Spastic Colon (IBS): Symptoms, Diagnosis, and Management

What Is Spastic Colon?

An outdated term for Irritable Bowel Syndrome (IBS)—a disorder of gut-brain interaction (DGBI) defined by recurrent abdominal pain ≥1 day/week for 3 months associated with ≥2 of: related to defecation, change in stool frequency, change in stool form (Rome IV criteria).

Key Features

• No structural lesions: Normal colonoscopy, biopsy—distinguishes from IBD, cancer, colitis.
• Subtypes: IBS-C (constipation), IBS-D (diarrhea), IBS-M (mixed), IBS-U (unclassified).
• Triggers: Stress, food (FODMAPs), hormones, infection (post-infectious IBS), dysbiosis.
• Comorbidities: Anxiety, depression, fibromyalgia, chronic fatigue, interstitial cystitis.

Diagnosis

• Clinical (Rome IV) + limited testing (CBC, CRP/fecal calprotectin, celiac serology if IBS-D/M; colonoscopy if >45, alarm features, family history).

Management (Multimodal)

• Diet: Low FODMAP (dietitian-guided), soluble fiber (psyllium), regular meals.
• Medications: Antispasmodics (peppermint oil, dicyclomine), laxatives (PEG), antidiarrheals (loperamide), gut-targeted antidepressants (low-dose TCA, SSRI), secretagogues (linaclotide, plecanatide for IBS-C), bile acid sequestrants (IBS-D).
• Psychological: Gut-directed hypnotherapy, CBT, mindfulness.
• Lifestyle: Exercise, sleep, stress management.

Prognosis

Chronic, fluctuating. Not progressive to cancer/IBD. Quality of life improves with tailored management.