Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a common digestive disorder that affects the large intestine. With IBS, you may have symptoms such as stomach pain, bloating, gas and changes in your bowel habits. IBS doesn’t damage your intestines permanently or affect how long you will live, but it can have a strong impact on your quality of life.

If you have IBS symptoms, you may feel embarrassed and avoid getting care. Because symptoms may come and go, you may wonder if they are all in your head. But when you understand IBS symptoms and you know how to manage them, you can reduce discomfort and improve your well-being. 

Understanding IBS

Irritable bowel syndrome (IBS) is a disorder where symptoms affect your digestive tract, especially your large intestine. Unlike inflammatory bowel diseases, IBS doesn’t change your bowel tissue. Instead, it prevents your bowel from working normally. 

IBS is common. In fact, it’s the most common disease diagnosed by doctors who specialize in digestive diseases. But only about half of the people who have IBS seek treatment. 

IBS is a long-lasting (chronic) condition, so you’ll need to manage it over time. There aren’t any quick fixes.

Symptoms of IBS

If you have IBS, you may notice common symptoms including:

• Changes in your bowel habits, including diarrhea, constipation or both
• Changes in how your stool looks
• Abdominal pain, discomfort or cramping with or before bowel movements
• Bowel movements that are more or less frequent than usual
• Bloating, gas or flatulence
• Nausea
• Mucus in your stool
• The need to pass a stool urgently
• A feeling that you still need to empty your bowels after you pass a stool

Sometimes, the symptoms may go away after you have a bowel movement. Symptoms are different from one person to another.

It’s important to understand how IBS can affect your daily life so you can find support and ways to cope. If you have IBS, you may face challenges such as:

• Disruptions to your daily routines that affect your work, social activities and commitments.
• Stress, anxiety and a negative impact on your mental health.
• Dietary restrictions, which can influence your food choices and social interactions.

IBS causes, triggers and risk factors

It’s not clear exactly what causes IBS, but one or more of these factors might play a role:

• Genetics 
• Lifestyle habits
• Environmental factors
• The way the muscles in your intestine contract
• Problems with the nerves in your digestive system
• Infection
• Stress in childhood
• Changes in your gut microbiome

Whatever the cause, some triggers can make IBS symptoms worse. Many people with IBS notice issues linked to:

• Certain foods: Milk and other dairy products, carbonated drinks, wheat, beans, citrus fruits and cabbage.
• Stress: Stress doesn’t cause symptoms, but it may make them worse.
• Menstrual cycles: Some people notice predictable changes in their symptoms that align with their periods.

You may be more likely to have IBS if you:

• Are under age 50
• Are female, especially if you use estrogen therapy
• Have a family history of IBS
• Have mental health issues such as post-traumatic stress disorder (PTSD), anxiety or depression
• Have been abused in the past

Diagnosing IBS

If you have symptoms of IBS, you’ll want to see a health care provider for a diagnosis. To diagnose IBS, your provider will want to confirm that you have IBS symptoms and rule out other digestive conditions that could be causing them, especially inflammatory bowel diseases (IBD). 

The process may involve:

• A detailed medical history, focusing on what your symptoms feel like, how long you’ve had them, dietary habits and lifestyle factors.
• A physical examination to check your overall health and look for any signs related to IBS.
• Questions about how long you have had IBS symptoms. Providers often use the Rome Criteria, which includes belly pain or discomfort at least one day a week for the last three months, plus at least two of these symptoms:
  • Pain when you pass a stool
  • A change in how often you have a bowel movement
  • A change in the consistency of your stools
• Blood tests, breath tests or stool tests to rule out other conditions, such as lactose intolerance, bacterial overgrowth, celiac disease or inflammatory bowel diseases.
• Imaging studies like colonoscopy, sigmoidoscopy, endoscopy or abdominal imaging to rule out other digestive disorders.

There are four different types of IBS:

• Constipation-predominant (IBS-C)
• Diarrhea-predominant (IBS-D)
• Mixed (IBS-M), with both constipation and diarrhea
• Unclassified (IBS-U), which doesn’t meet the definition of any of the other types

Lifestyle changes that can help manage IBS

Lifestyle changes may help control your symptoms and improve your overall well-being. Responses to lifestyle changes are different for everyone, so work with your provider to tailor them to your needs.

Treatment can take some time before you see results. Staying consistent with your treatment plan may lessen your symptoms over time. Here are some strategies to try:

• Eat small, regular meals and try not to skip meals or eat close to bedtime.
• Gradually increase the fiber in your diet by adding more fruits, vegetables and whole grains. You may also want to talk to your provider about taking fiber supplements. Fiber can help regulate your bowel movements.
• Keep a food diary so you can identify and avoid foods that may trigger IBS symptoms. Common triggers include certain types of dairy, foods that cause gas, chewing gum, carbonated drinks, gluten, spicy foods and artificial sweeteners.
• Consider a low FODMAP diet, where you get the nutrients you need from foods that are easier to digest. Talk to your provider or a dietitian first, since diets like this aren’t right for everyone.
• Drink plenty of fluids, especially water.
• Reduce stress levels with mindfulness and relaxation techniques, such as deep breathing exercises or meditation. Take regular breaks to relax and unwind. Balancing work and rest is important for managing stress.
• Get regular low-impact exercise, such as walking, swimming or yoga, to help with regular bowel movements and lower stress. A consistent exercise routine may help keep your digestive system on track and improve your gut health.
• Get enough restorative sleep.
• Consider therapy so you can learn coping skills that may reduce symptoms.

Medications for IBS

Your provider may work with you to develop a personalized treatment plan based on your symptoms and needs. You may be able to control IBS with lifestyle changes alone. If not, your plan may include:

• Antispasmodic medications, such as hyoscyamine and dicyclomine, which help reduce muscle spasms in the intestines. This may help with pain.
• Fiber supplements, such as psyllium or methylcellulose, to help you have regular bowel movements if you have IBS-C.
• Laxatives, if fiber isn’t helping enough.
• Anti-diarrheal medications, like loperamide, if you have IBS-D.
• Selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) to help regulate bowel function and reduce symptoms.
• Tricyclic antidepressants, which can lower the activity of neurons in your intestines to reduce pain.
• Probiotics, which contain good bacteria and may promote a healthy gut microbiome and reduce symptoms.
• Other medications that can help with IBS, such as dicyclomine (Bentyl), hyoscyamine (Levsin), linaclotide (Linzess), lubiprostone (Amitiza), plecanatide (Trulance) or rifaximin (Xifaxan).

It’s important to work with a health care provider before you start taking any medication to treat IBS symptoms. A provider can tailor treatment for IBS to your needs, recommend a combination of medication and lifestyle changes, monitor you for side effects and make sure any medications you take are safe if you have other health conditions.