IRRITABLE BOWEL

SYNDROME
CONTENT CREATED BY

Learn more at
www.health.harvard.edu

Table of Contents
WHAT IS IRRITABLE BOWEL
SYNDROME? 4
SYMPTOMS 5
MANAGING IBS WITH DIET 8
MEDICATIONS 10
STRESS REDUCTION 12
YOUR MICROBIOME 14
Irritable bowel syndrome. It can
cause diarrhea so unpredictable that
you always know where to find the
nearest bathroom. Or it can lead to
constipation so uncomfortable that
you wish for relief. Abdominal cramps,
gas, and bloating are often part of the
mix too.
Irritable bowel syndrome has no clear
cause and, often, no straightforward
treatment. But with patience, persistence,
and trial and error, chances are good
that you will find relief.
2 irritable bowel syndrome
TALK WITH YOUR DOCTOR
Here are some questions to ask your doctor.
• Are there any foods that I should avoid?
• Would lifestyle changes help relieve my symptoms?
• What is the role of stress in irritable bowel
syndrome? Would I benefit from stress-reduction
therapy or techniques?
• Will medication help?
• Is there anything other than irritable bowel
syndrome that could be causing my symptoms?
Tell your doctor:
• How often you have bowel movements
• If you are bothered by diarrhea, constipation, or both
• Whether your symptoms improve after a bowel
movement
• If specific foods seem to trigger your symptoms
• What medications you are taking, if any
• To what extent your symptoms interfere with your
day-to-day activities
• If you plan to try alternative or complementary
therapies
irritable bowel syndrome 3
 WHAT IS IRRITABLE BOWEL SYNDROME?
Irritable bowel syndrome (IBS) is a very
common condition that causes a variety of
unpleasant symptoms.
IBS has no clear cause — at least, not one that has
been identified yet. Two factors that may play a
role include too much activity of the colon (large
intestine) and heightened sensitivity to pain.
Abnormal intestinal activity
Normally, the intestines have smooth, rhythmic
contractions. Not so for people with IBS. They often
experience irregular contractions with spasms.
Sometimes, the spasms lead to diarrhea; other
times, to constipation.
Heightened pain sensitivity
In addition, people with IBS have a heightened
sensitivity to pain in their gut. Experiments have
shown that people with IBS generally have a much
lower threshold for experiencing pain in the colon,
rectum, and small intestine than healthy people do.
4 irritable bowel syndrome
SYMPTOMS OF IBS
IBS may cause a variety of symptoms.
These include:
abdominal
diarrhea
and/or bloating
pain constipation
gas cramping
The symptoms of IBS usually start in your late teens, 20s,
or 30s. You’re relatively healthy; then you begin to suffer
abdominal discomfort.
You may have to move your bowels more often than usual.
And when you have to go, you have to go right away. Or
you may notice you are moving your bowels less than usual
and need to strain. You often feel bloated and full of gas.
Some people with IBS have only some of these
symptoms. Others have all of them.
Over time, your main problem might be frequent loose
stools, known as diarrhea-predominant IBS, or IBS-D.
Or it may be the opposite: difficulty having bowel
movements. This is known as constipation-predominant
IBS, or IBS-C.
People with IBS generally feel better after a bowel
movement or passing gas. But they may not feel that they
have fully emptied their rectum, even after a movement.
Some people with IBS have continuous symptoms.
Others experience long symptom-free periods.
irritable bowel syndrome 5
 DIAGNOSIS

There is no specific test to diagnose IBS.

IBS is a clinical diagnosis, which means your doctor
diagnoses IBS based primarily on your symptoms.
Usually, you will be diagnosed with IBS if you
experience abdominal pain or discomfort at least
three days a month, for at least three months, with
two or more of the following:
IT’S PROBABLY NOT IBS IF...
increase or
improvement a change
decrease in
in symptoms in the form
frequency
after a bowel (appearance)
Certain symptoms are not associated with IBS. movement
of bowel
of stools
movements
If you experience any of the following, it’s not
caused by IBS:
The following features (if they occur more than
• abdominal pain • black, tarry stool about one-quarter of the time) further support a
accompanied by diagnosis of IBS:
fever (fever can signal • excess fat in the stool
inflammation or infection) • abnormally hard or loose stool
• persistent pain in just
• rectal bleeding one part of your belly
• straining, urgency, or the feeling of incomplete
• bright red blood in the • unintended weight loss emptying
stool
• passage of mucus in bowel movements
Some symptoms, such as abdominal pain with fever,
rectal bleeding, or black stools, require immediate • bloating or the sensation of having a distended
medical attention. abdomen

• more than three bowel movements per day or

Food intolerance
fewer than three per week
For some people, gas, stomach upset, diarrhea,
cramps, and flatulence (all common symptoms of IBS)
Your doctor will want to be sure that your symptoms
may be caused by food intolerance — the body’s
or exam findings are not caused by a condition
inability to digest a particular substance. Dairy
products and grain products containing gluten are other than IBS. If needed, your doctor may perform
two common types of food that cause intolerance. certain tests to rule out other conditions.

