A strategy for management of the irritable bowel

Abstract

The irritable bowel is one of the most common complaints facing clinicians. Its management is difficult but a strategy is proposed that is useful in most instances. It is well to remember that most people with these symptoms do not complain to a doctor. The reason for the visit to the physician may, therefore, hold a clue as to the best course of management. The physician must first establish his credibility through a careful history, physical examination, and sigmoidoscopy. He needs to identify the precipitating factors such as dysentery, drugs, diet, emotion, or an important life event. In accordance with the patient's needs, the physician should comfort and reassure. Bran appears to be a safe method of treatment and many are satisfied with it. A follow-up visit is important to ensure compliance and comprehension. The biggest risk of the IBS lies in uncertainty, which generates needless anxiety, costly investigation, fruitless drug side effects, and even the hazards of surgery. If the patient is unimproved at the second visit, one must consider diagnostic alternatives while resisting the temptation to order irrevelant investigative procedures. Continued empathy with the patient is important and certain drugs might be considered either for their placebo effect or because of their effect on a specific complaint such as diarrhea. In the patient who continues to be dissatisfied, the physician must offer continued support and reassurance. Certain referral options may be considered but if possible, the physician should retain the initiative.