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This article is based on scientific evidence, written by experts and fact checked by experts.

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This article contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.

What You Should Know About IBS Probiotics

Written by Michael Ruscio on August 22, 2020

Hilary Watts

Written by Michael Ruscio on August 22, 2020 — Reviewed by Hilary Watts Hilary Watts

The Science Behind Using Probiotics for IBS

An IBS probiotics capsule broken open to reveal the powder inside

Key Takeaways
  • Five separate meta-analyses have shown that probiotics are likely an effective treatment for IBS, with very few side effects.
  • The most important probiotic strategy for IBS (or any digestive problem) is to include a diversity of high-quality probiotics.

If you’re one of the 20% of Americans with Irritable Bowel Syndrome (IBS) [1] you’ll be happy to know that probiotic supplements may help you feel better. Many studies show probiotics to be effective and safe for IBS symptoms, without side effects. Let’s talk about why you likely want to use probiotics for IBS.

What is Irritable Bowel Syndrome (IBS)?

IBS, or irritable bowel syndrome, is one of the most common gastrointestinal disorders. It is more of a broad collection of gut symptoms, than a specific disease.

Common symptoms of Irritable Bowel Syndrome include:

  • Bloating
  • Abdominal pain
  • Cramping
  • Gas and flatulence
  • Frequent diarrhea, constipation, or both

Non-digestive symptoms of Irritable Bowel Syndrome include:

  • Brain fog and cognitive effects [2, 3]
  • Joint pain or body pain  [4, 5, 6]

IBS is categorized as either IBS-D (when diarrhea is the predominant symptom), IBS-C (when constipation is the primary symptom), or mixed (when diarrhea and constipation alternate). General practitioners and gastroenterologists often diagnose IBS when they don’t know how else to categorize your digestive symptoms or when there is no clear cause.

What Causes IBS?

There is no single proven cause of IBS, and the root cause varies from patient to patient. However, there is a close association between IBS and small intestinal bacterial overgrowth (SIBO) and other types of gut infections. [7] One meta-analysis reported an average of 38% of people with IBS tested positive for SIBO. [8]

Certain dietary habits, such as a diet too high [9] or too low in fiber [10], or high in FODMAP foods [11], can contribute to symptoms of IBS too. These are likely not the root cause of the problem, but reducing these foods can help reduce IBS symptoms. What is also clear is that probiotics help improve IBS.

What Are Probiotics?

Probiotic bacteria are live microorganisms in your digestive system that have beneficial effects on your health. Probiotics have been shown in many recent studies and double-blind clinical trials to improve IBS symptoms. [12, 13]

Collectively, probiotics have been shown to:

  • improve stool consistency, and regulate bowel movements and bowel habits [14, 15, 16]
  • Improve bloating, abdominal pain, flatulence, and gas [17, 18]

This is great news because there’s no effective conventional treatment of irritable bowel syndrome.

Probiotics Improve Irritable Bowel Syndrome

IBS probiotics: A woman doubled over from stomach pain

Though some doctors continue to insist that there is no evidence that probiotics are beneficial for irritable bowel syndrome, the evidence speaks for itself. Multiple high quality meta-analyses and clinical trials show that various types of probiotics improve IBS symptoms.

Overall IBS Symptoms

Five separate meta-analyses (the highest quality scientific evidence) have shown the efficacy of probiotics as a likely effective treatment of IBS, with very few side effects. [19, 20, 21, 22, 23]

Across these studies, people given probiotic supplements showed significant improvement in IBS symptoms and quality of life compared to a placebo group. This included improvements in:

  • Diarrhea, or loose stools
  • Constipation
  • Bloating and abdominal pain
  • Flatulence or gas
  • Fatigue and difficulty sleeping

Here is a summary of the research about the most common IBS symptoms.

Bloating and Abdominal Pain

Bloating, abdominal pain, and cramping are three of the most bothersome IBS symptoms for patients. Probiotics have been shown to be particularly effective at reducing abdominal pain.

A meta-analysis noted that “Probiotics were…associated with less abdominal pain compared to placebo,” [24] and a randomized controlled trial showed that probiotics significantly reduced abdominal pain and distention in IBS patients. [25] Several other studies reached similar conclusions. [26, 27, 28, 29]

Diarrhea

Diarrhea can be a debilitating IBS symptom. Fortunately, there is evidence that probiotics can help relieve IBS-related diarrhea.