6 irritable bowel syndrome irritable bowel syndrome 7

 MANAGING IBS WITH DIET
Making strategic changes to your diet and
the way you eat may help reduce symptoms.
Most important, you will need to discover what
dietary changes help you the most. Make notes in
a food diary to help you keep track of how each
change affects your symptoms.
Start by considering meal size. Perhaps eating large
meals causes cramping, bloating, and loose stools.
Eating smaller meals or snacks multiple times per day
may help improve these symptoms. Eating quickly can
cause you to swallow air, which can cause belching or
gas. Try eating slowly and more mindfully.
It’s important to try different strategies to find what
works best for you. To help you get started, here are
some general guidelines based on whether you tend
to be bothered more by constipation or diarrhea.
For constipation
Fiber and water are most important. Fiber is the
nondigestible component of plant food that helps
soften stool and move it forward through the
intestines. Drink plenty of water to make sure the
stool stays soft and bulky.
You can increase the fiber in your diet by eating plenty
of fresh fruits and vegetables. Fiber supplements
containing psyllium or methylcellulose can also help.
When introducing fiber to your diet, do so gradually
to avoid bloating and excess gas.
8 irritable bowel syndrome
For diarrhea, loose stools, and
cramps
Try a low-FODMAP diet. “FODMAPs” is the
nickname for a group of dietary sugars that are
poorly absorbed by the small intestine. Gut bacteria
feed on these sugars, creating gas, bloating,
abdominal discomfort, and increased trips to the
bathroom.
To follow a low-FODMAP diet, first eliminate all
FODMAPs from your diet. Then add them back
one at a time and monitor your symptoms. You may
tolerate some foods better than others.
High-FODMAP foods (to avoid or eat less of) include:
• Dairy: cow’s milk, yogurt, pudding, custard, ice cream,
cottage cheese, ricotta cheese, and mascarpone
• Fruits: apples, apricots, blackberries, cherries,
pears, peaches, mangoes, nectarines, plums, and
watermelon
• Vegetables: artichokes, asparagus, Brussels sprouts,
broccoli, beets, cauliflower, mushrooms, snow peas,
garlic, and onions
• Grains: wheat and rye
• Beans and legumes: chickpeas, lentils, kidney beans
• Sweeteners: high-fructose corn syrup, honey, and
agave nectar; sorbitol, mannitol, xylitol, maltitol, and
isomalt found in sugar-free gum and mints, and cough
medicines and drops
irritable bowel syndrome 9
 MEDICATIONS TO TREAT IBS
Medications can’t cure IBS. But they can
ease symptoms.
The medication your doctor prescribes will depend
on whether you have diarrhea- or constipation-
predominant IBS.
For people who have diarrhea-predominant IBS
(IBS-D), medication options include:
u Antidiarrheals. These medicines reduce fluid
secretion by the intestine and slow down intestinal
contractions. Although they are available over-
the-counter (OTC) and by prescription, always
follow your doctor’s advice.
u Antispasmodics. These medications, available by
prescription, may provide temporary relief of mild
abdominal pain by reducing bowel spasms. People
who regularly experience cramps after eating may
experience reduced symptoms if they take one of
these medications before meals.
u Antidepressants. Tricyclic antidepressants are
sometimes prescribed to treat IBS pain. Selective
serotonin reuptake inhibitors (SSRIs) do not
control pain as effectively as the tricyclics, but
they tend to cause fewer side effects.
u Antibiotics. Research suggests that there is a
connection between IBS and the mix of bacteria
in the intestines (see “Your microbiome,”page
14). Treatment with certain antibiotics may help
improve symptoms, though the exact reason why
they help is not known.
10 irritable bowel syndrome
u Serotonin antagonist. This drug is approved only
for women with severe diarrhea-predominant IBS
who have not responded to other treatments.
To receive this drug, you must sign a form
stating that you are aware of life-threatening
complications, such as a blocked, ruptured, or
damaged bowel.
For people with constipation-predominant IBS
(IBS-C), if medication is needed, your doctor
may prescribe:
u L
 axatives. Laxatives that promote the secretion
of water into the colon are generally considered
to be safe and effective for IBS. Stimulant
laxatives may cause cramping.
u P
 rescription drugs for IBS-C. Drugs currently
approved by the FDA to treat constipation-
predominant IBS act on the cells that line the
inside of the intestines. They promote increased
fluid secretion into the intestine, making it
easier for stool to pass through, and help relieve
discomfort.
Try heat
A home heating pad can be a simple and
inexpensive way of soothing abdominal pain.
Heat can help relax cramping muscles. Similarly,
drinking warm, non-caffeinated tea such as
chamomile may help reduce discomfort.
irritable bowel syndrome 11
 STRESS REDUCTION FOR SYMPTOM RELIEF
Stress can trigger chemical and physical
responses in the body that worsen symptoms
and lead to more discomfort.
For example, stress stimulates colon spasms in
people with IBS. It can also influence how the body
regulates pain signals from the gut, making existing
pain seem even worse.
Treating stress, through behavioral therapy
or relaxation techniques, can help relieve IBS
symptoms.
Cognitive behavioral therapy (CBT).
CBT involves reframing negative thoughts
and actions into more positive and
productive ways of thinking and behaving.
CBT can reduce the stress of dealing with
IBS. As stress decreases, symptoms often
improve.
Relaxation response training and
meditation. Simple and easy to learn,
these techniques help reduce nervous
system activity and relax muscles. A
mind-body program, relaxation response
CD, or meditation class can help you to
learn these techniques.
Yoga. This ancient Indian discipline seeks
to bring body and mind into balance.
It has proved valuable to some IBS
sufferers. Yoga, like meditation, can serve
as a form of self-relaxation.
12 irritable bowel syndrome
ALTERNATIVE AND COMPLEMENTARY THERAPIES
People with IBS frequently turn to
alternative or complementary therapies to
ease symptoms.
Biofeedback. Biofeedback is a mind-body
technique. Participants use a machine to see and
learn to control their body’s responses to stimuli
such as pain.
Acupuncture. This is a system of applying small
needles to specific points along the body. It has
been used to treat IBS symptoms, but evidence to
support its effectiveness is weak.
Herbal remedies. Peppermint oil may improve
abdominal pain and overall symptoms in people
with IBS. It appears to work by relaxing the smooth
muscles in the walls of the intestine. The evidence in
support of other herbal remedies for IBS is limited.
Let your doctor know before you start taking an
herb or supplement. These preparations are not
regulated by the FDA.
irritable bowel syndrome 13
 YOUR MICROBIOME

