Constipation, Irritable Bowel Syndrome, and Colic: (Stomach Cramps)

Presentation

Patients with functional constipation will often come in with the complaint of abdominal pain or bloating. Often it is not until they are asked that they will describe infrequent bowel movements, straining at stooling, incomplete evacuation, hard or small stools, a blockage in the anal region, or the need for digital manipulation to enable defecation.

Patients with irritable bowel syndrome (IBS) will complain of abdominal pain or discomfort, with a change in the form or frequency of defecation. They will have constipation (fewer than three bowel movements per week), diarrhea (more than three bowel movements per day), or alternating constipation and diarrhea. Their pain is often but not always relieved by defecation.

At the age of 6 weeks, infants with colic will begin having episodes of inconsolable crying that last more than 3 hours per day for more than 3 days per week and that continue longer than 3 weeks. These infants are well fed and otherwise healthy.

In all of these cases, the patient’s discomfort is rarely accompanied by nausea or vomiting. In addition, signs and symptoms should not include fever, anorexia, or weight loss, and rarely are patients awakened with nocturnal symptoms.

The physical examination is generally benign, with normal vital signs and no jaundice, tenderness, masses, organomegaly, rectal bleeding, or other abnormalities, and the patient does not appear ill between the episodes of abdominal pain. Some patients may exhibit vital sign abnormalities such as low-grade tachycardia or tachypnea when in pain and may have minimal tenderness on exam; however, they should not exhibit any rebound or guarding.