Digestive Health

IBS Symptoms: Understanding the Mystery Behind Irritable Bowel Syndrome

by Lindsay Delk

Irritable bowel syndrome (IBS for short) affects around 11% of the world’s population and is more common in women than men. If you suffer from frequent abdominal pain, bloating, constipation, and/or diarrhea, IBS may be the culprit.

Lindsay Delk Avatar

written by:

Lindsay Delk
Carole Childers C.N., L.D.N

reviewed by:

Carole Childers C.N., L.D.N.

IBS symptoms

Table of contents

IBS symptoms are diverse and can significantly impact quality of life. This variability is often influenced by factors such as diet, stress, and hormonal changes. Particularly in women, the menstrual cycle can exacerbate IBS symptoms, leading to increased discomfort during certain phases.

Daily Life Impact

  • Disruption: Daily routines and activities can be significantly disrupted by unpredictable symptom flare-ups.
  • Social Implications: Social events and work commitments might be affected, adding a layer of anxiety and planning.

Menstrual Cycle Connection

Management Strategies for IBS During Menstruation

Women with IBS often experience an exacerbation of symptoms during their menstrual cycle, particularly during menstruation. Effective management strategies are crucial in alleviating these symptoms.

Lifestyle Modifications

  • Exercise: Regular, mild to moderate exercise such as walking, yoga, or swimming can help alleviate both menstrual and IBS symptoms.
  • Stress Management: Techniques like deep breathing, meditation, and mindfulness can help manage stress, which can worsen IBS symptoms during menstruation.
  • Heat Therapy: Using a heating pad on the abdomen can ease menstrual cramps and IBS pain.

Dietary Adjustments

  • Avoid Trigger Foods: Reduce intake of foods that are known to exacerbate IBS symptoms, like high-FODMAP foods, during menstruation.
  • Stay Hydrated: Drinking plenty of water can help reduce bloating and aid in digestion.
  • High-Fiber Diet: If constipation is a symptom, increasing soluble fiber intake can help, but do it gradually to avoid gas and bloating.

Medical Management

  • Pain Relief: Over-the-counter pain relievers like ibuprofen can help alleviate menstrual cramps and IBS pain. However, they should be used cautiously as some pain relievers can irritate the gut.
  • Consult a Doctor: If menstrual or IBS symptoms are severe, consult a healthcare provider. They might suggest hormonal contraceptives to regulate menstrual cycles, which can sometimes help manage IBS symptoms.

Support and Education

  • Menstrual Tracking: Keeping track of menstrual cycles and IBS symptoms can help identify patterns and triggers.
  • Educational Resources: Knowledge about how menstruation affects IBS is key to managing symptoms effectively.

Further Resources

Hormonal Fluctuations and IBS

Hormonal changes throughout the menstrual cycle have a significant impact on the gastrointestinal (GI) tract, influencing IBS symptoms in many women. The primary hormones involved are estrogen and progesterone, which fluctuate throughout the cycle.

How Hormones Affect IBS

  • Estrogen and Progesterone Levels: These hormones can affect gut motility, leading to changes in bowel habits. High levels of progesterone, for instance, may slow down the digestive process, potentially worsening symptoms of IBS-C (constipation predominant IBS).
  • Pre-Menstrual Phase: Many women report an increase in IBS symptoms during the pre-menstrual and menstrual phases. This is when estrogen and progesterone levels drop sharply, which can lead to increased GI sensitivity and contractions.
  • Post-Ovulation Phase: After ovulation, increased progesterone levels can lead to bloating and constipation, aggravating IBS-C symptoms.

Case Studies and Research

  • A study published in Gastroenterology found that nearly 40% of women with IBS report worsening of symptoms during their menstrual periods, particularly those with IBS-D (diarrhea predominant IBS).
  • Research in The American Journal of Gastroenterology highlights that hormonal contraceptives may influence IBS symptoms, suggesting a strong hormonal component to the disorder.

