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Irritable bowel syndrome: diagnosis and management

BMJ 2006; 332 doi: (Published 02 February 2006) Cite this as: BMJ 2006;332:280
  1. A Agrawal, clinical research fellow1,
  2. P J Whorwell, professor of medicine and gastroenterology (
  1. 1 Department of Medicine and Gastroenterology, Wythenshawe Hospital, Manchester M23 9LT
  2. 2 Education and Research Centre, Wythenshawe Hospital
  1. Correspondence to: P J Whorwell
  • Accepted 25 November 2005

Irritable bowel syndrome is often dismissed as just being a nuisance rather than anything more serious, but its symptoms can seriously diminish a patient's quality of life. When the disease is better understood and treatment is tailored to the individual patient, it can often be rewarding to manage

What is it, and who gets it?

Irritable bowel syndrome (IBS) is a chronic condition characterised by abdominal pain, bowel dysfunction, and abdominal bloating in the absence of any structural abnormality. A number of pathophysiological abnormalities, however, can often be identified.1 About 10-15% of the adult population in the United Kingdom is affected by irritable bowel syndrome.2


IBS is now clearly understood to be a multifactorial condition, with a variety of factors contributing to expression of the disease rather than its just being due to psychopathology. These include motility, visceral sensation, central processing, genetics, dietary factors, inflammation, and neurotransmitters.1

Exacerbating factors

Stress exacerbates IBS rather than being causative in any way. If stress is severe and chronic—for example, stress caused by continuous domestic strife—it can result in the disorder being virtually untreatable.3

Antibiotics need to be used with care in patients with IBS. Some antibiotics, particularly erythromycin, can make the condition worse.4

Non-steroidal anti-inflammatory drugs are often prescribed for the pain associated with IBS, but they may exacerbate symptoms. Paracetamol does not upset IBS.5

How do I diagnose it?

In the absence of a specific diagnostic test, the diagnosis remains largely clinical.


Patients typically report

  • Abdominal pain or discomfort

  • Disordered bowel habit, with either diarrhoea, constipation, or alternating diarrhoea and constipation

  • Abdominal bloating or distension.

Many patients experience extracolonic features that can be useful for making the diagnosis:

  • Low backache

  • Constant lethargy

  • Nausea

  • Thigh painy

  • Urinary symptoms:

    • Frequency

    • Urgency

    • Urge incontinence

  • Gynaecological symptoms:

    • Dysmenorrhoea

    • Dysparaeunia.6

The diagnosis of IBS is usually made intuitively with remarkable safety and reliability. Attempts …

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