A graphical image of the human digestive system with arrows pointed towards the colon showing the area affected by certain aspects of irritable bowl syndrome with text that reads constipation, area of spasm, distended bowel, diarrhea.

Irritable Bowel Syndrome (IBS): Symptoms, Causes & More

by Dr. Matt Olesiak, M.D.

Irritable bowel syndrome or IBS is a chronic gastrointestinal disorder affecting the large intestine and bowel habits. It is the most common functional bowel disorder. (1)

Functional gastrointestinal disorders are caused by a dysfunction of the gut-brain interaction resulting in the nerves or muscles in the digestive tract not functioning normally. This condition is not detected with conventional testing but by specific GI symptoms.

Those with IBS experience middle or lower gastrointestinal tract symptoms affecting bowel movements. (2)

An image of a sign with white text that reads gut health.

How Does IBS Differ From Inflammatory Bowel Disease?

IBS is a functional bowel disorder diagnosed by symptomatology and exclusion, i.e., ruling out other diseases and conditions. Patients demonstrate no clinical signs of bowel disease, and their test results are normal. There are no diagnostic tests for irritable bowel syndrome because it is not caused by a structural defect.

By contrast, inflammatory bowel disease (IBD) is characterized by prolonged inflammation in various areas of the digestive tract. The most common inflammatory bowel diseases are Crohn's disease and ulcerative colitis.

How Common Is Irritable Bowel Syndrome?

Irritable bowel syndrome is common, occurring in an estimated 5% to 10% of the global population. (3) Between 25 and 45 million people in the United States are believed to suffer from this disorder. (4)

Cartoon images of a human body and large intestine and images describing the symptoms and causes of irritable bowel syndrome with explanatory text. Explanatory text is described below.

Explanatory Text

Irritable Bowel Syndrome.

Irritable Bowel Syndrome (IBS) is a common disorder that affects the large intestine.

Text describing the parts of the large intestine: transverse colon, descending colon, abnormal contractions, rectum, appendix, ascending colon.

Text describing the symptoms of IBS: abdominal pain, cramping, or bloating, excess gas, diarrhea or constipation, mucus in the stool.

Text describing the causes of IBS: muscle contractions in the intestine, nervous system, inflammation in the intestines, severe infection, changes in microflora.

End Explanatory Text

Who Is More Likely To Develop IBS?

Women are twice as likely to develop IBS than men. Approximately 2 in 3 IBS sufferers are female, while only about 1 in 3 are male. (5)

Irritable bowel syndrome also affects people of all ages, even children. However, those under 50 are at a higher risk of developing this disorder. Unlike IBS, irritable bowel disease is diagnosed with various lab tests.

Risk Factors

According to the National Institute of Diabetes and Digestive and Kidney Diseases, risk factors for developing IBS include: (5a)

Having a family member with IBS
Having a history of stressful or difficult life events, such as abuse, in childhood
Having a severe infection in your digestive tract

IBS Symptoms

An image of a mature woman sitting on the edge of a bed and holding her stomach in pain.

The signs and symptoms of irritable bowel syndrome vary and can include:

Abdominal pain
Cramps in the lower abdomen
Bloating
Excessive gas
Indigestion
Diarrhea
Constipation
Mucus in the stool
Diarrhea alternating with constipation
Constipation alternating with diarrhea
Bowel movement changes
Abrupt changes in bowel habits
Acid reflux

Fortunately, only a small number of people have severe IBS symptoms, but even minor symptoms can interfere with your life.

Health Conditions With Symptoms Similar to IBS

You must get a medical evaluation if you experience any of the above symptoms, as there are several conditions with symptoms similar to irritable bowel syndrome, including:

Lactose intolerance, when your body cannot digest the sugar in milk.
Stomach cancer
Colon cancer
Ulcerative colitis, a type of inflammatory bowel disease
Crohn's disease, a type of inflammatory bowel disease
Diverticulitis, inflammation or infection of the pouches formed in the colon
Celiac disease, an autoimmune disorder in which your immune system attacks the small intestine when you eat gluten
Gallstones
Pancreatitis, a condition that occurs when your pancreas is not working properly
Endometriosis, a condition occurring when the cells in the lining of a woman's uterus start growing in other areas of the body, in this case, the bowel
Intestinal parasites, i.e., tapeworms

What Causes Irritable Bowel Syndrome?

The exact cause of IBS is not known. However, the factors below are believed to play a role in this condition.

Abnormally Weak or Strong Intestinal Contractions

Those with IBS have been shown to have abnormally strong or weak intestinal contractions compared to those without this disorder.

If you have strong intestinal contractions, foods will pass through your intestines too quickly, causing diarrhea. Muscular contractions might explain why some people with IBS feel like they have to take a bowel movement every 15 minutes after meals.

On the other hand, if intestinal contractions are abnormally weak, you'll find it difficult to pass stool, and constipation will result.

If you have intestinal contractions that are sometimes strong and sometimes weak, you may experience alternating bouts of diarrhea and constipation.

Stress or Anxiety

An image of a woman having a panic attack surrounded by people walking around her on a busy street.

The brain and gut are connected in a way that science is only beginning to understand. If you've ever felt "butterflies" in your stomach before giving a speech or taking an exam, you've experienced this connection.

Numerous studies show stress and/or anxiety can trigger spastic colon, colonic contractions, and gut hypersensitivity.

While it is true that there is no definitive proof that stress or anxiety causes IBS or vice versa, studies suggest that those with this disorder have higher levels of stress and anxiety that can worsen the symptoms.

