What is irritable bowel syndrome (IBS)?
Irritable bowel syndrome (IBS) is a disorder of the intestines. It causes belly pain, cramping or bloating, and diarrhea or constipation. IBS is a long-term problem, but there are things you can do to reduce your symptoms.
Your symptoms may be worse or better from day to day, but your IBS won't get worse over time. IBS doesn't cause more serious diseases, such as inflammatory bowel disease or cancer.
What causes it?
It's not clear what causes IBS. It may be caused by problems with the way the brain communicates with the digestive tract, problems digesting certain foods, or stress. People with IBS may have sensitive intestines or problems with the muscles of the intestines. Hormonal changes and some antibiotics may trigger symptoms.
What are the symptoms?
The main symptoms of IBS are belly pain with constipation or diarrhea. Other symptoms are bloating, mucus in the stools, and a feeling that the bowels haven't completely emptied. These symptoms are real and not imagined, even though there are no structural problems in the intestines of people with IBS.
How is it diagnosed?
Most of the time, doctors can diagnose IBS from the symptoms. Your doctor will ask you about your symptoms and past health and will do a physical examination. In some cases, you may need other tests, such as stool analysis or blood tests to rule out other problems.
How is IBS treated?
Treatment for IBS usually includes making changes in your diet and lifestyle. You avoid foods that trigger your symptoms, get regular exercise, and manage your stress. If these changes don't help enough on their own, your doctor may prescribe medicines for symptoms such as pain, diarrhea, or constipation.
It isn't clear what causes IBS. The cause may be different for different people. It may be caused by problems with the way signals are sent between the brain and the digestive tract, problems digesting certain foods, or stress or anxiety. People with IBS may have unusually sensitive intestines. Or they may have problems with the way the muscles of the intestines move.
For some people with IBS, certain foods, stress, hormonal changes, and some antibiotics may trigger pain and other symptoms.
The main symptoms of IBS are belly pain with constipation or diarrhea. Other common symptoms are bloating, mucus in the stools, and a feeling that you haven't completely emptied your bowels.
Many people with IBS go back and forth between having constipation and having diarrhea. Most people have one of these more often than the other.
IBS is quite common, but most people's symptoms are so mild that they never see a doctor for treatment. Some people may have troublesome symptoms, especially stomach cramps, bloating, and diarrhea.
Because there are no structural problems in the intestines of people who have IBS, some people may think this means that the symptoms "are all in their head." This isn't true. The pain, discomfort, and bloating are real.
Symptoms of irritable bowel syndrome (IBS) may last for a long time. But IBS doesn't cause cancer or shorten your life.
The pattern of IBS varies from one person to the next and from one bout to the next. Some people have symptoms off and on for many years. You may go months or years without having any symptoms. But most people have symptoms that keep coming back. It is rare for a person to have symptoms constantly.
Between 7 and 10 out of 100 people in the world have irritable bowel syndrome.footnote 1 But most people with IBS don't see a doctor about their symptoms.
When to Call
Call your doctor if:
- You have been diagnosed with irritable bowel syndrome (IBS) and your symptoms get worse, begin to disrupt your activities, or don't respond as usual to your home treatment.
- You are more tired than usual.
- Your symptoms wake you from sleep.
- You have unexplained weight loss.
- You have decreased appetite.
- You have belly pain that is not linked with changes in bowel function or that is not relieved when you pass gas or a stool.
- You have belly pain that is now in one area (localized) more than any other area.
- You see blood in your stool.
- You have a fever.
Watchful waiting is a wait-and-see approach.
If your symptoms are mild, it might be okay to try home treatment for 1 week or longer. If you think you may have IBS, try to rule out other causes of belly problems, such as eating a new food; eating sugar-rich foods, especially milk products; eating foods containing sorbitol or other sugar substitutes; nervousness; or a stomach infection. If your symptoms don't get better or if they get worse, call your doctor.
