HOW SHOULD IBS BE EVALUATED

The IBS Workup

By the time clients see me, they have usually seen 3 or more physicians, including at least one gastroenterologist. They have often undergone at least a colonoscopy, and often had other procedures and various lab tests performed. They have probably been prescribed a number of different medicines from different classes of drugs (e.g., anti-depressants, anti-spasmodics, protein pump inhibitors) and may have been advised to use various supplements and/or stool bulking agents to make bowel movements more controllable and efficient. The fact that they are coming to see me, a health psychologist, also means that the sum total of all of these efforts has not yielded a satisfying result.

So, what should a thorough IBS work-up involve?

The Relevant Elements

According to material published by Drossman Gastroenterology, a world-renowned center for research and treatment into IBS, a comprehensive work-up of IBS is impacted by 4 elements:

  1. The specific pattern of symptoms you show will influence what steps are taken to understand your condition. Diarrhea vs. constipation. Severe pain vs. general bloating. Intermittent vs. multiple times per day episodes. These are some of the factors that will impact what types of tests or procedures are ordered.
  2. Your demographic profile is an essential element. What is your age, gender, or family history of GI problems, including a family history of colon cancer? These factors can lead to a more thorough work up that includes a wider range of diagnostic tests.
  3. Where you are seen for your concerns makes a difference. Generally, if you see a gastroenterologist, you may undergo a wider range of tests. The base rate (i.e., the odds or probability of occurrence) for conditions other than IBS are much lower in primary care settings. This makes is less likely that a primary care doctor will order a wider range of blood work studies or procedural tests such as colonoscopies or endoscopies. Also, the rate of accurate prediction of IBS based on whether your symptoms and complaints meet the Rome Criteria is well above 90%. In other words, the odds are strong that common GI complaints reflect the presence of IBS, and physicians other than gastroenterologists are less likely to actively search for other causes: the odds of finding something else that is more dire is low.
  4. The way you present your concerns was also found to impact what tests and procedures are ordered. When concerns are presented in a way that is thoughtful, reveals efforts to address possible causes or triggers, is respectful but straightforward in conveying the degree of personal and lifestyle disruption that has been caused, the more likely you are to have a physician respond in a thoughtful, measured approach that is targeted and sensitive.
  5. To Dr. Drossman’s list I want to add the following. Too often, even when clients are diligent and detailed in how they bring their digestive concerns to their physicians, the physician’s response can be: I don’t see anything wrong. Or, just start taking probiotics, or eat more fiber, or have yoghurt in the morning. Or, you just have to learn to relax. Or, why don’t you go see a good therapist. The role of the doctor-patient relationship in creating a collaborative connection that is helpful in stabilizing IBS symptoms is too often underplayed or dismissed altogether. IBS is not just about the gut but also about the person through whom IBS gets expressed. So, what can you do to obtain the thorough workup that you need and deserve?
    • Ask questions about what explanations there are for the symptoms you experience, and what are the ways that other possibilities get actively ruled out before concluding that what you have is best described as IBS (e.g., “Why are you so confident that this isn’t something else?).
    • Get a thorough physical examination. Problems elsewhere in the body can show up as digestive tract difficulties because our gut is so vital and central to everything else that we do.
    • Ask whether obtaining a conservative set of tests makes sense in your case (e.g., a colonoscopy, blood test, stool culture) makes sense, and if not, why not?
    • Give yourself the IBS Severity Index, which I included in a previous post. Not only does it provide you with useful information about how your symptoms compare to others. The scale also offers you and your physician a common language around which to discuss your situation comprehensively.
    • Do a thorough self-assessment of your current life circumstances, including stress levels. Completing my Life in Balance Scale, can help you with that.

Thanks for staying in touch. Remember that if you have specific questions or concerns, send me an email. I read them all and select frequently occurring concerns to translate into blogs posts, like this one, that I share with our growing community. Take good care…

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