Introduction
These are relatively common, and this term encompasses a large amount of diseases that have no underlying pathology present.
Functional bowel disorders are probably a result of an abnormal brain-gut relationship.
Basically, IBS is the major functional bowel disorder. Other disorders will often be variations of IBS, generally with fewer or slightly different symptoms.
Symptoms
These can be divided in to general and specific. General symptoms are present ‘across the board’ i.e. some of these symptoms are present in all types of functional bowel disorders. Specific symptoms are confined to one specific type of disorder.
General
- Nausea alone
- Vomiting alone
- Belching
- Chest pain unrelated to exercise
- Postprandial fullness (fullness after eating)
- Abdominal bloating
- Abdominal discomfort and pain (particularly in the right iliac fossa)
- Passage of mucous from the rectum
- Frequent bowel actions, with urgency first thing in the morning
- Often patients are young
- There is no blood loss
- No weight gain
Non-GI manifestations
- Gynaecological
- Painful periods (dysmenorrhoea)
- Pain after sex( dyspareunia)
- Premenstrual tension
- Urinary symptoms
- Frequency
- Urgency
- Nocturia
- Incomplete emptying of bladder
- § Other
Epidemiology
- About 20% of the general population fulfil these criteria, but only 10% of the population will consult their doctor as a result of GI symptoms. An important question for researches to ask is: ‘Do patients who seek medical help have different underlying pathological disease from those who do not?’ – basically, does seeking medical help just mean you are a worrier, or does it mean you genuinely have worse symptoms.
- IBS is the most common cause of GI referral in the UK – it is also a major cause of absenteeism at work.
- Women are 2-3x as likely to be affected as men.
- There is a wide overlap with non-ulcer dydpepsia, chronic fatigue syndrome (CFS), dysmenorrhea and urinary frequency.
- A significant number of patients have a history of sexual or physical abuse.
The Rome Criteria
These are a set of criteria that attempt to define the symptoms of functional bowel disorders. Using the criteria, you can put sufferers into different categories in an attempt to tailor treatments to them.
The criteria state that in the preceding 12 months, there should be at least 12 consecutive weeks of abdominal pain and discomfort with at least two of the following:
- Pain relieved on defecation
- Onset associated with a change in frequency of stool
- Onset associated with change in appearance of stool.
- It is important to remember that the symptoms of functional bowel disease vary widely, and as a result, you may not be able to categorise all patients. This does not mean that a patient does not suffer from functional bowel disease.
Types of functional bowel disorders
- IBS
- Functional abdominal bloating (pain/gas/bloat syndrome)
- Functional constipation
- Functional diarrhoea
- Functional abdominal pain
Aetiology
About 50% of patients referred to hospital for their symptoms will have some sort of diagnosable
psychiatric condition.
Anxiety,
depression, somatisation and neurosis are common problems. However, most patients who present in general practice do not have a condition.
- Neurosis is a condition that causes psychological distress, but unlike psychosis, or some personality disorders, it does not prevent or affect rational thought. In neurotisism, symptoms are interpreted more negatively than in ‘normal’ people.
- Somatisation – is where a person who has psychological distress may display this in the form of some sort of physical ailment.
Many functional bowel disorder patients will have abnormal health behaviours; i.e. they have a tendency to consult for many minor ailments that otherwise people would not bother about – they are worriers. These patients will also have reduced coping ability.
Infectious diarrhoea precedes the onset of symptoms in 7-30% of patients.
Most patients will have a colicky LLQ pain that is relieved by defecation. They will also tend to have
diarrhoea and
constipation regularly. Although most patients have both, it is useful to categorise patients as having mostly
diarrhoea or mostly
constipation.
Those with
diarrhoea tend to pass low volume stools regularly, sometimes with mucus but never with blood. They also tend to have few symptoms during the night.
It is also quite common for patients to experience increased bloating throughout the day, despite the fact that it has not been proven that they produce any more gas than a normal patient.
