IBS diagnosis is tough and most people consult more than one doctor before proper diagnosis. Luckily, Rome Diagnostic Criteria ease IBS diagnosis.
A physical examination is require to exclude certain conditions such as enlarged liver, abdominal mass, and signs of bowel obstruction. A pelvic examination is often require, if there is any lower abdominal, pelvic symptoms and/or change in menstrual pattern. A rectal examination is require for patients with incontinence to identify lax sphincter or paradoxical pelvic floor muscle contraction. This may require anorectal testing of pelvic floor muscle function.
The medical community is now understand that IBS is a diagnosis by exclusion. IBS diagnosis is identifying the symptoms (e.g., Rome criteria) and excluding other inflammatory bowel or organ conditions like Crohn’s disease or stomach ulcers.
The inflammatory conditions generally have some alarming features. Exclude this alarm features such as weight loss, refractory diarrhea, and family history of colon cancer, then the risk of missing organic disease is low.
IBS exclusion conditions
Here is a partial list of conditions your doctor need to exclude before you are diagnose as IBS.
- Food intolerances: Lactose intolerance means you cannot properly digest dairy. Gluten intolerance (celiac disease) means you cannot properly digest gluten-containing grains such as wheat, barley, etc. Fruit intolerance means you cannot properly digest fruits (specifically fruits with certain natural sugar). Identifying a food allergy is simple, just stop eating those allergic foods; IBS-like symptom vanishes.
- Inflammatory bowel diseases (IBD) are Crohn’s disease and ulcerative colitis; they are serious conditions than IBS causing intestinal structural damage such as strictures or ulcerations. The symptoms of IBD is similar to that of IBS but also include rectal bleeding. Crohn’s has symptoms of mouth ulcers and fissures &fistulas around the anus. An IBD cause damage to the intestinal tract shows up on an x-ray, endoscope, or blood tests.
- Bowel cancer develops tumor that gradually blocks the intestine causing cramping pain worsen over time. The symptoms of cancer differ from IBS; they are more localized and severe.
Rome III criteria for IBS
An international group of gastroenterologists with a special interest in IBS felt; a set of criteria was require that was more specific and useful when conducting research in IBS. The Rome criteria is useful in IBS epidemiological studies and as entry criteria for clinical trials.
At least 12 weeks, which need to be consecutive, in the preceding 12 months of abdominal discomfort or pain that has two of three features:
(1) Relieved by defecation; and/or
(2) Onset associated with a change in frequency of stool; and/or
(3) Onset associated with a change in form (appearance) of stool.
The following symptoms cumulatively support the diagnosis of IBS
- Abnormal stool frequency (more than three times a day or less than three times a week).
- Abnormal stool form (lumpy/hard or loose/watery stool.)
- Abnormal stool passage (straining, urgency, or feeling of incomplete evacuation).
- Passage of mucus.
- Bloating or feeling of abdominal distension.