Irritable Bowel Syndrome (IBS)

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Irritable Bowel Syndrome: Overview

In general, treatments for IBS are directed towards the patient’s main symptoms. There are a wide variety of treatment options. Many improve individual symptoms, but only a small number help with global symptoms of IBS. ACG's guidelines will help you and your doctor make the best decisions for your symptom management. Learn More

Symptoms

Audio Podcasts: ACG Experts Answer Your Most Common Questions

Clinician Resources

• ACG Clinical Guideline: Management of Irritable Bowel Syndrome (The American Journal of Gastroenterology: January 2021, 116(1), 17-44)
• Constipation and Defecation Problems
• Tips for Belly Breathing
• Fecal Incontinence and Chronic Constipation
• Optimizing the Patient-Provider Relationship

Overview

• What is Irritable Bowel Syndrome?
  • Irritable bowel syndrome (IBS) is a condition that leads to belly pain and problems with bowel movements (constipation, diarrhea, or both.) People with IBS may have bloating, gas, or a change in how their bowel movements look.
  • IBS is common – 10% to 15% of people in the United States have it. It is more common in women, but anyone can be affected.
  • IBS is a lifelong problem that can be challenging to manage. But it does not cause more serious problems like colon cancer. Effective treatment options are available.

Symptoms

• Belly Pain associated with stool changes including diarrhea or constipation, gas, bloating

  Recurring belly pain can occur with bowel movements. People can also see change in what their poop looks like and how often they have bowel movements. They can have diarrhea and/or constipation, increased gas, or bloating. IBS is NOT associated with weight loss, blood in the stool, or waking up at night to have bowel movements. It does not commonly start in people older than 50.

  You can still have IBS, even if you do not have all of these problems. You should talk to your doctor to see what treatments may help you.

  Studies show that IBS is caused by changes in the nerves and muscles that control gut sensation and movement . IBS is not “in your head,” but it can be worsened by stress and anxiety. Remember, IBS is a real medical condition, but it is not life threatening. It will not lead to other serious diseases. Your bowels just work differently than most people.

Causes

• What Causes Irritable Bowel Syndrome?

  We do not really know what causes IBS. We do think that it is due to problems with how the bowels work. In recent years, we have discovered certain chemicals in the gut which send signals from the intestines to the brain. Learning about these have helped make pills to treat IBS.

  We do think that IBS can be due to problems that continue after people have had a bowel infection. This can persist even after the infection is gone. We also think that it could be because of overgrowth of normal good bugs or getting bad bugs growing in the gut.

  It does not seem like IBS comes from "food intolerance" or allergies. If you have bad IBS that doesn’t get better with treatment, your doctor may check you for celiac disease. This is a severe allergy to the protein gluten, which is found in wheat. Celiac disease can cause problems that are a lot like IBS.

• What should I do if I think I have IBS?
  • See your doctor to review your symptoms. IBS is diagnosed based on symptoms and does not usually require having a lot of tests done. Your doctor can decide if you need to be checked for other conditions.
  • IBS does not cause weight loss or bleeding with bowel movements. Make sure to see a doctor if you notice these symptoms.
  • If you are an adult age 45 or older, talk to your doctor about getting screened for colon cancer. If you have a family history of colon cancer, you may need to do this before age 45.

Treatment Options

• What can I do to manage IBS symptoms?

  Most treatment for IBS is focused on changes in lifestyle, the type of food you eat, and decreasing your level of stress.

  • Try not to eat gassy foods such as beans, onions, broccoli, Brussel sprouts or cabbage. Some people have trouble with wheat, dairy products, and some fruits like bananas, apples, apricots, peaches, pears and plums. Consider meeting with a dietician to help with this.
  • Taking more dissolvable fiber in your diet can help to decrease your symptoms, especially if you are constipated. You should make sure to drink plenty of water before adding fiber to your diet. Fiber without enough fluid can make your constipation worse. Start with a small amount and increase it slowly.
  • Avoid any other foods that you have found to cause your IBS symptoms.

