Irritable bowel syndrome, chronic pelvic inflammatory disease and endometriosis: a comparison of symptomatology

BACKGROUND AND OBJECTIVES: Both irritable bowel syndrome and some gynaecological diseases can give rise to lower abdominal pain, which may result in diagnostic confusion. Disorders such as endometriosis and chronic pelvic inflammatory disease can be diagnosed definitively only by laparoscopy, which is seldom undertaken in the gastroenterological setting. It was the aim of this study to compare the symptomatology of irritable bowel syndrome with that of laparoscopically confirmed chronic pelvic inflammatory disease and endometriosis. PATIENTS AND METHODS: A symptom questionnaire was administered to 50 women with irritable bowel syndrome and 51 gynaecological patients (30 patients with endometriosis, 21 patients with chronic pelvic inflammatory disease). As the symptoms of the two gynaecological conditions were so similar, the groups were combined for the purposes of comparison with irritable bowel syndrome. RESULTS: Patients with irritable bowel syndrome suffered significantly more upper abdominal pain, colicky pain and exacerbation of pain by food or stress. They also experienced more disturbance of bowel habit, distension and nausea. In contrast, the only gynaecological features that were more common in the gynaecological patients were intermenstrual bleeding, premenstrual exacerbation of pain and forniceal tenderness. CONCLUSION: The presence of gastrointestinal symptomatology, especially bowel dysfunction, in a woman with lower abdominal pain is suggestive of irritable bowel syndrome. However, the history may not be so helpful in detecting gynaecological disease.