Some patients are exquisitely tender on rectal examination. The patient will be tender over an area of the colon, most commonly the descending colon. On examination, there is usually a disparity between the severity of the patient's symptoms and his or her physical condition, since they look well. The Rome II Criteria are excellent for standardization of therapeutic trials and the discipline that they brought to the field but their very rigidity brings artificial constraints that will have to be reconsidered in the future ( Camilleri 1998). Recently at a second conference in Rome on IBS, the Rome II Criteria evolved ( Box 8.7). Cancer phobia is another frequent observation in these patients. They frequently have a past history of appendicectomy for ‘chronic appendicitis’. IBS may have been the cause of pelvic pain in 60% women attending gynaecological clinics, having dilatation and curettage for dysmenorrhoea, 40% having elective hysterectomy, compared to 32% of age-matched controls ( Crowell et al 1994). IBS pain is asociated with nausea without vomiting, dyspepsia, urinary symptoms, especially dysuria, gynaecological symptoms, especially dysmenorrhoea, and headache IBS symptoms may begin after an attack of gastroenteritis ( Gwee et al 1999). However, the patient's appetite is rarely affected, and therefore a history of significant weight loss (i.e., more than 3.5 kg) is unusual and should raise suspicions of an alternative diagnosis. In about half the patients pain is aggravated by eating and relieved by defecation. ‘Meteorism’ is due to ‘air trapping’ in which segmental accumulation of gas occurs.Īlterations of bowel habit, diarrhoea or constipation occur in up to 90% of the patients. It varies from a dull ache to attacks of excruciating severity, lasting from minutes to several hours to all day, but it rarely prevents the patient from sleeping through the night. Laurence M Blendis, in Handbook of Pain Management, 2003 Clinical featuresĪbdominal pain is predominantly periumbilical in children ( Milla et al 2001), whereas in adults it tends to occur over the surface markings of the colon with the commonest site in the left lower quadrant, less commonly the right or left upper quadrant over the hepatic or splenic flexures.
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