Irritable bowel syndrome : a case for musculoskeletal assessment

Abdominal pain of non-visceral origin has been recognised as a clinical entity for many years. In many gastroenterology clinics up to 50 per cent of patients attending have no pathological cause to their symptoms and such patients often become chronic attenders and suffer repeated investigation without resolution of their problem. They are often left with a label' of Irritable Bowel Syndrome (lBS) without a precise diagnosis being made. This is both unsatisfactory for the patient and physician. This study set out to determine the incidence of musculoskeletal causes of abdominal pain and to determine what diagnostic tools will help identify this group of patients and thus allow the physicians to refer the appropriate patients at an early stage. The aims were to identify questions that act as predictors of the presence of abdominal pain of musculoskeletal origin, patterns of pain presented in this group of patients and the ability of physiotherapists to detect cases of abdominal pain of musculoskeletal origin. The incidence of abdominal pain of musculoskeletal origin in this study was 14 per cent. Questions that act as predictors include an affirmative response to pain being aggravated by movements such as bending, twisting and turning, and coughing and sneezing, and a negative response to change in bowel habit, symptoms being aggravated by food and no weight change. The ability of the physiotherapist to detect cases was 88.3 per cent. No particular pattern of pain areas emerged to differentiate patients with abdominal pain of visceral and musculoskeletal causes. Early assessment of the musculoskeletal system by a trained physiotherapist is recommended. An early referral will lead to prompt and appropriate treatment and, consequently, to a reduction in costs for the NHS. For patients where the cause of their abdominal pain is not obvious it is unacceptable that they are left with the diagnosis of IBS without the musculoskeletal system being assessed. This study shows that such an assessment is vital to detect cases where the pain has a musculoskeletal origin.