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Irritable Bowel Syndrome

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Irritable bowel syndrome is a gastrointestinal disorder that can cause cramping, excess gas, loose stools, or constipation. Symptoms may be triggered by a variety of things, including diet and increased stress. Learn more about IBS, including how to treat it, below.

What Is Irritable Bowel Syndrome?

We’ve all experienced bowel trouble at one time or another. But for some people, cramping, excess gas, loose stools, or constipation, are all too common of an occurrence. If you suffer from these symptoms, you may have a condition called IBS, or Irritable Bowel Syndrome. IBS is a gastrointestinal disorder and is not the same as IBD (Inflammatory Bowel Disease) which is a more serious condition and can cause more severe complications.

Symptoms Of Irritable Bowel Syndrome

Common symptoms of IBS include:

  • Abdominal pain or cramping (which goes away once you have a bowel movement)
  • Excess gas and bloating
  • Diarrhea or constipation (sometimes people with IBS experience both)
  • Changes in stool consistency or frequency
  • Mucus in the stool
  • Loss of appetite

Based on what you’re experiencing, your doctor may indicate that your IBS fits into one of four categories:

  1. Constipation-predominant (IBS-C)
  2. Siarrhea-predominant (IBS-D)
  3. Mixed (IBS-M, for those whose symptoms alternate between constipation and diarrhea)
  4. Unclassified (IBS-U, which is used for those whose symptoms may vary).


The type of irritable bowel syndrome you experience can dictate the type of treatment you receive. 

Causes & Triggers

It’s not completely clear what causes irritable bowel syndrome, sometimes referred to as spastic colon, but many experts believe that people with IBS simply have a more sensitive colon. Things such as changes in your gut bacteria could have a greater effect on you than on others. Some experts also believe that the condition is a result of problems with brain-gut interaction, or how your brain and gut communicate with each other.

And, just like other conditions, such as overactive bladder, IBS has it’s own triggers. While everyone’s trigger might be different, here are some of the more common ones:

Foods In Your Diet

Depending on your symptoms, different foods may be causing you problems. If you suffer from constipation, some foods, such as breads and cereals, processed foods, high-protein diets, and dairy products (especially cheese) can contribute to you IBS symptoms. If you’re making more trips to the bathroom because of diarrhea, things like too much fiber, large meals, fried and fatty foods, and dairy products can be a problem. And for either symptom, you should avoid caffeine, alcohol and carbonated beverages.

How You Eat

It’s not just what you’re putting in your body that can have an effect on you – how you eat can also impact your IBS symptoms. Eating too fast, or with distractions (like eating while you work or drive) can increase symptoms of irritable bowel syndrome. Make sure to eat slowly and without disruptions.

Stress And Anxiety

Stressful life events, or even certain mental conditions such as depression, can bring on symptoms of IBS.  Learning ways to stay calm and manage stress can be helpful tools in managing IBS symptoms.

Hormonal Changes

Many women with irritable bowel syndrome often experience an increase in symptoms around their menstrual cycle (in fact, 70% of people who live with IBS are women). While you can’t prevent your menstrual cycle from happening, it may help to find ways to better manage your symptoms. Birth control pills can sometimes lessen the effects of your periods, which may also help with IBS symptoms.

Not Enough Exercise

Simply put, exercise can keep things moving if you’re suffering from bouts of constipation. And, as a widely known way of banishing stress, it’s helpful in keeping you calm and stress free, which can eliminate another trigger of IBS symptoms.

Risk Factors For Irritable Bowel Syndrome

Irritable bowel syndrome is a common disorder affecting up to 20% of US adults, and there are a number of risk factors that are frequently – though not always – associated with the condition: 

  • Age – IBS is not an old person’s disease. It can strike when you’re young, often occurring in people before they turn 35. 
  • Sex – The majority of sufferers are female (70%).  
  • Family History – While IBS has not been proven to be hereditary, people who have had family members with IBS may be at a greater risk for developing the condition themselves. 
  • Mental Health – Those who have certain mental health issues such as anxiety or depression may be more likely to have IBS, as are those who have experienced sexual, physical or emotional abuse. 

Diagnosis

Generally, diagnosis for irritable bowel syndrome is made by examining a patient’s symptoms, usually with few laboratory tests performed. Your doctor will take a complete medical history, discuss your symptoms with you and perform a physical examination to make sure there aren’t other issues that might be causing your troubles.

The "Rome Criteria"

Your doctor will then take this information and see if it fits what’s called the “Rome Criteria,” which is a diagnostic guideline to help determine if what you have is clinical IBS.

According to the Rome Criteria, those with IBS will have experienced abdominal pain at least once a week over the past three months, and symptoms will have started at least six months previously. They will also have at least two of the following symptoms: 

  • The abdominal pain is associated with bowel movements
  • The appearance of bowel movements has changed
  • The frequency of bowel movements has changed

Other Tests

Beyond the Rome Criteria, other tests may make sense based on your consultation. In particular, the following symptoms are often associated with other, potentially more serious conditions and may call for additional procedures to identify or eliminate them:

  • Emergence of symptoms in those over 50 years old
  • Unexpected weight loss
  • Nausea or vomiting
  • Rectal bleeding
  • Fever
  • Belly pain unrelated to bowel movements
  • Belly pain at night
  • Ongoing diarrhea
  • Nighttime urgency with diarrhea
  • Anemia


If your doctor does recommend additional testing, there’s a good chance you’ll start with bloodwork. There are a couple of different types of blood tests that can identify certain antibodies that may be associated with IBS that develops following an infection, and these tests are particularly helpful with those who have the diarrhea-predominant or mixed types of IBS. Blood tests can also be useful to check for celiac disease in those with IBS-D. 

