Some conditions can be hard to diagnose, especially if they have a wide range of symptoms that show up in different ways. Irritable bowel syndrome, or IBS, is one of those tricky conditions.
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“Diagnosing IBS can be difficult because symptoms are the same as many other digestive diseases,” says gastroenterologist Brian Baggott, MD.
Because it’s difficult to diagnose, it’s important you see a trusted healthcare provider to get a correct diagnosis if you start showing signs and symptoms of IBS or other abdominal issues.
Dr. Baggott breaks down the symptoms of IBS you should watch out for. He also highlights symptoms that don’t point to IBS but may be a sign of a more serious condition.
Symptoms of IBS
IBS is generally associated with discomfort in your abdominal area. This can be triggered by stress or worsen after eating. A key sign that your symptoms indicate IBS: Your symptoms improve after going to the bathroom.
Prolonged belly pain
Signs of IBS include abdominal pain on average of one day a week over the course of three months.
As you already know (probably too well), belly pain can happen for any number of reasons, from food poisoning to an ulcer to kidney stones. Keeping track of what exactly you’re feeling — and what you were doing when the pain started — will help your provider narrow down the list of suspects.
Bloating, cramping or excess gas
People love to joke about having a “food baby” after a particularly hearty meal, but when bloating, cramping and gas get serious, they’re no laughing matter. In fact, trapped gas can cause chest pain so severe that people sometimes think they’re having a heart attack.
Changes in bowel frequency
Everybody has their own “normal” when it comes to pooping, but as a general rule, you should be going somewhere between three times a week and three times a day.
If you suddenly find yourself going much more (or less) than usual, it’s a reason to talk to your provider. You also need to speak up if you’re experiencing greater urgency than usual, or are having accidents. Trust us: You’re not the only one.
Changes in stool shape, size or consistency
It’s doesn’t make for great dinner conversation, but changes in the characteristics of your poop are worth discussing with your provider. If your stool has become watery or hard, or if you’re noticing clear or white mucous in the mix, it could be a sign that you have IBS.
Diarrhea, constipation or a combination of the two
There are three different types of IBS: IBS with constipation (IBS-C), IBS with diarrhea (IBS-D) and IBS with mixed bowel habits (IBS-M). The different types occur at roughly the same rate.
Anxiety and/or depression
Of all the signs of IBS we’ve listed here, this one tends to surprise people the most. But it probably shouldn’t. We know that our brain and our gut are deeply interconnected. And we’ve all experienced nervous poops and stress nausea from time to time.
It makes sense, but we don’t yet know the exact nature of the relationship between anxiety disorders, mood disorders and IBS. Does our mental health dictate our gut health, or vice versa? After all, IBS can be stressful, especially when you’re in an environment you can’t control.
To make matters more confusing, some medications for anxiety and depression can help calm IBS symptoms, while others can make them worse. Add that to the pile of reasons to see your healthcare provider for a formal diagnosis.
Many people with IBS are able to point to certain foods that trigger a flare. The most common offenders fall into the FODMAP category: fermentable oligosaccharides, disaccharides, monosaccharides and polyols.
Say that five times fast!
FODMAPS are carbohydrates that are difficult to digest. Specifically, we’re talking about fructose, lactose, fructans, galactans and polyols.
It’s not uncommon for people to have an intolerance to some or all of these carbohydrates. For example, research suggests as many as 70% of us become lactose intolerant as we age. In other words, having an intolerance doesn’t mean you have IBS, but it’s often the case that people with IBS happen to have food intolerances, too.
Many people with IBS follow a low FODMAP diet to manage their symptoms. If you aren’t sure if you have a food intolerance (as opposed to an allergy), keeping a journal of your symptoms might help. More on that later.
Fatigue and sleep issues
Are you sick and tired of feeling sick and tired? Do you ever notice that your gastrointestinal symptoms are worse when you’ve had a bad night’s sleep?
While we don’t fully understand why yet, studies suggest that over 50% of people living with IBS experience fatigue and sleep issues. It’s a vicious cycle: Poor quality sleep leads to a flare, which leads to poor quality sleep.
What to do if you think you have IBS?
“IBS is a real disease that has real treatments that can significantly improve your quality of life,” says Dr. Baggott. That’s why it’s important to monitor your symptoms and see a healthcare provider for evaluation.
While you wait for an appointment, keeping a symptom journal can help speed up the diagnostic process.
Keep a symptom journal
Not only can keeping a symptom journal help your provider determine if you’re experiencing IBS, but it can also help you identify your specific triggers. All you have to do is write down the following:
- The date, time and duration of your symptoms.
