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What is a Colic Cord?
A colic cord is a characteristic symptom associated with certain diseases of the large intestine, specifically the colon, which is the terminal portion of the digestive system. Rather than being a disease in itself, it is a clinical sign: something perceptible either by the patient or by a doctor during a physical examination.
It presents as an elongated, hardened swelling (tumefaction) along the abdominal wall. This swelling usually runs in a vertical orientation on one side of the body, almost always the left side. This lump can be felt through the skin during abdominal palpation and is described by both patients and clinicians as resembling a firm, taut “cord” or rope lying just beneath the surface of the abdomen.
To fully understand what a colic cord is, it helps to have a basic picture of colon anatomy. The colon is a large muscular tube, approximately 1.5 meters (5 feet) in length, that frames the abdominal cavity. It begins in the lower right abdomen (cecum), ascends on the right (ascending colon), crosses the upper abdomen (transverse colon), descends on the left (descending colon), and ends in an S-shaped segment (sigmoid colon) before reaching the rectum. Under normal circumstances, the colon is soft and generally not perceptible on abdominal palpation. When it becomes noticeable, particularly as a firm and tender cord, this is considered a clinically relevant finding.
The left colic cord (also referred to as a sigmoid colic cord) is the most commonly reported variant. However, a right colic cord, which involves the ascending colon, has also been described, though it is less frequent.
It is important to understand from the outset that the colic cord is a symptom, not a diagnosis. It is a manifestation of an underlying condition that must be properly evaluated and identified by a qualified healthcare professional.
Why Does It Form? The Causes
Understanding why a colic cord forms requires knowledge of how the colon works. The colon’s walls are lined with layers of smooth muscle. These muscles contract rhythmically to propel intestinal contents toward the rectum, in a process known as peristalsis. Under normal conditions, these contractions are coordinated and relatively imperceptible. When something disrupts this coordination, the muscular wall can go into spasm: a prolonged, intense, and abnormal contraction of a segment of the colon.
This localized spasm is precisely the underlying mechanism of the colic cord. The sustained muscular contraction stiffens a portion of the colon, making it firm and palpable through the abdominal wall. The phenomenon tends to worsen after meals, when the presence of food stimulates increased intestinal activity. This reaction is linked to the gastro-colic reflex, which is discussed in detail below. This is why it is generally considered a functional condition (related to the organ’s activity and function) rather than a structural one (related to permanent anatomical changes).
The Most Common Causes
Several underlying conditions can lead to the formation of a colic cord:
1. Irritable Bowel Syndrome (IBS)
The most frequent cause of a colic cord is irritable bowel syndrome (IBS), a chronic functional gastrointestinal disorder characterized by recurrent abdominal pain, bloating, and altered bowel habits (diarrhea, constipation, or both). IBS is estimated to affect between 10% and 15% of the global population and is one of the most commonly diagnosed gastrointestinal conditions worldwide (Lacy et al., 2016).
In IBS, the colon is hypersensitive and prone to exaggerated muscular responses to normal stimuli such as eating, stress, or hormonal changes. A colic cord may appear as a characteristic sign in some IBS patients, though it is not universal.
2. Inflammatory and Infectious Conditions of the Colon
Inflammation of the colon, whether due to infection (infectious colitis caused by bacteria, viruses, or parasites) or autoimmune processes (such as Crohn’s disease or ulcerative colitis), can trigger similar spastic reactions in the intestinal wall. These conditions may produce transient colic cord presentations that resolve as the underlying inflammation is treated.
3. Coprostasis (Fecal Accumulation)
Coprostasis refers to the abnormal accumulation of feces within the colon, most often in the sigmoid colon, caused by slowed intestinal transit. When stool builds up in a segment of the bowel, the surrounding muscular wall may react with increased tension and spasm, producing the characteristic cord-like hardness felt on palpation. Coprostasis is frequently associated with chronic constipation and can be worsened by inadequate hydration, a low-fiber diet, sedentary lifestyle, or the use of certain medications.
