Irritable Bowel Syndrome (IBS)

Overview

What is irritable bowel syndrome (IBS)?

Irritable bowel syndrome, or IBS, is a group of symptoms that affect your digestive system. It’s a common but uncomfortable gastrointestinal disorder. People with IBS get excessive gas, abdominal pain and cramps.

What is a functional GI disorder?

IBS is a type of functional gastrointestinal (GI) disorder. These conditions, also called disorders of the gut-brain interaction, have to do with problems in how your gut and brain work together.

These problems cause your digestive tract to be very sensitive. They also change how your bowel muscles contract. The result is abdominal pain, diarrhea and constipation.

What are the different types of IBS?

Researchers categorize IBS based on the type of bowel movement problems you have. The kind of IBS can affect your treatment. Certain medicines only work for certain types of IBS.

Often, people with IBS have normal bowel movements some days and abnormal ones on other days. The type of IBS you have depends on the abnormal bowel movements you experience:

  • 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 on the same day.

How does IBS affect my body?

In people with IBS, the colon muscle tends to contract more than in people without the condition. These contractions cause cramps and pain. People with IBS also tend to have a lower pain tolerance. Research has also suggested that people with IBS may have excess bacteria in the GI tract, contributing to symptoms.

What are other names for IBS?

You may hear these names for IBS:

  • Irritable bowel.
  • Irritable colon.
  • Spastic colon.
  • Nervous stomach, since symptoms often happen when you’re feeling emotional stress, tension and anxiety.

Who is at risk for developing IBS?

The condition most often occurs in people in their late teens to early 40s. Women can be twice as likely than men to get IBS. IBS may happen to multiple family members.

You may be at higher risk if you have:

What triggers IBS?

If you have IBS, you may have noticed that certain things trigger symptoms. Common triggers include some foods and medication. Emotional stress can also be a trigger. Some researchers suggest that IBS is the gut’s response to life’s stressors.

How common is IBS?

Experts estimate that about 10% to 15% of the adult population in the United States have IBS. However, only 5% to 7% receive an IBS diagnosis. It’s the most common disease that gastroenterologists diagnose.

Symptoms and Causes

What are the causes of IBS?

Researchers don’t exactly know what causes IBS. They think a combination of factors can lead to IBS, including:

  • Dysmotility: Problems with how your GI muscles contract and move food through the GI tract.
  • Visceral hypersensitivity: Extra-sensitive nerves in the GI tract.
  • Brain-gut dysfunction: Miscommunication between nerves in the brain and gut.

What are IBS symptoms?

Symptoms of IBS include:

  • Abdominal pain or cramps, usually in the lower half of the abdomen.
  • Bloating.
  • Bowel movements that are harder or looser than usual.
  • Diarrhea, constipation or alternating between the two.
  • Excess gas.
  • Mucus in your poop (may look whitish).

Women with IBS may find that symptoms flare up during their periods. These symptoms often happen again and again, which can make you feel stressed or upset. As you learn management techniques and gain control over flare-ups, you’ll start to feel better, physically and mentally.

Diagnosis and Tests

How is IBS diagnosed?

If you’ve been having uncomfortable GI symptoms, see your healthcare provider. The first step in diagnosing IBS is a medical history and a physical exam. Your provider will ask you about your symptoms:

  • 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. Blood tests, stool samples and X-rays can help rule out other diseases that mimic IBS.

Will I need a colonoscopy?

Depending on your symptoms, medical history and other factors, your provider may recommend a flexible sigmoidoscopy or colonoscopy to examine your colon in more detail. These two outpatient procedures are similar. The difference is that a sigmoidoscopy examines just the lower half of the colon. A colonoscopy examines the entire colon.

A flexible sigmoidoscopy can help evaluate bowel disorders, rectal bleeding or polyps. Your provider will:

  1. Insert a sigmoidoscope, a long, thin, flexible instrument, into the rectum.
  2. Advance the sigmoidoscope to the colon.
  3. View the lining of the rectum and lower part of the colon.

Here’s what you can expect during a colonoscopy. Your provider will:

  1. Insert the colonoscope through the rectum.
  2. Advance the scope and examine the entire colon.
  3. Remove small amounts of tissue for a biopsy (if necessary).
  4. Identify and remove small growths called polyps (if necessary).

Often, providers can make an accurate diagnosis and even deliver treatment using a colonoscopy. A colonoscopy is a much less invasive procedure compared to an abdominal operation.

Do I need to see a gastroenterologist?

If you have IBS symptoms, first talk to your primary care physician or regular healthcare provider. Your provider may refer you to a gastroenterologist.

A gastroenterologist is a doctor who specializes in diagnosing and treating diseases of the digestive system, including:

Management and Treatment

What is IBS treatment?

