Figuring out if you have IBS means ruling out other possible causes.
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.
Dr. Starpoli is a board-certified gastroenterologist who is affiliated with Lenox Hill Hospital-Northwell Health, Mt. Sinai-Beth Israel Medical Center, and NYU Langone Medical Center.
00:00:00.635 --> 00:00:02.490
(slow piano music)
00:00:02.490 --> 00:00:06.370 line:15%
There is no one test to find IBS.
00:00:06.370 --> 00:00:09.250 line:15%
IBS is a constellation of symptoms
00:00:09.250 --> 00:00:11.810 line:15%
and you put together that story
00:00:11.810 --> 00:00:15.730 line:15%
making sure that there is not organic disease.
00:00:15.730 --> 00:00:18.030
Meaning somebody presents to you
00:00:18.030 --> 00:00:20.120
with a change in bowel habits
00:00:20.120 --> 00:00:20.953
you need to make sure
00:00:20.953 --> 00:00:23.095
that there's nothing else taking place.
00:00:23.095 --> 00:00:26.012
(slow piano music)
00:00:27.080 --> 00:00:31.570
IBS is most importantly featured by having pain.
00:00:31.570 --> 00:00:35.250
Usually by definition at least of a three month duration
00:00:35.250 --> 00:00:36.930
that's the general idea.
00:00:36.930 --> 00:00:41.290
It's usually associated with constipation
00:00:41.290 --> 00:00:43.850
or diarrhea or both,
00:00:43.850 --> 00:00:47.610
and very importantly they have to have relief
00:00:47.610 --> 00:00:50.763
of the pain with a bowel movement, that's important.
00:00:51.650 --> 00:00:54.170
Another interesting point about the IBS patient
00:00:54.170 --> 00:00:58.470
distinguishing them from patients with more organic disease
00:00:58.470 --> 00:01:03.470
is with IBS the pain does not awaken you out of your sleep.
00:01:03.490 --> 00:01:04.580
00:01:04.580 --> 00:01:07.280
don't take you out of your sleep pattern.
00:01:07.280 --> 00:01:09.320
Irritable Bowel Syndrome
00:01:09.320 --> 00:01:13.130
is different from Inflammatory Bowel Disease
00:01:13.130 --> 00:01:16.460
because in IBD or Inflammatory Bowel Disease
00:01:16.460 --> 00:01:20.270
the lining of the colon is inflamed,
00:01:20.270 --> 00:01:25.270
it's raw, ulcerated, weeping, bleeding.
00:01:25.280 --> 00:01:27.610
When you look at the colon of a patient
00:01:27.610 --> 00:01:31.920
with Irritable Bowel Syndrome it's completely normal.
00:01:31.920 --> 00:01:35.350
The alarm symptoms that would signal
00:01:35.350 --> 00:01:39.660
it being a diagnosis other than IBS would include
00:01:39.660 --> 00:01:43.350
waking up from your deep sleep with pain,
00:01:43.350 --> 00:01:46.830
bleeding, and unexplained weight loss.
00:01:46.830 --> 00:01:48.910
In general you want to make sure
00:01:48.910 --> 00:01:51.360
that there are no organic diseases in the colon
00:01:51.360 --> 00:01:54.550
and that would include the Inflammatory Bowel Disease
00:01:54.550 --> 00:01:56.800
or colon cancer.
00:01:56.800 --> 00:02:00.630
So you would never label a 50 year old
00:02:00.630 --> 00:02:03.490
who never had IBS and who's a male
00:02:03.490 --> 00:02:04.880
without really being sure
00:02:04.880 --> 00:02:08.093
that there's no other process taking place in the colon.
00:02:09.164 --> 00:02:12.164
(slow piano music)
Colonoscopy.Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases. (Accessed on January 20, 2021 at https://www.niddk.nih.gov/health-information/diagnostic-tests/colonoscopy.)
Definition & facts for irritable bowel syndrome. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases. (Accessed on January 20, 2021 at https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/definition-facts.)
Irritable bowel syndrome. Bannockburn, IL. American Society of Colon and Rectal Surgeons. (Accessed on January 20, 2021 at https://fascrs.org/patients/diseases-and-conditions/a-z/irritable-bowel-syndrome)
Irritable bowel syndrome. Washington, DC: U.S. National Library of Medicine. (Accessed on January 20, 2021 at https://medlineplus.gov/irritablebowelsyndrome.html.)
What are the symptoms of IBS? Mount Pleasant, SC. International Foundation for Functional Gastrointestinal Disorders. (Accessed on January 20, 2021 at https://aboutibs.org/what-is-ibs-sidenav/symptoms-of-ibs.html.)