  Stress makes it harder to live with any condition. IBS and its symptoms are no exception. Some people will feel better with relaxation techniques and regular exercise or having a hobby. Meeting with a counselor can also help.

• What Medical Treatments are Used for Symptoms of IBS?

  There is no cure for IBS. Medicines that can improve IBS are used to help symptoms and help people feel better. Only a few treatments have been shown to help all the symptoms of IBS. None will help every patient with IBS.

  • Belly pain or cramping can be helped by peppermint oil or medicine that relaxes your bowels.
  • Anti-diarrheal drugs reduce the frequency of bowel movements in people with IBS with diarrhea.
  • Laxatives increase stool frequency in IBS with constipation.
  • Rifaximin is an antibiotic has been shown to reduce symptoms in some IBS patients with diarrhea.
  • Anti-depressant medicines can work on the nerves in the gut and can reduce pain due to IBS.
  • Other medicines are available that either slow or increase movement of your bowels and can help reduce gut pain.
  • Some medicines increase the movement of fluid into the gut. This can help people who have IBS with constipation.
  • Meeting with a psychologist may also be helpful to IBS patients.

Author(s) and Publication Date(s)

Elizabeth Huebner, MD, FACG, Washington University School of Medicine, St. Louis, MO – Updated January 2022

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IBS FAQs

• What Is Irritable Bowel Syndrome (IBS)?

  Irritable bowel syndrome (IBS) is a problem with how your bowels work. They can have other problems like bloating, gas, or wanting to poop more often.

  IBS is NOT:

  • A problem with the structure or lining of your bowels
  • Caused by physical or chemical disorder
  • A cancer and will not cause cancer
  • The start of other serious problems
  • Something you have to 'just live with'

  Scientific test show that IBS is caused by changes in the nerves and muscles that control sensation and motility of the bowel. IBS is not “in your head,” but it can be worsened by stress and anxiety. Remember, IBS is a real medical condition, but it is not life threatening, and will not lead to other serious diseases. Your bowels just work differently than most people.

• How Common is IBS?

  IBS is a very common disorder and scientific tests show that about 10% to 15% of people in the United States have it. IBS is more common in women with almost twice as many women having it than men.

  We do not really know why women get IBS easier than men. It does not seem to be because they have different hormones than men. It seems to be because women may feel sensations from the intestines differently. IBS seems to be the same in all different types of people here and around the world. IBS is one of the most common disorders seen by doctors.

• How Does IBS Affect Patients' Lives?

  IBS can really cause people to have problems living a good life. IBS symptoms can be bad enough to cause them to miss school or work, or reduce social activities. Some may skip meals or make other changes to diet and nutrition. According to research, people with IBS make more visits to their doctors and undergo more tests. They are prescribed more medicines, miss more workdays, and are less effective at work. They go to the hospital more frequently and spend more money for healthcare than patients without IBS.

• Are There Different Types of IBS?

  Generally, doctors think that IBS is different in people due to the type of problems they are having. They group these into IBS with constipation, IBS with diarrhea, or IBS with mixed symptoms. Abdominal discomfort or pain is present in all groups. There are similar numbers of people in each of these groups. By determining the IBS group that you belong to, your doctor can find the right treatment for you. Make sure you tell all of your symptoms to your doctor so they can know how best to treat you.

• What Causes Bowel Symptoms in Irritable Bowel Syndrome?

  We do not really know what causes IBS. We do think that it is due to problems with how the bowels work. Most people experience their symptoms off and on. They have diarrhea or constipation that comes with belly pain, cramping, or bloating.

• When Should You See the Doctor?

  If you have constipation or diarrhea that comes and goes, belly pain or discomfort, and/or bloating, you may have a real and treatable problem called IBS. You should see your doctor to discuss your symptoms.

• What is a Gastroenterologist?

  A gastroenterologist is a physician who specializes in disorders and conditions of the bowels, liver, and pancreas. These doctors are specially trained to look for and treat problems like IBS.

• How is IBS Diagnosed?