4. Other Functional Disorders
Less commonly, colic cords may be associated with other functional gastrointestinal disorders or with conditions causing secondary bowel dysmotility, such as hypothyroidism, diabetes mellitus, or neurological diseases affecting intestinal motility.
Left vs. Right Colic Cord: Does the Location Matter?
The location of the colic cord can sometimes provide diagnostic clues. A left-sided colic cord most commonly involves the descending colon or sigmoid colon and is most often associated with IBS or coprostasis in the sigmoid. A right-sided colic cord may involve the ascending colon or cecal region and can occasionally be associated with inflammatory conditions or, less commonly, right-sided IBS variants. In both cases, a medical evaluation is necessary to determine the specific cause.
What Are the Symptoms?
The clinical presentation of a colic cord encompasses both subjective symptoms felt by the patient and objective signs observable or palpable during a physical examination.
The Main Physical Sign: Palpable Hardness
The defining characteristic of the colic cord is the presence of a firm, elongated, cord-like mass that can be felt in the abdomen. This mass is almost always found along the left side, corresponding to the descending or sigmoid colon. Under normal conditions, the colon is soft and not distinctly palpable. When it is hardened and clearly demarcated from surrounding structures, this constitutes a clinically significant finding.
Crucially, this hardness is perceptible even in a non-tense abdomen, meaning it can be felt even when the patient is relaxed and not bloated. This distinguishes the colic cord from other causes of abdominal rigidity, such as guarding (which occurs when the abdominal muscles tense in response to peritoneal irritation).
The cord-like mass is clearly distinct from the surrounding intestinal loops and structures, giving it its characteristic “rope-like” quality.
Associated Symptoms
Beyond the palpable mass itself, patients with a colic cord typically experience a constellation of associated symptoms:
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Abdominal pain: Often described as cramping, aching, or pressure-like, the abdominal pain is typically located on the same side as the cord. It may be intermittent or persistent and tends to worsen after meals and improve after defecation.
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Bloating and abdominal distension: Many patients report a sensation of fullness, pressure, or visible abdominal bloating, which is a hallmark symptom of IBS.
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Flatulence and gas: Excessive gas production and flatulence are frequently reported, contributing to discomfort and social distress.
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Altered bowel habits: Depending on the underlying cause, patients may experience diarrhea, constipation, or alternating episodes of both.
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Sensation of incomplete evacuation: A feeling that the bowel has not been completely emptied after defecation is common, particularly in IBS.
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Worsening after meals: Symptoms, including the palpable hardness, tend to intensify after eating. This occurs because of the gastro-colic reflex (see below). This post-prandial worsening is a hallmark feature of IBS-related colic cords.
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Improvement after defecation: Many patients note temporary relief of pain and cord-like tension following a bowel movement.
It is worth noting that the colic cord is also perceptible when fasting, as the hardness does not completely disappear between meals. This persistence distinguishes it from purely post-prandial colonic distension.
What Is the Gastro-Colic Reflex?
The gastro-colic reflex is an involuntary physiological response of the large intestine triggered by the presence of food in the stomach. It is most visibly evident in newborns. These infants typically have a bowel movement shortly after feeding, a phenomenon familiar to any new parent.
In adults, the same reflex persists, though it is generally less dramatic. Most people will recognize it as the urge to defecate shortly after eating a meal, particularly breakfast. This occurs because food entering the stomach triggers the release of hormones (including gastrin and cholecystokinin) that stimulate increased motility throughout the gastrointestinal tract. In essence, the body begins preparing to move waste material out of the system to make room for incoming food.
The gastro-colic reflex is most pronounced in the morning, shortly after waking, when the colon has been in a relatively quiescent state overnight and responds strongly to the first meal of the day.
