Irritable bowel syndrome

Irritable bowel syndrome

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Table of contents
OverviewWhat is Irritable bowel syndrome (IBS)?Types of IBSSymptoms of IBSCauses and triggers of IBSDiagnosis of IBSMedical history and physical examinationDiagnostic criteria for IBSTreatment options for IBSFrequently asked questions about IBSConclusionSources
Navin Khosla NowPatientGreen tick
Medically reviewed by Navin Khosla, BPharm and written by Rajive Patel, BPharm - Updated on 26 Jan 2024
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Irritable Bowel Syndrome (IBS) is a common disorder that affects the GI tract (gastrointestinal), causing symptoms such as abdominal pain, cramping, and changes in bowel movements. It is a chronic condition that requires long-term management. In this comprehensive guide, we will explore the various aspects of IBS, including its symptoms, causes, diagnosis, and treatment options.

What is Irritable bowel syndrome (IBS)?

IBS is a chronic disorder of the digestive system characterized by recurring symptoms, including abdominal pain, cramping, bloating, and changes in bowel movements. These changes may manifest as diarrhoea, constipation, or a combination of both. While the exact cause of IBS is unknown, it is believed to involve an interplay of factors such as hypersensitivity of the gut nerves, abnormal muscle contractions in the intestines, and imbalances in gut bacteria. IBS does not put you at a higher risk of developing colitis, Crohn’s disease, ulcerative colitis or colon cancer, but you are however recommended to be tested for coeliac disease if you have IBS.

Types of IBS

There are several subtypes of IBS, each characterized by specific bowel movement patterns:

  • IBS-D (Irritable Bowel Syndrome with Diarrhea): This subtype is characterized by frequent loose and watery stools
  • IBS-C (Irritable Bowel Syndrome with Constipation): This subtype is characterized by infrequent bowel movements and difficulty passing stools
  • IBS-M (Mixed Irritable Bowel Syndrome): This subtype involves a combination of both diarrhea and constipation
  • IBS-U (Unclassified Irritable Bowel Syndrome): This subtype is diagnosed when the symptoms do not fit into any specific category

Symptoms of IBS

Common symptoms of irritable bowel syndrome can vary from person to person and may include:

  • Abdominal pain and cramping, often relieved after a bowel movement
  • Changes in bowel movements, such as diarrhea, constipation, or alternating between the two
  • Bloating and swelling of the abdomen
  • Excessive gas (flatulence)
  • Urgency to have a bowel movement
  • Mucus in the stool

It is important to note that IBS symptoms can significantly impact a person’s quality of life, leading to feelings of fatigue, anxiety, and depression. If you experience persistent changes in bowel habits or other concerning symptoms, it is advisable to consult a healthcare professional for evaluation.

Causes and triggers of IBS

While the exact cause of IBS remains unknown, several factors have been identified as potential contributors to the development of the condition. These factors include:

  • Muscle contractions in the intestines: In individuals with IBS, the muscles in the intestines may contract more forcefully or for longer durations than usual, leading to abdominal pain, cramping, and changes in bowel movements
  • Nervous system abnormalities: Problems with the nerves in the digestive system can cause discomfort and pain when the abdomen stretches due to gas or stool. Poor coordination between the brain and intestines can result in an overreaction to normal digestive processes, leading to symptoms of IBS
  • Severe infection: Some individuals develop IBS after experiencing a severe gastrointestinal infection, such as gastroenteritis. This condition, known as post-infectious IBS, may result in long-term changes in gut function
  • Early life stress: Childhood exposure to significant stressors, including physical, sexual, or emotional abuse, may contribute to the development of IBS later in life
  • Changes in gut microbes: Research suggests that alterations in the composition and diversity of gut bacteria, fungi, and viruses may play a role in the development of IBS. Individuals with IBS often exhibit differences in their gut microbiome compared to those without the condition

Triggers for IBS symptoms

Certain factors or triggers can exacerbate IBS symptoms in susceptible individuals. These triggers include:

  • Food: While food allergies or intolerances rarely cause IBS, certain foods or beverages can worsen symptoms in some individuals. Common culprits include foods containing gluten, wheat, dairy products, citrus fruits, beans, cabbage, and carbonated drinks. Keeping a food diary can help identify specific triggers for each individual
  • Stress: Increased stress levels can lead to the worsening of IBS symptoms. While stress does not directly cause IBS, it can contribute to symptom flare-ups. Managing stress through relaxation techniques, exercise, and counseling may help alleviate symptoms

It is important to note that everyone’s triggers and sensitivities may differ. Identifying and avoiding personal triggers can be an essential part of managing IBS.

