Suffering from a gastrointestinal disorder is no walk in the park. While it’s normal to have a little gas or bloating after an especially indulgent meal, feeling discomfort, pain, or noticing a change in your bathroom habits regularly is not. So how can you determine if what you’re experiencing is typical or if you’re suffering from some of the telltale symptoms of IBS?
IBS or irritable bowel syndrome is a digestive disorder that impacts the large intestine (colon) and causes uncomfortable symptoms like abdominal pain, bloating, and changes in bowel movements. There’s no good blood test or marker to diagnose IBS, Linda A. Lee, M.D., clinical director of the division of gastroenterology and hepatology and director of the integrative medicine and digestive center at Johns Hopkins Medicine, tells SELF. Instead, doctors look for symptoms that meet diagnosis criteria.
“IBS is one of about 30 different GI diseases we consider functional, meaning there are no tests or markers, and diagnosis is all based on symptoms,” Dr. Lee says. It’s not a default diagnosis when everything else is ruled out, but rather a very distinct diagnosis based on criteria. (Diagnostic criteria basically tell doctors how frequently a specific mix of symptoms should be happening to be able to give a diagnosis.)
IBS is not the same as IBD (inflammatory bowel disease).
“IBD is characterized by an immune-mediated inflammatory process that results in ulceration and actual inflammation in the intestine,” Dr. Lee explains. IBD can be either Crohn’s disease or ulcerative colitis, Christine Frissora, M.D., gastroenterologist at Weill Cornell Medicine and NewYork-Presbyterian, tells SELF.
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“People with IBS do not have the kind of inflammation that we typically associate with IBD, though some people can have both,” Dr. Lee adds. Another big difference: IBS does not cause changes in the bowel tissue or increase the risk of colorectal cancer, according to the Mayo Clinic. In addition to GI distress, IBD may also cause “alarm signs,” like “fever, bleeding, weight loss, joint pain, and eye problems,” Dr. Frissora says.
In the United States, IBS is reported more often in women.
Dr. Lee says the reason is probably biological, though experts don’t have a clear answer for why women would be more susceptible than men. Some research suggests a connection between estrogen and progesterone and IBS symptoms in women—though many women (with and without IBS) report GI issues during menstruation, those with IBS are more likely to have worsened symptoms during that time of the month.
Social factors may also play into the difference in diagnosis rates. “If you go to India, for example, you’ll find that prevalence of IBS is equal. The thought is that it’s because men who have GI symptoms in India are more likely to go to a doctor to seek help than men in the United States,” says Dr. Lee.
IBS symptoms can vary greatly from person to person, and range from mild to extreme.
Generally, IBS involves abdominal pain plus altered bowel movements, Dr. Lee says. The pain and bowel movements can take many forms. Here are some of the most common symptoms of IBS:
- Abdominal pain
- Excessive gas
- Anxiety or depression
- Loss of appetite
The symptoms typically show up in childhood, and usually always before age 40. “It’s very unusual for someone who is 80 to present with IBS [for the first time],” Dr. Lee says.
People with IBS often have triggers that bring on these symptoms. “Some of the biggest triggers are artificial sweeteners, carbonated beverages, onions, garlic, smoking, and alcohol,” Dr. Frissora says. But many foods can be triggers. Dr. Lee adds that greasy foods can increase colonic contractions, so those whose guts are super sensitive may respond more dramatically to that. Any food that causes gas can cause IBS symptoms, too.
IBS symptoms in women can also be triggered or worsened by menstruation, though the reason why isn’t completely clear.
Stress can also spark symptoms of IBS. “Some people say the GI tract is a stress barometer,” says Dr. Frissora. The symptoms of IBS, and worrying about if you’ll be able to get to a bathroom or not, can give sufferers even more to stress about, creating a vicious cycle.
The exact cause of IBS is unknown, though a few factors seem to play a role.
Contractions in the intestine that are either too strong (causing diarrhea) or too weak (causing constipation) may be to blame, though the cause of these muscle problems may never be known. Other abnormalities in the GI tract, like poorly coordinated signals between the brain and the intestines, can throw the digestive process out of whack, the Mayo Clinic explains.
Experts also believe that gut bacteria play a role. “Perhaps your gut bacteria are not optimized in some way and that somehow has affected your gut function,” Dr. Lee says. Some studies are currently looking at how probiotics can be used to treat IBS, specifically the kind that causes diarrhea, but it’s tough to say one treatment can work across the board because our guts are so individualized. “Our science is not so advanced yet that we can predict who is going to actually respond in a favorable way. It’s a lot of trial and error, which is a source of frustration for many patients.”
Finally, there seems to be a predisposition for those with a family history of IBS. “Many patients report that a family member has it,” Dr. Lee says. “Whether [the connection] is environmental or genetic, we don’t really know.”
IBS is chronic, but there are ways to manage (and oftentimes, eliminate) symptoms.
Many times, IBS can be managed through dietary changes. If your IBS causes diarrhea, doctors will usually put you on a low-FODMAP diet to determine what foods might be triggering to you.
“FODMAPs are carbs that all of us eat every day, but humans do not have the enzymes to break them down very well. They’re not absorbed in the small intestine, so they’re passed into the colon where bacteria begin to ferment them and produce gas,” Dr. Lee explains. “For those with [gut] hypersensitivity, any kind of gas distention triggers discomfort, a sense of bloating, and it sometimes can trigger hypermotility and diarrhea with that.”
A low-FODMAP diet (you can read more on what it entails here) is a temporary elimination diet, meant to help you determine which foods are IBS triggers so you can avoid them in the future and reduce symptoms dramatically.
If constipation is a problem, adding more fiber to your diet or taking medication like stool softeners can help. Dr. Lee also says that some patients may benefit from certain supplements, probiotics, or other medications that target specific symptoms. Antidepressants are also used to modulate nerve activity in the gut and make it less sensitive to certain stressors—but these meds come with their own side effects, so Dr. Frissora says she tries to avoid treating IBS this way if she can.
At the end of the day, treating IBS is highly individualized, and might differ depending on what you’re comfortable with as a patient. If your IBS symptoms are significant and interfering with your life, it’s worthwhile to seek help, Dr. Lee says. “Even if symptoms are mild, there are things we can do.”