

Mohammad Elbatta, MD; Jason Schairer, MD


August 12, 2019


Abdominal pain is a common issue encountered by primary care physicians. Differentiating functional disorders (eg, irritable bowel syndrome, chronic idiopathic constipation) from other more concerning causes (eg, small intestinal bacterial overgrowth [SIBO], cancer, celiac disease, Crohn disease, ulcerative colitis) is important.

Figure 1.

Irritable bowel syndrome is a gastrointestinal syndrome characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause (Figure 1). It is the most commonly diagnosed gastrointestinal condition. The prevalence of irritable bowel syndrome in North America is approximately 10%-15%, and the incidence is 1%-2% of the population per year.[1] Women are two to three times more likely than men to develop irritable bowel syndrome.[2]

The hallmark symptoms of irritable bowel syndrome are abdominal pain or discomfort that happens once every week for at least 3 months. This pain or discomfort is noted to have at least two of the following Rome IV criteria for irritable bowel syndrome[3]:

  • Pain or discomfort associated with a change in the form of the stool: These can be loose bowel movements, hard bowel movements, or a combination of both.

  • Pain or discomfort associated with a change in the stool frequency: Bowel movements can either be more frequent or less frequent.

  • The pain or discomfort is relieved by having a bowel movement.

The reality of clinical practice is that irritable bowel syndrome can have a wide variety of clinical presentations. In addition to the "classic" symptom complex mentioned above, patients often have other abdominal or defecation-related symptoms, such as bloating, a prominent gastrocolic reflex, flatulence, distention, mucus in the stool, tenesmus (a sense of incomplete evacuation), and straining required for defecation.


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