By: Douglas A Drossman, MD, Center for Education and Practice of Biopsychosocial Care, Center for Functional GI and Motility Disorders at UNC, and Drossman Gastroenterology,
Chapel Hill, NC

Introduction

Pain, by definition, is the dominant symptom experienced by patients with irritable bowel syndrome (IBS). Three out of 4 people with IBS report continuous or frequent abdominal pain, with pain the primary factor that makes their IBS severe. Importantly, and unlike chronic pain in general, IBS pain is often associated with alterations in bowel movements (diarrhea, constipation, or both).

The standard general definition for pain is, an unpleasant sensory and emotional experience that’s associated with actual or perceived damage to the body. Pain that is short-lived is termed acute, while pain that lasts 6 months or longer is termed chronic. Chronic pain may be constant or recurring frequently for extended periods of time.

The chronic pain in IBS can be felt anywhere in the abdomen, though is most often reported in the lower abdomen. It may be worsened soon after eating, and relieved or at times worsened after a bowel movement. It is not always predictable and may change over time. People with IBS use different descriptors to explain how the pain feels; some examples include cramping, stabbing, aching, sharp or throbbing.

IBS is a long-term condition that is challenging both to patients and healthcare providers. It affects 10–15% of adults. Less than half of those see a doctor for their symptoms. Yet patients with IBS consume more overall health care than those without IBS. The primary reason people with IBS see a clinician is for relief of abdominal pain.

Standard diagnostic test results are normal in people with IBS; diagnosis is based on certain symptoms that meet defined (Rome IV) criteria. How can IBS be so painful when nothing irregular shows up on tests?

The answer is that IBS is a condition where the symptoms relate to alterations in normal gastrointestinal function; that is, dysregulation of brain and gut affecting both pain signals and motility (movement of the bowels).

The aim of this publication is to explain this relationship between the brain and the gut in order to help those affected understand why and how pain in IBS occurs, and how it can be confidently managed.

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