Illness & Conditions - Health Conditions
Discusses disorder of intestines that causes symptoms such as belly pain, cramping or bloating, and diarrhea or constipation. Covers treatment by avoiding foods that trigger symptoms, getting regular exercise, and managing stress. Includes medicines.
Irritable Bowel Syndrome (IBS)
What is irritable bowel syndrome (IBS)?
Irritable bowel syndrome (IBS) is a disorder of the intestines. It causes belly pain, cramping or bloating, and diarrhea or constipation. IBS is a long-term problem, but there are things you can do to reduce your symptoms.
Your symptoms may be worse or better from day to day, but your IBS will not get worse over time. IBS doesn't cause more serious diseases, such as inflammatory bowel disease or cancer.
What causes IBS?
It isn't clear what causes irritable bowel syndrome. The cause may be different for different people. IBS may be caused by problems with the way signals are sent between the brain and the digestive tract , problems digesting certain foods, and stress or anxiety. People with IBS may have unusually sensitive intestines or problems with the way the muscles of the intestines move.
For some people with IBS, certain foods, stress, hormonal changes, and some antibiotics may trigger pain and other symptoms.
What are the symptoms?
The main symptoms of irritable bowel syndrome are belly pain with constipation or diarrhea. Other common symptoms are bloating, mucus in the stools, and a feeling that you have not completely emptied your bowels.
Many people with IBS go back and forth between having constipation and having diarrhea. For most people, one of these happens more often than the other.
IBS is quite common, but most people's symptoms are so mild that they never see a doctor for treatment. Some people may have troublesome symptoms, especially stomach cramps, bloating, and diarrhea.
Because there are no structural problems in the intestines of people who have IBS, some people may think this means that the symptoms "are all in their head." This isn't true. The pain, discomfort, and bloating are real.
How is IBS diagnosed?
Most of the time, doctors can diagnose irritable bowel syndrome from the symptoms. Your doctor will ask you about your symptoms and past health and will do a physical exam.
In some cases, you may need other tests, such as stool analysis or blood tests. These tests can help your doctor rule out other problems that might be causing your symptoms.
How is it treated?
Treatment usually includes making changes in your diet and lifestyle, such as avoiding foods that trigger your symptoms, getting regular exercise, and managing your stress.
If diet and lifestyle changes don't help enough on their own, your doctor may prescribe medicines for symptoms such as pain, diarrhea, or constipation.
Frequently Asked Questions
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The exact cause of irritable bowel syndrome (IBS) isn't known. But health experts believe that faulty communication between the brain and the intestinal tract is one cause of symptoms. In some people, this miscommunication causes abnormal muscle contractions or spasms, which often cause cramping pain. The spasms may speed the passage of stool, causing diarrhea. Or they may slow it down, causing constipation or bloating.
Many people who have IBS seem to have unusually sensitive intestines. It isn't known why their intestines are more likely to react strongly to the elements that contribute to IBS. People who have IBS may start having symptoms because of one or more factors, including:
Symptoms of irritable bowel syndrome include:
You are more likely to have IBS if you have these symptoms and they have lasted at least 6 months, you have had belly pain at least 3 days each month for at least 3 months, and at least two of the following are true: 1
Because there are no structural problems in the intestines of people who have IBS, some people may think this means that the symptoms "are all in their head." This isn't true. The pain, discomfort, and bloating are real. They have many different causes that can be addressed to help relieve symptoms.
Bowel movement patterns
When you have IBS, your pattern of bowel movements may be different over time. Two or more of the following may happen:
Other intestinal symptoms
Some people may have pain in the lower belly with constipation that is sometimes followed by diarrhea. Other people have pain and mild constipation but no diarrhea.
Some people have intestinal gas and passage of mucus in stools.
You may sometimes have other symptoms that don't affect the intestines, such as:
Symptoms often occur after a meal, during stressful times, or during menstruation.
There are many other conditions with symptoms similar to IBS.
Symptoms of irritable bowel syndrome (IBS) may last for a long time. But IBS doesn't cause cancer or shorten your life.
