Rome III Criteria and IBS Symptoms

Every one of us at some point of time has experienced intestinal disorders like diarrhea, abdominal pain, constipation, bloating and gas. But when all these irritations overwhelm a person continuously, it may refer to Irritable Bowel Syndrome (IBS). IBS symptoms should be properly diagnosed to warrant appropriate treatment.

Primarily diagnosed as functional disorder, IBS does not tend to exhibit any kind of noticeable sickness. In order to distinguish that a particular person is suffering of usually passing digestive disorders, from IBS, medical profession have now fallen back on what is known as Rome III criteria. This criterion when adopted for diagnosing a person as indeed having IBS, mandatory associates the following IBS symptoms with the disorder:

a) That the digestive disorders mentioned above must have been present in the patient for a minimum period of six months,

b) That these disorders must have manifested at least on three days during the last three months.

c) The IBS symptoms should include constant recurring pain or discomfort in the abdominal area, associated with the following two or more factors:

• Bowel movement usually relieves pain.
• Pain begins with the change in composition of stool – soft, or harder.
• Pain begins with the change in the regular cycle of bowel movement.

IBS symptoms can be medically diagnosed only on the basis of continuous pain in the abdominal area, combined with a noticeable change in your bowel movement habits. IBS in the context of an individual patient might mean a combination of the symptoms including abdominal pain, which is relieved after a bowel movement; Constipation – strained movement of bowels, with fewer than three bowel movements a day, or hard/dry stools; diarrhea – feeling of urgency for bowel movement, with more than three bowel movement per day, or watery loose stools; feeling of incomplete evacuation, passage of mucus or gas and bloating. IBS symptoms can be broadly classified into three types, one with predominant constipation, second – predominant diarrhea, and third kind with symptoms alternating between diarrhea and constipation.

There are certain IBS symptoms which are usually of serious and upsetting nature, leaving the people wonder whether there has been wrong diagnosis and whether the attending medical people have not been able to consider a more serious disorder in their health. Given below are the symptoms which are not associated with IBS, and therefore which should be investigated further to know the reasons for their manifestation.

a) nausea;
b) fever;
c) significant and unexplained weight loss
d) fatigue
e) presence of blood in the stool due to hemorrhoids, which should be immediately brought to doctor’s notice
f) Anemic conditions, bloodlessness in the body;
g) Pain in the abdomen which isn’t relieved by bowel movement
h) Pain in the abdomen which disturbs sleeps and awakens the patient.
i) Decrease in food intake/Loss of appetite

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Managing IBS Pain

Pain associated with Irritable Bowel Syndrome (IBS) is usually relieved with bowel movement. However, a person may continue to feel unexplained tenderness, contractions and aching, unconnected with bowel movements. Abdominal uneasiness or pain of this nature is usually a key indication of IBS. This uneasiness/pain may be present anywhere in the region between hips and chest which can change over a period of time. IBS pain is described as a cramp-like, sharp stabbing pain, also known as a stomach migraine.

In general IBS pain is directly associated with our bowel movements. This explains why we feel a reduced amount of pain after moving bowels. Also, when there is a change in the regular cycle of bowel movements the uneasiness manifests. Similarly when there is a change in the composition of stools, soft or harder, the pain and uneasiness is usually felt.

During a recent study on 1,966 people suffering from IBS, done by IFFGD in association with the UNC Center for Functional GI and Motility Disorders, it was discovered that this pain is one of the basic factors which adds to the harshness of their IBS. Eighty percent of the study patients confirmed that it is the sharpness of pain which makes their condition severe.

Among other factors, 74% referred to bowel movements, 69% to bloating and another 69% to the diet or eating restrictions which are noted as the reasons for the severity of IBS pain. It is common for people with IBS to experience frequent abdominal pain, while some feel it in a continuous manner. The people who participated in this survey have described this pain in various ways calling it as unbearable, intense, excruciating or merely awful.

The most important aspect of IBS pain is that it changes from time to time, day to day, hour to hour, and even minute to minute. As noted above, IBS pain may be felt along the entire region of the abdomen, and essentially it can be classified as upper abdominal pain, which is felt as a result of bloating, with a tendency to worsen after every meal or a cramping pain which is usually felt around the belly button and lower parts of abdomen, and lastly the lower abdominal pain which generally reduces with bowel movement.

IBS pain can change instantaneously, the range of pain can fluctuate from mild to constant to unbearable. IBS has been described as a wrenching ache which feels a “stitch-like”, stabbing pain. It is also described as frequent aches, tenderness when you feel the area, and the discomfiture associated with bloating.

The parts of abdominal area, where the IBS pain manifests distinguishes it from other digestive malfunctions: After-meal pain felt from behind the sternum, which worsens when you lie down is likely to be heartburn, after-meal pain below the sternum, on top of abdomen may be due to indigestion. It is important note these characteristics of IBS pain.

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Common Symptoms In Diagnosing IBS

IBS or Irritable Bowel Syndrome is a gastrointestinal affliction. It affects about 15 to 25 percent of people. It is a chronic condition affecting the small or the large bowels. IBS can cause different degrees of discomfort and distorted bowel habits. A large amount of patients visit their doctor for gastrointestinal and related complaints, some patients have enormous anxiety regarding factors that cause IBS. Physicians use a confidential diagnosis as an initial and crucial step to provide patients a clear explanation, an effective treatment and therefore reducing the patients’ anxiety. IBS symptoms may be attributed to other factors and conditions in your health and must always be diagnosed by a physician. Patients are usually diagnosed with IBS after exhibiting structural or biochemical abnormalities. Considerations of differential possibilities from the signs and symptoms are observed and given by the patient in order to obtain a positive or negative diagnosis for IBS.

Your doctor will investigate and detail your symptoms and take your health history into consideration and perform a complete physical examination to accurately diagnose the issue. Lab work for blood and stools and endoscopic procedures are also performed to either confirm that it is IBS and to rule out other possible conditions such as inflammatory bowel disease or colon cancer.

Adrian Manning and his colleagues developed the symptom criteria that was used in the diagnosis of IBS in 1978 where the key factor is having the patient describe the symptoms they are experiencing. The criteria is composed of 6 symptoms; first is visible abdominal distension; second is relief of pain with or after bowel movement, third is more frequent bowel movement with the onset of pain, fourth is loose stools at onset of pain, fifth is passage of mucus via the rectum, and the sixth is feeling of incomplete evacuation. Patients that experience the first four symptoms are likely to suffer from IBS. The last two symptoms are not typical for IBS as are the first four although the symptoms are present for IBS sufferers. This was known as the Manning Criteria.

Gastroenterologists in Rome held an international consensus meeting in 1988 where they further specified the criteria for IBS and these criteria were revised in 1999 are now called Rome II criteria. The symptoms that cumulatively support the diagnosis of IBS are as follows in the Rome II criteria; first is abnormal stool frequency. Second is abnormal stool form, wherein stool may be lumpy or watery, and a diagnostic aid called Bristol stool form scale or the BSF-Scale is used to classify the stool form into seven groups because the stool’s form depends on the time it spent in the colon and a parallel between the colonic transit time and the BSF type is obtained. Abnormal stool passage is the third criteria, possible straining and urgency and sometimes a feeling of incomplete evacuation. The passage of mucus is the fourth criteria, and bloating or feeling of abdominal distension is the 5th criteria. IBS needs to be correctly diagnosed and confirmed by a doctor.

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