Who to see for symptoms of IBS
The following health professionals can diagnose and treat irritable bowel syndrome (IBS):
If more tests are needed or your symptoms don't respond to treatment, it may be helpful to see a doctor who specializes in treating digestive system problems (gastroenterologist). If stress may be playing a role in IBS, it may be helpful to see a psychiatrist or psychologist.
Examinations and Tests
Most of the time, doctors can diagnose IBS from the symptoms. Your doctor will ask you about your symptoms and past health and will do a physical examination.
In some cases, you may need other tests, such as stool analysis or blood tests. These tests can help your doctor rule out other problems that might be causing your symptoms. Most people won't need tests. But some people may need them because of their age and symptoms. The amount of testing you get depends on several things: your age, how your symptoms come on and how severe they are, and how you respond to your first treatment.
Tests may include a blood test for celiac disease and a complete blood count. Other tests include sedimentation rate, which checks for inflammation in the body, and a stool analysis. A thyroid function test or a colonoscopy is sometimes done.
Treatment for IBS depends on what symptoms you have, how severe they are, and how they affect your daily life. No single treatment works best for everyone.
Treatment usually includes making changes in your diet and lifestyle. You avoid foods that trigger your symptoms. You get regular exercise, and you manage your stress. You'll likely also record your symptoms, your bowel habits, what you eat, and other daily activities that affect your symptoms. This can help you and your doctor see patterns in your symptoms. You may be able to see what things make your symptoms worse. Then you can start to avoid them.
If these changes don't help enough on their own, your doctor may prescribe medicines for symptoms such as pain, diarrhea, or constipation. Your doctor may also want you to try different medicines, or different dosages of your medicines, if your symptoms don't respond to treatment.
To reduce constipation
- Check with your doctor about increasing the amount of fibre you eat. If your doctor recommends more fibre:
- Slowly increase the amount of fibre you eat. For some people who have IBS, eating more fibre may make some symptoms worse. This includes bloating. Adding fibre slowly may help you avoid these problems.
- Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fibre.
- Take a fibre supplement, such as Benefibre or Metamucil, every day if needed. Read and follow all instructions on the label.
- Drink plenty of fluids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
- Get some exercise every day. Build up slowly to at least 2½ hours of exercise a week.
- Schedule time each day for a bowel movement. Having a daily routine may help. Take your time and do not strain when having a bowel movement.
To reduce diarrhea
You may try giving up foods or drinks one at a time to see whether symptoms improve. Limit or avoid the following:
- Caffeine, which is found in coffee, tea, cola drinks, and chocolate
- Nicotine, from smoking or chewing tobacco
- Gas-producing foods, such as beans, broccoli, cabbage, and apples
- Dairy products that contain lactose (milk sugar), such as ice cream and milk.
- Foods and drinks high in sugar, especially fruit juice, soda, candy, and other packaged sweets (such as cookies)
- Foods high in fat, including bacon, sausage, butter, oils, and anything deep-fried
- Sorbitol and xylitol, sugar substitutes found in some sugarless candies and chewing gum
Keep track of foods
- Some people with IBS use a daily food diary to keep track of what they eat and whether they have any symptoms after eating certain foods. The diary also can be a good way to record what is going on in your life.
- Stress plays a role in IBS. So if you are aware that certain stresses bring on symptoms, you can try to reduce those stresses.
Keep mealtimes pleasant
- Try to maintain a pleasant environment when you eat. This may reduce stress that can make symptoms likely to occur.
- Give yourself plenty of time to eat, rather than eating on the go. Chew your food slowly. Try not to swallow air, which can cause bloating.
- American College of Gastroenterology (2009). An evidence-based position statement on the management of irritable bowel syndrome. American Journal of Gastroenterology, 104(Suppl 1): S1–S7.
Current as of: September 8, 2021
Author: Healthwise Staff
E. Gregory Thompson MD - Internal Medicine
Adam Husney MD - Family Medicine
Current as of: September 8, 2021