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Diagnosing IBS: Discussing Symptoms with Your Doctor

There are a number of reasons why people don't seek a physician's help for IBS. Oftentimes they attribute the symptoms to the food they eat. Sometimes they think stress causes their symptoms, so they don't really think that they have a gastrointestinal problem. But digestive problems in response to stress or certain foods – such as caffeinated drinks, dairy products or wheat – can be a sign of IBS. And often, IBS symptoms can be reduced with changes in diet and lifestyle.

In the past, patients who did see a physician were sometimes told that they had IBS, but that there was not much that could be done for them. Or if a treatment was offered, it might have been ineffective or caused side effects. But new IBS treatments are becoming available, and people who’ve failed to improve with older therapies should speak to their doctors about these new medications.

Two drugs that are approved specifically for IBS are alosetron (Lotronex), which is for women whose primary symptom is diarrhea, and tegaserod (Zelnorm), which is approved for women with constipation-dominant IBS.

What does the medical evaluation entail?
The initial evaluation for possible IBS  involves blood work and stool tests, in addition to a thorough medical history, particularly when a person has diarrhea. Sometimes patients who are younger than 40 undergo a flexible sigmoidoscopy. A sigmoidoscope is a flexible tube with a light that allows a doctor to see inside the lower section of the colon. Those older than 40 may have a colonoscopy, which examines the entire colon. Both of these examinations help doctors see the lining of the colon to rule out other, more serious gastrointestinal conditions that can have IBS-like symptoms – including inflammatory bowel disease (ulcerative colitis or Crohn’s disease) and colorectal cancer. 

What if it isn’t IBS?
The alarm signs and symptoms that go against a diagnosis of IBS include weight loss, anemia and an elevated white blood cell count. This suggests inflammation or infection. Patients who have diarrhea and/or abnormal electrolyte counts in their blood could be suffering from dehydration. In addition, a family history of colon cancer, inflammatory bowel disease or celiac disease will raise a doctor’s suspicion that one of these disorders is the problem. Symptoms occurring at night also point to a more serious condition. Generally, when people with IBS go to sleep, their gut goes to sleep, and they do not have symptoms at night.

Why is a good patient-doctor relationship especially important when it comes to IBS?
It is very important to establish a good patient-doctor relationship because this is a chronic disorder with symptoms that can be very frustrating. Both the patient and doctor need to feel confident about the diagnosis, and then form a treatment strategy together.

It is important for patients to be involved in their own care. They should recognize the relationship between their symptoms, stress and other factors, like eating certain foods. If patients can gain insight into their symptoms and then report it to their doctor, they can work together on changing these contributing factors.

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