History and exam

Key diagnostic factors

common

abdominal pain

Generally cramping in nature and in the lower and/or mid-abdomen. Can be mild or severe.

alteration of bowel habits associated with pain

There may be diarrhea or more frequent soft stool, constipation, or alternating diarrhea and constipation. The passage of stool relieves the abdominal pain.

abdominal bloating or distension

This increases during the day and is not associated with nausea and vomiting. It is improved with defecation or passage of flatus.

normal exam of abdomen

There are no significant findings. Mild tenderness may be found in the right lower quadrant or left lower quadrant.

Other diagnostic factors

uncommon

passage of mucus with stool

Occurs when the patient is symptomatic and is not accompanied by blood.

urgency of defecation

This symptom is more prevalent in Asian populations.[10]

Risk factors

strong

physical and sexual abuse

Several studies have shown that a history of physical and/or sexual abuse is more common in patients with IBS than in patients with other gastrointestinal disorders. Abuse has been reported in 32% to 44% of patients with IBS.[20][21][22]

posttraumatic stress disorder (PTSD)

One meta-analysis found that PTSD is associated with an increased likelihood of IBS (pooled odds ratio 2.80, 95% CI 2.06 to 3.54, P <0.001).[31]

age <50 years

Symptoms of IBS can begin in adolescence or early adulthood. The onset of IBS in patients aged >50 years is unusual, and patients in this group need to be evaluated carefully for other etiologies of their symptoms.[15][16]

female sex

There is a 2:1 female/male ratio among adults who seek help for symptoms of IBS.[14]

previous enteric infection

Symptoms of IBS may occur in up to 30% of patients following acute bacterial gastroenteritis.​[24][32]

family history

The odds of having IBS increase (odds ratio 2.75) if a first-degree relative has IBS.[19]

weak

family and job stress

Stressful life events sometimes correlate with symptom exacerbation, but the nature of this link is unclear.​[2]​

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