No one likes to talk about it, but everyone knows what constipation and diarrhea feel like. If you often struggle with either problem (or both!), you might be dealing with irritable bowel syndrome, or IBS.
“IBS is a gastrointestinal (GI) disorder where digestive function is impaired in some way,” says Laura Poe Mathes, RD, a Wisconsin-based dietitian who specializes in gut health. Typically, there’s an imbalance of good and bad microbes in the gut. This is called dysbiosis.
“It can lead to such symptoms as diarrhea or constipation, or a combination of the two,” says Mathes. IBS affects as many as 45 million Americans, about two-thirds of them women, according to the International Foundation for Gastrointestinal Disorders (IFGD). Researchers are still trying to explain that disparity and think sex hormones may play a role.
The symptoms of IBS can be more than just annoying or uncomfortable. Some people have to plan their days around staying near restrooms. And many IBS patients call in sick to work because of their symptoms. Yet most people deal with IBS symptoms for nearly 7 years before they get a diagnosis, according IFGD.
The reason is partly because the symptoms of IBS can vary and seem contradictory. Also, IBS looks a lot like other GI conditions, especially inflammatory bowel disease, or IBD. Examples of IBD include Crohn’s disease and ulcerative colitis.
But IBS and IBD are two very different health issues. “IBD is inflammation of the GI tract that’s caused by an autoimmune response,” explains Spencer Kroll, MD, an internal medicine specialist based in New Jersey. IBD sufferers can also have symptoms of diarrhea or constipation along with abdominal pain. But they often also have bleeding and problems absorbing enough nutrients.
“IBD patients can have 20-plus bowel movements a day. They can become malnourished and anemic and lose significant amounts of weight,” says Dr. Kroll.
Because these two conditions are so different, IBS and IBD also respond to different treatments. That’s why getting the right diagnosis is so important. The first step is to look at your symptoms to decide if they’re normal or not. If they’re not, it’s time to see a gastroenterologist. Here are the 4 top symptoms to consider.
Normal: occasional abdominal pain that clears up quickly
Not: frequent or even constant abdominal pain
We’ve all been there: Nausea, gas or stomach cramps set in, and you have a pretty good idea what caused it. Maybe it was the chili you ate, or it could be that stomach virus that’s going around. As miserable as pain like this is, it’s also normal. It typically passes in 24 to 48 hours.
The abdominal pain that comes with IBS isn’t so rare or short-lived. In fact, it’s the key symptom of IBS. In one survey, 80% of people said pain was the symptom that made their IBS feel severe. And the pain was enough to cause many people to cancel plans or miss days of work.
Not everyone’s IBS pain feels the same. Some describe it as cramping, while others say it’s stabbing or sharp. One telltale sign of IBS: The pain or discomfort happens when you also have bowel movement changes. This can include changes in frequency (you go more often or less often) or consistency (when stool becomes harder or softer).
Normal: diarrhea a couple of times a year
Not: chronic or recurring diarrhea
Some people define diarrhea as having loose, watery stools. Others say it’s having more frequent bowel movements. Either way, diarrhea normally hits only a few times a year, and it goes away on its own in 1 to 3 days.
But for people with IBS who have diarrhea as a primary symptom (sometimes called IBS-D), loose or frequent stools can continue for months or even years. In one study, adults with IBS-D had more than twice the number of bowel movements in a week than those without IBS. These happen during the day (so no midnight emergencies). But the need to go can be so often and urgent that it gets in the way of everyday life.
Normal: occasional constipation
Not: chronic, painful constipation
Occasional constipation is common. As many as a third of American adults deal with it, according to a review of studies by the American Gastroenterology Association. Symptoms include:
- Fewer stools than usual (fewer than 3 per week)
- Hard stools
- Straining to go
- Feeling that the bowel doesn’t empty completely
- Symptoms lasting longer than 2 months and less than 6 months
Constipation is also common in people with IBS (called IBS-C). The symptoms mimic the “normal” type described above, but there’s a key difference: With IBS-C, the constipation comes with abdominal pain and discomfort, as well as bloating and/or gas. Plus, people with IBS-C often have constipation well beyond the 6-month mark, making it a chronic and painful problem.
Normal: Occasional constipation or occasional diarrhea
Not: Both constipation and diarrhea in the same day
Constipation and diarrhea are uncomfortable enough on their own. People who have what’s called IBS with mixed bowel habits (IBS-M) must cope with both. Here’s how to determine if you have IBS-M: Think about the days when you have at least one abnormal bowel movement. Are more than 25% of your stools on those days hard and lumpy? And are more than 25% loose or watery? If you answered yes to both, that qualifies at IBS-M.
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How to confirm you have IBS
There’s no definitive diagnostic test yet for IBS, says David D. Clarke MD, a gastroenterologist based in Oregon. “Instead, the diagnosis is made based on typical symptoms and by ruling out other causes of those symptoms, such as IBD or celiac disease.”
Sometimes your symptoms alone are enough to move forward with a treatment for IBS. If that treatment doesn’t help, or if the gastroenterologist suspects there might be something else going on, you might need additional tests. Those could include:
- Stool test to detect possible infection, parasites or trouble absorbing nutrients from food
- Colonoscopy to look for polyps or signs of IBD or colon cancer
- X-ray or CT scan to detect other conditions such as diverticula (small pouches on the colon), inflammation, polyps, ulcers or cancerous growths
- Upper endoscopy, where a long, flexible tube with a camera on the end is inserted into the throat and down into the small intestine to find visible signs of inflammation
- Lactose intolerance test to see if you lack the enzyme needed to digest lactose, the sugar found in dairy products
- Breath test for bacterial overgrowth in the small intestine
How to treat IBS with diet and lifestyle changes
The focus of treating IBS is easing symptoms, and a top trigger for IBS symptoms is diet. Keeping a food diary can help you identify troublemakers on your plate. Just jot down what you eat throughout the day, along with any symptoms that pop up afterward.
Here are some foods that doctors suggest avoiding if you have IBS:
- High-gas foods, such as beans, lentils, dairy and certain vegetables (broccoli, cauliflower and cabbage)
- Gluten, a protein in wheat, barley and rye that’s linked with diarrhea in IBS
- FODMAPs, which are certain carbohydrates found in some grains, fruits, veggies and dairy products that cause sensitivities in people with IBS. (In case you’re wondering, FODMAPs stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols.)
Another common and often ignored reason for IBS flare-ups? Stress, says Dr. Clarke. Do you focus so much on the needs of others that you neglect your own? Do you have money or relationship troubles? Other stressors include the prolonged impact of Adverse Childhood Experiences (ACEs), undiagnosed depression, anxiety and post-traumatic stress. “When those issues are found and treated, it can achieve some of the best outcomes in the improvement of IBS symptoms,” says Dr. Clarke.
How to treat IBS with medication
There are several over-the-counter (OTC) and prescription medications that can help ease the symptoms of IBS. Here are some of the most common medications doctors recommend, depending on your specific symptoms:
- Fiber supplements or laxatives to help ease constipation. Another option is a prescription IBS-C medication, such as Linzess® or Amitiza®.
- Smooth-muscle relaxants or anticholinergic medications. They help relieve the painful muscle spasms in the bowel as well as diarrhea.
- Anti-diarrhea medications. This might be an OTC medication such as loperamide (Imodium A-D®), or a prescription medication approved for treating IBS with diarrhea such as alosetron (Lotronex®). However, alosetron is used in women only.
“Ultimately, there’s no one best way to treat IBS. Everyone’s symptoms and root causes are different,” says Mathes. “Working with a physician and a dietitian can help you not only get the right diagnosis, but also find the right treatment.”