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7 IBS Symptoms, Plus IBS Causes, Diagnosis, and Treatment

Written by Dr. Michael Ruscio, DC on October 30, 2020

Written by Dr. Michael Ruscio, DC on October 30, 2020 — Reviewed by Aimee Gallo

• Core IBS Symptoms|
• Other IBS Symptoms|
• Causes|
• Diagnosis|
• Treatment|
• Managing Symptoms|

Irritable bowel syndrome (IBS), formerly known as spastic colon, is a chronic condition that can significantly reduce patients’ quality of life [1]. Symptoms are often unpredictable — most patients have periods of symptom flare-ups and other times when they may be relatively symptom free.

According to the American College of Gastroenterology, in the United States, “it is estimated that 10-15 percent of the adult population suffers from IBS symptoms” [2].

Core IBS Symptoms

The diagnosis of IBS is based on two key symptoms: abdominal pain and altered bowel movements [3]. IBS patients experience frequent bouts of either diarrhea, constipation, or alternating diarrhea and constipation.

While pain and altered bowel habits are the core symptoms of IBS, there are many other common symptoms of IBS that involve the digestive system, including:

• Bloating [4]
• Cramping [5]
• Indigestion [6]
• Heartburn [6]
• Reflux [6]
• Flatulence (gas) [5]

Other IBS Symptoms

What’s not always recognized is that IBS symptoms go far beyond the digestive system. Here are seven IBS symptoms and associated conditions you might not know about:

1. Fatigue (Including Chronic Fatigue Syndrome)

Research shows strong associations between IBS and a number of other symptoms and conditions. For example, fatigue is a common symptom of IBS. A meta-analysis of 17 studies found that more than 50% of IBS patients have symptoms of fatigue [7].

In a systematic review, patients with chronic fatigue syndrome reported high rates of IBS, ranging from 35% to 92% across studies (median 51%) [8].

2. Depression and Anxiety

Mood disorders are also one of the most common symptoms of IBS: More than half of IBS patients report symptoms of depression or anxiety [9, 10, 11, 12]. A 2016 study of 1,900 people with an anxiety disorder and IBS found that two-thirds of them experienced irritable bowel syndrome (IBS) before mental health symptoms. This implies gut disturbance may be the source of many patients’ anxiety [13].

3. Migraine Headaches

Migraine headaches are also associated with IBS [14]. Those with a long headache history and high headache frequency have a greater chance of being diagnosed with IBS [15].

4. Respiratory Symptoms

Two studies have also found a connection between respiratory conditions and IBS. In the first study, bronchial hyperresponsiveness, acid reflux, and IBS occurred more frequently together than expected [16]. A follow-up study found the rate of IBS in asthma patients was almost double that of healthy controls [17].

5. Fibromyalgia

A large systematic review found very strong connections between IBS and fibromyalgia. An estimated 48% of patients with fibromyalgia also have IBS [8].

6. TMJ (or Lockjaw)

Among patients with temporomandibular joint disorder (TMJ), a condition involving jaw pain and restricted jaw movement, 64% were diagnosed with IBS [8].

7. Chronic Pelvic Pain

About half of women with chronic pelvic pain are estimated to have IBS. Results across studies ranged from 29%-79% with a median of 50% [8].

A systematic review also found higher rates of IBS in patients with back pain, PMS, and interstitial cystitis. However, the quality of this data was not as strong.

IBS Causes

IBS is a syndrome rather than a disease. This means that IBS is defined by its symptoms rather than a known disease process. Research suggests there may be a number of factors that can lead to IBS symptoms [18], including:

• Gut dysbiosis, which is an imbalance in the microorganisms of the gut [19]. Dysbiosis may be a result of poor diet, stress, antibiotic use and other lifestyle factors [20].
• A bout of food poisoning may cause between 5% and 32% of IBS cases [21]. This is known as post-infectious IBS.
• SIBO, an overgrowth of bacteria in the small intestine, and other types of gut infections are yet another likely cause of IBS [22, 23, 24]. A recent meta-analysis found high correlations between SIBO and IBS across 50 studies [25].
• Leaky gut [26, 27] and immune disruptions have also been found in IBS patients [28] and may be the reason for some IBS symptoms [29].
• Brain-gut interactions may also be a reason for IBS symptoms. Research suggests that altered serotonin levels can impact bowel function in IBS and also may be the reason for pain and mood disorders [30]. Serotonin is a chemical messenger and one of the body’s most important signaling chemicals for digestion.