In individuals with irritable bowel syndrome, this reflex appears to be exaggerated or dysregulated. Rather than producing normal, comfortable peristaltic contractions, it triggers excessive and often painful spasms. This is believed to explain why many IBS patients experience a significant worsening of abdominal pain, bloating, flatulence, and diarrhea immediately after meals.
In the context of a colic cord, the exaggerated gastro-colic reflex is likely responsible for the post-prandial intensification of the palpable cord and associated pain. Understanding this mechanism can help patients predict and manage their symptoms more effectively. For example, they can avoid large meals, eat slowly, and reduce dietary triggers.
How Long Does It Last?
One of the most frequently asked questions about the colic cord concerns its duration: how long can it be expected to persist?
The honest answer is that there is no single, universally applicable timeframe. Like most symptoms of irritable bowel syndrome, which is the most common underlying condition, the colic cord is characterized by significant inter-individual variability. Its course is highly subjective and influenced by multiple factors, including the severity of the underlying condition, the patient’s dietary habits, stress levels, physical activity, and response to treatment.
In general terms, the following patterns have been described:
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Short-term fluctuations: The cord may be more pronounced after meals and softer or less perceptible after defecation or during fasting. This waxing and waning throughout the day is typical.
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Exacerbation during flares: IBS and other functional bowel disorders frequently follow a relapsing-remitting course. During periods of disease flare, which are often triggered by stress, dietary indiscretion, illness, or hormonal changes, the colic cord may become more persistent. It can also grow more painful and resistant to the usual relieving factors.
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Long-term persistence: In patients with chronic, inadequately managed IBS or coprostasis, the colic cord may persist over months or even years, though its intensity typically fluctuates over time.
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Resolution with treatment: When the underlying cause is effectively addressed, whether through dietary modifications, pharmacological therapy, or lifestyle changes, the colic cord typically diminishes or resolves entirely.
It is therefore important not to interpret the persistence of the colic cord as a sign of danger, but rather as a signal that the underlying condition requires better management. Patients are encouraged to work closely with their healthcare provider to optimize their treatment plan.
Is It Dangerous?
This is perhaps the most urgent concern for patients who notice a hard lump in their abdomen: is it dangerous?
The reassuring answer, from a strictly medical standpoint, is that a colic cord is not dangerous in itself. It does not carry an increased risk of developing into something more serious, and it is not associated with life-threatening complications in the context of irritable bowel syndrome. IBS, the most common cause, is not linked to a higher risk of colorectal cancer, inflammatory bowel disease, or other serious gastrointestinal conditions (Ford et al., 2020).
However, this reassurance comes with several important caveats that must not be overlooked:
1. Impact on Quality of Life
While not dangerous in the traditional medical sense, a colic cord and its associated symptoms can profoundly affect a patient’s quality of life. Chronic abdominal pain, unpredictable bowel habits, bloating, and the anxiety surrounding unexplained physical symptoms can collectively lead to significant psychological distress, social withdrawal, impaired work performance, and reduced overall wellbeing.
Research consistently shows that IBS, the most common underlying condition, carries a quality-of-life burden comparable to or even greater than that of conditions like gastroesophageal reflux disease (GERD) and some chronic inflammatory conditions (Drossman et al., 2002). This underscores the importance of taking the symptom seriously and seeking appropriate medical care, even in the absence of immediate physical danger.
2. The Importance of Medical Evaluation
Any new or unusual abdominal symptom must be evaluated by a physician. While the colic cord may appear benign and straightforward after an IBS diagnosis, it’s important to remember that other conditions, some far more serious, can sometimes present in a similar way. If symptoms persist or worsen, consult a doctor to rule out more concerning causes. Only a qualified doctor can perform the appropriate history-taking, physical examination, and diagnostic investigations (such as blood tests, stool analysis, ultrasound, or colonoscopy where indicated) to rule out concerning alternatives.
