Irritable Bowel Syndrome: Symptoms and Diagnosis - Gastroenterology and Hepatology

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Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder characterized by a combination of symptoms that can include abdominal pain, bloating, and changes in bowel habits, such as diarrhea or constipation. The diagnosis of IBS is primarily based on clinical criteria, as there are no specific laboratory tests or imaging studies that can definitively confirm the condition.
In your case, the long-term left lower abdominal pain that radiates to the pubic area, along with the discomfort in your lower back while sitting, can indeed be indicative of IBS, especially since you have undergone various diagnostic tests (stool tests, gastroscopy, barium enema, and abdominal ultrasound) that have returned normal results. One of the hallmark features of IBS is that the abdominal pain often improves after a bowel movement, but you mentioned that your pain does not alleviate after defecation. This detail is important as it may suggest that your symptoms could be due to other underlying conditions rather than IBS.

According to the Rome IV criteria, which is the most recent set of diagnostic criteria for functional gastrointestinal disorders, IBS is diagnosed when a patient experiences recurrent abdominal pain, on average, at least one day per week in the last three months, associated with two or more of the following criteria:
1. Related to defecation (improvement or worsening).

2. Associated with a change in the frequency of stool.

3. Associated with a change in the form (appearance) of stool.

Since your symptoms do not seem to align perfectly with the typical presentation of IBS, it is crucial to consider other potential causes of your discomfort. Conditions such as inflammatory bowel disease (IBD), endometriosis, or even pelvic floor dysfunction could present with similar symptoms. Given your family history of colorectal cancer, it is also essential to remain vigilant and discuss any concerning symptoms with your healthcare provider.

In terms of management, if IBS is confirmed, treatment typically focuses on symptom relief and may include dietary modifications, stress management techniques, and medications such as antispasmodics or laxatives, depending on whether diarrhea or constipation is predominant. It is also advisable to keep a symptom diary to help identify any potential triggers related to food or stress.

If your symptoms persist or worsen, or if you experience any alarming signs such as weight loss, rectal bleeding, or severe pain, it is imperative to seek further evaluation. A gastroenterologist may recommend additional tests, such as a colonoscopy, to rule out other conditions, especially given your family history of colorectal cancer.

In conclusion, while your symptoms may suggest IBS, the lack of pain relief after bowel movements and the persistence of discomfort warrant further investigation. It is essential to work closely with your healthcare provider to explore all possible diagnoses and develop an appropriate management plan tailored to your specific needs.