Irritable Bowel Syndrome (IBS)

If you have an IBS symptom that lasts a long time, you get a new symptom, your pain is worse than usual, or you have new pain, see your doctor. If you usually take over-the-counter medications but now they don’t ease problems like diarrhea, gas, or cramping, you also need to see a doctor.

IBS vs. IBD

Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are very different conditions that share a few symptoms in common, such as belly discomfort and diarrhea. Both are chronic and have no known cure. But IBD is much more serious. The inflammation that it causes can damage your intestines, and the disease raises your risk of colorectal cancer. IBS, on the other hand, does not harm your gut or increase your chances of cancer or other serious health concerns. 

What Causes IBS?

While several things are known to trigger IBS symptoms, experts don't know what causes the condition.

Studies suggest that the colon gets hypersensitive, overreacting to mild stimulation. Instead of slow, rhythmic muscle movements, the bowel muscles spasm. That can cause diarrhea or constipation.

Another theory suggests it may involve chemicals made by the body, such as serotonin and gastrin, that control nerve signals between the brain and digestive tract.

Other researchers are studying to see if certain bacteria in the bowels can lead to the condition.

Risk Factors for Irritable Bowel Syndrome

IBS affects between 25 million and 45 million Americans. Some things seem to make people more likely to have it than others:

• Being assigned female at birth. About twice as many people AFAB as those assigned male at birth (AMAB) have the condition. It’s not clear why, but some researchers think the changing hormones in the menstrual cycle may have something to do with it. So far, studies haven’t borne this out.
• Age. IBS can affect people of all ages, but it's more likely to happen in people in their teens through their 40s.
• Family history. The condition seems to run in families. Some studies have shown that your genes may play a role.
• Emotional trouble. Some people with IBS seem to have trouble with stress, have a mental disorder, or have been through a traumatic event in their lives, such as sexual abuse or domestic violence. It's not clear what comes first – the stress or the IBS. But there's evidence that stress management and behavioral therapy can help relieve symptoms in some people with the condition.
• Food sensitivities. Some people may have digestive systems that rumble angrily when they eat dairy, wheat, a sugar in fruits called fructose, or the sugar substitute sorbitol. Fatty foods, carbonated drinks, and alcohol can also upset digestion. There's no proof any of these foods cause IBS, but they may trigger symptoms.
• Medications. Studies have shown a link between IBS symptoms and antibiotics, antidepressants, and drugs made with sorbitol.
• Other digestive problems, like stomach flu, traveler's diarrhea, or food poisoning. A small study published in January 2021 suggests that a GI tract infection can change the immune system so that it responds to certain foods as if they're a threat, like germs or viruses. Researchers are looking into these early findings.
• Chronic pain conditions. Several disorders that cause pain have been linked to irritable bowel syndrome, including:
  • Fibromyalgia
  • Chronic pelvic pain
  • Interstitial cystitis, which causes bladder pain
  • Migraine
  • Temporomandibular syndrome, which causes pain when chewing
  • Chronic fatigue syndrome

IBS Diagnosis

There are no specific lab tests that can diagnose IBS. Your doctor will see if your symptoms match with the definition of IBS, and they may run tests to rule out conditions such as:

• Food allergies or intolerances, such as lactose intolerance and poor dietary habits
• Medications such as high blood pressure drugs, iron, and certain antacids
• Infection
• Enzyme deficiencies where the pancreas isn't releasing enough enzymes to properly digest or break down food
• Inflammatory bowel diseases like ulcerative colitis or Crohn's disease

IBS Treatment

Nearly all people with IBS can get help, but no single treatment works for everyone. You and your doctor will need to work together to find the right treatment plan to manage your symptoms.

Many things can trigger IBS symptoms, including certain foods, medicines, the presence of gas or stool, and emotional stress. You’ll need to learn what your triggers are. You may need to make some lifestyle changes and take medication.

Lifestyle changes

Usually, with a few basic changes in activities, IBS will improve over time. Here are some tips to help ease symptoms:

• Avoid caffeine (in coffee, tea, and soda).
• Add fiber to your diet with foods like fruits, vegetables, whole grains, and nuts. Go slowly, though. Adding too much fiber at once can lead to gas and bloating. A fiber supplement may be easier on your gut than foods loaded with fiber.
• Drink at least eight glasses of water per day.
• Don't smoke.
• Learn to relax, either by getting more exercise or by reducing stress in your life. Find a relaxation technique that works for you. There are lots to choose from, including:
  • Diaphragmatic/belly breathing
  • Progressive muscle relaxation
  • Visualization/positive imagery
  • Meditation
• Eat slowly and chew your food thoroughly to ease digestion.
• Don’t skip meals. Instead, stick to a regular meal schedule to help keep your bowels moving regularly.
• Eat smaller meals more often instead of big meals.
• Keep a record of the foods you eat so you can figure out which foods bring on bouts of IBS.
• Sleep 7 to 9 hours every night, which can help relieve IBS-triggering stress
• Exercise regularly – think walking, biking, swimming, or other workouts that raise your heart rate – with a goal of at least 30 minutes a day, 5 days per week.
• Skip carbonated beverages. Those bubbles can irritate your gut.

IBS Triggers

While the cause of IBS remains unknown, it’s clear that certain things can trigger your symptoms. Avoiding those triggers can bring relief. But IBS triggers vary from person to person, so it’s important to identify those that affect you. Here are some common triggers that could be contributing to your IBS discomfort.

