Irritable bowel syndrome(IBS) is one of the commonest conditions seen in gastroenterologic practice. It is characterized by recurrent chronic abdominal pain and discomfort associated with disordered bowel habit. The bowel habit can vary between constipation and diarrhea often with disordered defecation and associated bloating. The (only) great thing about IBS is that is it not associated with, nor does it lead to any other illness. It will not progress, it does not raise the risk of colon cancer and it never requires surgery.

 It is important to note that it is the combination of symptoms that characterize IBS - constipation as a stand -alone problem should not be diagnosed as IBS, nor should abdominal pain that comes without a change in bowel movements. Interestingly because IBS is a "functional disorder" one cannot actually be tested for it rather it is determined by a diagnosis of exclusion. This is because there are no structured, inflammatory, biochemical or infectious abnormalities present in IBS.

 In other words the blood tests, stool examination and barium study of large bowel do not reveal any abnormalities. Not only that even an endoscopic examination of the large bowel, C.T. Scan of abdomen or ultrasonography do not show any abnormality. If the bowel is healthy as is evident from laboratory tests then why does a patient who suffers from "irritable bowel syndrome" experience intermittent pain in the abdomen and change in bowel habits?.Is it possible that these patients malinger or are telling lies? Absolutely not ! These patients suffer from pain, which is evident from positron emission tomography.(a special kind of brain scan) Infact our understanding of the origin of the pain is vague. However recent medical research points to a dysfunction of the brain, known as enteric nervous system or "Local brain of the gut". There are almost 10 million nerve cells embedded in the walls of the human digestive tract. This 'Local brain of the gut' can perform routine jobs such as absorption of food contraction and relaxation of bowel wall in a rhythmic manner (i.e peristalsis) without any help from the central nervous system (i.e. our central brain located in skull). The local brain of the gut send message to the central brain by a group of nerve fibers called the afferent nerves and the central brain sends commands, through another group nerve called efferent nerve, to modulate the function of the gut. For some reason, mostly due to antecedent infectious diarrhea nerve cells of local brain of the gut get over sensitized and even small change in pressure in intestine causes pain and discomfort in patients with IBS. similar change in pressure in normal individuals will not cause pain if their nerve do not get sensitized.

If the diagnosis of irritable bowel syndrome is not made with the confidence and certainty then the possibility of either chronic appendicitis or dysfunction of gall bladder or inflammation of uterus is considered and these organs are moved in the belief that the pathology in these organs is responsible for the patient's discomfort. Hence a precise understanding of irritable Bowel syndrome can avert these unnecessary operations.

Therefore it is important to know the symptoms of IBS, which are : -

1. Alternating constipation and diarrhea.

2. Constipation and / or diarrhea as a sole symptom accompanied by abdominal pain.

3. Pain in different parts of the abdomen.

4. Pain precedes or accompanies bowel movement.

5. No satisfaction after bowel evacuation.

6. Passing mucus.

7. Pain worsens after meals.

8.Feeling of bloating or fullness throughout the day, which may increase after meals.

9.Abdominal discomfort vanishes after satisfactory bowel movement.

10. Bowel movement begins soon after solids or liquids are ingested.

11. Once in bed, hardly any urge to visit toilet.

Management of patients with IBS should start by establishing a relationship with the patient, Time must be dedicated to explain the nature of the condition, treatment option and the impact of anxiety and stress on symptoms. Anxiety and stress may not be the causative or aetiological factors but the certainly exacerbate or intensify symptoms of IBS. This happens due to degranulation of mast cells located in the bowel wall releasing chemicals, which intern sensitizes neurons. Similarly food intolerance is common in patients with IBS many patients are keen to pursue restricted diets and individuals many benefit from exclusion of certain substances. Lactose intolerance is common in patients with IBS.

In patients with constipation predominant IBS, the traditional advice has been to adapt a high fiber diet. Increasing intake of a range of different dietary fibers including those from cereals,fruits and vegetables have shown to increase stool weight and accelerate gut transit. Isapghula husk, a bulking agent ,may improve constipation or diarrhea with IBS but stimulant laxatives should be avoided. Anticholinergic such as dicyclomine and smooth muscle relaxant such as mebeverine is used for pain relief. there are many new drug being used viz,probiotics,tricyclic anti depressants and several serotonergic modulations must be taken after consulting with your doctor.With a few simple investigations, sympathetic explanations and appropriate treatment most patients with IBS have a god prognosis.