Irritable bowel syndrome: making sense of it all

Though the basic science of the irritable bowel syndrome is far from certain, and the clinical science is often confusing, it is still possible to make some sense of the syndrome in a clinical context. These common complaints of altered bowel patterns, pain and bloating are extremely common and vary greatly in the impact they have on persons’ lives. From ‘non-patients’ who do not present for medical care to those who seek referral to multiple specialists, the spectrum is well known. If sense is to be made, the physician must understand the patient’s major symptoms, how and to what degree they disturb their lifestyle, what is the patient’s knowledge about and understanding of the syndrome, what has been done before, and why the patient is now presenting. What are the expectations and potential frustrations anticipated with this present consultation? A positive diagnostic approach can be taken but care is necessary to assuage lingering fears of organic disease, to correct misconceptions of the syndrome, to settle existing frustrations of the patient, and to educate. With these approaches, managing irritable bowel syndrome can be rewarding, though demanding.