Symptoms of Irritable Bowel Syndrome

What are the symptoms of IBS?

How do doctors diagnose irritable bowel syndrome? There is no laboratory or other test that confirms the diagnosis of IBS; doctors have to rely on the symptoms alone. These vary from person-to-person, but there are three main types.

The predominant symptom may be painful constipation, or the main problem may be a painless, though worrying and inconvenient, diarrhoea. Also, both types of bowel disturbances can occur together accompanied by abdominal pain.

Additional symptoms may include swelling (distension) of the abdomen with wind and unpredictable, erratic bowel actions varying from day to day.

There are some sex differences: straining and passage of hard stools may occur more commonly in women. In contrast men are more likely to have frequent, loose stools.

As irritable bowel syndrome can be diagnosed only from a collection of symptoms, doctors use certain criteria to help them.

Symptoms of IBS – the symptoms vary from person-to-person.

There are three main types:

  1. Painful constipation
  2. Diarrhoea
  3. Painful constipation and diarrhoea together, accompanied by abdominal pain.

Additional symptoms may include:

  • Swelling (distension) of the abdomen with wind
  • Unpredictable, erratic bowel actions varying from day to day
  • Indigestion (dyspepsia)

The Manning criteria

An early attempt by a doctor called Manning to define irritable bowel syndrome came up with a list of symptoms associated with the disorder.

This identified six main features:

  1. Abdominal pain relief by defecation (bowel action]
  2. Loose stools with the onset of abdominal pain
  3. Frequent stools the onset of abdominal pain
  4. Abdominal distension
  5. Passage of mucus in stools
  6. Sensation of incomplete evacuation of the bowel.

The Rome criteria

More recently, an international team of gastroenterologists listed further symptoms, known as the Rome criteria. These recommend that a diagnosis of irritable bowel syndrome is made when someone has had abdominal pain or discomfort for at least 12 weeks in the previous 12 months and the pain or discomfort shows to of the following features:

  1. The pain is relieved by defecation.
  2. Onset of pain is associated with a change in frequency of passing stools.
  3. Onset of pain is associated with the change in form (appearance) of stools.

According to the Rome criteria, the diagnosis of irritable bowel syndrome is strengthened by the occurrence of further symptoms.

People with constipation as the main symptom may have fewer than three bowel movements a week, with hard lumpy stools. In contrast those with diarrhoea as the main symptom may have three or more bowel movements in a day with loose (mushy) or watery stools.

Other symptoms seen in irritable bowel syndrome

  • Straining during bowel movements
  • Urgency, having to rush to have a bowel movement)
  • Having a feeling of incomplete bowel movement
  • Passing mucus or slime with the bowel movement
  • Having abdominal fullness, bloating or swelling.

Non- gastrointestinal features

A wide range of non-gastrointestinal features may also be associated with irritable bowel syndrome. In addition, about 90% of people with irritable bowel syndrome also have dyspepsia (indigestion). Symptoms can vary over the years from mainly bowel type to mainly indigestion type symptoms.

Quality of life

Medically speaking, irritable bowel syndrome is not a life-threatening condition. However, if you are a sufferer you will know how much it can restrict your social activities and reduce your quality of life. Chronic food related pain may mean that you have to avoid going out eat with family or friends. Fears about the need to open your bowels frequently may seriously limit what you feel that you are able to do.

Restricting activities

Over 40% of people with irritable bowel syndrome say that they avoid some activities as a result of their symptoms. Examples are: socialising, travelling, domestic and leisure activities, eating certain foods or sexual intercourse. Often it is this disruption of normal life rather than individual symptoms as much that determines how you rate the severity of your condition.

Effects on well-being

People with irritable bowel syndrome often also experience symptoms of anxiety and disturbed sleep, with associated lethargy and an inability to get on with their lives. These symptoms can easily start to dominate a sufferer’s existence. If your doctor is unable to diagnose the cause of your symptoms easily, you are likely to be worried. You may have to keep going back to your GP family, family doctor and//or the hospital outpatient clinic for unpleasant tests. Sometimes, especially if you are a woman, you may end up having unnecessary surgery in an attempt to improve persistent symptoms. This may be removal of your gallbladder or uterus (womb). However, surgery can make your existing disorder worse. It may also create its own specific post-operative complications such as pain in the operation scar and adhesions (internal scarring causing cramping pains).

Non-gastrointestinal features of irritable bowel syndrome

A wide range of other problems may occur along with the more typical ones of irritable bowel syndrome. Women may have gynaecological problems, there may be problems passing urine or other symptoms that affect well-being.

Gynaecological symptoms

  • Painful periods (dysmenorrhoea)
  • Pain during or after sexual intercourse (dyspareunia)
  • Pre-menstrual tension

Urinary symptoms

  • Frequency – needing to urinate often
  • Urgency – not being able to wait to urinate
  • Passing urine at night (nocturia)
  • Incomplete emptying of the bladder.

Other symptoms

  • Back pain
  • Headaches
  • Bad breath
  • Unpleasant taste in the mouth
  • Poor quality of sleep
  • Constant tiredness
  • Anxiety
  • Depression
  • Fibromyalgia

Key points

  • Your doctor will diagnose irritable bowel syndrome if you meet the Manning or the Rome criteria
  • A wide range of non-gastrointestinal features can be associated with irritable bowel syndrome, for example urinary, gynaecological, musculoskeletal and psychological symptoms.