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Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a common condition of the digestive system. IBS symptoms include abdominal pain, cramping, and excessive gas. You may also hear IBS called irritable bowel, irritable colon, spastic colon, or nervous stomach. Symptoms are often triggered by stress. Since IBS is a chronic condition, it requires long-term management.

IBS Is often confused with irritable bowel disease (IBD). Irritable bowel syndrome causes changes in the type and frequency of bowel movements, but it does not involve the tissues in your bowel. IBD causes changes in the tissues of the bowel wall. It is possible to have both. IBS does not increase your risk of developing colon cancer or other digestive disorders like IBD or diverticulitis.

Most people with IBS won’t have severe symptoms, and mild symptoms may be controlled with lifestyle and diet changes. Severe symptoms of IBS may be treated with medications and counseling. IBS is typically a lifelong condition with symptoms that can be disruptive to your daily life, though they may come and go.

Gastroenterology Consultants of San Antonio - Irritable Bowel Syndrome

IBS Symptoms

An estimated 10 to 20 percent of Americans experience symptoms of IBS, but only about 15 percent of those affected seek medical help.  Irritable bowel syndrome symptoms can be different from person to person. Symptoms of IBS include:

  • Abdominal Pain
  • Cramping
  • Bloating
  • Excessive Gas
  • Constipation, Diarrhea, or both
  • Mucus in the stool

Symptoms of IBS typically come and go, and may range from severe to having no symptoms at all.

Types of IBS

There are different types of IBS that are categorized by the primary type of abnormal bowel movement. Some medications used to treat IBS only work on a particular type.

IBS with constipation (IBS-C) – Most abnormal bowel movements are hard, and you have fewer than three bowel movements per week.
IBS with diarrhea (IBS-D) – Most abnormal bowel movements are watery and loose.
IBS with mixed bowel habits (IBS-M) – Abnormal bowel movements can include constipation and diarrhea on the same day.

When to see a doctor

Ongoing changes in bowel habits or other symptoms of IBS should be evaluated by a doctor. Because many diseases or conditions of the digestive tract have similar symptoms, these signs and symptoms could indicate a more serious condition like colon cancer.  You should also see a doctor if you experience more serious symptoms including:

  • Losing weight
  • Rectal bleeding
  • Excessive diarrhea, or diarrhea at night
  • Unexplained vomiting
  • Difficulty swallowing
  • Abdominal pain or cramping that isn’t relieved after a bowel movement or passing gas

IBS Causes

The exact cause of IBS is unknown, but these factors seem to be related:

Intestine muscle contractions – Muscles in the lining of the intestine help move food through the digestive tract.  These muscles may contract more or less than normal and cause issues. Stronger contractions may cause bloating, gas, or diarrhea.  Weaker contractions than normal slow down digestion, which could lead to hard stools and constipation.

Nervous system abnormalities – In some cases, the nerves in the digestive tract may overreact to changes that normally occur during digestion.  This may cause pain, constipation, or diarrhea.

Intestinal inflammation –  Some people with IBS have inflammation in the intestines due to an increase in immune-system cells in the digestive tract. This could cause diarrhea and pain.

Infection – IBS may develop following severe diarrhea caused by a virus or bacteria. An overgrowth of bacteria in the intestines is also associated with IBS.

Changes in microflora – The good bacteria in the gut (microflora) are an important part of digestive health. Some research shows that microflora in IBS patients may be different.

Brain-gut communication – The gastrointestinal tract has its own nerve system, called the enteric nervous system (ENS). Your brain and ENS communicate back and forth. Dysfunction in communication between the brain and the ENS may contribute to symptoms of IBS.

IBS Triggers

There are several triggers of IBS:

Food: Many people see an increase in IBS symptoms when they eat or drink certain foods. This includes carbonated drinks, milk and other dairy products, cabbage, beans, citrus fruits, and wheat. Food allergies, however, do not normally cause IBS.

Stress: Stress does not cause IBS symptoms, but it can aggravate symptoms.  Most people with IBS see an increase in symptoms when they have more stress. Managing stress can help alleviate the symptoms. People who experienced stressful events in childhood typically experience more IBS later in life.

Hormones: IBS affects women more often than men, which may indicate hormones play a role. Some women find that symptoms of IBS increase around the time of their menstrual cycle.

Medications: Certain drugs can cause constipation or diarrhea, including antibiotics, medicine made with sorbitol, and some antidepressants.

IBS Risk Factors

Some risk factors that may increase your chances of experiencing symptoms of IBS include:

  • Age: People under age 50 are more likely to have IBS
  • Gender: Females are twice as likely to have IBS.
  • Family History: Having other family members with IBS means you are more likely to have IBS.  Researchers have not concluded if this is related to genetics, environment, or a combination of both.
  • Mental Health: People with depression, anxiety, or other mental health issues are more likely to have IBS.

IBS Diagnosis

There is no definitive test for IBS, and the symptoms can be identical to several other intestinal disorders.  Your doctor will review your medical history, perform a physical exam, and select tests that can rule out other conditions that may be causing your symptoms.

Other gastrointestinal conditions that have similar signs and symptoms are malabsorption, inflammatory bowel disease (ulcerative colitis / Crohn’s), and microscopic and eosinophilic colitis.

Tests your doctor may order include:

  • Blood tests
  • Colonoscopy
  • Stool samples
  • X-rays

IBS Treatment

Treating IBS often uses a combination of approaches, including diet changes, stress relief, and in some cases medication to control symptoms.  It may take time to find the right combination that works for you. IBS treatment focuses on relieving and preventing symptoms.

