Irritable bowel syndrome affects 12% of Americans.

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If you have IBS—or you suspect you may have IBS—you can probably remember with great clarity when your symptoms first started showing up. The foods you once loved and ate for years suddenly betrayed you, leaving you feeling confused and frustrated. Why is your beloved morning coffee consistently all of a sudden plaguing you with pain?

You can look at IBS, or irritable bowel syndrome, in two key ways: what it is, and what it’s not. That’s because a syndrome is really a group of symptoms that occur together, with no visibly obvious cause. Because of that, there’s no one test that can diagnosis IBS; to determine whether you have it,  doctors must first rule out other possible conditions, according to Anthony Starpoli, MD, gastroenterologist in New York City.

IBS is a functional gastrointestinal disorder, according to the National Institute of Diabetes and Digestive and Kidney Diseases. It’s believed to be caused by a disorder of the gut-brain interaction, which leads to heightened sensitivity and abnormal contractions of the colon. Because of this gut-brain connection, it is perhaps not surprising that IBS disproportionately affects people with mental health issues such as anxiety  or depression, according to the Anxiety and Depression Association of America.

What Are the Symptoms of IBS?

“IBS is most importantly featured by having pain: bloating, cramping, gaseous discomfort,” says Dr. Starpoli. Symptoms of IBS often appear after eating or during times of stress. People with IBS may experience the following symptoms:

  • Bloating

  • Cramping

  • Pain

  • Constipation

  • Diarrhea

One feature that distinguishes IBS from other conditions is the role of bowel movements. “[Patients] have to have relief of the pain with a bowel movement,” says Dr. Starpoli. That doesn’t mean pain will go away completely, but it may subside. (Learn other ways to tell your stomach pain is IBS.)

Who Gets IBS?

Around 65 percent of patients with IBS are women, according to the International Foundation for Functional Gastrointestinal Disorders.

Risk factors for IBS include a family history of IBS, a prior history of infection in the intestines, and a stressful live event or ongoing mental health issues.

How Is IBS treated?

Currently, the primary treatment for IBS involves lifestyle changes. Common dietary changes include eating more fiber, drinking plenty of water, and limiting “triggering” foods, which vary from person to person and can include sugar, garlic, onion, wheat, caffeine, and dairy.

People with IBS may benefit from keeping a food diary to pinpoint which foods are more likely to cause IBS symptoms. (Learn more foods to avoid with IBS here.)

Other lifestyle changes for IBS include exercise, minimizing stress, and getting enough sleep, according to NIDDK. If managing your mental health is a concern, psychotherapy or medication for the mental illness may help.

Lifestyle changes, and whether or not they work for you, may reveal a misdiagnosis. For example there’s a difference between chronic constipation and IBS with constipation (IBS-C), and if habits to prevent constipation solve the problem, then what you have is probably not IBS, according to Dr. Starpoli.

How Is IBS Different from IBD?

Due to their similar names and acronyms, IBS and IBD, which includes ulcerative colitis and Crohn’s disease, often get confused, but they’re very distinct conditions. “In IBD, or inflammatory bowel disease, the lining of the colon is inflamed,” says Dr. Starpoli. “It’s raw, ulcerated, weeping, [and] bleeding. When you look at the colon of a patient with irritable bowel syndrome, it’s completely normal.”

Other conditions that must be ruled out before making an IBS diagnosis include celiac disease, food allergies, lactose intolerance, and colon cancer, to name a few.