Irritable bowel syndrome (IBS) symptoms & treatment

Irritable bowel syndrome (IBS) is usually a long-term condition. Symptoms include abdominal pain or discomfort, cramping, bloating, constipation and diarrhea. It doesn’t increase the risk of colon cancer or cause any permanent damage to the colon.

What causes IBS?

Doctors aren’t certain what causes IBS, but some studies suggest it may be related to abnormal nerve and muscle function in the gastrointestinal system and communication signals between the gut and the brain.

Most people can manage IBS with simple changes to their daily routine. IBS affects about 10% to 20% of people around the world.

Types of IBS

Researchers have identified four types of IBS:

• IBS with diarrhea (IBS-D)
• IBS with constipation (IBS-C)
• Mixed IBS (IBS-M) alternates between constipation and diarrhea
• Unsubtyped IBS (IBS-U) for people who don't fit into the other types

IBS symptoms

The most common symptoms of IBS are pain in your abdomen, often during bowel movements, and changes in your bowel movements over time. Other IBS symptoms vary and can be mild or severe. They may include:

• Anxiety and depression
• Bloating and gas
• Constipation
• Constipation alternating with diarrhea
• Cramping, usually in the lower half of the belly, that feels better after a bowel movement and gets worse after meals
• Diarrhea
• Fatigue
• Harder or looser stools than normal (pellets or flat ribbon stools)
• Headache
• Heartburn and indigestion
• Mucus in your stool
• Stress

If you’re concerned about your symptoms, contact your doctor to schedule an appointment.

Diagnosing IBS

When diagnosing IBS your doctor will ask you about your IBS symptoms and your medical history. Family medical history will likely be discussed because IBS can run in families. The doctor will also do a physical exam and ask about any abdominal pain. Diagnosis of IBS is a process of ruling out more serious conditions such as ulcerative colitis, colon cancer and celiac disease.

The doctor may also order tests, such as stool studies, to check for infection and show how your intestine takes in the nutrients from food. The doctor might also order a lactose intolerance test to find out if your symptoms may be related to a sensitivity to dairy products.

Diagnostic procedures for IBS

If necessary, your doctor might also order these diagnostic tests:

• Esophagogastroduodenoscopy (EGD): For this procedure, also called an upper endoscopy, a long, flexible tube is inserted down your throat and into the esophagus (the tube that connects your mouth and stomach). A camera on the end of the tube shows images of your upper digestive tract. During an endoscopy, a tissue sample (biopsy) may be collected. A sample of fluid also may be collected to look for overgrowth of bacteria.
• CT scan: This test produces images of your abdomen and pelvis that might rule out other causes of your potential irritable bowel syndrome symptoms, especially if you have belly pain.
• Colonoscopy: Your doctor uses a small, flexible tube to examine the entire length of the colon, looking for polyps or other abnormalities. Tissue samples can also be taken.

IBS treatments & management

If you have IBS, your Advocate Health team will help you find the right plan to treat irritable bowel syndrome, which may include changes to your diet, dietary supplements or mental health therapies to help you manage stress. Their overall focus will be to treat irritable bowel syndrome symptoms and help improve your quality of life. You may have to try a few ways to treat irritable bowel syndrome to see what works best for you.

IBS treatments might include:

• Antibiotics (if you have an infection)
• Anti-cholinergic medication, which relieves bowel spasms
• Anti-diarrheal medication
• Eliminating foods that cause gas
• Fiber supplements
• IBS-specific medication for severe cases that aren’t relieved by other IBS treatments

Health routines & stress management

• Have fun as often as possible. Take a walk, listen to music, read or discover a new hobby.
• Exercise regularly and get plenty of sleep.
• Learn better ways to calm yourself such as mental health therapy, yoga or relaxation exercises.

Dietary changes

Your doctor may also recommend changes to your diet and refer you to a dietitian as part of your IBS treatment. It will take some trial and error to find the foods that cause your symptoms.

Low FODMAP diet

The low FODMAP diet temporarily restricts carbohydrates that are difficult to digest, relieving uncomfortable symptoms and giving your digestive system a rest. The diet’s name is an acronym for the names of the carbohydrates that can cause irritable bowel syndrome symptoms: fermentable oligosaccharides, disaccharides, monosaccharides and polyols. By following the low FODMAP diet, you’ll stop eating these foods:

• Artichokes, asparagus, beans, cabbage, cauliflower, garlic, lentils, mushrooms, onions, and sugar snap and snow peas
• Apples, apricots, blackberries, cherries, mango, nectarines, pears, plums and watermelon plus juice containing any of these fruits
• Candy, gum and other products with sweeteners ending in “ol,” such as sorbitol, mannitol, xylitol and maltitol
• Canned fruit in natural fruit juice, large amounts of fruit juice or dried fruit
• Dairy products such as milk, milk products, soft cheeses, yogurt, custard and ice cream
• Foods with high-fructose corn syrup
• Honey
• Wheat and rye products

Your doctor or dietitian may suggest trying the low FODMAP diet for a short time to see if it helps with your symptoms. If your IBS symptoms improve, you may slowly add back foods that contain FODMAPs to check if your symptoms return. If not, you may be able to continue some of the FODMAPs foods without having IBS symptoms.

Gluten-free diet

Some people with IBS have more symptoms after eating foods that contain gluten. Your doctor may recommend staying away from gluten, a protein found in wheat, barley and rye. Most cereals, breads, baked goods and pasta contain gluten, but many gluten-free options are also available.

Fiber-rich diet

Eating 20 to 35 grams of fiber per day can improve IBS with constipation by softening the stool and making it easier to pass. Soluble fiber is more helpful than insoluble fiber for relieving IBS symptoms. Soluble fiber is found in beans, fruit, and oat products. Add fiber slowly to help prevent bloating and gas.