3. Monitor for Changes
Even after a diagnosis has been established, patients should remain vigilant for any changes in their symptoms. A colic cord that was previously present and stable but suddenly becomes more painful, larger, firmer, or associated with new symptoms (such as unexplained weight loss, rectal bleeding, night sweats, or fever) warrants prompt reassessment.
Could It Be a Tumor?
Given that a colic cord presents as a palpable abdominal mass, it is entirely natural, and indeed prudent, for patients to wonder whether it could represent something malignant.
By definition, a colic cord is not a colorectal tumor, and it has no potential for malignant transformation. It is a functional phenomenon, specifically a muscular spasm, and not a structural growth like a polyp or neoplasm. Irritable bowel syndrome, the most common underlying cause, is not considered a risk factor for colorectal cancer (Canavan et al., 2014).
That said, this statement must be appropriately contextualized:
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Never self-diagnose: While a colic cord has characteristic features that distinguish it from malignant masses, distinguishing between the two requires clinical expertise and, in some cases, advanced diagnostic tools. A doctor must evaluate any unexplained abdominal lump.
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Red flag symptoms demand urgent attention: Certain symptoms, known as “alarm features” or “red flags”, should prompt immediate medical evaluation and should not be attributed to a functional disorder without proper investigation. These include:
- Unexplained and unintentional weight loss
- Rectal bleeding or blood in the stool
- A family history of colorectal cancer
- Onset of new symptoms after the age of 50
- Persistent change in bowel habits (especially new-onset constipation or diarrhea)
- Fever or night sweats
- Anemia of unknown cause
- A palpable mass that is hard, irregular, non-tender, and non-mobile
The presence of any of these features alongside an abdominal lump should prompt urgent evaluation, including colonoscopy and appropriate imaging studies.
How Is It Treated?
There is no single, universally effective cure for the colic cord. Since it is a symptom rather than a disease, its treatment focuses on managing the underlying condition, most commonly IBS or coprostasis. Unfortunately, there is no magic pill or single dietary approach guaranteed to provide immediate and lasting relief for every patient.
However, this should not be discouraging. With proper guidance from a physician or gastroenterologist, the vast majority of patients can achieve significant improvement in their symptoms and quality of life. This is typically accomplished through a combination of lifestyle modifications, dietary adjustments, and, when needed, pharmacological therapy.
Lifestyle Modifications
Lifestyle changes form the cornerstone of colic cord and IBS management, and their importance cannot be overstated:
Dietary Habits
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Follow a healthy, varied diet based on fresh, minimally processed foods. A healthy diet rich in whole, natural ingredients provides the gut microbiome with the diversity of nutrients it needs to maintain healthy function.
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Ultra-processed foods should be minimized or avoided whenever possible. These products, including packaged snacks, fast food, processed meats, sugary beverages, and many convenience foods, are rich in additives, preservatives, artificial sweeteners, and refined carbohydrates. These ingredients can disrupt intestinal flora and worsen IBS symptoms.
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Increase fruit and vegetable intake gradually. Fiber is essential for healthy bowel function, but a sudden increase in high-fiber foods can temporarily worsen bloating and gas. Introduce them slowly to allow the gut microbiome to adapt.
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Identify and limit personal dietary triggers. Certain foods are known to worsen IBS symptoms in many patients. These include fatty meals, spicy foods, caffeine, carbonated beverages, and alcohol. However, individual responses vary enormously. Keeping a detailed food and symptom diary can help identify personal triggers. Some foods, like legumes, may need only minor preparation changes. For example, soaking or thorough cooking, along with a gradual introduction, can help. There’s no need for complete elimination.
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Consider a low-FODMAP diet under professional supervision. The low-FODMAP diet (restricting Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) has strong evidence supporting its efficacy in reducing IBS symptoms in up to 75% of patients (Halmos et al., 2014). It involves a structured elimination and reintroduction protocol and should be guided by a registered dietitian.
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Eat regular meals at consistent times and avoid skipping them. Irregular eating patterns can disrupt intestinal rhythm and worsen spastic episodes.
