Irritable bowel syndrome (IBS) is a disorder of the intestines. It causes belly pain, cramping or bloating, and diarrhea or constipation. Irritable bowel syndrome 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 does not cause more serious diseases, such as inflammatory bowel disease or cancer.
It is not clear what causes irritable bowel syndrome, and the cause may be different for different people. Some ideas for what causes IBS include 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.
The main symptoms of irritable bowel syndrome are belly pain with constipation or diarrhea. Other common symptoms are bloating, mucus in the stools, or 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. Most people's symptoms are so mild that they never see a doctor for treatment. But some people may have troublesome symptoms, especially stomach cramps, bloating, and diarrhea.
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.
Irritable bowel syndrome is a long-term condition, but there are things you can do to manage your symptoms. 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.
There are also medicines that may help with your symptoms. If diet and lifestyle changes do not help enough on their own, your doctor may prescribe medicines for pain, diarrhea, or constipation.
Learning about IBS:
Living with IBS:
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The exact cause of irritable bowel syndrome (IBS) is not known. But health experts believe faulty communication between the brain and the intestinal tract is one cause of symptoms in IBS. In some people, this miscommunication causes abnormal muscle contractions or spasms, which often cause cramping pain. The spasms may either speed the passage of stool, causing diarrhea, or slow it down, causing constipation or bloating.
A complex combination of elements, including psychological stress, hormones, the immune system, and chemicals called neurotransmitters, appears to add up to cause the symptoms of IBS.
Many people who have IBS seem to have unusually sensitive intestines. It is not 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:
An expert panel has outlined a list of symptoms common in irritable bowel syndrome (IBS). Doctors often use this list of symptoms, known as the Rome III criteria, to distinguish IBS from other intestinal problems. But people who don't have all of these symptoms may still have IBS.
You meet the Rome III criteria for IBS if your symptoms began at least 6 months ago, you have had abdominal (belly) pain or discomfort at least 3 days each month in the last 3 months, and at least two of the following statements are true:1
The presence of any of the following symptoms supports a diagnosis of IBS.
When you have IBS, your pattern of bowel movements may be different over time. Two or more of the following may happen:
Some people may have lower abdominal pain with constipation that is sometimes followed by diarrhea. Other people have pain and mild constipation but no diarrhea.
Symptoms that are sometimes present include 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 persist for a long time. But IBS does not cause cancer or shorten life expectancy.
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 recurrent episodes of symptoms. It is rare for a person to have symptoms constantly.
Although IBS does not cause more serious conditions, such as cancer or inflammatory bowel disease, a person who has IBS may also have one of these illnesses.
IBS tends to be more common in:
Call your doctor or other health professional if:
If you think you may have IBS, try to rule out other causes of abdominal 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 are mild, it might be okay to try home treatment for 1 week. If your symptoms don't get better or if they get worse, call your doctor.
An occasional case of upset stomach, diarrhea, or constipation is common, especially during stressful times. Symptoms of stomach pain, nausea, vomiting, and diarrhea that come on quickly and that go away on their own are more likely to be caused by stomach flu or food poisoning, especially if other people around you are also sick.
The following health professionals can diagnose and treat irritable bowel syndrome (IBS).
If more tests are needed or your symptoms do not respond to initial therapy, 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.
Irritable bowel syndrome (IBS) can be diagnosed based on symptoms. In most cases, only minimal tests are needed. A doctor diagnoses IBS when a person has the typical symptoms of the disorder and, if needed, tests have ruled out other possible causes.
The amount of testing that may be done depends on several things: your age, how your symptoms come on and how severe they are, and how you respond to the initial treatment. For example:
Depending on your symptoms, the results of the first tests, or your response to treatment, other tests may be done.
Tests may include:
Thyroid function tests and other tests, such as colonoscopy, are sometimes done.
Irritable bowel syndrome (IBS) is a long-term (chronic) but manageable condition. Treatment will depend on the types of symptoms you have and their severity, as well as how they affect your daily life. Treatment will likely involve changes to your lifestyle. It is important that you work closely with your doctor to create a treatment plan that will meet your needs. Learn all you can about your condition so you can effectively communicate concerns and questions to your doctor.
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.
No single type of treatment for irritable bowel syndrome works best for everyone. You and your doctor will need to 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 are not helping your symptoms.