• Stress may cause spasms in your colon that make your symptoms worse.
• Periods. If you were assigned female at birth, you may notice that your IBS symptoms get worse during your menstrual cycle.
• Poor sleep has been linked to IBS symptoms, possibly because it contributes to stress.
• Caffeine. It's found in coffee, tea, and soda, as well as chocolate and some over-the-counter pain medications.
• Milk and milk-based foods like cheese and ice cream, which contain lactose.Yogurt’s an exception because it contains live cultures that break down lactose.
• Carbonated drinks. The bubbles may not be easy on your stomach.
• Foods and drinks that are high in fructose. These include many processed foods as well as some fruits, like apples, pears, and dried fruit, as well as fruit juices.
• Wheat. This may be due to carbs in foods like wheat bread rather than gluten.
• Artificial sweeteners. Check food labels for sorbitol, mannitol, isomalt, maltitol, and xylitol, sugar substitutes that can cause diarrhea.
• Alcohol. Drinking may worsen your symptoms.
• Cruciferous vegetables. Broccoli, cauliflower, cabbage, and Brussels sprouts, as well as leafy greens like kale and mustard greens, can cause gas and mess with your bowel movements.
• Onions, leeks, and shallots. These can make you gassy and upset your stomach.
• Beans or legumes. These contain indigestible chemicals called saccharides that can make you gassy. Baked beans, chickpeas, lentils, and soybeans are particular culprits.

Because there are so many possible triggers, you may find it helpful to keep a journal or diary to track how you react to certain foods or conditions. This can help you identify triggers and rule out suspects. Share your journal with your nutritionist or health care provider to help guide your care plan.

IBS Diet

If you have IBS, you may need to change your diet to better control your symptoms. 

Your doctor may suggest you try something called a low FODMAP diet that cuts down on different hard-to-digest carbs found in wheat, beans, and certain fruits and vegetables. 

FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Not all of these kinds of carbs may cause IBS symptoms for you, so your health care provider may suggest you start an elimination diet where you avoid eating all high FODMAP foods, then slowly reintroduce them to see which you react to. Once you know which ones trigger IBS symptoms, you can better avoid them.

Common high FODMAP foods include beans and lentils; dairy products; fruits like apples, cherries, pears, and peaches; and wheat products.

If you're concerned about getting enough calcium, you can try to get it from other foods, like spinach, turnip greens, tofu, yogurt, sardines, salmon with bones, calcium-fortified orange juice and breads, or calcium supplements.

Irritable Bowel Syndrome Complications

Because finding an IBS treatment that works can take time, other health problems can crop up in the meantime. None of the complications are life-threatening, though. IBS doesn't lead to cancer or other more serious bowel-related conditions. Here are some of the health issues it can cause:

• Impacted bowel: If you're constipated for a long time, stool can get blocked in your colon. Sometimes it can get so hard that you can't push it out. This is known as a fecal impaction. It can hurt and cause things like a headache, nausea, and vomiting. It happens most often with older adults. See your doctor right away if you have signs this may be happening.
• Food intolerance: Certain foods can make your IBS symptoms worse. What they are can be different for everyone. But some people feel better when they cut out wheat, dairy, coffee, eggs, yeast, potatoes, and citrus fruits. And fats and sugars can make diarrhea worse. Your doctor may suggest you try a FODMAP diet to cut out some carbohydrates that are hard to digest.
• Malnourishment: Cutting back on some types of foods can ease your IBS symptoms. But your body may not get all the nutrients it needs. A dietitian can help you find a diet that works for you.
• Hemorrhoids: Swollen blood vessels around your anus, the opening where stool comes out, can hurt and bleed. Very hard or very loose stools can make the situation worse. If the swollen vessels are inside your anus, they may fall far enough to stick out. You can often treat hemorrhoids at home with an over-the-counter cream. You also might try sitting on a cold ice pack. And be sure to keep the area clean.
• Pregnancy complications: Hormone changes and the physical pressure a baby puts on the bowel wall can cause digestive issues. Many people AFAB also choose to stop any IBS drugs they're taking. This can be better for the baby. But it can make parents-to-be more likely to have things like heartburn and indigestion.
• Quality of life: Flare-ups can happen without warning. Also, you may have diarrhea for a time and then be constipated. Not being able to predict how you'll feel can make it hard to go about your daily life. You also probably need to see your doctor often and are likely to miss more work than other people. It may be harder to focus when you're at your job. Managing stress, for example through exercise or meditation, can help.
• Depression and anxiety: It's common for people who have IBS to feel like they're losing control over their lives. If your symptoms are bad, you may find yourself always trying to map out the nearest bathroom. Because there's a link between your brain and gut, this kind of stress can make your IBS worse. The pain and the awkward symptoms you're dealing with can affect your mood. It may help to talk to a counselor about what's going on with you.

Takeaways

Doctors don’t know what causes IBS, but they do know that it does not raise your risk of more serious health conditions, like colorectal cancer. Still, its symptoms are unpleasant and can be painful. While no cure exists yet, treatment, including lifestyle changes, can ease your discomfort. 

Irritable Bowel Syndrome FAQs

What really causes IBS?

Experts don’t know, but it may be due to problems with the way your brain and your digestive system communicate with each other. Imbalances in your gut bacteria, serious infections, food intolerances, and stress in childhood all may contribute to IBS.

How do you treat an IBS flare-up?

Avoid your food triggers, drink plenty of water (not carbonated!), exercise, and get good sleep. Medications and fiber supplements can help control symptoms like diarrhea and constipation.

How long do IBS attacks last?

Everyone with IBS experiences it differently. For some people, symptoms occur everyday. Other people may go for long periods without symptoms. In general, episodes of IBS are frequent but unpredictable.

What should I eat during an IBS flare-up?

Choose foods that are easier on your stomach, like cooked vegetables instead of raw ones. You may find it easier to digest proteins like eggs, chicken, turkey, fish, and tofu. Cook with a minimal amount of fat, opting to roast, bake, steam, or boil foods. If you’re constipated, foods like oats and flax seeds can help.