Irritable bowel syndrome (IBS)

The main symptoms of IBS are belly pain with constipation or diarrhea. Other common symptoms are bloating, mucus in the stools, and a feeling that you haven't completely emptied your bowels.

Many people with IBS go back and forth between having constipation and having diarrhea. Most people have one of these 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.

It isn't clear what causes IBS. The cause may be different for different people. It may be caused by problems with the way signals are sent between the brain and the digestive tract, or problems digesting certain foods. People with IBS may have unusually sensitive intestines. Or they may have 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.

Most of the time, doctors can diagnose IBS 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. People with diarrhea as part of their symptoms usually need testing. What tests you need depend on your symptoms and your age.

Tests may include a blood test for celiac disease and a complete blood count. Other tests can include stool tests for colon inflammation and infection. A colonoscopy is sometimes done.

Treatment for IBS depends on what symptoms you have, how severe they are, and how they affect your daily life. You may need to try a few things before you find out what works best for you.

Record your symptoms

The first step in treating IBS usually involves watching and recording what you eat and drink, your activities, and your experiences. These experiences might be pleasant things like catching up with a friend—or more stressful ones like having an argument with a family member. You can record all of this on paper, a computer, or your phone calendar. You may be able to see what things make your symptoms worse. Then you can avoid them. You may also find things that make your symptoms better.

Look for food triggers

Many people learn to avoid foods that trigger their symptoms. Here are some things to try.

• Eat a low-FODMAP diet. FODMAPs are carbohydrates that are in many types of foods.
• Add soluble fiber every day. This is the kind of fiber that dissolves in water. Some foods with soluble fiber are oats and fruit without skin. Some supplements you can try are Benefiber and Citrucel.
• Limit caffeine and alcohol.
• Limit your intake of fatty foods.
• If diarrhea is your main symptom, limit dairy products, fruit, and artificial sweeteners such as sorbitol and xylitol.
• Avoid foods such as beans, cabbage, or uncooked cauliflower or broccoli. This can help relieve bloating or gas.

Other steps to take

• Get some exercise. It's healthy and helps some people have fewer symptoms. It can also help with constipation.
• If you smoke, quit or cut back as much as you can. Talk to your doctor if you need help quitting.
• Reduce stress, if stress seems to trigger symptoms.
• Ask your doctor for a counselor who works with patients with IBS. A type of counseling called cognitive behavioral therapy can help with pain.
• Ask your doctor if they think pelvic floor physical therapy might help you. Some people have an imbalance in the muscles that are used to pass stool.

Take medicines

If diet and lifestyle changes don't help enough on their own, your doctor may prescribe medicines. Certain medicines are designed to help with constipation and diarrhea. Other medicines can help with pain. The medicines that are used for IBS pain are the same ones doctors use to treat anxiety and depression.

Irritable bowel syndrome, or IBS, is a problem with the intestines. IBS can cause belly pain, bloating, gas, constipation, and diarrhea. Most people can control their symptoms by changing their diet and easing stress.

No specific foods cause everyone with IBS to have symptoms. Many people find that they feel better by limiting or eliminating foods that may bring on symptoms. Make sure you don't stop eating all foods from any one food group without talking with a dietitian. You need to make sure you are still getting all the nutrients you need.

• Keep track of foods and symptoms.
  • Keep a food diary to track what you eat. Also record when you have symptoms and what they are. There are phone apps that can help, or you can just write it down.
  • A food diary can help you figure out if certain foods trigger symptoms and if cutting out certain foods helps.
  • When you make changes to your diet, plan on it taking about 6 weeks to know if the changes help.
• To reduce pain, gas, and bloating:
  • Try adding soluble fiber every day. This is the kind that dissolves in water. Some foods with soluble fiber are oats and fruit without skin. Some supplements you can try are Benefiber and Citrucel.
  • Try a low-FODMAP diet. FODMAPs are types of carbohydrates that can make IBS symptoms worse. Your doctor or a registered dietitian can help you with this diet.
• To reduce constipation:
  • Talk to your doctor or a dietitian about whether you should increase how much fiber you eat. If they suggest more fiber:
    • Try soluble fiber first.
    • If they recommend more insoluble fiber, go slow. Add a little bit at a time. Insoluble fiber is in fruits and vegetables with skin, most whole grains, and beans.
  • Drink plenty of fluids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
  • Get some exercise every day. Build up slowly to 30 to 60 minutes a day on 5 or more days of the week.
  • Schedule time each day for a bowel movement. Having a daily routine may help. Take your time and do not strain when having a bowel movement.
• To reduce diarrhea, limit or avoid:
  • Alcohol.
  • Caffeine, which is found in coffee, tea, cola drinks, energy drinks, and chocolate.
  • Nicotine from smoking or chewing tobacco.
  • Gas-producing foods, such as beans, broccoli, cabbage, or apples.
  • Dairy products that contain lactose (milk sugar), such as ice cream or milk.
  • Foods and drinks high in sugar, especially fruit juice, soda, candy, and other packaged sweets (such as cookies).
  • Foods high in fat, including bacon, sausage, butter, oils, and anything deep-fried.
  • Sugar alcohols like sorbitol, xylitol, mannitol, and isomalt. These are artificial sweeteners found in some sugarless candies and chewing gum.
• Take medicines exactly as directed.
• If you are in counseling to help with pain, follow your treatment plan carefully.
• If you are getting physical therapy to help with your bowel movements, make sure you do your home exercises.
• If stress makes your symptoms worse, look for ways to reduce stress.