Dr. Michael Ruscio, DC is a clinician, Naturopathic Practitioner, clinical researcher, author, and adjunct professor at the University of Bridgeport. His work has been published in peer-reviewed medical journals and he speaks at conferences around the globe.
Irritable bowel syndrome (IBS), formerly known as spastic colon, is a chronic condition that can significantly reduce patients’ quality of life . 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” .
Core IBS Symptoms
The diagnosis of IBS is based on two key symptoms: abdominal pain and altered bowel movements . 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:
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 .
In a systematic review, patients with chronic fatigue syndrome reported high rates of IBS, ranging from 35% to 92% across studies (median 51%) .
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 .
3. Migraine Headaches
Migraine headaches are also associated with IBS . Those with a long headache history and high headache frequency have a greater chance of being diagnosed with IBS .
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 . A follow-up study found the rate of IBS in asthma patients was almost double that of healthy controls .
A large systematic review found very strong connections between IBS and fibromyalgia. An estimated 48% of patients with fibromyalgia also have IBS .
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 .
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% .
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 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 , including:
Gut dysbiosis, which is an imbalance in the microorganisms of the gut . Dysbiosis may be a result of poor diet, stress, antibiotic use and other lifestyle factors .
A bout of food poisoning may cause between 5% and 32% of IBS cases . 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 .
Leaky gut [26, 27] and immune disruptions have also been found in IBS patients  and may be the reason for some IBS symptoms .
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 . 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 . This test can be used to rule out digestive diseases like IBD.
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 , 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 .
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 .
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:
Normalizing serotonin levels in the large intestine for IBS patients 
Keeping a daily food diary along with a list of symptoms can help to identify your personal trigger foods.
Research shows that probiotics improve IBS symptoms, but there are no specific recommendations about individual probiotic species or strains . 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 .
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 . A systematic review found probiotics were effective for treating anxiety .
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.
Spiegel BM. The burden of IBS: looking at metrics. Curr Gastroenterol Rep. 2009 Aug;11(4):265-9. doi: 10.1007/s11894-009-0039-x. PMID: 19615301.
Lacy BE, Patel NK. Rome Criteria and a Diagnostic Approach to Irritable Bowel Syndrome. J Clin Med. 2017 Oct 26;6(11):99. doi: 10.3390/jcm6110099. PMID: 29072609; PMCID: PMC5704116.
Enck P, Aziz Q, Barbara G, Farmer AD, Fukudo S, Mayer EA, Niesler B, Quigley EM, Rajilić-Stojanović M, Schemann M, Schwille-Kiuntke J, Simren M, Zipfel S, Spiller RC. Irritable bowel syndrome. Nat Rev Dis Primers. 2016 Mar 24;2:16014. doi: 10.1038/nrdp.2016.14. PMID: 27159638; PMCID: PMC5001845.
Masuy I, Van Oudenhove L, Tack J, Biesiekierski JR. Effect of intragastric FODMAP infusion on upper gastrointestinal motility, gastrointestinal, and psychological symptoms in irritable bowel syndrome vs healthy controls. Neurogastroenterol Motil. 2018 Jan;30(1). doi: 10.1111/nmo.13167. Epub 2017 Aug 1. PMID: 28762592.
de Bortoli N, Tolone S, Frazzoni M, Martinucci I, Sgherri G, Albano E, Ceccarelli L, Stasi C, Bellini M, Savarino V, Savarino EV, Marchi S. Gastroesophageal reflux disease, functional dyspepsia and irritable bowel syndrome: common overlapping gastrointestinal disorders. Ann Gastroenterol. 2018 Nov-Dec;31(6):639-648. doi: 10.20524/aog.2018.0314. Epub 2018 Sep 26. PMID: 30386113; PMCID: PMC6191868.
Han CJ, Yang GS. Fatigue in Irritable Bowel Syndrome: A Systematic Review and Meta-analysis of Pooled Frequency and Severity of Fatigue. Asian Nurs Res (Korean Soc Nurs Sci). 2016 Mar;10(1):1-10. doi: 10.1016/j.anr.2016.01.003. Epub 2016 Feb 1. PMID: 27021828.