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Eat slowly and chew thoroughly. Taking time to eat properly reduces the amount of air swallowed, supports the initial phases of digestion, and diminishes the stress load on the intestine.
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Stay adequately hydrated. Drinking sufficient water (generally 1.5–2 liters per day for most adults) supports healthy stool consistency and bowel transit.
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Limit caffeine and alcohol. Both substances can stimulate intestinal motility, worsen intestinal permeability, and aggravate IBS symptoms.
Stress Management
The gut-brain axis, a bidirectional communication network between the central nervous system and the enteric nervous system, plays a crucial role in IBS pathophysiology. Stress is one of the most potent triggers of IBS flares, and effective stress management is therefore an essential component of treatment.
Strategies that have demonstrated benefit include:
- Regular physical activity: Even gentle exercise such as walking has been shown to reduce IBS symptoms, improve bowel regularity, and enhance overall wellbeing.
- Mindfulness-based stress reduction (MBSR): Structured mindfulness programs have shown promising results in reducing both the severity and frequency of IBS symptoms.
- Yoga: Several randomized controlled trials have demonstrated that yoga practice can significantly reduce IBS symptom severity, particularly in patients with anxiety comorbidity.
- Breathing techniques: Diaphragmatic breathing exercises can activate the parasympathetic nervous system, reducing intestinal hyperreactivity.
- Psychological support: Cognitive-behavioral therapy (CBT) is one of the most evidence-based psychological interventions for IBS. Gut-directed hypnotherapy is another approach with strong clinical evidence, particularly for refractory cases.
- Adequate sleep: Poor sleep quality is strongly associated with increased IBS symptom severity. Prioritizing regular, restorative sleep is an important but often overlooked component of management.
Physical Activity
Regular physical activity has a direct positive effect on intestinal motility, muscular tone, and the gut microbiome. Studies have shown that even moderate aerobic exercise, such as brisk walking for 30 minutes five days per week, can significantly reduce IBS symptom scores compared to a sedentary lifestyle (Johannesson et al., 2011). Physical activity also helps manage stress, improves sleep quality, and supports a healthy body weight. These factors all indirectly benefit bowel function.
Pharmacological Treatment
When lifestyle and dietary modifications are insufficient to provide adequate symptom relief, a physician may recommend pharmacological interventions. It is important to emphasize that any medication should be prescribed and supervised by a doctor. Self-medication for gastrointestinal symptoms carries real risks, including delayed diagnosis of more serious conditions.
The number of medications specifically approved for IBS treatment is limited; more commonly, doctors prescribe medications targeting specific symptoms:
Antispasmodic Agents
Antispasmodics work by relaxing the smooth muscle of the intestinal wall, directly addressing the mechanism responsible for the colic cord. Examples include:
- Hyoscine butylbromide: An anticholinergic antispasmodic widely used for IBS-related abdominal cramping. It can provide rapid but short-term relief.
- Mebeverine: A more selective intestinal antispasmodic with fewer systemic side effects.
- Peppermint oil: Natural enteric-coated peppermint oil capsules have demonstrated antispasmodic effects through calcium channel antagonism and are supported by meta-analytic evidence (Khanna et al., 2014).
- Alverine citrate and simethicone: Combination products targeting both spasm and gas-related symptoms.
Analgesics and Anti-inflammatory Agents
For the management of abdominal pain, a physician may recommend analgesic medications. It is important to note that non-steroidal anti-inflammatory drugs (NSAIDs) should be used with caution in IBS, as they can worsen gastrointestinal irritation and mucosal integrity.
Laxatives and Stool Softeners
In cases where the colic cord is associated with coprostasis, or fecal accumulation, specific laxatives may be recommended to restore normal bowel transit and relieve the physical build-up responsible for colon tension. These include osmotic laxatives, such as polyethylene glycol and lactulose, as well as bulk-forming agents like psyllium or ispaghula husk.