Diagnosis of IBS

The diagnosis of IBS is primarily based on a thorough evaluation of an individual’s symptoms and medical history. There is no specific test for IBS, but diagnostic criteria have been established to aid in its identification.

Medical history and physical examination

During the diagnostic process, healthcare professionals will typically inquire about the nature, frequency, and duration of symptoms, as well as whether you have a family history of IBS and perform physical exams. They will also ask about any potential triggers or factors that exacerbate symptoms. A comprehensive physical examination may be performed to rule out other conditions such as a gluten or lactose intolerance before diagnosing IBS.

Diagnostic criteria for IBS

The Rome IV criteria are commonly used to diagnose IBS. According to these criteria, individuals must experience recurrent abdominal pain or discomfort for at least six months, with symptom onset occurring at least three days per month in the past three months. Additional criteria include the presence of symptoms that are associated with a change in bowel movements and the absence of alarm features such as bleeding, weight loss, or anemia. Additional tests may be necessary to rule out other conditions, such as blood tests, stool tests, X-rays, CT scans, colonoscopy, or endoscopy.

Exclusion of other conditions

Other conditions that may present with similar symptoms, such as inflammatory bowel disease (IBD), celiac disease, and colon cancer, must be ruled out before a diagnosis of IBS can be established. This may involve additional tests such as blood tests, stool tests, and imaging studies.

It is essential to consult with a healthcare professional for an accurate diagnosis, as self-diagnosis can lead to unnecessary anxiety and delays in appropriate treatment.

Treatment options for IBS

While there is no cure for IBS, various treatment options are available to manage symptoms and improve quality of life. The approach to treatment often involves a combination of lifestyle modifications, dietary changes, medications, and psychological interventions.

Lifestyle modifications

Several lifestyle modifications can help alleviate symptoms and manage IBS effectively. These include:

  • Stress Management: Stress reduction techniques such as relaxation exercises, deep breathing, hypnotherapy, and mindfulness meditation can help minimize symptoms triggered by stress
  • Regular Exercise: Engaging in regular physical activity, such as walking, yoga, or swimming, can promote healthy digestion and reduce symptoms
  • Sleep Hygiene: Establishing a regular sleep schedule and practicing good sleep hygiene can contribute to overall well-being and symptom management

Dietary changes

Dietary modifications tailored to individual needs can play a significant role in managing IBS symptoms. Some common dietary recommendations include:

  • Fiber intake: Gradually increasing dietary fiber supplements, particularly soluble fiber found in fruits, vegetables, and whole grains, can help regulate bowel movements. However, it is essential to monitor the response to fiber intake, as some individuals may experience increased bloating or gas
  • Low FODMAP diet: The low FODMAP diet involves temporarily restricting foods high in fermentable carbohydrates (FODMAPs) and gradually reintroducing them to identify specific triggers. This approach has shown promising results in reducing IBS symptoms for many individuals
  • Food journaling: Keeping a food diary to track symptoms and identify potential trigger foods can be beneficial in managing IBS
  • Adequate hydration: Drinking enough water and staying hydrated can help maintain regular bowel movements


Several medications may be prescribed to alleviate specific symptoms of IBS. These include:

  • Antispasmodic medications: These medications help relax the muscles of the gastrointestinal tract, reducing abdominal pain and cramping
  • Over the counter anti-diarrheal medications such as loperamide that slow down bowel movements can help control diarrhea
  • Laxatives: Individuals with IBS-C may benefit from the use of laxatives to relieve constipation and promote regular bowel movements
  • Probiotics: Probiotics, which are beneficial bacteria, may help restore a healthy balance of gut bacteria and alleviate symptoms. However, the effectiveness of probiotics varies among individuals
  • Tricyclic antidepressants: These help to block the action of neurons that control the intestines, helping to reduce pain. Side effects may include blurred vision, drowsiness, dizziness and dry mouth

Psychological Interventions

Since stress and emotional factors can significantly impact IBS symptoms, psychological interventions can be beneficial. These may include:

  • Cognitive behavioral therapy (CBT): CBT aims to identify and modify negative thoughts and behaviors that contribute to the experience of IBS symptoms. It can help individuals develop effective coping strategies and improve their overall well-being
  • Relaxation techniques: Techniques such as deep breathing exercises, progressive muscle relaxation, and guided imagery can help reduce stress and promote relaxation
  • Mindfulness-based stress reduction (MBSR): MBSR combines mindfulness meditation, body awareness, and yoga to cultivate awareness and reduce stress

It is important to work closely with a healthcare professional to determine the most appropriate treatment plan based on individual symptoms and needs.