The pattern of IBS varies from one person to the next and from one bout to the next. Some people have symptoms off and on for many years. You may go months or years without having any symptoms. But most people have symptoms that keep coming back. It is rare for a person to have symptoms constantly.
Between 7 and 10 out of 100 people in the world have irritable bowel syndrome. 2 But most people with IBS don't see a doctor about their symptoms.
What Increases Your Risk
IBS tends to be more common in:
When To Call a Doctor
Call your doctor if:
Watchful waiting is a wait-and-see approach.
If your symptoms are mild, it might be okay to try home treatment for 1 week. If you think you may have IBS, try to rule out other causes of belly problems, such as eating a new food; eating sugar-rich foods, especially milk products; eating foods containing sorbitol or other artificial sweeteners; nervousness; or stomach flu. If your symptoms don't get better or if they get worse, call your doctor.
Who to see
The following health professionals can diagnose and treat irritable bowel syndrome.
If more tests are needed or your symptoms don't respond to treatment, it may be helpful to see a doctor who specializes in treating digestive system problems ( gastroenterologist ). If stress may be playing a role in IBS, it may be helpful to see a psychiatrist or psychologist .
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Irritable bowel syndrome (IBS) can be diagnosed based on symptoms. A doctor diagnoses IBS when a person has the typical symptoms of the disorder and, if needed, tests have ruled out other possible causes.
Most people won't need tests, but some people may because of their age and symptoms. The amount of testing you get depends on several things: your age, how your symptoms come on and how severe they are, and how you respond to your first treatment. For example, a 20-year-old might not need tests. But a 50-year-old with new symptoms might need tests because of the higher risk of colon cancer in people over 50.
Tests may include:
Thyroid function tests and other tests, such as colonoscopy , are sometimes done.
Treatment for irritable bowel syndrome (IBS) will depend on the types of symptoms you have, how severe they are, and how they affect your daily life. No single type of treatment works best for everyone.
Learn all you can about IBS so that you and your doctor can work together to find out what may be triggering your symptoms. You will need to adapt your lifestyle to best deal with your symptoms and still carry on with your daily activities. Let your doctor know if parts of your treatment aren't helping your symptoms.
Record your symptoms
The first step in treating IBS usually involves watching and recording your symptoms, your bowel habits, what you eat, and other daily activities (such as exercise) that affect your symptoms. Writing all this down in a notebook for a few weeks can help you and your doctor see patterns of symptoms in your daily life. You may be able to see what things make your symptoms worse (such as eating dairy products) and start to avoid them.
Manage your symptoms
For some people who have IBS, certain foods may trigger symptoms. These tips may help prevent or relieve some IBS symptoms:
Here are some other steps you can take to help your symptoms:
To learn more, see Home Treatment.
Watch for new symptoms
Because IBS is a long-term problem, it's important for you to be aware of big changes in symptoms. For example, watch for blood in your stools, increased pain, severe fever, or unexplained weight loss. If any of these occur, your doctor may want to do more tests to find out if there is another cause for your symptoms.
Your doctor may also want you to try different medicines, or different dosages of your current medicines, if your symptoms aren't responding to treatment.
You can't prevent irritable bowel syndrome (IBS). But proper self-care may help ease symptoms and may extend the time between episodes. Self-care includes quitting smoking, avoiding caffeine and foods that make symptoms worse, and getting regular exercise.
For most people who have irritable bowel syndrome (IBS), home treatment may be the best way to manage the symptoms. It is also helpful to learn all you can about IBS so you can better share your concerns and questions with your doctor.
Careful attention to diet, exercise, and stress management should help keep your symptoms under control. They may even prevent your symptoms from coming back.
In many people who have IBS, eating may trigger symptoms. But for most people, there is not a certain type of food that triggers symptoms.
Increasing the amount of fiber in your diet can help control constipation. High-fiber foods include fresh fruits (raspberries, pears, apples), fresh vegetables (carrots, leafy greens), wheat bran, and whole-grain breads and cereals. Beans such as kidney, pinto, and garbanzo are also high-fiber foods. (So are vegetables such as peas, cabbage, and broccoli.) But they should probably be avoided if gas is one of your symptoms.