Other tests can include breath tests to identify lactose intolerance or bacterial overgrowth in the small intestine, and if your symptoms warrant further inspection, your doctor could prescribe procedures such as colonoscopies, CT scans or upper endoscopies. 

Treatment Options

If you’ve been diagnosed with irritable bowel syndrome, there are a number of treatment options available to you that can make a real difference in the frequency and intensity of the symptoms you experience – eliminating them entirely for some and significantly reducing them for many others. Some of the most common include: 

There are many qualified professionals who can help you find the care you deserve – gynecologists, urologists, urogynecologists and colorectal surgeons are all expertly trained to deal with these sorts of issues on a regular basis. Following your examination, you’ll likely be presented with one of the following treatment options: 

Counseling

If you suffer from a lot of anxiety or have experienced a traumatic event, speaking with a counselor can help you work through some of those feelings and may help ease your IBS symptoms in the process.

Diet Changes

Making some changes to what you eat can have a big effect for some people experiencing IBS symptoms. There are some obvious candidates to avoid, like those that cause gas or cramping (so watch your beans and broccoli!), but there are other foods that you may not realize are also potential trouble sources, too.

Caffeine is a big one, as is alcohol, both of which can produce cramps and diarrhea. Too much fat in your diet can also result in symptoms, and sweeteners like sorbitol and fructose can be problematic, as well. Try eliminating these foods to see if you experience any relief. 

A good way to identify your triggers is to keep a food diary for a couple of weeks, listing what you eat and your symptoms as they occur. It’s not surprising for people to discover that there are some foods they thought were safe that are actually associated with IBS episodes. 

There are some other general guidelines which IBS patients tend to find helpful when it comes to controlling their symptoms:

  • Slow down! Don’t rush your meals – a more leisurely pace can be beneficial
  • Schedule your eating. Try to eat at the same time each day
  • Don’t eat too late. Avoiding late eating can be helpful for many
  • Don’t overeat. Learn to recognize when you’re full and stop before you’re stuffed
  • Get fluids. Between 8 and 12 cups of liquid a day 
  • Watch your coffee, tea and soda. Remember, caffeine can be a real trigger
  • Stick to your diet. The unfortunate reality is that some foods you love might not love you back. Do your best to avoid or at least minimize those foods that you know produce symptoms

Special Diets

People often wonder whether specific diets can be beneficial in reducing irritable bowel syndrome symptoms, particularly gluten-free or low-histamine diets. Here’s a brief summary of what we know about these approaches. But remember, you should always, always consult with your physician or a qualified nutritionist before adopting any of these

Gluten-Free Diet.

 While gluten-free diets have been all the rage lately, there is not a convincing amount of research to suggest that they help those with IBS. Those who do benefit from it may find that it’s not the reduction in gluten that is actually doing the trick, but the elimination of certain trigger foods that’s getting the job done.
Before trying a gluten-free diet, check with your physician to see if it’s the best choice for you.

Low-FODMAP Diet. 

Among specialized diets, the one most likely to be of benefit is the Low-FODMAP Diet. FODMAP is an acronym for “Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.” That’s a mouthful, but what they all have in common is that they’re all types of sugar that can produce digestive distress. The idea is that by avoiding these foods, you can reduce those nutrients that contribute to your symptoms.


There is clinical research that suggests that a diet low in FODMAP foods can make a real difference for those with IBS. A number of studies have found meaningful reductions in symptoms, including abdominal pain, bloating, gas, and flare-ups.

 
That being said, a low FODMAP diet is not intended to be a life-long change in eating. Instead, it’s typically started as a strict 3 to 6 week restriction of all FODMAP foods to see how your symptoms are impacted. After this initial period, various FODMAPs will be gradually re-introduced to your diet to help you identify which – if any – you are particularly sensitive to. Because of the way this diet is implemented and monitored, it’s particularly important that you do it under the care of a doctor or dietician. 

 

Biofeedback

This technique involves training your body to have more control over your bowels and has been proven an effective tool in managing IBS symptoms. Learn more about biofeedback here.

Mindfulness

Practicing mindfulness meditation has been shown to result in a reduction of IBS symptoms. Mindfulness meditation involves focusing on the present moment and has been thought to reduce stress and calm the mind. (Read our information on how to cope with a bowel condition here.)

Medications

People tend to think of medications specifically as drugs that are prescribed by their physician, but it’s important to remember that pretty much anything you take to treat your condition is a medication. That includes over-the-counter products, nutritional supplements and herbs. 

The good news is that there are a number of medications that may be helpful for those living with IBS. Depending on your symptoms, your doctor may be able to prescribe one or more of these to address your symptoms or their underlying causes.

Some of the most common OTC products that doctors recommend are fiber supplements or laxatives to treat constipation and anti-diarrheals for, you guessed it, diarrhea. Some patients find that peppermint oil can also be helpful in digestion by reducing muscle contractions in your digestive tract. 

Prescription medications include those from a class of drugs called secretagogues, which increase the amount of fluid and movement in your gut, which may help with pain and bloating. Retainagogues help your intestines hold more water by blocking the amount of sodium your gut absorbs, and this can result in softer stools. And antispasmodics can reduce pain by relaxing your digestive muscles. 

For those whose Irritable Bowel Syndrome has an emotional component, antidepressant medications may help with symptoms of stress and anxiety, both of which are common triggers of IBS. 

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