IBS may result, in part, from the mix NOTES

of bacteria in the intestines.

The bacteria in our intestines make up our

microbiome. We all have trillions of bacteria in our
gut. Researchers have found that some people
with IBS have a different mix of intestinal bacteria.
This may contribute to the bloating, diarrhea,
constipation, and heightened sensitivity to pain that
are common in IBS.

Antibiotics may help improve symptoms by changing

some of this bacterial mix (see “Medications to treat
IBS,” page 10).

Probiotics and prebiotics

Probiotics and prebiotics may also help by nurturing

our microbiome. Probiotics are live bacteria used to
benefit health. Prebiotics are nonliving substances
that promote the growth of beneficial bacteria.

Fermented or cultured dairy products, such

as yogurt and buttermilk, are good sources of
probiotics. Other sources include miso, tempeh,
and soy beverages. Prebiotics are found in
asparagus, bananas, oatmeal, and legumes.
Probiotics and prebiotics are both also available as
dietary supplements.

Probiotics are generally considered safe. But there’s

not yet enough evidence to declare which ones are
truly effective.

14 irritable bowel syndrome irritable bowel syndrome 15

 CONTENT CREATED BY

Harvard Health Publications and Harvard Medical School

content should not be used for diagnosis or treatment,
or as a substitute for visits to your medical provider.
Always seek the advice of your health care provider if
you have questions regarding your health or any
medical condition.

©2016 Harvard University. All Rights Reserved.

Harvard Health Publications and Harvard Medical School do

not endorse drug products.

16 irritable bowel
IBS-H04016 syndrome