IBS Flares and Bowel Obstruction

Understanding IBS Flares

IBS is characterized by recurrent abdominal pain associated with defecation and changes in stool frequency or form, with intermittent symptoms lasting two to four days followed by periods of remission 1
Patients with IBS typically experience abdominal pain that may be severe but is not associated with mechanical obstruction 2
Changes in bowel habits including diarrhea, constipation, or mixed patterns are common in IBS patients 3
Bloating, abnormal stool form, straining at defecation, urgency, feeling of incomplete evacuation, and passage of mucus are also typical symptoms of IBS 1

IBS symptoms typically subside during sleep; waking from sleep with pain or diarrhea usually indicates that another diagnosis should be considered 4

Age over 50 years at symptom onset should prompt consideration of diagnoses other than IBS 4
Rectal bleeding or blood in stool should prompt further investigation 4
Fever is an alarm feature that requires further investigation 5
Nighttime symptoms that wake the patient from sleep should be considered an alarm feature 4

IBS-C is characterized by hard stools >25% of the time, loose stools <25% of the time 3
IBS-D is characterized by loose stools >25% of the time, hard stools <25% of the time 3
IBS-M is characterized by both hard and soft stools >25% of the time 3
IBS-U is characterized by neither loose nor hard stools >25% of the time 3
For IBS-D, management options include Loperamide, ondansetron, ramosetron, or eluxadoline 5
For IBS-C, management options include water-soluble fibers, osmotic laxatives, linaclotide, or lubiprostone 5
For IBS-M, management options include SSRIs, rifaximin, psychological therapy, or antispasmodics 5

Severe, unrelenting abdominal pain is a symptom that requires immediate medical attention 4
Persistent vomiting is a symptom that requires immediate medical attention 5
Abdominal distension with tympanic percussion is a symptom that requires immediate medical attention 4
Fever or other signs of infection are symptoms that require immediate medical attention 5

IBS is characterized by chronic, recurring abdominal pain or discomfort associated with disturbed bowel habits that typically follows a pattern of flares and remissions 6, 7
Some patients, known as "alternators," may switch between IBS subtypes over time, with one study showing 29% of patients changing from diarrhea-predominant IBS (IBS-D) to constipation-predominant IBS (IBS-C) within a one-year period 6
Prognosis depends significantly on the length of history, with patients having a longer history being less likely to improve 7
About one-third of patients have diarrhea-predominant IBS (IBS-D), one-third have constipation-predominant IBS (IBS-C), and the remainder have mixed patterns 6

Chronic ongoing life stress is a key prognostic factor that can significantly impact recovery - one study found that no patients with ongoing life stresses recovered over a 16-month follow-up period, compared with 41% recovery in those without such stresses 7
The pattern of symptoms may change over time, with patients experiencing different predominant symptoms during different periods 6

IBS symptoms frequently peak in the third and fourth decades of life 7
There is a female predominance of approximately 2:1 in patients in their 20s and 30s, though this gender bias becomes less apparent in older patients 7
IBS symptoms persist beyond middle life and continue to be reported by a substantial proportion of individuals in their seventh and eighth decades 7