IBS treatment is a long-term process due to the chronic nature of the condition.  It’s important to let your doctor know about your symptoms, concerns, and stressful situations that may trigger IBS.

IBS Diet Changes

Each person’s food triggers and responses are different, so it may take time to discover what works best for you. As a first step in customizing your irritable bowel syndrome diet, you may try:

  • Eating high-fiber foods or taking a fiber supplement
  • Staying hydrated & drinking plenty of water
  • Staying active / exercising regularly
  • Getting plenty of sleep at night

What is a Low FODMAP Diet?

A low FODMAP diet has been helpful to some IBS patients. Your doctor may recommend removing the following from your diet:

Foods that cause gas: Some foods cause more gas in the digestive system. These include carbonated beverages, alcohol, caffeine, raw fruit, legumes (beans), and cruciferous vegetables like broccoli, cabbage, and cauliflower.

Gluten: Some patients have found relief by eliminating gluten from their diet, even if they don’t have celiac disease.

Lactose: Temporarily removing lactose from your diet can help determine if your symptoms are related to lactose intake.  You can try removing lactose from your diet for two weeks to see if IBS symptoms improve. Lactose rich foods include milk and ice cream, but can also be found in other dairy products like yogurt and cheese.

What Foods are Best for IBS?

Certain foods may contribute to constipation or diarrhea, so you might make different diet choices depending on your type of IBS. In general, foods that may be easier for people with IBS include:

  • Water, Ginger Ale, Sprite, and Gatorade
  • Soy milk or rice milk
  • Soy or rice-based products
  • Plain pasta, plain noodles, white rice. No sauces or gravies
  • Potatoes: boiled or baked. (no french fries)
  • Breads: French, Italian, white bread, English muffins, and white rolls
  • Plain fish, plain chicken, plain turkey, or plain ham
  • Eggs: soft-boiled, poached
  • Cereals: Plain Cornflakes, rice crispies, Corn or Rice Chex, Cheerios; dry or with soymilk or rice milk
  • Salads: lettuce, hard-boiled egg slices, oil and vinegar dressing
  • Cooked peas, carrots
  • Margarine, jams, jellies, peanut butter
  • Small amounts of: applesauce, cantaloupe, watermelon, honeydew melon
  • Small amounts of: fruit cocktail, peaches, pears (canned, non-dietetic)

Foods to Avoid

If you have irritable bowel syndrome, foods to avoid may depend on individual triggers and whether you have IBS-C or IBS-D.

If you have IBS-C, it can help to boost your fiber intake and drink plenty of water. Foods with higher amounts of sorbitol, like prune juice, can also help.

Some foods that can make constipation worse include:

  • Refined grains
  • Processed foods
  • Carbonated drinks
  • Coffee
  • Alcohol
  • Dairy products
  • High-protein diets

If you have IBS-D, it might help to eat smaller portions and avoid drinking beverages with meals. Some foods that can make diarrhea worse include:

  • Too much fiber
  • Chocolate
  • Alcohol
  • Caffeine
  • Fructose or sorbitol
  • Carbonated drinks
  • Large meals
  • Fried or fatty foods
  • Dairy products

Psychosocial Therapies

Anxiety and stress can worsen IBS symptoms in some people. Treatment for stress reduction will depend on the severity of your symptoms.  You should discuss stress reduction techniques with your doctor as part of your treatment plan.

Counselors can help equip you with stress reduction techniques that may reduce your chances of developing symptoms of IBS.

IBS Medications

If changes in diet aren’t effective, medications may help control the symptoms of IBS.  There are no medications that treat IBS, but they can help control the symptoms.

The medications used will depend on your symptoms (e.g. diarrhea, constipation, or digestive pain).

Preventing IBS

Dealing with stress is one of the best ways to prevent IBS.  You may try:

  • Counseling: Studies have shown that counseling and psychotherapy can reduce symptoms of IBS.  Counselors can teach you how to react differently to stress and difficult situations.
  • Mindfulness training: Mindfulness is a stress-reduction technique that can help reduce anxiety.
  • Healthy lifestyle: Eating a healthy diet, getting regular exercise, and getting enough quality sleep can help keep you healthier overall.



What is irritable bowel syndrome?
IBS is a gastrointestinal disorder that causes gas, pain, abdominal cramps, diarrhea, and/or constipation.

What causes irritable bowel syndrome?
The exact cause is unknown, but a number of factors may contribute.

What is the best diet for irritable bowel syndrome?
Dietary triggers differ from person to person, but a low FODMAP diet may eliminate most triggers.

How to cure irritable bowel syndrome?
There is no cure for IBS, but symptoms can often be managed with diet, lifestyle, and medication.

What is the best irritable bowel syndrome treatment?
Diet changes, stress management, and medications to control symptoms are generally the best way to control symptoms.

Is a high fiber diet recommended for IBS?
There is no specific irritable bowel syndrome high fiber diet but adding fiber may decrease symptoms and improve bowel function for some people. For others, fiber may actually increase gas and bloating.

Irritable Bowel Syndrome Testimonial

“Dr. Cunningham is such a nice guy. We both grew up in the Texas Panhandle so we usually spend the first couple of minutes updating each other on our hometowns. I have a great deal of confidence in his skills as a physician. He has been treating my IBS for several years and we have a plan of action if things get worse in the future. So far, I am doing quite well and am confident I am in good hands.” -Sandy

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