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 on physical exam. Physical examination of patients with IBS may elicit abdominal tenderness in some patients. 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.   

Physical Examination

Appearance of the Patient

• Patients with IBS usually appear normal/mildly distressed.

Vital Signs

• Afebrile
• Regular pulse
• Normal blood pressure
• Normal respiratory rate
• IBS-diarrhea patients with dehydration/hypovolemia as a complication develop:
  • tachycardia
  • low blood pressure
  • postural hypotension

Skin

• Skin turgor is normal in most patients
• IBS-diarrhea patients with dehydration/hypovolemia as a complication develop:
  • decreased skin turgor
  • dryness of tongue and oral mucosa due to decreased salivary secretions

Lungs

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

Heart

• S1 /S2 normal
• No additional sounds

Abdomen

• Examination results are usually normal
• Abdominal distention may be present
• Abdominal tenderness may be elicited in different quadrants
• Absence of abdominal masses, hepatospleenomegaly
• Normal bowel sounds

Rectal exam

• IBS patients usually have a normal rectal exam.To rule out organic causes of constipation and diarrhea, 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