Editor's note: In the July 3 Bee Healthy column, Dr. Singh wrote on the most common symptoms of irritable bowel syndrome. This column takes a deeper look at IBS.
Irritable bowel syndrome is usually diagnosed by a complete medical history and physical exam. Since there are no clear-cut physical signs to diagnose IBS, it is usually a diagnosis of elimination. To help diagnose IBS, researches have come up with the Rome criteria (the experts met in Rome to come up with the criteria, hence the name).
According to these criteria, you must have certain signs and symptoms before a doctor diagnoses irritable bowel syndrome. The most important are abdominal pain and discomfort lasting at least 12 weeks, though the weeks don't have to occur consecutively. You also need to have at least two of the following:
• A change in the frequency or consistency of your stool. For example, you may change from having one normal, formed stool every day to three or more loose stools daily, or you may have only one hard stool every three to four days.
• Straining, urgency or a feeling that you can't empty your bowels completely.
• Mucus in your stool.
• Bloating or abdominal distension.
Some red-flag signs and symptoms that might prompt your doctor to do additional testing include:
• New onset after age 50
• Weight loss
• Rectal bleeding
• Fever
• Nausea or recurrent vomiting
• Abdominal pain, especially if it's not completely relieved by a bowel movement
• Diarrhea that is persistent or awakens you from sleep
Additional tests
Your doctor may recommend several tests, including stool studies to check for infection or malabsorption problems. Among the tests that you may undergo to rule out other causes for your symptoms are the following:
• Flexible sigmoidoscopy. This test examines the lower part of the colon (sigmoid) with a flexible, lighted tube (sigmoidoscope).
• Colonoscopy. In some cases, your doctor may perform this diagnostic test, in which a small, flexible tube is used to examine the entire length of the colon.
• Computerized tomography scan. CT scans produce cross-sectional X-ray images of internal organs.
• Lactose intolerance tests. Lactase is an enzyme you need to digest the sugar found in dairy products. If you don't produce this enzyme, you may have problems similar to those caused by irritable bowel syndrome, including abdominal pain, gas and diarrhea. To find out if this is the cause of your symptoms, your doctor may order a breath test or ask you to exclude milk and milk products from your diet for several weeks.
• Blood tests. Celiac disease (nontropical sprue) is sensitivity to wheat protein that also may cause signs and symptoms like those of irritable bowel syndrome. Blood tests may help rule out that disorder.
Living with IBS
Because it's not clear what causes IBS, treatment focuses on the relief of symptoms so you can live as normally as possible.
In most cases, you can successfully control mild signs and symptoms of irritable bowel syndrome by learning to manage stress and making changes in your diet and lifestyle. But if your problems are moderate or severe, you may need more than lifestyle changes. Your doctor may suggest:
• Fiber supplements. Taking fiber supplements, such as psyllium (Metamucil) or methylcellulose (Citrucel), with fluids may help control constipation.
• Anti-diarrheal medications. Over-the- counter medications, such as loperamide (Imodium), can help control diarrhea.
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Bee Healthy is a column written by a variety of Sutter Gould health care providers on topics that will range from how to pack healthy school lunches to coping with holiday stress, from cancer awareness to superfoods.