  The doctor will start by asking you about what is going on. It is important for the doctor to understand the problems you are having. Make sure to explain what is happening to your doctor. Tell your doctor about your belly discomfort, bloating, and your bowel symptoms. Your doctor may ask if you strain or have problems having a bowel movement. They may ask you to describe the appearance of your bowel movement. Your doctor will make sure you do not have any other more dangerous problems. Your doctor will ask if you have noticed bleeding, weight loss, fever, low blood counts, or diarrhea that won’t stop. These problems may need to be looked into more.

  For most people with IBS, a doctor can figure this out by talking to you, examining you, and doing a few blood tests. Sometimes additional testing is needed to look for more dangerous problems. People over the age of 45 should have a screening test done for colon cancer.

• Recommendations on Diagnostic Testing in IBS

  In people with problems that look just like IBS, a lot of tests are not needed and can be expensive and unhelpful. Blood tests for celiac disease may be helpful in patients with IBS and a lot of diarrhea or both diarrhea and constipation. Lactose intolerance can be checked by testing your breath and may be suggested by your doctor.

• Treatment by Adjusting Lifestyle, Diet & Stress

  Most treatment for IBS is focused on changes in lifestyle, the type of food you eat and decreasing your level of stress. Some changes in the diet can help and are safe to try. Up to 90% of IBS patients stop eating some foods trying to improve their problems. Keeping a diary of what you eat and what symptoms you have can help you figure out what to stop.

  • For patients who have a lot of bloating, try to slow down when you eat and do not overeat./li>
  • Avoid a lot of sugar substitutes, since these can sometimes cause more gas, bloating, cramping, and diarrhea.
  • Try not to eat gassy foods, such as beans, onions, broccoli, Brussel sprouts or cabbage. Some people have trouble with wheat, dairy products, and some fruits like bananas, apples, apricots, peaches, pears and plums. IBS patients also should avoid any other foods that you have found to aggravate your IBS symptoms. Diet changes are most successful when they are supervised by a dietician.
  • Avoid chewing gum, which can lead to too much air being swallowed.
  • Taking more dissolvable fiber in your diet may help your symptoms, especially if you are constipated. You should make sure to drink enough water before adding fiber to your diet. Fiber without enough fluid can make your constipation worse. Start with a small amount and increase it slowly.
  • When you make any change to your diet, then do it gradually to give your body time to adjust. Stress makes it harder to live with any condition. IBS and its symptoms are no exception. Some people will feel better with relaxation techniques and regular exercise or having a hobby. Meeting with a counselor can also help.
• What Other Treatments are Used for Symptoms of IBS?

  There is no cure for IBS. Medicines that can improve IBS are used to help symptoms and help people feel better. Only a few treatments have been shown to help all the symptoms of IBS. None will help every patient with IBS.

  • Scientific studies suggest that psyllium fiber can be helpful for constipation.
  • Belly pain or cramping can be helped by peppermint oil or medicine that relaxes your bowels.
  • Anti-diarrheal drugs reduce the frequency of bowel movements in people with IBS with diarrhea.
  • Laxatives increase stool frequency in IBS with constipation.
  • Rifaximin is an antibiotic has been shown to reduce symptoms in some IBS patients with diarrhea.
  • Other medicines are available that either slow or increase movement of your bowels and help reduce gut pain.
  • Anti-depressants seem to help the pain of IBS patients. These drugs are used in low doses to reduce pain in IBS, and not to treat depression.
  • Some medicines increase the movement of fluid into the gut. This can help people who have IBS with constipation.
  • Meeting with a counselor may also be helpful to IBS patients.
• What are Some Key Points to Remember about IBS?

  Symptoms of abdominal discomfort, bloating, diarrhea, and/or constipation may be part of a real medical condition called IBS

  • Through no fault of their own, patients have spent a significant amount of time suffering
  • Symptoms disrupt patients' everyday lives, social life and work
  • Abdominal pain, bloating, diarrhea and/or constipation characterize a major portion of IBS sufferers
  • Many sufferers do not seek care for IBS

  New therapies for IBS offer realistic hope to help restore quality of life which these patients deserve, but which many may have believed was out of reach.

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