GuidelinesOther guideline
Irritable Bowel Syndrome
This booklet is intended as a practical guide to patient care for registrars, medical officers, interns and medical students attached to the gynaecology units at the University of the Witwatersrand Academic Hospitals. Anyone can use it.
This is responsible for 50% chronic LAP or pelvic pain often mistakenly thought to be gynaecological, often incorrectly diagnosed as PID.
Diagnosis
- A chronic rather than an acute history makes the diagnosis more likely. There may be acute episodes
- The pain is typically colicky, intermittent
- Occasionally the pain is very severe
- The pain may go under the ribs
- Abdominal distension is reported sometimes
- Irregularity of bowel habit is often present but in some cases may be mild - a single day’s constipation, or frequency of only two or three times a day
- Symptoms usually absent at night & do not wake the patient
- There is tenderness over the descending colon or the ascending colon
- Notable absence of pelvic signs on bimanual palpation
- No pyrexia, unless of other origin
- Presence or absence of vaginal discharge is of little relevance
- Diagnosis of exclusion – ultrasound should be normal
Management
- Explain the condition – non-pathological, bowel overactivity, pain is likely to recur, no cancer
- Do not underplay the patient’s symptoms
- Diet: eat regular meals, green vegetables lightly cooked, wholewheat bread
- Lifestyle: reduce or discontinue caffeine or tobacco
- Liquid paraffin or Lactulose 10 mL twice daily orally for constipation
- Antispasmodics e.g. mebeverine 135 mg orally three times daily before meals; N.B. anticholinergics may worsen constipation