Antidepressants (Low-Dose)
Certain antidepressants, when prescribed off-label at doses well below those used for depression, have demonstrated significant benefit in IBS management. Their mechanism of action in this context is neurological rather than psychiatric: they modulate the gut-brain axis, reduce visceral hypersensitivity, and decrease intestinal hyperreactivity.
- Tricyclic antidepressants (TCAs) (e.g., amitriptyline, nortriptyline at doses of 10–50 mg/day): Particularly effective for IBS-D (diarrhea-predominant) and pain management. Meta-analyses support their efficacy in reducing abdominal pain and overall IBS symptom severity.
- Selective serotonin reuptake inhibitors (SSRIs) (e.g., fluoxetine, paroxetine): May be beneficial particularly in IBS-C (constipation-predominant) and in patients with comorbid anxiety.
The decision to prescribe antidepressants for IBS-related symptoms should always be made by a physician, taking into account the individual patient’s full clinical picture.
Probiotics
Growing evidence supports the use of certain probiotic strains in reducing IBS symptom severity, particularly bloating and flatulence. The gut microbiome plays a central role in intestinal motility, immune function, and the gut-brain axis. While the evidence is not yet sufficient to recommend a specific probiotic formulation universally, meta-analyses suggest a modest but statistically significant benefit for selected multi-strain probiotics (Ford et al., 2018).
Medications Specifically Approved for IBS
A small number of medications have been specifically approved for IBS treatment in certain countries:
- Linaclotide and lubiprostone: Approved for IBS-C (constipation-predominant IBS), these work by increasing intestinal fluid secretion and accelerating transit.
- Eluxadoline: Approved for IBS-D in some countries, it acts on opioid receptors in the gut to reduce intestinal motility.
- Rifaximin: A minimally absorbed antibiotic with evidence for IBS-D, thought to work by modulating the gut microbiome.
When to See a Doctor
Given that a colic cord is fundamentally a symptom that requires medical evaluation, it is essential to know when to seek professional advice. The following situations warrant prompt medical consultation:
- First occurrence of a palpable abdominal lump: Any new mass in the abdomen should be professionally evaluated.
- Persistent or worsening symptoms: If symptoms do not improve with general lifestyle measures, or if they deteriorate, a medical assessment is necessary.
- Red flag symptoms: As previously described, symptoms such as unexplained weight loss, rectal bleeding, persistent fever, or new symptoms after age 50 require urgent evaluation.
- Change in existing symptom characteristics: If a previously stable colic cord changes in size, hardness, location, or is associated with new symptoms, this warrants reassessment.
- Significant impact on daily life: If symptoms are severely disrupting work, social activities, or mental health, professional help from both a medical and psychological perspective should be sought.
Living With a Colic Cord: Practical Advice
Managing a colic cord in the context of chronic IBS requires a holistic, patient-centered approach. Beyond the specific medical and dietary interventions described above, the following practical strategies can help patients better navigate their daily lives:
Keep a Symptom Diary
Recording your symptoms, meals, stress levels, sleep quality, and bowel habits in a daily diary can be invaluable for identifying patterns and triggers. This information is also extremely useful during medical consultations, allowing your doctor to tailor recommendations more precisely.
Educate Yourself (from Reliable Sources)
Understanding your condition reduces anxiety and empowers you to make informed decisions. However, be cautious about online health information. Prioritize reputable sources such as peer-reviewed journals, established medical organizations, and healthcare professionals.
Build a Support Network
Chronic gastrointestinal conditions can be isolating, particularly given the stigma sometimes associated with bowel problems. Connecting with others who share similar experiences, whether through support groups, patient organizations, or online communities, can provide emotional support and practical coping strategies.
Communicate Openly with Your Doctor
IBS and related conditions respond best to a collaborative, ongoing relationship between patient and healthcare provider. Do not hesitate to report new symptoms, ask questions about your treatment plan, or request referral to a gastroenterologist if your symptoms are not adequately controlled.
