Symptoms

There is no single, typical symptom of irritable bowel syndrome. Instead, in most cases a similar symptom complex prevails, which is harmless. People with irritable bowel syndrome often suffer from symptoms such as flatulence, cramps and irregular digestion.

The stomach feels tense and full. As a result of air accumulation, pain can develop in different regions of the abdomen. Cramps, also called spasms, and pain in the abdomen are also observed in connection with going to the toilet.

In addition, the stool changes in terms of frequency, texture and the urge to defecate. Added mucus is not rare. Listening to the bowel region with a stethoscope results in a lively bowel sound.

Basically, different types of irritable bowel syndrome can be distinguished. This depends on which symptom dominates. Among other things, one can differentiate between the irritable bowel syndrome of the constipation or diarrhea type.

Since patients with irritable bowel syndrome are sick but physically actually healthy, it is often difficult for the doctor to make a diagnosis. The procedure is called “exclusion diagnostics”, because the final diagnosis of “irritable bowel syndrome” is based on the fact that all other diseases and inflammations that are present in the digestive tract and could lead to corresponding symptoms must be excluded. The beginning of this odyssey is always a detailed medical history (anamnesis), during which the doctor can often already gather valuable information about the type and duration of the symptoms.

Some symptoms as well as late recourse to medical assistance can be characteristic for the presence of irritable bowel syndrome. It is very helpful if the affected person brings a diary to the doctor’s visit, in which he or she has noted down the frequency, intensity, type and duration of pain. The first consultation, after which the doctor usually suspects that irritable bowel syndrome is present, is followed by a thorough physical examination.

Depending on the findings of the medical history, different examinations can be useful in different ways. For example, the doctor will not perform the same examinations on every person suspected of having irritable bowel syndrome. First, the abdomen is often palpated and listened to or the rectum is also palpated (rectal examination).

This is usually followed by a laboratory examination of blood, which usually includes at least a blood count and inflammation parameters (such as CRP). Liver and kidney values can also be requested in order to rule out diseases in these organs. In addition, the stool is examined for the presence of blood, bacteria or parasites.

In addition, depending on the suspicion of specific other diseases, further measures are taken to make a diagnosis. An ultrasound of the abdomen can be performed, for example to rule out gallstones. In order to rule out diseases such as chronic inflammatory bowel diseases (especially Crohn’s disease and ulcerative colitis) or bowel tumors, a colonoscopy or gastroscopy can be performed, possibly supplemented by taking a tissue sample (biopsy).

If necessary, an X-ray examination or computer tomography (CT) may also be useful. Since food intolerances such as lactose intolerance can also be responsible for corresponding symptoms, food intolerance tests also occasionally play a role in the diagnosis. Finally, under certain circumstances, the diagnosis should also include a psychosomatic examination to determine the possible presence of anxiety disorders and depression, which may be both causative of and caused by the disease and play an important role in the patient’s quality of life.Finally, important for the definitive diagnosis of irritable bowel syndrome are the so-called Rom criteria, which presuppose that no biochemical or structural changes in the digestive tract can explain the symptoms. These criteria are met if the patient has experienced abdominal pain or discomfort within the last 12 months that was associated with at least two of the following three characteristics: (1) the symptoms improve after bowel movement (2) the frequency of bowel movement has changed since the symptoms occurred (3) the appearance or consistency of the bowel movement has changed since the symptoms occurred The symptoms must have occurred on at least three days per month during the last three months. Secondary criteria that support but do not prove the diagnosis are flatulence, abnormal stool frequency (more than three times a day or less than three times a week), abnormal stool consistency, mucusy stools or difficult stoppage of bowel movements (incomplete evacuation or heavy pressing).