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This is a clinical condition based on a history of more than 3 mths in a yr of abdominal pain (in the preceding 12 mths) or discomfort with 2 of the following (Rome III criteria):
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relieved by defecation and/or
onset associated with change in stool frequency and/or
onset associated with change in form (appearance) of stool (loose, watery or pellet-like)
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Typically in younger women (21–40 yrs)
Any age or sex can be affected
Cramping abdominal pain (central or iliac fossa)
Passage of mucus
Sense of incomplete evacuation
Variable bowel habit (constipation more common)
Often precipitated by eating
Faeces sometimes like small, hard pellets or ribbon-like
Anorexia and nausea (sometimes)
Bloating, abdominal distension, ↑ borborygmi
Tiredness common
Onset and exacerbation may be associated with mental stress
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IBS is a diagnosis of exclusion. FBE, ESR, stool microscopy and thorough physical examination and colonoscopy are necessary. Insufflation of air at colonoscopy may reproduce the abdominal pain of IBS.
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Management Basis of initial treatment is simple dietary modifications, stress management and other non-drug therapy:
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education and reassurance (incl. cancer absent)
avoid foods that ‘irritate’, smoking, excess alcohol, laxatives, codeine
avoidance of constipation
consider a diet low in dairy products and processed foods
high-fibre diet and ↑ fluids (for constipation without flatulence)
consider ongoing stress management, relaxation therapies
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The basis of treatment is simple dietary modification with a low-carbohydrate diet using FODMAPs, exercise, fluids (2–3 L water/day) and non-fermentable fibre. FODMAPs stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols, which are poorly absorbed. All of these carbohydrates need to be eliminated (under a dietician’s guidance) and gradually reintroduced. See www.monashfodmap.com (app: the Monash University low FODMAP diet).