IBS symptoms can vary but there are some you should be on the lookout for. Learn more about the symptoms of IBS and what to do if you think you have it.
Just three letters, IBS, can be loaded with embarrassment, pain, and isolation for the roughly 35 million Americans dealing with this common chronic gastrointestinal disorder.
With IBS, which stands for Irritable Bowel Syndrome, your large intestine doesn't function normally, which leads to a variety of unpleasant symptoms. The illness doesn’t spiral into any serious medical conditions, but IBS can heavily impact your quality of life. It’s not unusual for the symptoms of IBS to sideline you from social outings and work. Behind the common cold, IBS is the second most common reason why people call out from work, according to the American College of Gastroenterology(ACG).
Medical experts haven’t pinpointed the exact cause of IBS, but there are some research-based theories. “It’s often believed that multiple factors contribute to IBS,” says Jasmine Zia, MD, assistant professor in the division of gastroenterology at the University of Washington in Seattle. “Some think that communication between the brain and gut is off, and the gut is signaling to the brain that it’s in more pain than it is, causing hypersensitivity in the gut; others suspect it’s the pain nerves within the intestines that are hypersensitive.” Inflammation in the intestines, past infection, changes to the bacteria in our gut, and hormonal factors are other areas considered to play a role, says Dr. Zia. Detecting the true driving force is difficult, since these issues can influence each other.
Without knowing the specific cause, it’s not surprising that there is no cure for IBS. (Thankfully, there are good ways to manage IBS symptoms.) Also, “there is no test to diagnose IBS, which is one of the most frustrating parts for patients,” says Dr. Zia. Doctors may first run tests, such as a colonoscopy, to rule out other conditions before basing a diagnosis of IBS on your symptoms.
Common IBS Symptoms
Recognizing when tummy troubles may point to IBS symptoms could help you find relief faster.
It’s a tricky task because IBS doesn’t look the same in everyone. There are three different types of IBS (IBS with constipation, IBS with diarrhea, and IBS with mixed bowel habits); within each group, certain symptoms can be more bothersome than others. To complicate matters, your IBS may not always stay the same type.
The symptoms of IBS most commonly come in waves, or episodes, that last for days or weeks at a time, but some people can suffer every day. Many docs wait until IBS-like symptoms last at least three months, including if it’s stop-and-go during that time, to officially diagnose you.
No matter which type of IBS you have, you probably have pain, typically in the lower part of your abdomen, below the belly button, that’s steady or recurrent. “For a diagnosis of IBS, the abdominal pain needs to be paired with either a change in bowel habits, meaning diarrhea or constipation, or provoked or relieved by a bowel moment,” says Dr. Zia.
If you have diarrhea-predominant IBS, or IBS-D, you can expect abdominal pain, loose stools, and the urgency to go. “For many people with IBS, feeling like they always need to be close to a bathroom can be very debilitating,” says Dr. Zia.
On the days you’re experiencing IBS-D symptoms, over a quarter of your stools will be loose or watery, and less than a quarter will be hard, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Over a three-month period, infrequent bowel movements or straining while they are happening are hallmarks of IBC-C. Besides constipation and abdominal pain, patients with IBC-C tend to be bothered by bloating or the feeling that they can’t completely evacuate their stool, says Dr. Zia.
During IBS-C episodes, more than a quarter of your stools are hard and less than a quarter of your stools are loose, according to NIDDK.
Those who have IBS with mixed bowel habits, or IBS-M, have symptoms of both IBS-D and IBS-C; they have diarrhea and constipation coupled with pain. On days with abnormal bowel moments, more than a quarter of stools are hard and more than a quarter are loose, reports NIDDK.
Gas, Cramping, Bloating
People with IBS can have increased sensitivity to intestinal gas, even when the volume is in a normal range, which can cause abdominal cramping and a bloating sensation. Gas can also visibly "puff out" your belly—a symptom that occurs more frequently in women.
IBS Symptoms Specific to Women
Almost twice as many women than men are reported to have IBS, according to ACG. There’s no definitive reason for the gender differences, but there’s solid speculation.
For one, women are more likely to seek healthcare, which on paper leads to more IBS diagnoses for females, says Margaret Heitkemper, RN, Ph.D., professor at the University of Washington School of Nursing.
Certain factors may make IBS symptoms more difficult for women to ignore. Women appear to have a more heightened sensitivity to pain (in the case of IBS, having smaller intestines might mean females perceive issues like gas more readily), and they tend to have more pain-related conditions, such as fibromyalgia, that can overlap with IBS symptoms and magnify the discomfort, says Dr. Heitkemper.
Questions as to whether female sex hormones influence the bacteria in the gut and give rise to IBS symptoms in women are being examined as well.
As if getting your period wasn’t enough of a misery, research has found that your monthly visitor can amp up the intensity and frequency of IBS symptoms, including cramping, bloating, diarrhea, and constipation; this double-whammy strikes women with IBS in the days right before or at the start of their periods, when hormones levels are low.
Other less-than-desirable symptoms women with IBS report around menstruation, according to the International Foundation for Functional Gastrointestinal Disorders:
- Insomnia (Many IBS sufferers already report poor or inadequate sleep, which has been found to increase bowel problems, notes Dr. Heitkemper.)
- Increased sensitivity to certain foods
When a woman is expecting a baby, changing hormones tend to cause heartburn, reflux, and constipation, but studies are too thin right now to say how adding IBS to the mix impacts the pregnancy, says Dr. Heitkemper. Anecdotally, there are some reports of decreasing pain sensitivity in women with IBS during pregnancy.
What to Do If You Think You Have IBS
Instead of trying to will away the discomfort or embarrassment (sorry, it won’t work), consider the many research-backed solutions that have proven beneficial in managing IBS symptoms. Diet, lifestyle practices, traditional medication and natural therapies are channels that can provide relief. Keep in mind: The right remedies are partly dependent on the type of IBS you have.
Studies have shown that introducing probiotics—so-called good bacteria—into the intestinal tract to balance out the bad may have a positive effect on IBS symptoms. Data is limited, though, on the exact strains that are helpful, or even the right amount that can be effective, says Dr. Zia. (Too much good bacteria can cause overwhelming gas.) Research has found that the specific probiotic formulations in Activia yogurt, and the supplements VSL #3 and Align, potentially help IBS symptoms, notes Dr. Zia.
Opinions about the helpfulness of fiber pills and powders is divided, since fiber in your diet helps keep you regular, but it also can create bloat. “Fiber can help some people with IBS, while it makes others feel worse,” says Dr. Zia.
Herbal remedies may be another option. A Journal of Clinical Gastroenterology study found that peppermint oil capsules can improve IBS symptoms, including abdominal pain.
Your doctor may recommend medications, such as laxatives, antidiarrheals, or low-dose antidepressants that help calm nerve sensitivity in the gut as part of your arsenal.
Turning toward diet, the buzz centered around the low FODMAP diet isn’t just hype. Dr. Zia says this diet has really good data behind it for IBS. It limits foods rich in poorly-digestible carbs, a.k.a. FODMAPS, that get fermented by bacteria in our gut; this process unleashes gas that can increase uncomfortable symptoms, such as abdominal pain and bloating in those with IBS. By drawing water into the intestinal tract, FODMAPS can also intensify diarrhea or constipation. Deciphering which foods are FODMAPS often requires reference lists Dr. Zia says. Finding a dietitian with FODMAP expertise can help you identify and eliminate your specific FODMAP triggers and at the same time, ensure a heathy, balanced diet.
Lowering intake of gluten, which also causes fermentation, could aid symptoms as well.
Which Trigger Foods to Avoid
Identifying the foods that spark your symptoms is a big part of IBS self-management, says Dr. Heitkemper. Generally, these are foods you might benefit from cutting back on or skipping:
- Foods known to produce gas, i.e. beans, Brussels sprouts, apples, green peppers, onions, bran
- Spicy foods (can cause increased pain/cramping)
- Carbonated drinks
- Gum and hard candies (they cause you to swallow air—and sugar-free types may contain gas-inducing sorbitol)
- High-fat foods (Fatty foods causes your intestinal system to empty slower, which leaves the potential for more symptoms.)
- Drive-through meals (Instead of feeling stressed eating in the car, you want to be relaxed while eating to allow blood to easily flow to the gut, says Dr. Heitkemper.)
Is there anything exercise doesn’t help with? Research shows that vigorous cardio can help keep your bowels moving steadily along.
On the mental health side, cognitive behavioral therapy, hypnotherapy, and yoga have all been shown as effective ways to control anxiety that can increase pain and escalate symptoms.
Which Doctors to Call
Only one in four people with IBS see a doctor for their symptoms. When you have recurring diarrhea or constipation and stomach pain, you should set up an appointment with your primary doctor to confirm a diagnosis and for guidance on easing your symptoms. Your physician may refer you to a gastroenterologist if you have a severe case of IBS, says Dr. Zia. Granted, these “private” issues aren’t easy to talk about with others, but the conversation can lead you to a fuller, happier life.