Irritable bowel syndrome physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Patients with IBS usually appear normal. Physical examination of patients with IBS may elicit tenderness in the abdomen. A digital rectal examination must be performed in all patients to rule out rectal growths, blood in stool and evaluate for dyssynergic defecation (where paradoxical contraction of the rectal sphincter occurs on straining leading to constipation). Physical findings such as fever, abdominal mass, hepatosplenomegaly, lymph node enlargement, weight loss, peritoneal signs and ascites are absent in IBS and help rule out organic causes.   

Appearance of the Patient

• Patients with IBS usually appear normal/mildly distressed.

Vital Signs

• patients are usually afebrile.
• patients have regular pulse, tachycardia may be present in IBS-diarrhea patients with dehydration/hypovolemia as a complication
• Blood pressure is normal in most patients, decreased in complicated cases with dehydration
• Postural hypotension occurs in complicated cases with hypovolemia
• Respiratory rate normal

Skin

• skin turgor is normal in most patients
• skin turgor is reduced in IBS-diarrhea patients with dehydration/hypovolemia as a complication
• Tongue and oral mucosa may also be dry since salivary secretions are decreased in dehydrated patients.

HEENT

WNL

Neck

WNL

Lungs

• Normal chest expansion
• Normal vesicular breath sounds in B/L lung fields
• Normal tactile fremitus

Heart

• S1 /S2 normal

Abdomen

• Examination results are usually normal
• Abdominal distention may be present
• Abdominal tenderness may be elicited in different quadrants
• Absence of abdominal masses, organomegaly
• Normal bowel sounds
• To rule out organic causes, rectal exam must be done in patients to evaluate for:
  •  presence of stool and its consistency
  • Rectal tenderness
  • Strictures
  •  Masses
  • rectal prolapse
  •  Fistulas
  •  Hemorrhoids
  •  Abscesses
  •  Fissures
  • impaired sphincter function due to a neurologic disorder
  • responses of the puborectalis and external anal sphincter muscles while straining to rule out dyssynergic defecation

Genitourinary

• WNL

Neuromuscular

• Patient is usually oriented to persons, place, and time

Extremities

• WNL