Illness Script for Irritable Bowel Syndrome

Keep/Refer
Decision
Keep and Refer

A forty-year-old female came into the clinic via direct access presenting with abdominal
pain. She is unaware of any specific event that might have caused this pain. Upon evaluation,
you find that the patient reports abdominal cramping in addition to a gradual onset off irregular
bowel movements accompanied by mucus. She states that she has experienced these irregular
bowel movements for approximately six months now. She is uncertain why symptoms continue
without improvement, seeing as there is no deviation in her ADL’s or lifestyle from prior to
onset of symptoms. She is employed as a secretary at the local elementary school, where she has
worked the past 10 years.

When screened for red flags, nothing stood out. The patient does not experience night pain with
the abdominal cramping, nor does she note any unexplained weight loss. Patient does not have
any significant past medial history, including previous injuries or surgeries, and she is not on any
medications.

Identify physical features you should note as a physical therapist that

the patient might not report or identify.

There are no physical features related to IBS. IBS is a disease that is classified by signs and
symptoms, so all of the information one would need to diagnose this disease are self-reported
by the patient.

Physical Therapy Findings: Physical therapy findings that would be identified

during the patient’s visit are reports of the following signs and symptoms when taking a

Group Members: Abby Flaminio, Kayla Rolling, Riley Ballard, Jonathan McBain Page 1
history: chronic abdominal pain, altered bowel movements with unknown cause,
cramping, bloating, excessive flatulence, and/or mucus in the stool.

Regular physical activity helps relieve stress

Should adhere to regular exercise activity even during bouts of increased symptoms

Want to avoid exercises with jumping/jarring

Problems List:

Chronic abdominal pain

Diarrhea - Accompanied by mucus
Excess gas
Abnormal bowel habits
Cramping – Alleviated by bowel movements

Differential Diagnosis (What is this similar to? What should be ruled

out?)

Differential diagnoses for IBS include Crohn’s Disease, lactose intolerance, Celiac
Disease, intestine obstructions, digestive tract infections, pancreatic insufficiency, hyper
or hypothyroidism, or intestinal carcinomas.
IBS symptoms are usually not present at night. Therefore, those disease in which
symptoms are present at night as well as during the day can be ruled out. IBS is a
disease that is diagnosed by ruling out other diseases, so it is important to take a
careful history of signs and symptoms. The Rome III Scale is commonly used to rule out
other diseases and rule in IBS.

**** Write in the keep/refer decision whether this is a keep, keep & refer or refer
situation upon evaluation typically.

Group Members: Abby Flaminio, Kayla Rolling, Riley Ballard, Jonathan McBain Page 2