Collagenous colitis is not found in IBS when diagnosed by strict criteria so colorectal biopsy is not indicated. Of course IBS and constipation have no histologic features. A phosphate enema or other rectal application may cause transient mucosal abrasions and microscopic loss of epithelium with some polymorphonuclear reaction. The persistent pain and inattention to symptom details can lead to inappropriate surgery. Gallstones do not cause dyspepsia.
Pelvic pain is a very frequent complaint to gynaecologists.
Creed demonstrated that amongst patients undergoing emergency appendectomy, those whose appendix was normal tended to have chronic IBS symptoms, emotional difficulties or previous life-stress. The causes of the physical symptoms of IBS are unknown. Drossman has reported a high prevalence of sexual and physical abuse among out-patients with the irritable bowel, and this observation has been confirmed in other centres. Others have noted anxiety, depression or recent exposure to a threatening life event in IBS patients compared to those with organic gastrointestinal diseases. However, most of those who suffer IBS do not see doctors, especially gastroenterologists.