What Is Irritable Bowel Syndrome (IBS)?

IBS is a mix of belly discomfort or pain and trouble with bowel habits: either going more or less often than normal (diarrhea or constipation) or having a different kind of stool (thin, hard, or soft and liquid). Doctors used to call IBS other names, including:

IBS colitis

Mucous colitis

Spastic colon

Nervous colon

Spastic bowel

IBS isn’t life-threatening, and it doesn't make you more likely to get other colon conditions, such as ulcerative colitis, Crohn's disease, or colon cancer. But it can be a long-lasting problem that changes how you live your life. People with IBS may miss work or school more often, and they may feel less able to take part in daily activities. Some people may need to change their work setting: shifting to working at home, changing hours, or even not working at all.

Constipation and diarrhea can be symptoms of IBS. (Photo Credit: iStock/Getty Images)

There are four types of irritable bowl syndrome:

IBS with constipation (IBS-C)

IBS with diarrhea (IBS-D)

Mixed IBS (IBS-M), which alternates between constipation and diarrhea

Unsubtyped IBS (IBS-U), which is for people who don't fit into the above types

Irritable bowel syndrome symptoms can include:

Other things may cause these symptoms sometimes. If it’s IBS, you’ll likely have these symptoms weekly for 3 months, or less often for at least 6 months. People assigned female at birth (AFAB) who have IBS may have more symptoms during their period. Some people also have urinary symptoms or sexual problems. Stress can make symptoms worse.

When to call your doctor

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.

Even if you don’t think a problem is physically part of IBS, but it bothers you, tell your doctor. For example, if you’re stressed out or anxious about it, or if you’re losing sleep over the problem, let your doctor know.

IBS usually doesn’t lead to more serious diseases, but there are “red flags” to look for that could mean something more serious is going on. A red-flag symptom is one that isn’t usually seen with IBS. If you have one or more, see your doctor. You’ll need tests to find out what’s going on.

Red-flag symptoms include:

Irritable bowel syndrome symptoms in children

IBS affects as many as 1 in 6 children, and they share many of the same symptoms of IBS that adults have. Irritable bowel syndrome symptoms in children may include:

Children also can have red-flag symptoms that could mean something more concerning than IBS. These symptoms include:

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. 

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.

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

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:

Your doctor may do some of the following tests to decide if you have IBS:

10 questions to ask your doctor

Going to the doctor can be intimidating. You might feel rushed and forget to ask questions that are important. It's always a good idea to know what to ask beforehand and to take notes during your appointment.

Some of the questions below may be worth asking. Print them out to take with you to your next appointment:

Could some other condition be causing my IBS symptoms? Could I have inflammatory bowel disease or colon cancer?

Should I keep a diary of my IBS symptoms, and, if so, what should I write down?

Should I take laxatives or other over-the-counter medications? If so, what type, and how often is it safe to take them?

Would adding more fiber to my diet help with my IBS symptoms? If so, how much and what kind?

Are there other dietary changes you would recommend for IBS, and should I consult a dietitian?

Could relaxation therapy, counseling, or exercise ease my IBS?

Should I take prescription medications for my IBS symptoms? If so, what side effects should I expect?

Are there any tests you would recommend now or in the future?

Are there any other approaches or treatments I should know about?

How soon should I have a follow-up appointment?

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:

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.

Therapy

Anxiety and depression often travel with IBS, and managing those conditions may ease your IBS symptoms. Talk to you doctor about the following therapies. One of them may be right for you.

Medications

The following types of drugs and supplements are used to treat IBS:

Bulking agents, such as psyllium, wheat bran, and corn fiber, help slow the movement of food through the digestive system and may also help relieve symptoms.

Antibiotics, such as rifaximin (Xifaxan), can change the amount of bacteria in your intestines. You take pills for 2 weeks. It can control symptoms for as long as 6 months. If they come back, you can be treated again.

Other treatments can help with symptoms of IBS:

Belly pain and bloating

Constipation

Diarrhea

Make sure to follow your doctor's instructions when taking IBS medications, including laxatives, which can be habit-forming if you don’t use them carefully.

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.

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:

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. 

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.