According to Harvard Health Publishing, "A 2017 study in the Journal of Neurogastroenterology and Motility found that people with IBS have higher levels of depression and anxiety compared with those who don't have the disorder. IBS also is more common among people who experienced psychological trauma as children." (7)

Bacterial Overgrowth

Bacterial overgrowth in the small intestine, a condition called small intestinal bacterial overgrowth (SIBO), is associated with irritable bowel syndrome. Indeed, those with IBS are more likely to have SIBO than the general population.

SIBO is created when there is an increase in the bacterial population in the colon that backs up into the small intestine. The symptoms of SIBO are similar to IBS, including bloating, constipation, diarrhea, and abdominal pain.

However, it is not clear whether SIBO is the cause or the result of IBS.

Antibiotics

Antibiotics have saved millions of lives since they were introduced as a treatment for bacterial infections in the 1930s.

But the one downfall of using antibiotics is that they kill good and bad bacteria. Consequently, overuse or extended usage of antibiotics can alter your gut bacteria in a way that negatively impacts colon and bowel function. Scientists theorize that this disruption may lead to the development of IBS, though studies have yet to confirm this theory.

How is IBS Diagnosed?

To diagnose IBS, your doctor will review your symptoms and look for any patterns that might indicate this condition. Then, they will take a medical and family history and conduct a physical exam checking for abdominal pain or tenderness.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, your doctor may diagnose IBS if you have abdominal pain along with at least two of the following symptoms: (8)

Your pain is related to your bowel movements.
The frequency of your bowel movements has changed.
The appearance of your stools has changed.

Your doctor may also run diagnostic tests to check for other health conditions.

How to Manage IBS Symptoms

IBS cannot be cured, but there are ways to manage the symptoms so that they have a less negative effect on your life.

Manage Dietary Triggers

Certain foods frequently trigger IBS symptoms, and specific foods can worsen symptoms.

Dietary triggers vary depending on the person, but there are some foods known to trigger IBS attacks, including:

Carbonated drinks
Caffeine
Alcohol
Fatty foods
Sausage
French fries
Certain fruits and vegetables

Keep a Food Diary

Keeping a food diary is the best way to find out which foods trigger your IBS symptoms.

Write down everything you eat and note any symptoms of an irritable colon -- such as abdominal cramping, diarrhea, constipation, etc. -- that occur shortly after eating that food.

Practice an Elimination Diet

If you're unsure what foods give you digestive grief, try an elimination diet.

With an elimination diet, you simply remove certain foods from your diet, which may relieve symptoms. If its removal does not affect symptoms, it probably isn't one of your IBS trigger foods.

Be sure to record each food you eat in your food diary, note any digestive or bowel symptoms you may experience, and monitor your symptoms for improvement. Then, gradually add those foods back into your diet one at a time.

Practicing an elimination diet will help you pinpoint the foods and beverages that mess up your digestive system so that you can avoid them.

Increase Fiber Intake

A high-fiber diet is beneficial for irritable bowel syndrome because it helps regulate bowel movements. This can reduce diarrhea and relieve constipation. Fiber is also essential for the digestive system and overall health.

Fiber also fills you up quickly and keeps you full longer, which can help you maintain a healthy weight. It has also been shown to reduce your risk of obesity, type 2 diabetes, heart disease, and other conditions.

Excellent sources of dietary fiber include nonstarchy vegetables, leafy greens, oats, and low-sugar fruit. If you're not accustomed to eating a lot of fiber, you'll want to increase your fiber intake slowly to avoid digestive distress.

Practice Stress Management Techniques

Take time to de-stress every day. Here are a few suggestions to get you started.

Practice yoga
Go for regular leisurely walks
Meditate
Practice deep breathing exercises
Play or cuddle with your dog or cat. (Pets are proven stress-busters!)
Go out to dinner or a movie with friends.
Binge-watch comedies on Netflix. Studies show that laughter lowers blood pressure and triggers the release of endorphins, which are "feel good" hormones.
Do aerobic exercises
Take up a hobby
Help someone out. (Studies show that helping others lowers our stress levels.)
Spend quality time with friends and family

Enjoy Regular Exercise

There are many ways that regular exercise can help IBS symptoms.

Exercise Reduces Anxiety

Exercise has been shown to relieve stress and anxiety. As mentioned above, stress can worsen IBS symptoms.

Indeed, a study published in the American Journal of Gastroenterology found that increased exercise levels significantly decreased IBS symptoms.

Exercise Relieves Constipation

Exercise can improve bowel regularity and relieve constipation, which is especially beneficial for IBS.

Why does it help constipation? Exercise helps speed up the time it takes for food to move through the large intestine. This keeps your stool from drying out, making it easier to pass. Exercise also speeds up your heart rate and respiration, which may help stimulate muscles in your gastrointestinal tract. This, too, will speed the transit time of food through your GI tract.

How much exercise should you get?

According to the Department of Health and Human Services, most healthy adults should get "at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week, or a combination of moderate and vigorous activity," spreading it out over the course of a week.

Great exercises for IBS include:

Walking
Yoga
Pilates
Tai Chi
Bicycling

Get More Sleep

Sleep helps relieve stress and is beneficial for your overall mood and health.

Here are a few suggestions to help improve your sleep schedule.

Go to bed at the same time every night. A consistent sleeping schedule is critical, as it trains your body to start getting tired near bedtime.
Avoid devices before bed. The blue light emitted from device screens interferes with melatonin production. So, to cultivate a good night's sleep, you may want to put away your devices an hour before bedtime.
Make sure your bedroom temperature is cool. Sleeping in a cool temperature -- around 65-68 degrees -- helps you fall asleep faster. It also helps your body produce more melatonin.
Reduce light in your bedroom. Any light can interfere with melatonin production, even if it's coming from the neon numbers on your alarm clock. So, you might want to turn your alarm clock away from you, put black drapes on your window, or wear a sleep mask to bed.

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