Let's move to our next case
A 32-year-old woman is seen for
6 months of intermittent diarrhea
alternating with periods of constipation.
She frequently passes mucus with straining and
complains of abdominal discomfort and bloating
that it is relieved after
she has a bowel movement
She has no fever, bloody
stool, or weight loss.
On exam, there are normal vitals.
Her abdomen is diffusely tender to light
palpation but without rebound or guarding.
And rectal exam is normal.
Her lab studies show a normal
electrolytes and a normal hemoglobin
What is the most likely diagnosis?
So she has chronic intermittent
diarrhea without any alarm features
She does have abdominal pain that is associated
with her bowel movements which is a good clue
And her normal exam and labs is
just potentially a functional disorder
by which we mean, a disorder in which there is no
organic or structural explanation for their disease.
So in this case again, her normal exam
and labs indicate a functional disorder
and the most likely functional disorder is
irritable bowel syndrome or IBS.
Let's talk a bit more about more about IBS.
As we said, it's a functional bowel disorder
that presents with a change in the bowel habits
and an important distinguishing factor here is that
patients have associated abdominal pain or distention.
They have mucousy stools and they have relief
or worsening of their pain with bowel movements.
Their symptoms tend to worsen with stress.
We don't actually know the
exact pathophysiology of IBS
But what we do suspect is that things
like stress, anxiety and depression
that affect the central nervous system
can lead to many different interactions
with the autonomic nervous system
and the enteric nervous system.
With these interactions, we get changes in
contraction of the smooth muscle of our intestines
thus leading to symptoms
like diarrhea or constipation.
Because this is such a difficult diagnosis to
make, it is a diagnosis of exclusion.
And the treatment is
primarily with reassurance,
and you may give things like fiber
supplements, or antidiarrheals or laxatives
depending on which symptom predominates.