Whitehead WE, Palsson O, Jones KR. Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications? Gastroenterology. 2002 Apr;122(4):1140-56. doi: 10.1053/gast.2002.32392. PMID: 11910364.
Tang YR, Yang WW, Liang ML, Xu XY, Wang MF, Lin L. Age-related symptom and life quality changes in women with irritable bowel syndrome. World J Gastroenterol. 2012 Dec 28;18(48):7175-83. doi: 10.3748/wjg.v18.i48.7175. PMID: 23326122; PMCID: PMC3544019.
Sperber AD, Atzmon Y, Neumann L, Weisberg I, Shalit Y, Abu-Shakrah M, Fich A, Buskila D. Fibromyalgia in the irritable bowel syndrome: studies of prevalence and clinical implications. Am J Gastroenterol. 1999 Dec;94(12):3541-6. doi: 10.1111/j.1572-0241.1999.01643.x. PMID: 10606316.
Hamilton WT, Gallagher AM, Thomas JM, White PD. Risk markers for both chronic fatigue and irritable bowel syndromes: a prospective case-control study in primary care. Psychol Med. 2009 Nov;39(11):1913-21. doi: 10.1017/S0033291709005601. Epub 2009 Apr 15. PMID: 19366500.
Przekop P, Haviland MG, Zhao Y, Oda K, Morton KR, Fraser GE. Self-reported physical health, mental health, and comorbid diseases among women with irritable bowel syndrome, fibromyalgia, or both compared with healthy control respondents. J Am Osteopath Assoc. 2012 Nov;112(11):726-35. Erratum in: J Am Osteopath Assoc. 2013 Jan;113(1):15. PMID: 23139343; PMCID: PMC3542981.
Koloski NA, Jones M, Talley NJ. Evidence that independent gut-to-brain and brain-to-gut pathways operate in the irritable bowel syndrome and functional dyspepsia: a 1-year population-based prospective study. Aliment Pharmacol Ther. 2016 Sep;44(6):592-600. doi: 10.1111/apt.13738. Epub 2016 Jul 22. PMID: 27444264.
Cámara-Lemarroy CR, Rodriguez-Gutierrez R, Monreal-Robles R, Marfil-Rivera A. Gastrointestinal disorders associated with migraine: A comprehensive review. World J Gastroenterol. 2016 Sep 28;22(36):8149-60. doi: 10.3748/wjg.v22.i36.8149. PMID: 27688656; PMCID: PMC5037083.
Arzani M, Jahromi SR, Ghorbani Z, Vahabizad F, Martelletti P, Ghaemi A, Sacco S, Togha M; School of Advanced Studies of the European Headache Federation (EHF-SAS). Gut-brain Axis and migraine headache: a comprehensive review. J Headache Pain. 2020 Feb 13;21(1):15. doi: 10.1186/s10194-020-1078-9. PMID: 32054443; PMCID: PMC7020496.
Kennedy TM, Jones RH, Hungin AP, O’flanagan H, Kelly P. Irritable bowel syndrome, gastro-oesophageal reflux, and bronchial hyper-responsiveness in the general population. Gut. 1998 Dec;43(6):770-4. doi: 10.1136/gut.43.6.770. PMID: 9824603; PMCID: PMC1727355.
Roussos A, Koursarakos P, Patsopoulos D, Gerogianni I, Philippou N. Increased prevalence of irritable bowel syndrome in patients with bronchial asthma. Respir Med. 2003 Jan;97(1):75-9. doi: 10.1053/rmed.2001.1409. PMID: 12556015.
Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. JAMA. 2015 Mar 3;313(9):949-58. doi: 10.1001/jama.2015.0954. PMID: 25734736.