Diagnosis of IBS

The diagnosis of IBS is based on symptoms rather than testing. Two symptoms of irritable bowel syndrome must be present: pain and altered bowel habits. Again, additional symptoms may be present.

An important part of IBS diagnosis is to rule out other digestive diseases with similar symptoms, such as inflammatory bowel disease (IBD), celiac disease, or colon cancer. In some cases, a gastroenterologist may recommend a colonoscopy of the large intestine to rule out these digestive diseases.

An IBS diagnosis will identify one of the following types of IBS:

• IBS-D (with diarrhea)
• IBS-C (with constipation)
• IBS-M (mix of diarrhea and constipation)

While blood tests have not traditionally been a part of IBS diagnosis, a new blood test is available for IBS-D and IBS-M [31]. This test can be used to rule out digestive diseases like IBD.

IBS Treatment

There are a number of treatment options for IBS, and most patients will benefit from using several IBS treatments. A step-by-step approach, as detailed in my book, Healthy Gut, Healthy You, can help you identify the treatments that work best for you.

Diet and Lifestyle

The foundation of your gut health lies in diet and lifestyle changes. It’s important to first address these fundamentals in your IBS treatment plan.

IBS is a stress-sensitive disorder [32], so it’s important to do what you can to manage your stress levels. Getting a full 7-8 hours of sleep a night is important. Exercising, spending time outdoors, and doing a relaxing hobby can all help to keep your stress in check.

Research also shows that the stress-reducing effects of hypnotherapy can help IBS patients. In one study, 71% of IBS patients responded to hypnotherapy, and the majority of them maintained positive effects for up to five years post-treatment [33].

Diet is also critical for managing IBS symptoms. A good starting point is a healthy diet that is low in inflammatory ingredients like sugars and trans fats, while high in fresh, whole foods [34].

There are also specific IBS diets that are low in fermentable carbohydrates. The low FODMAP diet is often recommended. A low FODMAP diet restricts certain foods that may trigger symptoms, including dairy products, beans, and certain grains.

Low FODMAP diets have produced impressive results in research, including:

• Reducing symptoms associated with IBS [35]
• Improving fatigue in those with IBS [36]
• Normalizing serotonin levels in the large intestine for IBS patients [37]

Keeping a daily food diary along with a list of symptoms can help to identify your personal trigger foods.

Probiotics

Research shows that probiotics improve IBS symptoms, but there are no specific recommendations about individual probiotic species or strains [38]. However, when mixed probiotic strains were compared with single probiotic strains for treating IBS, multi-strain probiotics were shown to be more effective than single-strain probiotics [38, 39]. Multistrain probiotics were also found to perform better in studies using probiotics to treat constipation [40].

There’s also growing research to show that probiotics can improve moods. A meta-analysis found that probiotics can significantly improve mild to moderate depressive symptoms [41]. A systematic review found probiotics were effective for treating anxiety [42].

Medication

Depending on the specifics of your IBS diagnosis, some medications can be an important part of your treatment plan.

If you have been diagnosed with SIBO and IBS, herbal antimicrobials or antibiotic treatment with rifaximin can help eradicate bacterial overgrowths in your small intestine.

Medications can also help manage the frequency of bowel movements as needed. For diarrhea, three medications are typically used:

• Imodium (loperamide) is an over-the-counter medication to slow gut motility by relaxing the smooth muscles of the digestive system.
• Viberzi (eluxadoline) is a prescription medication for IBS with diarrhea.
• Lotronex (alosetron) is a prescription medication for women with IBS-D and trouble controlling their bowel movements.

For those with IBS-C, laxatives may help manage symptoms. Consider a prescription laxative such as the following:

• Lubiprostone is a prescription medication used to manage constipation associated with irritable bowel syndrome in women.

Managing IBS Symptoms in the Long Term

Finding the right mix of treatment options for IBS will take trial and error. However, armed with the knowledge of which treatments work best, most patients can either eliminate IBS symptoms completely or effectively manage them in the long term.