Irritable Bowel Syndrome (IBS)

What is irritable bowel syndrome (IBS)?

Irritable bowel syndrome (IBS) is a group of symptoms that affect your digestive system. It’s a common but uncomfortable gastrointestinal disease, or condition that affects your intestines.

People with IBS experience symptoms that include abdominal pain and cramps. With IBS, you may also have frequent diarrhea, constipation or both. IBS doesn’t cause tissue damage in your GI (gastrointestinal) tract or increase your risk of more serious conditions, like colon cancer. Instead, it’s a chronic (long-term) condition that most people can manage by changing their routines and what they eat, taking medications and receiving behavioral therapy.

What are the types of IBS?

Researchers categorize IBS based on how your stools (poop) look on the days when you’re having symptom flare-ups. Most people with IBS have normal bowel movements on some days and abnormal ones on others. The abnormal days define the kind of IBS you have.

• IBS with constipation (IBS-C): Most of your poop is hard and lumpy.
• IBS with diarrhea (IBS-D): Most of your poop is loose and watery.
• IBS with mixed bowel habits (IBS-M): You have both hard and lumpy bowel movements and loose and watery movements.

The differences are important. Certain treatments only work for specific types of IBS.

How common is IBS?

It’s very common. Experts estimate that about 10% to 15% of adults in the United States have IBS. Only about 5% to 7% see a provider and receive a diagnosis.

It’s the most common disease that gastroenterologists (experts in GI diseases) diagnose.

What are the symptoms of IBS?

Symptoms of IBS can appear frequently. Or, they may occur during flare-ups. In other words, you don’t always experience symptoms. Instead, symptoms may go away (and you’ll have normal bowel movements). At other times, symptoms return.

Signs and symptoms of IBS include:

• Abdominal pain or cramps, usually related to the urge to poop.
• Excess gas and bloating.
• Diarrhea, constipation or alternating between the two.
• Mucus in your poop (may look whitish).
• Feeling like you’re unable to empty your bowels after pooping.

What causes IBS?

Researchers don’t know exactly what causes IBS, but they classify it as a neurogastrointestinal (GI) disorder. These conditions, also called disorders of the gut-brain interaction, have to do with problems with how your gut and brain coordinate to help your digestive system work.

Communication challenges between your brain and gut can cause:

• Dysmotility: You may have problems with how your GI muscles contract and move food through your GI tract. The colon (large intestine) muscle tends to contract more in people with IBS. These contractions cause cramps and pain.
• Visceral hypersensitivity: You may have extra-sensitive nerves in your GI tract. People with IBS tend to have a lower pain tolerance than people without it. Your digestive tract may be super sensitive to abdominal pain or discomfort.

Other potential causes of IBS include:

• Gut bacteria: Research has shown that people with IBS may have altered bacteria in their GI tract, contributing to symptoms. Studies have shown that the types and amounts of gut bacteria are different in people with IBS than in people without it.
• Severe infections: Some people get diagnosed with IBS after a severe infection affecting their GI tract, suggesting germs may play a role.
• Food intolerance: Sensitivities or allergies to certain foods may contribute to IBS.
• Childhood stress: IBS is more common in people who experienced severe stressors in childhood, including physical, sexual and emotional abuse.

IBS triggers

If you have IBS, you may have noticed that certain things trigger symptoms. A trigger doesn’t cause the condition itself, but it can cause or worsen a symptom flare-up. Common triggers include:

• Periods: You may notice symptoms worsen predictability according to your menstrual cycle.
• Certain foods: Food triggers vary from person to person. Still, common culprits that can trigger an IBS symptom flare-up include dairy, foods that contain gluten (like wheat) and foods/drinks known to make you gassy.
• Stress: Some researchers suggest that IBS is your gut’s response to stress. Related, this is why IBS is sometimes called “nervous stomach” or “anxious stomach.”

Risk factors for IBS

IBS most often occurs in people in their late teens to early 40s. Women are up to twice as likely to get diagnosed with IBS. Other risk factors include:

• Intolerance to certain foods.
• Severe digestive tract infection.
• History of abuse.
• Diagnosis of anxiety, depression or post-traumatic stress disorder (PTSD).

Many people with IBS also have other chronic pain conditions. Conditions associated with an increased risk of IBS include:

• Fibromyalgia.
• Chronic fatigue syndrome.
• Chronic pelvic pain.

How is IBS diagnosed?

The first step in diagnosing IBS is a detailed medical history. Your provider will ask about your symptoms. They may ask:

• Do you have pain related to bowel movements?
• Do you notice a change in how often you have a bowel movement?
• Has there been a change in how your poop looks?
• How often do you have symptoms?
• When did your symptoms start?
• What medicines do you take?
• Have you been sick or had a stressful event in your life recently?

Depending on your symptoms, you may need other tests to confirm a diagnosis. There isn’t a single test to diagnose IBS. Instead, your provider will determine if you have IBS by:

• Asking about your symptoms.
• Making sure you’re up to date on your colon cancer screening.
• Checking that you don’t have symptoms suggesting other disorders.

Lab tests

Most lab tests exclude other conditions that may be causing your symptoms, like an infection, food intolerance or a different digestive condition, like inflammatory bowel disease (IBD). Not everyone needs the same tests.

• Blood test: To check for a digestive disease condition or another condition that may cause your symptoms.
• Stool test: To check for an infection or signs of inflammation in your bowel caused by a digestive condition.
• Hydrogen breath test: To see if you have an overgrowth of bacteria in your gut (SIBO) or a food intolerance.

Imaging tests

You may need imaging procedures to rule out conditions involving inflammation or abnormal growths in your GI tract.