For some people who have IBS, certain foods may trigger symptoms. The following suggestions may help prevent or relieve some IBS symptoms:
Getting more exercise (such as swimming, jogging, cycling, or walking) may help reduce your IBS symptoms. It can also improve your quality of life (especially how well you sleep, your energy level, and your emotional and social life).4
Because IBS is a long-term disease, it's important for you to be aware of big changes in symptoms, such as the appearance of blood in your stools, increased pain, severe fever, or unexplained weight loss. If any of these occur, your doctor may want to do additional tests to find out whether there is another cause for your symptoms.
In treating IBS, be sure to stay with the changes to lifestyle and diet that relieve your symptoms. Quitting smoking, limiting caffeine and foods that make symptoms worse, and getting regular exercise should all be permanent parts of your daily routine.
Medicines may be used along with lifestyle changes to manage symptoms of IBS. Medicines for IBS may include anticholinergics for cramping, medicines for diarrhea or constipation, antidepressants, or antianxiety drugs.
Because IBS often results from a combination of physical and stress-related factors, a treatment approach that addresses both these causes will be most successful. In addition to treating constipation or diarrhea with medicines and changes to diet and lifestyle, stress management or other psychological therapy may be a major part of your treatment plan.
If your symptoms get worse, your doctor will likely do more tests to find out whether there is another cause for your symptoms. Irritable bowel syndrome (IBS) does not lead to more serious conditions, such as cancer or inflammatory bowel disease. But a person with IBS may also have one of these illnesses.
Your doctor may also want you to try different medicines, or different dosages of your current medicines, if your symptoms are not responding to treatment.
You cannot prevent irritable bowel syndrome (IBS). But proper self-care may help minimize symptoms and perhaps extend the time between episodes. This 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 effectively communicate concerns and questions to your doctor.
Although there currently is no cure for IBS, careful attention to diet, exercise, and stress management should help keep your symptoms under control and perhaps even prevent them from coming back.
In many people who have IBS, eating may trigger symptoms. But for most people, there is not a particular 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 (as 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 and very slowly increase the dose over a month or more. Also, make sure you drink plenty of fluids, enough so that your urine is light yellow or clear like water.
You can take steps to reduce the possibility that certain foods will cause symptoms, such as avoiding or limiting gas-producing foods (including beans and cabbage), sugarless chewing gum and candy, caffeine, and alcohol.
Most people know that getting more exercise is good. And it's been known for a long time that physical activity can improve constipation and gas pain.
The best news is that getting more exercise can make your symptoms of IBS less severe. And it 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.
Another finding in this study was that in the group that did not increase their activity level, more people had an increase in their IBS symptoms. These people were not active and their symptoms got worse.4
If stress seems to trigger your symptoms, the following may help you better manage stress and avoid or ease some IBS episodes:
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 is not true. The pain, discomfort, and bloating are real and have many different causes that can be addressed to help relieve symptoms.
While the symptoms are quite real, psychological factors often play a role in the development of IBS. 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.
Medicine may be used along with lifestyle changes to manage symptoms of irritable bowel syndrome (IBS).
The goal of medicine treatment is to relieve your symptoms enough to prevent them from interfering with your daily activities. It may not be possible to eliminate your symptoms. Medicines may be prescribed to treat moderate to severe pain, diarrhea, or constipation that does not respond to home treatment. No single medicine has been shown to be effective in relieving IBS over the long term.
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.
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 does not improve with home treatment. Most of these medicines are available without a prescription and are okay to take once in awhile. Check with your doctor before you use any of these medicines every day for constipation. Medicines for constipation include:
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:
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.
Alosetron, a medicine that reduces abdominal sensitivity, has been shown to relieve symptoms in some women who have severe diarrhea and who have not responded to other treatments. Although this medicine was previously removed from the market when its use was shown to contribute to ischemic bowel disease (which occurs when there is not enough blood flowing to the intestines), the U.S. Food and Drug Administration (FDA) reapproved alosetron for limited use in IBS. Specific guidelines for the use of alosetron require doctors who prescribe it to sign a certificate and patients to sign a consent form.
A wide range of other therapies can be used to treat irritable bowel syndrome (IBS).
Increasing the amount of fiber in your diet can help with some symptoms of IBS, especially constipation. You can get more fiber in your diet by eating foods that are high in fiber such as fresh fruits (raspberries, pears, apples), fresh vegetables (carrots, spinach, celery), wheat bran, and whole-grain breads and cereals.
If you have trouble getting enough fiber in your diet, try a fiber supplement. Examples include wheat dextrin (such as Benefiber) and psyllium (such as Metamucil). If you take a fiber supplement, start with a small dose and very slowly increase the dose over a month or more. Also, make sure you drink plenty of fluids, enough so that your urine is light yellow or clear like water.
