The abdominal pain is often in the form of cramping pain and it could be in multiple different parts of the abdomen. One time it's here, on time it's there - it moves around. It's confusing to patients because first they felt it on this side, then it was on this side - but that's very typical of irritable bowel syndrome. The diarrhea is typically unpredictable and so is the constipation. When you ask a patient with irritable bowel syndrome "do you know what your bowel movements are going to be like tomorrow?" They often say "no" because they could have normal bowel movement, they can have multiple bowel movements in the case of diarrhea predominant irritable bowel syndrome, or they could have no bowel movements in the case of a patient with constipation predominant irritable bowel syndrome. It's really unpredictable and that's one of the hallmarks of irritable bowel syndrome that differentiates it from other conditions such as inflammatory bowel disease or Crohn's Disease, where in those patients it's very predictable. In addition, typically patients with irritable bowel syndrome don't have symptoms while they're asleep. They usually have daytime symptoms but once they're asleep, they're not in severe abdominal pain. They're not having nocturnal bowel movements. That's really important in terms of differentiating irritable bowel syndrome from other conditions. Also, there are a number of alarm symptoms that we look for to differentiate. If a person has weight loss, if a person is having rectal bleeding, if a person is anemic, and there are other red flags - we need further evaluation in those patients because there may be something more going on.
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