Living with IBS

Living with IBS requires ongoing management and self-care strategies. Here are some tips for coping with IBS:

  • Educate Yourself: Learn more about IBS to better understand your condition and its management
  • Identify triggers: Keep track of your symptoms and potential triggers to help avoid or minimize symptom flare-ups
  • Prioritize self-care: Practice stress management techniques, prioritize quality sleep, and engage in regular physical activity to support overall well-being
  • Support network: Seek support from friends, family, or support groups to share experiences and coping strategies
  • Open communication: Maintain open communication with your healthcare provider, discussing any concerns or changes in symptoms
  • Be patient: Managing IBS is a journey, and finding the right combination of treatments and strategies may take time

Remember, while IBS may present challenges, it is possible to live a fulfilling life with effective symptom management and support.

Frequently asked questions about IBS

What is Irritable bowel syndrome?

IBS is a disorder of the gut-brain axis, where the communication between the intestines and the brain is disrupted. Although the exact cause of IBS is unknown, several factors are believed to contribute to its development. These factors include changes in muscle contractions within the digestive tract, malfunctions in the digestive nerves, intestinal inflammation, infections, and alterations in gut bacteria.

What are the main symptoms of IBS?

The symptoms of IBS can vary from person to person, but the most common ones include persistent abdominal pain or discomfort, changes in bowel habits such as diarrhea or constipation, bloating, excessive gas, urgency or difficulty in passing stool, and the feeling of incomplete bowel movements. It’s important to note that these symptoms are recurring and can significantly impact an individual’s quality of life.

Are there different types of IBS?

There are four different types of IBS based on the predominant symptoms:

  • IBS with constipation (IBS-C): Individuals with IBS-C experience infrequent bowel movements and often have hard, dry stools
  • IBS with diarrhea (IBS-D): People with IBS-D have frequent episodes of loose or watery stools
  • Mixed-type IBS (IBS-M): This type of IBS involves both constipation and diarrhea, with alternating episodes
  • Unspecified IBS (IBS-U): When the symptoms cannot be clearly categorized into any of the above types, it is classified as IBS-U

How common is Irritable bowel syndrome?

IBS is a prevalent condition, affecting approximately 1 in 10 individuals worldwide. It is more common in women, with about twice as many women being diagnosed with IBS compared to men. Despite its high prevalence, many people with IBS go undiagnosed or suffer in silence, not seeking medical help.

Is IBS curable?

While there is no cure for IBS, various treatments and lifestyle modifications can help manage the symptoms and improve your quality of life. The treatment plan for IBS is often personalized based on your specific symptoms and triggers. It may include dietary changes, stress management techniques, regular exercise, medications, and probiotics.

What changes should I make to my diet if I have IBS?

Diet plays a crucial role in managing your symptoms. One dietary approach that has shown success is the low FODMAP diet. FODMAPs are fermentable carbohydrates found in certain foods that can trigger gut symptoms if you have IBS. Following a low FODMAP diet involves restricting or eliminating high FODMAP foods and gradually reintroducing them to identify individual triggers. It is important to consult with a healthcare professional or registered dietitian before making any significant dietary changes.

What changes can I make to my lifestyle if I have IBS?

In addition to dietary modifications, certain lifestyle changes can also help manage your IBS symptoms. Regular exercise, such as gentle aerobic activities, has been shown to improve overall gut function and reduce stress. Stress management techniques, such as mindfulness, deep breathing exercises, and meditation, can also be beneficial in reducing the impact of stress on IBS symptoms. Adequate sleep, hydration, and maintaining regular meal times can further support gut health.


Irritable Bowel Syndrome (IBS) is a chronic disorder of the digestive system characterized by abdominal pain, changes in bowel movements, and other associated symptoms. While the exact cause of IBS remains unknown, various factors such as abnormal muscle contractions, nervous system abnormalities, and gut microbiome imbalances are believed to contribute to its development. Diagnosis involves a thorough evaluation of symptoms and the exclusion of other conditions. Treatment options for IBS include lifestyle modifications, dietary changes, medications, and psychological interventions. By implementing these strategies, individuals with IBS can effectively manage their symptoms and improve their quality of life. Remember, it is important to consult with a healthcare professional for personalized advice and guidance on managing IBS.


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