Menees S, Chey W. The gut microbiome and irritable bowel syndrome. F1000Res. 2018 Jul 9;7:F1000 Faculty Rev-1029. doi: 10.12688/f1000research.14592.1. PMID: 30026921; PMCID: PMC6039952.
Hawrelak JA, Myers SP. The causes of intestinal dysbiosis: a review. Altern Med Rev. 2004 Jun;9(2):180-97. PMID: 15253677.
Thabane M, Marshall JK. Post-infectious irritable bowel syndrome. World J Gastroenterol. 2009 Aug 7;15(29):3591-6. doi: 10.3748/wjg.15.3591. PMID: 19653335; PMCID: PMC2721231.
Schmulson M, Bielsa MV, Carmona-Sánchez R, Hernández A, López-Colombo A, López Vidal Y, Peláez-Luna M, Remes-Troche JM, Tamayo JL, Valdovinos MA. Microbiota, gastrointestinal infections, low-grade inflammation, and antibiotic therapy in irritable bowel syndrome: an evidence-based review. Rev Gastroenterol Mex. 2014 Apr-Jun;79(2):96-134. English, Spanish. doi: 10.1016/j.rgmx.2014.01.004. Epub 2014 May 23. PMID: 24857420.
Takakura W, Pimentel M. Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome – An Update. Front Psychiatry. 2020 Jul 10;11:664. doi: 10.3389/fpsyt.2020.00664. PMID: 32754068; PMCID: PMC7366247.
Saffouri GB, Shields-Cutler RR, Chen J, Yang Y, Lekatz HR, Hale VL, Cho JM, Battaglioli EJ, Bhattarai Y, Thompson KJ, Kalari KK, Behera G, Berry JC, Peters SA, Patel R, Schuetz AN, Faith JJ, Camilleri M, Sonnenburg JL, Farrugia G, Swann JR, Grover M, Knights D, Kashyap PC. Small intestinal microbial dysbiosis underlies symptoms associated with functional gastrointestinal disorders. Nat Commun. 2019 May 1;10(1):2012. doi: 10.1038/s41467-019-09964-7. PMID: 31043597; PMCID: PMC6494866.
Chen B, Kim JJ, Zhang Y, Du L, Dai N. Prevalence and predictors of small intestinal bacterial overgrowth in irritable bowel syndrome: a systematic review and meta-analysis. J Gastroenterol. 2018 Jul;53(7):807-818. doi: 10.1007/s00535-018-1476-9. Epub 2018 May 14. PMID: 29761234.
Camilleri M, Gorman H. Intestinal permeability and irritable bowel syndrome. Neurogastroenterol Motil. 2007 Jul;19(7):545-52. doi: 10.1111/j.1365-2982.2007.00925.x. PMID: 17593135.
Barbara G. Mucosal barrier defects in irritable bowel syndrome. Who left the door open? Am J Gastroenterol. 2006 Jun;101(6):1295-8. doi: 10.1111/j.1572-0241.2006.00667.x. PMID: 16771952.
Barbara G, Cremon C, Carini G, Bellacosa L, Zecchi L, De Giorgio R, Corinaldesi R, Stanghellini V. The immune system in irritable bowel syndrome. J Neurogastroenterol Motil. 2011 Oct;17(4):349-59. doi: 10.5056/jnm.2011.17.4.349. Epub 2011 Oct 31. PMID: 22148103; PMCID: PMC3228974.
Barbara G, Zecchi L, Barbaro R, Cremon C, Bellacosa L, Marcellini M, De Giorgio R, Corinaldesi R, Stanghellini V. Mucosal permeability and immune activation as potential therapeutic targets of probiotics in irritable bowel syndrome. J Clin Gastroenterol. 2012 Oct;46 Suppl:S52-5. doi: 10.1097/MCG.0b013e318264e918. PMID: 22955358.
Jin DC, Cao HL, Xu MQ, Wang SN, Wang YM, Yan F, Wang BM. Regulation of the serotonin transporter in the pathogenesis of irritable bowel syndrome. World J Gastroenterol. 2016 Sep 28;22(36):8137-48. doi: 10.3748/wjg.v22.i36.8137. PMID: 27688655; PMCID: PMC5037082.
