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5 key questions for patients to help diagnose IBS
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Irritable bowel syndrome is a common gastrointestinal condition, affecting approximately 30 million people in the United States. The hallmark of this condition is change in bowel movements, such as diarrhea, constipation or slow-moving stools. Other symptoms include abdominal pain and cramping, fatigue and more. IBS can be treated by diet or lifestyle changes, medications, or probiotics.
However, many IBS symptoms can be confused with those of more serious conditions, such as Crohn’s disease or colon cancer. To guide proper treatment, it is essential to make a differential diagnosis as soon as possible.
According to Jack Braha, DO, a practitioner at Brooklyn Gastroenterology and Endoscopy, asking five important “alarm questions” based on the ROME criteria for IBS can help make this important distinction.
“There’s a paper from the early 2000s which shows that if someone met the ROME criteria for IBS, was under age 50, and didn’t have any of the alarm features, it could be predicted with 98% positive predictive value that it is IBS,” he said. “It’s an older study, but I think it still holds true in our practice today.”
Braha discussed these five questions with Healio Gastroenterology and Liver Disease, outlined the information each question is designed to elicit, and detailed the potential meaning of the answers.
Question 1: How is your poop?
The lighthearted tone of this comprehensive introductory question is meant to encourage openness from the patient and begin to collect basic information, Braha said.
“It’s just a broad, open question,” he said. “We ask the patient if they have loose, watery stool, if they have hard stool, or if it is hard to evacuate. It’s really important to know whether the patient feels like they had a complete evacuation, or whether it was what we call an incomplete bowel movement.”
In cases of diarrhea, Braha said, the practitioner will need to determine if the cause is an infectious process, an inflammatory process, or irritable bowel.
Conversely, if the patient has difficulty evacuating, the constipation could be due to lack of fiber and/or hydration, an issue with how quickly the colon is moving, or a problem with the muscles of the pelvis or rectum.
“We call this dyssynergia, where folks will sit there and try to poop, and they just have an awful time trying to get it out,” Braha said.
Question 2: Do you have any pain or bloating?
According to Braha, patients with IBS tend to have abdominal pain and/or bloating that is related to bowel movements. This pain, which is alleviated after a bowel movement, is a key sign of IBS, but not necessarily of traditional constipation.
“Pain or distention that seems to get better when they go to the bathroom is more of a sign of irritable bowel,” he said “Usually, with irritable bowel, we see that the patient’s discomfort seems to be related to their bowel movements in some way.”
Question 3: Can you eat or are you full quickly?
The third question to ask patients is whether they experience early satiety when eating a meal. Braha said in many cases, if a patient answers this question in the affirmative, it is cause for concern.
“If folks are eating a meal and they feel full too quickly that’s a bad sign; that’s a sign there could be something wrong in the stomach,” he said. “Early satiety is an alarm feature. If a patient can’t finish their meal, then we would go investigate the stomach for things like ulcers or cancers.”
Question 4: Is there blood in your stool?
Bloody stool, particularly dark or black bloody stool, is indicative of bleeding and may point the diagnosis away from IBS, Braha said.
“Black or bloody stool is a sign of bleeding that could be anywhere in the digestive tract,” he said. “If someone comes in with bloat or discomfort and diarrhea, but then they say, ‘Hey, listen, sometimes my stool’s bloody’, that’s probably not going to be IBS in the end. That’s a red flag. For someone with black or bloody stool, we would do endoscopy or colonoscopy, and look for other signs of more significant disease.”
Question 5: Does your urgency wake you up at night?
Generally, IBS sleeps when the patient sleeps, so a patient who complains of interrupted sleep due to diarrhea or constipation would raise another red flag, Braha said.
“If the patient tells you they have diarrhea every day, but that it goes away when they’re sleeping, that would possibly indicate IBS, especially in the absence of any weight loss or anemia or any other alarming signs,” he said. “Symptoms at night are a little bit more alarming, as is weight loss. If we examine them and we feel a mass or something wrong in their belly, that’s an alarm feature, too.”
While age is not itself an alarm feature, patient age over 50 would prompt a closer look, Braha said, due to the increased risk for cancers in this population.
He said he would also ask the patient about the color of their stool, the frequency of bowel movements, eating habits, or any recent travel to areas where gastrointestinal illness is prevalent.
In addition to exploring the possibility of more serious conditions, asking patients these five questions may also circumvent unnecessary visits to a GI specialist. Braha emphasized that despite the awkward subject matter, patients should be as open and honest as possible with practitioners.
“I think it’s important for patients to be open with the doctor, to tell them about all of their digestive symptoms, however embarrassing they may be,” he said. “This information might serve as clues in helping us achieve a diagnosis.” – by Jennifer Byrne
Reference:
Hammer J, et al. Gut. 2004;doi:10.1136/gut.2003.021857.
Disclosure: Braha reports serving as a consultant/speaker for Allergan/Ironwood.
For More Information:
Jack Braha, DO , can be reached at 2211 Emmons Avenue, Brooklyn, NY 11235; email: drbraha@gmail.com.
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