Signs may include a typical facial appearance, hoarse slow speech, and dry skin. Symptoms include cold intolerance, fatigue, and weight gain. Patients with constipation and no anatomic lesions should be evaluated for hypothyroidism Hypothyroidism Hypothyroidism is thyroid hormone deficiency. Symptoms are left lower quadrant pain and rectal bleeding. In patients > age 60 with acute symptoms, ischemic colitis Ischemic Colitis Ischemic colitis is a transient reduction in blood flow to the colon. The bimodal age distribution of patients with inflammatory bowel disease makes it imperative to evaluate both younger and older patients. Psychosocial factors can also affect the outcome in IBS. ![]() The physician evaluating patients with IBS, particularly those with refractory symptoms, should investigate for unresolved psychologic issues, including the possibility of sexual or physical abuse. Some patients with IBS seem to have a learned aberrant illness behavior (ie, they express emotional conflict as a gastrointestinal complaint, usually abdominal pain). However, stress and emotional conflict do not always coincide with symptom onset and recurrence. Disorders characterized by somatization extend in a continuum from those in which symptoms develop unconsciously. read more, or a somatization disorder Overview of Somatization Somatization is the expression of mental phenomena as physical (somatic) symptoms. ![]() read more, depression Depressive Disorders Depressive disorders are characterized by sadness severe enough or persistent enough to interfere with function and often by decreased interest or pleasure in activities. Some patients have anxiety disorders Overview of Anxiety Disorders Anxiety disorders are characterized by persistent and excessive fear and anxiety and the dysfunctional behavioral changes a patient may use to mitigate these feelings. ![]() Psychologic distress is common among patients with IBS, especially in those who seek medical care.
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