Two studies showed that Bacillus species probiotics reduced diarrhea and stool frequency in IBS patients. [30, 31]In one more study, small intestinal bacterial overgrowth (SIBO) patients saw their diarrhea improve from probiotic supplements. [32]

Constipation

Patients who experience constipation often find the symptom to be tenacious. Probiotics have been shown to help improve stool frequency and regularity in patients with constipation. [33, 34] In one study, participants had less constipation even months after supplementation stopped. [35]

IBS Symptoms in Inflammatory Bowel Disease Patients

Many patients with Inflammatory Bowel Disease (IBD) have IBS symptoms as part of their clinical picture. Though one systematic review found probiotics do not help maintain symptom remission for IBD patients, [36] probiotics have been shown to improve IBD treatment outcomes. [37]

The best evidence is for ulcerative colitis. Several systematic reviews and meta analyses found that VSL#3, a brand-name probiotic, appeared to encourage remission of ulcerative colitis, but didn’t show a benefit for Crohn’s patients. [38, 39, 40] Another showed remission or improvement of ulcerative colitis symptoms from the use of probiotics, especially in pediatric patients. [41]

Probiotics also appear to improve the effectiveness of certain anti-inflammatory drugs used for treating ulcerative colitis [42] or may in some cases be as effective as the drugs alone. [43]

How Probiotics Heal IBS

Probiotics don’t work like medications. It’s not necessary to use specific strains to improve your IBS symptoms or any other health condition. Instead, all probiotics provide general health benefits to your gut environment by:

  • Increasing bacterial diversity, or health, of your gut flora [44]
  • Fighting pathogens (harmful bugs) and their toxins [45, 46, 47]
  • Promoting a more rapid recovery from imbalances in your gut microflora, which may be a root cause of your IBS symptoms [48] 
  • Promoting a healthy gut immune system [49, 50, 51]
  • Reducing gut inflammation [52]
  • Encouraging the growth of a healthier gut microbiome [53]
  • Reducing leaky gut [54, 55, 56]

As probiotic supplements help create these general changes to your digestive health, your IBS symptoms improve. For example, as inflammation decreases, diarrhea may improve. As your gut microbiota becomes more balanced, bloating and abdominal pain may decrease.

Using Probiotics for IBS

IBS probiotics: A hand holds a variety of probiotic pills

Along with an anti-inflammatory diet, such as the Paleo or low FODMAP diet, using a combination of probiotics is one of the primary approaches I recommend for IBS patients.

As I discuss more fully in my book Healthy Gut, Healthy You, the most important probiotic strategy for IBS (or any digestive problem) is to include a diversity of high-quality probiotics. 

Though there are hundreds of probiotic supplements on the market, most probiotics fall into one of these three categories:

Using one type of probiotic is good, but using all three different probiotics together allows them to work synergistically to improve your gut health. Probiotic strains from all three categories have been shown to help IBS symptoms.

The three types of probiotics work together like the legs of a three-legged stool. If the stool only has one or two legs, it’s likely to be unstable. With three legs, the stool is able to stay upright.

IBS probiotics: An infographic showing the benefits of using three strains of probiotics together

Choosing the Best Probiotics for IBS

Probiotic manufacturing is not highly regulated by the U.S. Food and Drug Administration (FDA) and some label claims do not stand up to scrutiny. In one study of 26 commercial probiotics, none fully supported their label claims, and some of them contained unacceptable microorganisms. [57]

You don’t need to purchase the most expensive probiotic supplements, but you should be wary of quality. Here are some tips for choosing high-quality probiotic supplements.

Choose Probiotic Supplements With:

  • A clearly stated list of species
  • A clearly stated number of colony-forming units (CFUs) in the billions
  • A manufacture date and/or expiration date
  • Labeled free of common allergens and other substances you may wish to avoid (e.g. gluten-free, non-GMO, vegan)
  • Good Manufacturing Practices (GMP) certification
  • Lab-verified for probiotic species and potency by third-party analysis (independent lab testing)

Are Probiotic Foods and Prebiotics a Good Idea for IBS?

Probiotic or fermented foods are healthy and beneficial for the digestive system, but they generally have a much smaller number of good bacteria than probiotic supplements. If you’re trying to use probiotics to address IBS, probiotic foods likely won’t be enough. 

Similarly, many recommend using prebiotics for gut health. But prebiotics are fiber supplements that feed gut bacteria and may irritate IBS symptoms for many IBS patients. Prebiotics are best left alone until you have recovered from your IBS.

The Bottom Line

Probiotics have been shown to improve many IBS symptoms, including bloating, abdominal pain, diarrhea, constipation, and more. Including probiotics and an anti-inflammatory diet in your regular routine is likely to reduce your IBS symptoms and leave you feeling better. Include one high-quality product from each probiotic category, and experience the results for yourself.

Dr. Michael Ruscio is a DC, natural health provider, researcher, and clinician. He serves as an Adjunct Professor at the University of Bridgeport and has published numerous papers in scientific journals as well as the book Healthy Gut, Healthy You. He also founded the Ruscio Institute of Functional Health, where he helps patients with a wide range of GI conditions and serves as the Head of Research.

➕ References

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