Some kinds of psychological treatment may help with IBS symptoms. These treatments include cognitive-behavioral therapy, psychotherapy, and hypnosis.6
Because IBS is so different for each person and because no medicines have been proved to work really well for IBS, many people try alternative or complementary treatments. Some of these treatments have been studied and some have not.
|American College of Gastroenterology|
|P.O. Box 342260|
|Bethesda, MD 20827-2260|
The American College of Gastroenterology is an organization of digestive disease specialists. The Web site contains information about common gastrointestinal problems.
|American Gastroenterological Association|
|4930 Del Ray Avenue|
|Bethesda, MD 20814|
The American Gastroenterological Association is a society of doctors who specialize in the digestive system (gastroenterologists). This Web site can help you find a gastroenterologist in your area. They also have patient information on many gastrointestinal diseases and disorders.
|International Foundation for Functional Gastrointestinal Disorders|
|P.O. Box 170864|
|Milwaukee, WI 53217-8076|
The International Foundation for Functional Gastrointestinal Disorders (IFFGD) is a nonprofit organization that provides information and support to adults and children affected by hard-to-diagnose gastrointestinal (GI) disorders. The website has information about GI symptoms and conditions such as irritable bowel syndrome, indigestion, gastroesophageal reflux disease (GERD), incontinence, gas, bloating, belching, heartburn, nausea, and belly pain.
|National Center for Complementary and Alternative Medicine (NCCAM), National Institutes of Health|
|9000 Rockville Pike|
|Bethesda, MD 20892|
The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) explores complementary and alternative healing practices in the context of rigorous science, trains complementary and alternative medicine researchers, and gives out authoritative information.
|National Digestive Diseases Information Clearinghouse|
|2 Information Way|
|Bethesda, MD 20892-3570|
This clearinghouse is a service of the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the U.S. National Institutes of Health. The clearinghouse answers questions; develops, reviews, and sends out publications; and coordinates information resources about digestive diseases. Publications produced by the clearinghouse are reviewed carefully for scientific accuracy, content, and readability.
- Longstreth GF, et al. (2006). Irritable bowel syndrome section of Functional bowel disorders. In DA Drossman et al., eds., Rome III: The Functional Gastrointestinal Disorders, 3rd ed., pp. 490–509. McLean, VA: Degnon Associates.
- 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.
- Johannesson E, et al. (2011). Physical activity improves symptoms in irritable bowel syndrome: A randomized controlled trial. American Journal of Gastroenterology, 106(5): 915–922.
- Pimentel M, et al. (2011). Rifaximin therapy for patients with irritable bowel syndrome without constipation. New England Journal of Medicine, 364(1): 22–32.
- American College of Gastroenterology (2009). An evidence-based systematic review on the management of irritable bowel syndrome. American Journal of Gastroenterology, 104(Suppl 1): S8–S35.
- Ljótsson B, et al. (2011). Internet-delivered exposure-based treatment vs. stress management for irritable bowel syndrome: A randomized trial. American Journal of Gastroenterology, 106(8): 1481–1491.
- 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.
Other Works Consulted
- Chang I, et al. (2005). A dose-ranging, phase II study of the efficacy and safety of alosetron in men with diarrhea-predominant IBS. American Journal of Gastroenterology, 100(1): 115–123.
- Ford AC, et al. (2008). Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: Systematic review and meta-analysis. BMJ. Published online November 13, 2008 (doi:10.1136/bmj.a2313).
- National Institute for Health and Clinical Excellence (NICE) (2008). Irritable bowel syndrome in adults: Diagnosis and management of irritable bowel syndrome in primary care. London: National Institute for Health and Clinical Excellence (NICE). Available online: http://www.nice.org.uk/CG061fullguideline.
- Spanier JA, et al., (2003). A systematic review of alternative therapies in the irritable bowel syndrome. Archives of Internal Medicine, 163: 265–274.
- Talley NJ (2010). Irritable bowel syndrome. In M Feldman et al., eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., vol. 2, pp. 2091–2104. Philadelphia: Saunders.
|Primary Medical Reviewer||E. Gregory Thompson, MD - Internal Medicine|
|Specialist Medical Reviewer||Arvydas D. Vanagunas, MD - Gastroenterology|
|Last Revised||April 26, 2012|
Last Revised: April 26, 2012
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