• Colonoscopy: Can help your provider determine if you have certain bowel disorders that may be causing your symptoms, including polyps, IBD and cancerous growths. For this procedure, a provider inserts a scope that allows them to view your entire colon.
• Flexible sigmoidoscopy: Similar to a colonoscopy, except a provider inserts a scope that allows them to view the lining of your rectum and the lower part of your colon only.
• Upper endoscopy: Can help your provider diagnose celiac disease or other GI conditions. This procedure uses a scope that allows your provider to see inside your esophagus (food tube), stomach and the first part of your small intestine (duodenum).

What is the treatment for IBS?

No specific therapy works for everyone, but most people with IBS can find a treatment plan that works for them. Typical treatment options include changing the foods you eat and your routine. Medications can help, too. Behavioral health therapy may help.

Many of these treatments take time to work. They can help your symptoms, but your symptoms may not go away completely.

Meal changes

A dietitian can help you choose foods and modify eating/drinking habits to avoid symptom flare-ups. They may recommend that you:

• Increase fiber in your diet. Fiber-rich foods, including fruits, vegetables, grains, prunes and nuts, can help if you’re struggling with constipation. Introduce fiber slowly into your diet to give your gut time to adjust.
• Add supplemental fiber to your diet. Another option is to try fiber supplements, like Metamucil® or Citrucel®.
• Limit dairy products, like cheese and milk. Lactose intolerance is more common in people with IBS. If you cut back on dairy, make sure to eat nondairy foods rich in calcium, like broccoli, spinach or salmon.
• Limit foods that can make you gassy. Foods like beans, brussels sprouts and cabbage are notorious for causing gas, but carbonated sodas and even chewing gum can make you gassy. Reduce these foods to go easier on your gut.
• Avoid gluten. People with IBS — even those without celiac disease — tend to be more sensitive to gluten. If you opt for a gluten-free diet, work with your provider to ensure you’re getting enough of the key vitamins and minerals (like fiber, iron and calcium) often found in foods with gluten.
• Try the low FODMAP diet. This food plan reduces the amount of hard-to-digest carbohydrates you eat. It recommends alternatives that allow you to get the nutrients you need while going easier on your GI tract.
• Drink plenty of water. Drink at least eight 8-ounce glasses of water a day (2 liters). Water keeps your GI tract lubricated and can help treat or prevent constipation.
• Keep a food diary. Your provider may recommend that you note the foods you eat to determine which foods trigger IBS flare-ups and then bring this to a nutritionist.

Activity changes

Changing daily activities can help, too. Your provider may recommend that you:

• Exercise regularly. Aim for 150 minutes of moderate exercise weekly. This is about 30 minutes a day, five days a week. “Moderate” means you’re raising your heart rate.
• Try relaxation techniques. Daily yoga, meditation and other de-stressing techniques can help calm an overtaxed nervous system and a “nervous gut.” Sometimes, a behavioral therapist can help.
• Get enough sleep. Aim for seven to nine hours of quality sleep each night. Go to bed at the same time each night. A good night’s rest is one of the most powerful de-stressors available. Reach out to a provider if you’re having trouble sleeping.
• Keep an activity diary. Record the activities that help you manage your IBS and compare notes with your provider.

Therapy

Many people with IBS benefit from seeing a therapist. Therapy can help you get a handle on stress and conditions such as anxiety and depression that contribute to IBS. Some people find relief through:

• Cognitive behavioral therapy (CBT).
• Hypnotherapy.
• Biofeedback.

Medications

Your healthcare provider may prescribe medications to provide symptom relief, including:

• Antidepressants (if you have depression and anxiety along with significant abdominal pain). Medications include tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs).
• Medications to ease constipation (including fiber supplements and laxatives).
• Medications to firm stools (anti-diarrheals).
• Medications to help with intestinal spasms.

Although research into their effectiveness is ongoing, your provider may recommend probiotics. These “good bacteria” may help relieve IBS symptoms.

Medications specifically used to treat IBS include:

• Dicyclomine (Bentyl®).
• Hyoscyamine (Levsin®).
• Lubiprostone (Amitiza®).
• Linaclotide (Linzess®).
• Plecanatide (Trulance®).
• Rifaximin (Xifaxan®).

Is there a cure for IBS?

There isn’t a cure for IBS. But, most people manage symptoms by avoiding triggers and taking medications when necessary.

Can I prevent IBS?

Since there’s no known cause for IBS, you can’t prevent or avoid it. If you have IBS, you can keep symptoms from flaring up by avoiding triggers.

Does having IBS increase my risk of developing serious gastrointestinal problems?

No, IBS doesn’t put you at higher risk of developing conditions such as colitis, Crohn’s disease or colon cancer.

What can I expect if I have IBS?

Living with IBS can be challenging because symptoms come and go throughout your life. Treatment often involves trial and error. But the good news is that nearly everyone with IBS can find a treatment that helps them over time.

Usually, changing the foods you eat and your activity levels improve symptoms with time. You may need some patience as you figure out your triggers and take steps to avoid them. Your symptoms may not completely disappear. But, after a few weeks or months, you should notice a significant improvement in how you feel.

When should I see a healthcare provider?

See your provider if your symptoms continue for more than three months or if they’re getting worse. If you have symptoms less often, but they interfere with your life, it’s still a good idea to talk to your primary care provider.

Some symptoms may indicate a more serious problem. Contact your provider as soon as possible if you have common IBS symptoms alongside:

• Fever.
• Vomiting.
• Rectal bleeding.
• Unexplained weight loss.
• Diarrhea so severe it wakes you up at night.
• Severe abdominal pain (especially that doesn’t improve when you poop or pass gas).

What questions should I ask my healthcare provider?

If you have IBS symptoms, ask your provider:

• What medications can help?
• What foods should I avoid?
• What lifestyle changes should I make?
• When will I start to feel better?