It just keeps happening: Day after day, your stomach turns against you after your morning smoothie, your kale salad at lunch, or your afternoon handful of trail mix. These are supposed to be healthy foods, so why is everything you eat giving you such bad cramps and upset stomach?
This is the question faced by about 12 percent of the U.S. population who deal with IBS, or irritable bowel syndrome. IBS is a functional gastrointestinal disorder that causes a cluster of different symptoms in the digestive tract, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
“There is no one test to find IBS. IBS is a constellation of symptoms, and you put together that story, making sure that there’s not organic disease,” says Anthony Starpoli, MD, a gastroenterologist in New York City. In other words, doctors need to rule out other conditions before they can suspect your stomach pain is IBS.
These symptoms may indicate that your stomach pain is IBS, and not another stomach ache-causing condition.
1. You have abdominal pain—often.
The key feature of IBS is abdominal pain, which may range from acute pangs and twinges in the intestines to a more dull throbbing all over the abdomen. Abdominal pain associated with IBS typically occurs after eating certain foods or eating too much food at once, but stomach pain can also occur during times of stress—or for seemingly no reason at all.
By definition, you should have abdominal pain for at least three months before a doctor would diagnosis your stomach pain as IBS, according to Dr. Starpoli.
2. You experience constipation, diarrhea, or both.
IBS has three subtypes: IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), and IBS with mixed bowel habits (IBS-M), according to the NIDDK.
IBS-C is associated with frequent constipation, causing hard, lumpy stools that are difficult to pass. Patients may say they never feel totally “empty” after going. Episodes of diarrhea occur less than a quarter of the time. Patients with IBS-C may be able to reduce the severity or frequency of symptoms by following lifestyle habits that prevent constipation.
IBS-D is associated with frequent diarrhea, resulting in loose, watery stools. Less than a quarter of stools are hard or lumpy. Some patients find relief by eating more soluble fiber, which helps slow down food’s movement through the intestines.
IBS-M will have a mostly equal occurence of constipation and diarrhea. Due to the unpredictability of symptoms, this subtype of IBS can be the most challenging to manage.
Regardless of which subtype of IBS a person has, going to the bathroom usually provides some relief in abdominal pain, according to Dr. Starpoli. This is a distinguishing feature of IBS.
3. The stomach pain does not wake you up at night.
Some conditions—like a stomach ulcer, acid reflux, a kidney stone, appendicitis, food poisoning, a stomach virus, or gallstones—worsen at night or are severe and sudden enough to wake you up from sleep. This is not true for functional GI disorders like IBS.
4. Your colon lining looks normal.
You’ll need your doctor’s help for this one. Using a colonoscopy—a procedure in which a scope looks inside your rectum and colon—a doctor can look for abnormalities such as inflammation, ulcers, or cancer, according to NIDDK.
Despite all the pain and upset stomach, someone with IBS will exhibit none of these colon abnormalities. This helps distinguish IBS from other issues like inflammatory bowel disease. “In IBD, or inflammatory bowel disease, the lining of the colon is inflamed. It’s raw, ulcerated, weeping, [and] bleeding,” says Dr. Starpoli. “When you look at the colon of a patient with irritable bowel syndrome, it’s completely normal.”
Whenever doctors consider whether someone has IBS, they must check for certain “alarm symptoms” that may signal other conditions. Red flags for other pain-causing conditions include:
Waking from deep sleep in pain
Unexplained weight loss
Conditions like IBD or colon cancer require immediate treatment and benefit from early detection, so ruling these out is crucial. “You would never label a 50-year-old who never had IBS and who’s a male without really being sure there’s no other process taking place in the colon,” says Dr. Starpoli.