From the Guidelines
Abdominal pain that wakens the patient at night is not considered typical of irritable bowel syndrome (IBS). According to the most recent and highest quality study, the British Society of Gastroenterology guidelines on the management of IBS 1, IBS is characterized by abdominal pain related to defecation, associated with a change in stool frequency and/or stool form. The study also notes that symptoms that cumulatively support the diagnosis of IBS include abnormal stool frequency, abnormal stool form, abnormal stool passage, passage of mucus, and bloating or feeling of abdominal distention. However, pain that awakens the patient from sleep is not a typical feature of IBS, as IBS pain is usually relieved by defecation and is not typically severe enough to wake a patient from sleep.
Some key features of IBS pain include:
- Relief after bowel movements
- Association with changes in stool frequency or form
- Often worsening after meals
- Chronic and recurrent, lasting at least one day per week over the past three months
- Symptom onset at least six months prior to diagnosis
- Commonly described as cramping, bloating, or a general discomfort in the lower abdomen
Other atypical features that would suggest conditions other than IBS include:
- Progressive worsening pain
- Pain associated with weight loss
- Pain accompanied by rectal bleeding These features are not typical of IBS and may indicate the presence of another underlying condition. The pathophysiology of IBS involves visceral hypersensitivity, altered gut motility, and dysregulation of the brain-gut axis, making pain that improves with defecation a hallmark diagnostic feature 1.
From the Research
Description of Abdominal Pain in Irritable Bowel Syndrome (IBS)
The typical descriptions of abdominal pain associated with IBS include:
- Abdominal pain ranging from mild to debilitating 2
- Intermittent abdominal pain 2, 3
- Abdominal pain aggravated by stress 2, 3
Atypical Description of Abdominal Pain in IBS
The description of abdominal pain that is not typical of IBS is:
- Abdominal pain that wakens patient at night 4, as sleep disturbances and waking episodes during sleep are more common in IBS patients, but abdominal pain that consistently wakens patients at night is not a characteristic feature of IBS. Instead, waking episodes during sleep are associated with worse abdominal pain and GI distress the following day.
Key Characteristics of IBS-Related Abdominal Pain
Key characteristics of IBS-related abdominal pain include: