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The Essential Guide to Irritable Bowel Syndrome (IBS): Symptoms, Causes, Treatments, and Natural Remedies

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By: Stacy Swartz

Irritable bowel syndrome (IBS) is a common condition affecting 5 to 10 percent of the global population. Characterized by intermittent abdominal pain along with diarrhea, constipation, or alternating episodes of both, the disorder targets the gastrointestinal tract which includes the stomach and intestines. While IBS is a chronic condition that requires long-term management, it doesn’t produce changes in bowel tissue or increase your chances of developing colorectal cancer.

What Are the Common Types of Irritable Bowel Syndrome?

IBS is categorized into four types, each defined by the group of symptoms a person with IBS might experience.

IBS With Constipation (IBS-C)

IBS with constipation (IBS-C) is a chronic condition classified by abdominal pain and bloating, gas, and constipation. People suffering from the disorder may experience straining or difficulty having bowel movements, feel as if they are unable to empty their bowels, or have the sensation of needing to go to the bathroom but are then unable.

IBS-C is typically defined by hard pellet-like bowel movements and a change in either frequency or consistency, and its cause is unknown. Researchers believe there are several factors that could act as catalysts:

Increased fluid absorption in the colon

Decreased muscle movement in the colon

Sensitive nerves

Miscommunication between the bowels and the brain

IBS With Diarrhea (IBS-D)

IBS-D is a multifactorial condition characterized by recurrent abdominal discomfort or pain and altered bowel function. Approximately one-third of the people diagnosed with IBS have the syndrome associated with diarrhea.

Factors such as prior gastroenteritis, changes in the gut microbiome, stress, bile acids, and short-chain fatty acids that alter gastrointestinal function can contribute to these IBS symptoms.

IBS With Mixed Symptoms of Constipation and Diarrhea (IBS-M)

IBS-M is a type of irritable bowel syndrome that is characterized by inconsistent bowel habits. Individuals affected by this subtype will experience all of the typical IBS symptoms but will also be challenged by bouts of constipation and diarrhea.

IBS-M is defined by hard, lumpy stools for over 25 percent of bowel movements on symptomatic days, and loose, mushy stools for over another 25 percent of bowel movements on symptomatic days.

Stool changes can occur over the span of hours or days, while the main bowel difficulties can fluctuate between weeks or months of constipation and weeks or months of diarrhea.

IBS With Undefined Subtype of Symptoms (IBS-U)

IBS-U is a subtype of irritable bowel syndrome where the main symptoms of IBS are present, but symptoms and patterns vary. More research needs to be done on this subtype to flesh out its profile.

What Are the Symptoms and Early Signs of Irritable Bowel Syndrome?

IBS is a chronic condition. Although symptoms vary, the most common include:

Stomach pain or cramps.

Changes in the appearance of bowel movement.

Changes in the frequency of bowel movements.


Abdominal bloating or distension.


An urgent need to go.


Passing mucus with a stool.

IBS patients may experience recurring episodes of abdominal discomfort or pain along with diarrhea, constipation, or a mixture of the two.

Logging a symptom journal where you can outline the food and quantities you have eaten will help you determine what foods trigger your symptoms. It’s important that you also document any symptoms that you experience after eating.

Patients should look for patterns in their tracked diet and symptoms to identify if certain foods improve or worsen their symptoms. When food triggers are identified, it’s important to cut back or eliminate one food at a time to know which food may have been triggering your symptoms.


IBS-C is triggered by various elements such as stress, certain foods, and hormones. Although the role of food allergies or intolerance isn’t entirely understood, many people affected by IBS experience increased symptoms after consuming particular food and drinks. Symptoms include:

Abdominal discomfort


Constipation, including difficulty moving your bowels or straining during bowel movements

Hard or lumped stools

Infrequent bowel movements and feeling like you want to go but can’t

Symptoms are often managed with diet and lifestyle changes. However, more severe cases will need to be treated with medication and counseling.


IBS-D symptoms include:

Stomach pain or cramps

Abdominal discomfort and pain


These can be triggered by numerous factors such as foods, beverages, stress, anxiety, and depression. While stress, anxiety, and depression do not cause IBS, they can lead to or worsen diarrhea symptoms. It’s important to find an effective way to manage your mood and stress levels.

Drinks with caffeine, carbonated drinks, alcohol, chocolate, sorbitol, dairy products, and fried foods may worsen IBS-related diarrhea. People challenged by IBS-D will also want to closely monitor fiber intake. While fiber is helpful for patients suffering from IBS with constipation, too much fiber could worsen symptoms for patients afflicted by IBS with diarrhea.

Vegetables, fruits, whole grains, and beans can also worsen diarrhea symptoms. IBS-D patients may need to experiment and track these foods in a food journal to identify what agrees with their stomachs.



IBS-M symptoms include:

Changes in bowel frequency.

Changes in the texture of bowel movements.

Abdominal pain.

Gas and bloating.

Mucus in the stool.

Gas and bloating.

A feeling of incomplete emptying.


IBS-U symptoms may include any of the common IBS symptoms, with varying patterns.

What Are the Causes of Irritable Bowel Syndrome?

While a specific cause of IBS hasn’t been identified, several factors are thought to play a role in the condition and its progression. These factors include:

Changes in gut microbes: The microorganisms that live in the digestive tract aid in digestion, metabolism, and immune function. Research suggests that changes to the bacteria in your gut may trigger symptoms of IBS.

Early life stress: People exposed to stress, especially during childhood, typically have more symptoms of IBS due to the interplay between the hypothalamic–pituitary–adrenal (HPA) axis and other systems.

Muscle contractions in the intestine: The intestine walls are lined with layers of muscle that contract as they move food through your digestive tract. When contractions are stronger or when they last longer than usual, gas, bloating, and diarrhea can occur. Contractions that are weak can slow food passage, causing hard, dry stools.

Post-infection: IBS may develop following a severe bout of diarrhea caused by a virus or bacteria (gastroenteritis). Research suggests IBS may also be linked with an overgrowth of bacteria in the intestines.

Brain-gut dysfunction: Weakly coordinated signals between the intestines and the brain may cause your body to overreact to changes that normally occur during the digestive process. This may result in abdominal pain, diarrhea, or constipation.

Who Is More Likely to Get Irritable Bowel Syndrome?

Most people have occasional symptoms of irritable bowel syndrome, but there are several factors that increase the probability of a person developing the syndrome. Such factors include:

Family history of IBS: Scientists believe genes and shared family factors may play a role in IBS.

Age: IBS appears to occur more frequently in people under the age of 50.

Sex: IBS is more prevalent in women. According to the Mayo Clinic, research suggests estrogen therapy before or after menopause is also a risk factor for developing the condition.

Mood disorders: People affected by depression, anxiety, or other mental health issues have an increased risk of developing IBS. Those challenged by a history of physical, emotional, or sexual abuse may also have a higher risk.

Food intolerance: Food intolerance occurs when your body can’t break down certain ingredients or foods. Symptoms may be uncomfortable, but they are not life-threatening.

What Are the Tests to Detect Irritable Bowel Syndrome?

There are no tests available to conclusively diagnose IBS. To determine if you have developed the condition, your physician will obtain a complete medical history, perform a physical exam, and order tests to rule out other conditions, such as inflammatory bowel disease (IBD) and celiac disease.

Rome IV Criteria for IBS

Subtypes of IBS are diagnosed by applying values known as the Rome IV Criteria.

Abdominal pain or discomfort at least once per week in the last three months associated with at least two of the following:

Change in the frequency of bowel movements

Pain and discomfort related to defecation

Change in stool consistency

The subtypes are based solely on the days an abnormal stool occurs.

Rome IV stipulates that symptoms have been present for the previous three months, with the original onset at least six months before irritable bowel syndrome was diagnosed.

If the initial assessment of IBS is not enough, your physician may order additional tests to check for other more serious conditions or to check for bacteria or infection.

Diagnostic Procedures

Colonoscopy: This procedure is performed using a small, flexible tube that allows your physician to examine the entire length of the colon, also known as the large intestine.

CT scan: This radiologic study produces images of your abdomen and pelvis. This test may be used to rule out other causes of your symptoms, especially if you are experiencing abdominal pain.

Upper endoscopy: This procedure employs a long, flexible tube that your physician uses to examine your upper digestive tract. This includes the esophagus, stomach, and duodenum. The duodenum is the first portion of the small intestine. During this exam, biopsies and fluid may be taken to look for an overgrowth of bacteria or other conditions. Endoscopy is often recommended if celiac disease is suspected.

Laboratory Tests

Breath test: A breath test may be ordered to investigate the possibility of bacterial overgrowth in the small intestine.

Stool test: A stool test may be performed to probe for bacterial growth and the presence of parasites.

Lactose tolerance test: This test helps to determine if there may be a lactose intolerance or gluten allergy.

What Are the Complications of Irritable Bowel Syndrome?

Complications of IBS are limited, but they can have a significant impact on your daily life. Complications include:

Hemorrhoids: chronic constipation or diarrhea can cause hemorrhoids.

Mood disorders: People suffering from IBS symptoms may experience anxiety or depression. Conversely, anxiety and depression may also make IBS symptoms worse.

Poor quality of life: Individuals who suffer from moderate to severe IBS report poor quality of life. Research reveals that people with IBS miss three times as many days of work as those without an IBS diagnosis.

What Are the Treatments for Irritable Bowel Syndrome?

Treatment for IBS is based solely on relieving symptoms. Mild symptoms are often relieved by managing stress and making lifestyle and diet changes. Diet and lifestyle changes include:

Getting regular exercise.

Getting enough sleep.

Eating high-fiber foods.

Avoiding foods that trigger symptoms.

Drinking plenty of fluids.

Upon evaluation, your doctor might also suggest that you eliminate certain foods from your diet:

Gluten: Studies show that IBS patients experience an improvement in diarrhea symptoms when they stop eating gluten, even if they do not have a diagnosis of celiac disease. Some examples of foods that contain gluten are wheat, rye, and barley.

High-gas foods: Individuals who experience gas or bloating may be advised to eliminate items such as alcoholic beverages, carbonated drinks, and specific foods that may lead to increased gas production.

FODMAPs: Fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols are a group of carbohydrates to which many people show sensitivity. This group includes fructans, fructose, lactose, and others. FODMAPs are found in certain vegetables, grains, and dairy products. However, prolonged dietary restrictions should be used cautiously, as they may cause nutritional deficiencies and alter the colonic microorganisms.


Based on your diet, your physician may recommend supplements and/or medication management to further support symptom relief. These recommendations might include:

Fiber supplements: Taking a fiber supplement such as psyllium husk alongside increased fluids may help manage constipation.

Laxatives: When fiber doesn’t relieve constipation, your physician may recommend over-the-counter laxatives, such as polyethylene glycol.

Anti-diarrheal medications: Medications such as loperamide can help control diarrhea. Your physician may also prescribe a bile acid binder, such as cholestyramine or colestipol.

Anticholinergic medications: These medications are often prescribed for people who suffer from painful bowel spasms and bouts of diarrhea. Medications such as dicyclomine are generally safe but can cause dry mouth, constipation, and blurred vision.

Tricyclic antidepressants: This type of medication is often used to relieve depression, but it also stalls the activity of neurons that control the intestines, which could help reduce abdominal pain. When IBS patients have abdominal pain and diarrhea without depression, their physician may recommend a lower-than-standard dose of imipramine, desipramine, or nortriptyline.

Pain medications: Medication that controls pain such as pregabalin and gabapentin may reduce severe abdominal pain and bloating.

Medications Specifically Approved for IBS

In severe cases of IBS or when other treatment modalities have failed, your physician may recommend medications that were specifically designed and approved for IBS. These medications include:

Alosetron: This medication was created to relax the colon and slow the movement of waste through the lower bowel. It is intended for use in only severe cases of diarrhea-predominant IBS in women who haven’t responded to other treatments. Alosetron is not approved for men and can only be prescribed by certain providers.

Eluxadoline: This medication is used to ease diarrhea symptoms by reducing fluid secretion and muscle contractions in the intestine. It may also help increase muscle tone in the rectum. This drug works via opioid receptors contained within the gut. Its addiction potential is low.

Rifaximin: This is an antibiotic that is used to reduce diarrhea and bacterial overgrowth.

Lubiprostone: This medication is used to increase fluid secretion in your small intestine to assist with the passage of stool. Lubiprostone is approved for women who have IBS-C only and is typically prescribed only for those with severe symptoms that haven’t responded to other treatment modalities.

Linaclotide: This medication is used to increase the fluid secretion in your small intestine, helping with the passage of stool.


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