No specific therapy works for everyone, but most people with IBS can find a treatment that works for them. Your healthcare provider will personalize your IBS treatment plan for your needs. Typical treatment options include dietary and lifestyle changes. A dietitian can help you create a diet that fits your life.

Many people find that with these changes, symptoms improve:

Dietary changes:

  • Increase fiber in your diet — eat more fruits, vegetables, grains and nuts.
  • Add supplemental fiber to your diet, such as Metamucil® or Citrucel®.
  • Drink plenty of water — eight 8-ounce glasses per day.
  • Avoid caffeine (from coffee, chocolate, teas and sodas).
  • Limit cheese and milk. Lactose intolerance is more common in people with IBS. Make sure to get calcium from other sources, such as broccoli, spinach, salmon or supplements.
  • Try the low FODMAP diet, an eating plan that can help improve symptoms.

Activity changes:

  • Exercise regularly.
  • Don’t smoke.
  • Try relaxation techniques.
  • Eat smaller meals more often.
  • Record the foods you eat so you can figure out which foods trigger IBS flare-ups. Common triggers are red peppers, green onions, red wine, wheat and cow’s milk.

Medical changes:

  • Your provider may prescribe antidepressant medications if you have depression and anxiety along with significant abdominal pain.
  • Other medicines can help with diarrhea, constipation or abdominal pain.
  • Probiotics may be an option for you. These “good bacteria” can help improve symptoms.
  • Talk to your provider if your symptoms don’t improve. You may need more tests to see if an underlying condition is causing the symptoms.

What happens if medications don’t work?

In some cases, symptoms don’t respond to medical treatment. Your provider may refer you for mental health therapies. Some patients find relief through:

Prevention

Can I prevent IBS?

Since there is 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.

How can I control IBS?

It may be frustrating trying to get a handle on IBS. Treatment can often be trial and error. But the good news is that nearly everyone with IBS can find a treatment that helps them.

Usually, diet and activity changes improve symptoms over time. You may need some patience as you figure out your triggers so you can take steps to avoid them. But after a few weeks or months, you should notice significant improvement in how you feel. A nutritionist can help you plan a healthy, filling diet that meets your needs.

Outlook / Prognosis

If I have IBS, does that mean I’m more likely to develop serious gastrointestinal problems?

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

Is IBS fatal?

IBS is not life-threatening. Living with this condition can be challenging because it can come and go throughout your life. But there are many ways to manage and live with IBS.

Is there a cure for IBS?

There’s no cure for IBS. The goal of treatment is to control and manage symptoms.

Living With

When should I see a healthcare provider?

See your provider if you have symptoms more than three times a month for more than three months. And if you have symptoms less often, but they interfere with your life, it’s a good idea to talk to your provider.

Some symptoms may point to a more serious problem. Contact your provider as soon as possible if you have:

  • Bleeding.
  • Fever.
  • Weight loss.
  • Severe pain.

How can I best take care of myself if I have IBS?

IBS will likely be with you for life. But it doesn’t shorten your lifespan, and you won’t need surgery to treat it. To feel your best, try to identify and avoid your triggers, including certain foods, medications and stressful situations. A dietitian can help you plan a nutritious diet around your specific needs. Talk to your healthcare provider if symptoms don’t improve.

What else should I ask my healthcare provider?

If you have IBS symptoms, ask your provider:

  • Could another condition be causing my symptoms?
  • What medications can help?
  • What foods should I avoid?
  • What other lifestyle changes should I make?
  • Can a dietitian help me?
  • Should I see a gastroenterologist?
  • When will I start to feel better?
  • Am I at risk for other health conditions?

A note from Cleveland Clinic

Living with irritable bowel syndrome, or IBS, can be challenging. IBS symptoms, such as stomach pain, diarrhea, gas and bloating, often interfere with your life. But IBS is manageable. Though there is no cure, you can control and improve symptoms through diet and lifestyle changes. If you have stomach symptoms that aren’t going away, talk to your healthcare provider. Together, you can find an IBS treatment plan that works for you.

Last reviewed by a Cleveland Clinic medical professional on 09/24/2020.

References

  • National Institute of Diabetes and Digestive and Kidney Diseases. . Accessed 9/24/2020.Irritable Bowel Syndrome (IBS) (https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome)
  • American Academy of Family Physicians. Accessed 9/24/2020.Irritable Bowel Syndrome (http://familydoctor.org/familydoctor/en/diseases-conditions/irritable-bowel-syndrome.html)
  • American Gastroenterological Association. . Accessed 9/24/2020.Irritable Bowel Syndrome (IBS) (https://gastro.org/practice-guidance/gi-patient-center/topic/irritable-bowel-syndrome-ibs/)
  • American College of Gastroenterology. Accessed 9/24/2020.Irritable Bowel Syndrome. (https://gi.org/topics/irritable-bowel-syndrome/)

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