These patients often complain of a sensation of incomplete evacuation, distension, passage of mucus, with or without associated abdominal, pelvic, and back pain. Pain is relieved by evacuation. Alternating constipation, diarrhea, and bloating is typical of irritable bowel syndrome. Diarrhea is not bloody unless accompanied by an anorectal lesion such as hemorrhoids or a fissure. There are no systemic symptoms or weight loss, and nutritional status is not compromised.
Physical examination is usually normal.
A work-up should be done to exclude other causes. Stool will usually be negative for occult blood. Sigmoidoscopy and barium enema are also usually normal. Associated symptoms and signs that increase the likelihood of organic disease include blood in stools, nocturnal diarrhea, recent onset, weight loss, painless diarrhea, positive HIV status. The absence of the above supports the diagnosis of functional bowel disease.