The physician evaluating a patient with IBS, particularly that with refractory symptoms, should investigate for unresolved psychological issues, should include the possibility of sexual or physical abuse; i.e., alternating constipation and diarrhea suggest an intestinal motility disorder such as IBS.

Diarrhea-predominant IBS is characterised by precipitous diarrhea that occurs immediately on rising or during or immediately after eating. Nocturnal diarrhea is unusual. Pain, bloating, and rectal urgency are common. Incontinence may occur. Painless diarrhea in not typical and should lead the physician to consider the diagnostic possibility (eg. malabsorption, osmotic diarrhea).

Therapy is supportive and palliative. The physician’s sympathetic understanding and guidance are of overriding importance.

J.M. Navarro

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