Be Patient with Treatment
Finding the optimal combination of dietary, lifestyle, and pharmacological interventions often takes time. Results may not be immediate, and some approaches may need to be tried and adjusted. Persistence and a positive, proactive mindset are important allies.
Frequently Asked Questions
Can a colic cord be felt by the patient themselves?
Yes. Many patients first notice the colic cord themselves during self-palpation of the abdomen, often prompted by discomfort or pain. The characteristic firm, elongated mass along the left (or, less commonly, right) abdomen is often detectable by the patient as well as by a physician during examination.
Is a colic cord the same as a hernia?
No. A hernia involves the protrusion of an organ or tissue through a weakness in the surrounding muscular wall and has a distinctly different presentation, typically presenting as a soft, reducible lump that may disappear when the patient lies down. A colic cord is a firm, cord-like structure within the abdominal cavity itself and has a different mechanism, appearance, and clinical significance.
Can stress alone cause a colic cord?
Stress does not directly cause a colic cord, but it is a powerful trigger for IBS flares, during which a colic cord may become more pronounced. Stress modulates gut motility through the gut-brain axis and can exacerbate intestinal spasm significantly.
Should I change my diet immediately if I notice a colic cord?
You should consult your doctor before making significant dietary changes. While a generally healthful diet is always beneficial, some specific dietary protocols, such as the low-FODMAP diet, should be implemented under professional guidance to ensure nutritional adequacy and proper application.
Can children have a colic cord?
Intestinal spasm and functional abdominal symptoms can occur in children, but the specific presentation and management differ from adults. Any palpable abdominal mass in a child should be evaluated by a pediatrician.
Bibliography and Sources
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Lacy, B.E., Mearin, F., Chang, L., et al. (2016). Bowel disorders. Gastroenterology, 150(6), 1393–1407. https://doi.org/10.1053/j.gastro.2016.02.031
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Ford, A.C., Sperber, A.D., Corsetti, M., Camilleri, M. (2020). Irritable bowel syndrome. The Lancet, 396(10263), 1675–1688. https://doi.org/10.1016/S0140-6736(20)31548-8
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Drossman, D.A., Morris, C.B., Schneck, S., et al. (2002). International survey of patients with IBS: symptom features and their severity, health status, treatments, and risk taking to achieve clinical benefit. Journal of Clinical Gastroenterology, 45(8), 693–700.
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Canavan, C., West, J., Card, T. (2014). The epidemiology of irritable bowel syndrome. Clinical Epidemiology, 6, 71–80. https://doi.org/10.2147/CLEP.S40245
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Halmos, E.P., Power, V.A., Shepherd, S.J., Gibson, P.R., Muir, J.G. (2014). A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology, 146(1), 67–75. https://doi.org/10.1053/j.gastro.2013.09.046
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Khanna, R., MacDonald, J.K., Levesque, B.G. (2014). Peppermint oil for the treatment of irritable bowel syndrome: a systematic review and meta-analysis. Journal of Clinical Gastroenterology, 48(6), 505–512.
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Johannesson, E., Simrén, M., Strid, H., Bajor, A., Sadik, R. (2011). Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. The American Journal of Gastroenterology, 106(5), 915–922.
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Ford, A.C., Harris, L.A., Lacy, B.E., Quigley, E.M.M., Moayyedi, P. (2018). Systematic review with meta-analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome. Alimentary Pharmacology & Therapeutics, 48(10), 1044–1060.
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Enck, P., Aziz, Q., Barbara, G., et al. (2016). Irritable bowel syndrome. Nature Reviews Disease Primers, 2, 16014. https://doi.org/10.1038/nrdp.2016.14
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Camilleri, M. (2021). Diagnosis and treatment of irritable bowel syndrome: a review. JAMA, 325(9), 865–877. https://doi.org/10.1001/jama.2020.22532