- A description of the symptoms and your pain level. The Bristol Stool Form Scale (BSFS) may be helpful for identifying changes in the quality of your poop.
- What you ate or drank in the lead up to your symptoms, as well as any medications you took.
- A quick inventory of other potentially relevant details. How stressed or anxious are you right now? Where are you in your menstrual cycle (if you have one)? How did you sleep last night? Did you do any exercise today and if so, what kind of exercise did you do?
Even if you don’t end up being diagnosed with IBS, a symptom journal can give you crucial insight into how and why you aren’t feeling well.
See a healthcare provider
While it’s important to identify the symptoms you’re experiencing, it’s also important that you don’t rely on self-diagnosis. It’s important to see a healthcare provider because it’s possible you have another digestive disease.
Even if you do have IBS, there are a lot of ways to manage the condition and treat flare-ups. Only a healthcare provider will be able to tell you what makes the most sense for your situation. They might recommend adjusting your diet, switching off medications that are common IBS triggers, getting prescriptions for antispasmodics, or making dietary and lifestyle changes to promote exercise and manage stress. And that’s just the tip of the IBS-management iceberg!
What can be mistaken for IBS?
Chalking your symptoms up to IBS — and not consulting with a healthcare provider — could be a dangerous mistake. That’s because abdominal pain, changes in bowel movement and stool changes can be associated with a variety of conditions, including the following:
- Inflammatory bowel disease (IBD). Inflammatory bowel disease may sound like IBS, but it’s quite different. IBS doesn’t cause damage to your intestines. IBD is a group of disorders. The most common forms of IBD are Crohn’s disease and ulcerative colitis.
- Celiac disease. This digestive and multisystem disorder is triggered when affected people eat gluten (a protein in some grains like wheat, barley and rye). “Celiac disease is very common and it’s become part of the initial workup for IBS,” notes Dr. Baggott. “There are a few tests you can do to diagnose digestive diseases, one of which is a blood test for celiac disease.”
- Diverticulosis. Diverticulosis happens in most adults. In response to an increase in pressure over time, diverticula, or expanded pockets or bubbles, can form in the wall of your colon (similar to the bulges that can form when you put too much air in a bike tire). On their own, these pockets don’t need to be treated and don’t cause any signs or symptoms. But over time, they can become inflamed or infected, which is called diverticulitis.
- Endometriosis. Endometriosis shares many symptoms with IBS, most notably abdominal and pelvic pain. Endometriosis occurs when tissue similar to the lining in your uterus (endometrial tissue) attaches to other structures in your abdomen or pelvis. “Generally, your pain will intensify before you get your period and it goes away after you have your period,” explains Dr. Baggott.
- Dyspepsia. Dyspepsia, or indigestion, is a condition that describes an upset stomach. This is generally accompanied by a painful or burning feeling in your abdomen. Indigestion itself can be a sign of several conditions, including IBS.
- Lactose intolerance. This condition describes someone’s inability to digest lactose, a specific sugar found most often in milk and dairy products. “It can seem similar to IBS, but a dietary trial of removing lactose-containing products from your diet to see if you get better can be helpful to determine the difference,” says Dr. Baggott.
- Cancer. Diagnostic tests are very important for ruling this possibility out. Early colorectal cancer can show no symptoms, so knowing your family history and getting screened is critical. Signs you should see a healthcare provider include weight loss, rectal bleeding and bloody stool.
Symptoms that aren’t typical for IBS
Some common symptoms that aren’t associated with IBS include:
- Excessive, sudden weight loss.
- Intestinal bleeding or blood in your stool.
- Constant and severe bouts of pain that start suddenly.
- Unexplained iron deficiency anemia.
- Swollen abdominal masses or lymph nodes.
- Onset of symptoms after the age of 50.
If you experience significant bleeding or sudden weight loss, you need to see a healthcare provider immediately.
“If your history raises red flags like bleeding or weight loss, you have to really act on that and not assume it’s IBS,” cautions Dr. Baggott.
The bottom line
IBS is associated with a wide range of symptoms, including abdominal pain, constipation, and diarrhea.
If you’ve been experiencing symptoms of IBS consistently over the course of three months, you should seek out a diagnosis from a healthcare provider. There are a number of different ways to treat IBS, and they’ll be able to review the options with you.
If you notice sudden weight loss or bleeding, you probably aren’t experiencing IBS. These symptoms can be a sign of a severe gastrointestinal issue, so you should also make an appointment with a provider as soon as possible.