If you have trouble getting enough fiber in your diet, you can take a fiber supplement such as psyllium (for example, Metamucil) or wheat dextrin (for example, Benefiber). If you take a fiber supplement, start with a small dose. Then very slowly increase the dose over a month or more. Also, make sure to drink plenty of fluids, enough so that your urine is light yellow or clear like water.
You can take steps to make it less likely that certain foods will cause symptoms. For example, avoid or limit gas-producing foods (including beans and cabbage), sugarless chewing gum and candy, caffeine, and alcohol.
Getting more exercise can make your symptoms less severe. Exercise also can improve your quality of life (especially how well you sleep, your energy level, and your emotional and social life). 4
Getting more exercise doesn't have to be hard. In one study, people with IBS increased their activity level by adding 20 to 60 minutes of moderate- to vigorous-intensity physical activity, 3 to 5 days a week. They did activities such as swimming, jogging, cycling, and walking.
In the group that did not increase their activity level, more people had an increase in their IBS symptoms. These people weren't active, and their symptoms got worse. 4
If stress seems to trigger your symptoms, these tips may help you better manage stress and avoid or ease some IBS episodes:
Medicine may be used along with lifestyle changes to manage symptoms of irritable bowel syndrome (IBS). It may be prescribed to treat moderate to severe pain, diarrhea, or constipation that does not respond to home treatment.
Medicine can help relieve your symptoms enough to prevent them from interfering with your daily activities. It may not be possible to eliminate your symptoms.
In most cases, the choice of medicine is based on your most troublesome symptom. For example, if diarrhea is the most bothersome symptom, using antidiarrheals or anticholinergics may be helpful.
Few medicines have proved consistently helpful, and all medicines have side effects. So medicine should be used for specific symptoms that disrupt your normal daily activities.
If you also have another illness, such as depression, that triggers symptoms of irritable bowel syndrome, medicine for that illness may be needed.
Medicines that may be used to treat severe diarrhea that does not improve with home treatment include:
There are many medicines for severe constipation that doesn't improve with home treatment. Most of these medicines are available without a prescription and are okay to take once in a while. Check with your doctor before you use any of these medicines every day for constipation. Medicines for constipation include:
Pain and cramping
The following medicines may be used for long-term pain and cramping:
The following medicines may be used if your IBS causes you to have anxiety or depression:
A wide range of other treatments can be used to treat irritable bowel syndrome (IBS).
Some kinds of psychological treatment may help with IBS symptoms. These treatments include cognitive-behavioral therapy, psychotherapy, and hypnosis. 6
People who have IBS are more likely than people without the condition to have depression , panic disorder, or other psychological conditions. 1 Acknowledging these factors may help you and your doctor successfully manage your condition.
IBS is different for each person, and no medicines have been proved to work really well for IBS. So people often try alternative or complementary treatments. Some of these treatments have been studied, and some have not.
Other Places To Get Help
Last Revised: November 5, 2012
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American College of Gastroenterology (2009). An evidence-based position statement on the management of irritable bowel syndrome. American Journal of Gastroenterology, 104(Suppl 1): S1–S7.
Tack J (2006). Irritable bowel syndrome. In MM Wolfe et al., eds., Therapy of Digestive Disorders, 2nd ed., pp. 701–710. Philadelphia: Saunders Elsevier.
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Pimentel M, et al. (2011). Rifaximin therapy for patients with irritable bowel syndrome without constipation. New England Journal of Medicine, 364(1): 22–32.
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Gaylord SA, et al. (2011). Mindfulness training reduces the severity of irritable bowel syndrome in women: Results of a randomized controlled trial. American Journal of Gastroenterology, 106(9): 1678–1688.
Liu JP, et al. (2006). Herbal medicines for treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.
Lim B, et al. (2006). Acupuncture for treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews (4). Oxford: Update Software.
Guglielmetti S, et al. (2011). Randomised clinical trial: Bifidobacterium bifidum MIMBb75 significantly alleviates irritable bowel syndrome and improves quality of life—a double-blind, placebo-controlled study. Alimentary Pharmacology and Therapeutics, 33(10): 1123–1132.
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