Pimentel M, Morales W, Rezaie A, Marsh E, Lembo A, et al. (2015) Development and Validation of a Biomarker for Diarrhea-Predominant Irritable Bowel Syndrome in Human Subjects. PLOS ONE 10(5): e0126438. https://doi.org/10.1371/journal.pone.0126438
Qin HY, Cheng CW, Tang XD, Bian ZX. Impact of psychological stress on irritable bowel syndrome. World J Gastroenterol. 2014 Oct 21;20(39):14126-31. doi: 10.3748/wjg.v20.i39.14126. PMID: 25339801; PMCID: PMC4202343.
Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ. Long term benefits of hypnotherapy for irritable bowel syndrome. Gut. 2003 Nov;52(11):1623-9. doi: 10.1136/gut.52.11.1623. PMID: 14570733; PMCID: PMC1773844.
McKenzie YA, Bowyer RK, Leach H, Gulia P, Horobin J, O’Sullivan NA, Pettitt C, Reeves LB, Seamark L, Williams M, Thompson J, Lomer MC; (IBS Dietetic Guideline Review Group on behalf of Gastroenterology Specialist Group of the British Dietetic Association). British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet. 2016 Oct;29(5):549-75. doi: 10.1111/jhn.12385. Epub 2016 Jun 8. PMID: 27272325.
Marsh A, Eslick EM, Eslick GD. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. Eur J Nutr. 2016 Apr;55(3):897-906. doi: 10.1007/s00394-015-0922-1. Epub 2015 May 17. PMID: 25982757.
Altobelli E, Del Negro V, Angeletti PM, Latella G. Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis. Nutrients. 2017 Aug 26;9(9):940. doi: 10.3390/nu9090940. PMID: 28846594; PMCID: PMC5622700.
Mazzawi T, El-Salhy M. Effect of diet and individual dietary guidance on gastrointestinal endocrine cells in patients with irritable bowel syndrome (Review). Int J Mol Med. 2017 Oct;40(4):943-952. doi: 10.3892/ijmm.2017.3096. Epub 2017 Aug 11. PMID: 28849091; PMCID: PMC5593462.
Ford AC, Quigley EM, Lacy BE, Lembo AJ, Saito YA, Schiller LR, Soffer EE, Spiegel BM, Moayyedi P. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. Am J Gastroenterol. 2014 Oct;109(10):1547-61; quiz 1546, 1562. doi: 10.1038/ajg.2014.202. Epub 2014 Jul 29. PMID: 25070051.
American College of Gastroenterology Task Force on Irritable Bowel Syndrome, Brandt LJ, Chey WD, Foxx-Orenstein AE, Schiller LR, Schoenfeld PS, Spiegel BM, Talley NJ, Quigley EM. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol. 2009 Jan;104 Suppl 1:S1-35. doi: 10.1038/ajg.2008.122. PMID: 19521341.
Zhang C, Jiang J, Tian F, Zhao J, Zhang H, Zhai Q, Chen W. Meta-analysis of randomized controlled trials of the effects of probiotics on functional constipation in adults. Clin Nutr. 2020 Jan 14:S0261-5614(20)30010-8. doi: 10.1016/j.clnu.2020.01.005. Epub ahead of print. PMID: 32005532.
Ng QX, Peters C, Ho CYX, Lim DY, Yeo WS. A meta-analysis of the use of probiotics to alleviate depressive symptoms. J Affect Disord. 2018 Mar 1;228:13-19. doi: 10.1016/j.jad.2017.11.063. Epub 2017 Nov 16. PMID: 29197739.
Yang B, Wei J, Ju P, et al
Effects of regulating intestinal microbiota on anxiety symptoms: A systematic review
I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!
Transform your health
Every product is science-based, validated by real-world use, and personally vetted by Dr. Ruscio, DC.