# Situation: A 29-year-old office worker has had recurrent crampy lower abdominal pain for 7 months. The pain occurs about twice a week, eases after she passes stool, and comes with looser, more frequent stools; she has had no hard or lumpy stools. She has no fever and no night-time symptoms. Over the past 3 months, about 40% of her bowel movements have been loose or watery, and none have been hard or lumpy. Using the Rome IV criteria, how is her pattern classified?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630483  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 29-year-old office worker has had recurrent crampy lower abdominal pain for 7 months. The pain occurs about twice a week, eases after she passes stool, and comes with looser, more frequent stools; she has had no hard or lumpy stools. She has no fever and no night-time symptoms.

Over the past 3 months, about 40% of her bowel movements have been loose or watery, and none have been hard or lumpy. Using the Rome IV criteria, how is her pattern classified?

## 보기

1. Irritable bowel syndrome with predominant diarrhea **✔ 정답**
2. Irritable bowel syndrome with mixed bowel habits
3. Irritable bowel syndrome, unclassified subtype
4. Not yet irritable bowel syndrome; 12 months are needed

**정답: 1**

## 해설

Rome IV irritable bowel syndrome needs recurrent pain at least 1 day a week for 3 months with two or more of: related to defecation, change in frequency, change in form, with onset at least 6 months before. Her stools are only looser, so the subtype is IBS with predominant diarrhea.

## 심화 해설

Confirming irritable bowel syndrome
Under the Rome IV criteria, irritable bowel syndrome (IBS) requires recurrent abdominal pain on average at least 1 day a week in the last 3 months, associated with two or more of the following: related to defecation, associated with a change in stool frequency, or associated with a change in stool form. Symptom onset must be at least 6 months before diagnosis. She has pain about twice a week that eases after defecation and comes with looser, more frequent stools, and her symptoms began 7 months ago. She meets the criteria.

Assigning the subtype
The IBS subtype is based on stool form on days with abnormal bowel movements, often described using the Bristol Stool Form Scale. IBS with predominant diarrhea (IBS-D) applies when more than 25% of abnormal bowel movements are loose or watery and less than 25% are hard or lumpy. Her loose stools make up about 40% of bowel movements, and none are hard or lumpy. Loose stools above the 25% threshold with almost no hard stools define the diarrhea-predominant subtype.

| Subtype | Loose or watery stools | Hard or lumpy stools |
| --- | --- | --- |
| IBS-D (diarrhea) | More than 25% | Less than 25% |
| IBS-C (constipation) | Less than 25% | More than 25% |
| IBS-M (mixed) | More than 25% | More than 25% |
| IBS-U (unclassified) | Meets IBS criteria but no subtype pattern |  |

Why the other options are wrong
The mixed subtype requires both hard and loose stools above the threshold; she has had no hard stools. The unclassified subtype is used when stool form does not fit any of the defined patterns, which is not the case here. The claim that 12 months are needed reflects older criteria; Rome IV requires 3 months of symptoms with onset at least 6 months before diagnosis. Watch out! Questions about IBS subtypes often hinge on whether the client has any hard stools at all.

Exam takeaway
First confirm the IBS criteria (pain frequency, relation to defecation or stool change, duration and onset), then assign the subtype by stool form. Before accepting a functional diagnosis, the nurse also checks for alarm features such as anemia, bleeding, weight loss, or nocturnal symptoms. Key point! Rome IV IBS needs pain at least 1 day a week for 3 months, onset 6 months earlier, and subtype is set by the proportion of loose versus hard stools.

## 임상 시나리오

Rome IV IBS SubtypesClassifying by stool form
IBS: recurrent pain at least 1 day a week for 3 months, with two or more of: related to defecation, change in frequency, change in form; onset at least 6 months before diagnosis.

IBS-D: more than 25% of abnormal stools loose or watery and less than 25% hard or lumpy. Her 40% loose stools with none hard fit IBS-D.

IBS-M needs both hard and loose stools; IBS-U is used when no subtype pattern fits.

CautionBefore confirming IBS, check for alarm features such as anemia, rectal bleeding, weight loss, or night-time symptoms.

## 핵심 개념

- **Irritable bowel syndrome** — A functional bowel disorder with recurrent abdominal pain linked to defecation or changes in stool frequency or form.
- **IBS-D** — Irritable bowel syndrome with predominant diarrhea, defined by loose stools in more than 25% of abnormal bowel movements.
- **Bristol Stool Form Scale** — A seven-type chart describing stool form from hard lumps to watery stool, used to classify bowel habits.
- **Rome IV criteria** — International symptom-based criteria for diagnosing functional gastrointestinal disorders.

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