time referral is most
appropriate.
Previous history
You need to know whether the patient has consulted his/her doctor
about the symptoms and, if so, what they were told. A history of travel
abroad and gastroenteritis sometimes appears to trigger an irritable
bowel. Referral is necessary to exclude an unresolved infection. Any
history of previous bowel surgery would suggest a need for referral.
Aggravating factors
Stress appears to play an important role and can precipitate and
exacerbate symptoms.
Caffeine often worsens symptoms and its stimulant effect on the
bowel and irritant effect on the stomach are well known in any case.
The sweeteners sorbitol and fructose have also been reported to
aggravate IBS. Other foods that have been implicated are milk and
dairy products, chocolate, onions, garlic, chives and leeks.
Medication
The patient may already have tried prescribed or OTC medicines to
treat the condition. You need to know what has been tried and
whether it produced any improvement. It is also important to know
what other medicines the patient is taking. IBS is associated with
anxiety and depression in many patients but it is not known whether
this is cause or effect.
When to refer
- Children
- Older person with no previous history of IBS
- Pregnant women
- Blood in stools
- Unexplained weight loss
- Caution in patients aged over 45 with changed bowel habit
- Signs of bowel obstruction
- Unresponsive to appropriate treatment
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