Irritable Bowel Syndrome: Symptoms, Diagnosis, and Next Steps

Diagnosed with irritable bowel syndrome (IBS)?

Doctor, I had a suspected case of acute gastroenteritis two months ago, and after taking medication, it seems to have triggered gastrointestinal dysfunction.
I was recently diagnosed with irritable bowel syndrome (IBS).
My current symptoms include mild constipation, no diarrhea or blood in the stool, bloating and discomfort in the middle and lower abdomen, occasional dull pain in the right abdomen that is tender to touch, and intermittent nausea without actual vomiting.
I also experience lower back pain and sleep disturbances.

The tests I have undergone include blood tests, urinalysis, X-rays, ultrasound, gastroscopy, and stool occult blood tests, all of which showed no abnormalities.
I have been controlling my diet to be healthy and light, have started to exercise gradually, and am taking probiotics, as this has severely affected my daily life for the past two months.
I have consulted several doctors.

Do you think I need to undergo further examinations such as a colonoscopy or a CT scan? I am currently considering trying traditional Chinese medicine along with autonomic nervous system therapy, as both my mental and physical health have been affected, and Western medications have not improved my condition.
I apologize for bothering you, and I would appreciate your advice.
Thank you.

Lu Yanxun, 20~29 year old female. Ask Date: 2022/11/07

Dr. Hu Guozheng reply Gastroenterology and Hepatology

If symptoms worsen or persist for more than 3-6 months, leading to weight loss, it may be advisable to consult a physician to discuss the necessity of further examinations.
The specific tests to be conducted would depend on the current symptoms and should be assessed accordingly.
It may also be beneficial to follow up with the original treating physician.

Reply Date: 2022/11/07

More Info

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder characterized by a combination of symptoms that can significantly impact a person's quality of life. Your recent diagnosis of IBS, following a bout of acute gastroenteritis, aligns with the typical progression of this condition. IBS is often triggered by infections, stress, dietary changes, or other factors that disrupt the normal functioning of the gastrointestinal tract.

Symptoms of IBS
The symptoms you are experiencing, including abdominal pain, bloating, and changes in bowel habits, are classic indicators of IBS. The fact that you have some constipation, occasional nausea, and discomfort in your abdomen, particularly on the right side, further supports this diagnosis. IBS can manifest in various forms, including IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), or a mixed type (IBS-M). Your symptoms suggest a possible IBS-C, given the presence of constipation.

Diagnosis of IBS
The diagnosis of IBS is primarily clinical, meaning it is based on your symptoms and medical history rather than specific tests. The Rome IV criteria are commonly used to diagnose IBS, which requires the presence of abdominal pain at least one day per week in the last three months, associated with two or more of the following: related to defecation, a change in frequency of stool, or a change in the form of stool. Since you have undergone various tests, including blood tests, urine tests, X-rays, ultrasounds, and endoscopy, and all results returned normal, it is reasonable to conclude that there are no organic causes for your symptoms, reinforcing the IBS diagnosis.

Next Steps and Management
Given that your symptoms have persisted for two months and are affecting your daily life, it is crucial to explore effective management strategies. Here are some recommendations:
1. Dietary Adjustments: Continue with a healthy, balanced diet. Many individuals with IBS find relief by following a low-FODMAP diet, which reduces certain carbohydrates that can trigger symptoms. Keeping a food diary can help identify specific triggers.

2. Probiotics: You mentioned taking probiotics, which can be beneficial for gut health and may help alleviate some IBS symptoms. It's essential to choose a probiotic that has been studied for IBS.

3. Physical Activity: Regular exercise can help manage IBS symptoms by promoting bowel regularity and reducing stress.

4. Stress Management: Since stress can exacerbate IBS symptoms, consider incorporating relaxation techniques such as yoga, meditation, or mindfulness into your routine.

5. Medications: If your symptoms do not improve with lifestyle changes, you might want to discuss medication options with your healthcare provider. There are specific medications available for IBS that target different symptoms, such as laxatives for constipation or antidiarrheal medications for diarrhea.

6. Further Investigations: Regarding your question about further testing, such as a colonoscopy or CT scan, these are typically not necessary if your symptoms are consistent with IBS and all previous tests have been normal. However, if you experience new symptoms, such as significant weight loss, blood in your stool, or persistent severe pain, further evaluation may be warranted.

7. Alternative Therapies: Exploring complementary therapies, such as acupuncture or herbal medicine, may provide additional relief. Consulting with a practitioner who specializes in these areas can be beneficial.

8. Mental Health Support: Since you mentioned experiencing mental and physical strain, consider seeking support from a mental health professional. Cognitive-behavioral therapy (CBT) has been shown to be effective for managing IBS symptoms.

In conclusion, while IBS can be a challenging condition to manage, a combination of dietary changes, lifestyle modifications, and possibly medication can help alleviate your symptoms. It is essential to maintain open communication with your healthcare providers, including any specialists you decide to consult, to ensure a comprehensive approach to your treatment.

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