There is also a guide that contains information specifically for the elderly. Diagnostic guidelines, such as the Manning or Rome criteria, emphasize the relief of pain on defecation, the relationship of abdominal pain to the onset of diarrhea or constipation, abdominal distention and sense of incomplete rectal evacuation. In a younger patient, the principal differential diagnoses are ulcerative colitis or Crohn's disease, whereas carcinoma of the large bowel must be considered in the older patient. The management strategy depends on the specific symptoms in each patient, but generally will include dietary advice, psychologic support and consideration of medication. Fiber consumption should be increased slowly in most patients, but it may exacerbate bloating.
Most patients require advice about exercise and stress reduction.
Response to placebo occurs in up to 70 percent of patients with IBS, and cognitive therapy can be effective in reducing symptoms and enhancing coping abilities. Medications that work predominately on the gastrointestinal system are usually selected to address specific symptoms such as diarrhea or constipation. Scaphoid fractures result from extreme dorsiflexion of the wrist with compression to the lateral hand. They are most common in young men 15 to 30 years of age. The classic finding of tenderness in the anatomic snuffbox is not specific for scaphoid fracture.