Coping Strategies

  • Medical Consultation: Women with IBS should discuss their symptoms with a healthcare provider, especially if they notice a menstrual cycle pattern. Hormonal treatments or adjustments in existing IBS management strategies may be recommended.
  • Lifestyle Adjustments: Engaging in stress-reducing activities like yoga and mild exercise can alleviate both menstrual and IBS symptoms.
  • Dietary Management: Adjusting the diet during sensitive phases of the menstrual cycle can help. For instance, increasing fiber intake during the luteal phase (post-ovulation) can alleviate constipation.

Further Resources

What Is Irritable Bowel Syndrome (IBS)?

Irritable bowel syndrome is a common gastrointestinal disorder. It is not an infection or disease. It is a functional disorder, which means there are no visible abnormalities in your body. 

The symptoms of IBS can range from mild to severe depending on the individual. IBS is a chronic condition, meaning it can last for months to years. And the symptoms may come and go throughout your life.

IBS is subdivided into three types:

  1. IBS with predominant constipation (IBS-C)
  2. IBS with predominant diarrhea (IBS-D)
  3. IBS with mixed bowel habits (IBS-M)

Common Symptoms of IBS

IBS can present itself in a variety of ways, but some of the most common symptoms of IBS include:

  • Abdominal pain and cramping, especially after eating
  • Bloating and abdominal distention (swelling)
  • Excessive gas
  • Changes in how hard or soft your stool is (diarrhea, constipation, or alternating between both)
  • Changes in how often you poop
  • Mucus in the stool
  • Feeling of incomplete emptying after pooping

It is important to note that not everyone with IBS will experience all these symptoms. Some may only have a few, while others may have more severe or frequent symptoms.

Causes and Triggers of IBS

The exact cause of IBS is unknown, but experts think it is due to a combination of physical and psychological factors.

Physical

Several physical factors might cause IBS. Your intestines may move too slowly or too quickly. You may have small intestinal bacterial overgrowth (SIBO) or other disturbances in your intestinal bacteria. Or certain foods or diet patterns may trigger the symptoms of IBS.

Psychological

Psychological factors can also play a role in IBS. Stress and anxiety can trigger or worsen symptoms, and people with IBS may perceive pain differently than those without the condition.

Psychological Aspects of IBS

The link between mental health and IBS is significant, with stress and anxiety often exacerbating symptoms.

Stress Response and IBS

Stress is a significant trigger for many people with IBS. The gut and brain are closely linked through the gut-brain axis, and stress can directly impact gut function and symptoms.

  • Physiological Impact: Stress can increase gut motility and sensitivity, leading to symptoms like diarrhea, constipation, or abdominal pain.
  • Hypersensitivity: People with IBS often have a heightened stress response, which makes their gut more reactive to stress.

Examples of Stress-Induced IBS Flare-Ups

  • Daily Stressors: Routine stress such as work pressure or family issues can exacerbate IBS symptoms.
  • Major Life Events: Significant events like a job change or loss, moving, or relationship issues can trigger more severe IBS flare-ups.

Coping Strategies

  • Relaxation Techniques: Practices like deep breathing, progressive muscle relaxation, and guided imagery can help manage stress.
  • Mindfulness and Meditation: These practices help in staying present and reducing overall stress levels, which can in turn ease IBS symptoms.
  • Regular Exercise: Physical activity is a proven stress reliever and can help regulate bowel movements.

Seeking Professional Help

  • Cognitive Behavioral Therapy (CBT): CBT can help modify the response to stress and develop coping mechanisms.
  • Gut-Directed Hypnotherapy: This therapy focuses specifically on reducing the sensitivity of the gut to stress and pain.

Well-being Strategies

  • Therapy Options: Cognitive-behavioral therapy, mindfulness, and relaxation techniques.
  • Lifestyle Changes: Stress reduction through lifestyle adjustments.

Further Resources

Psychosomatic Nature of IBS

Irritable Bowel Syndrome (IBS) is a prime example of the psychosomatic interplay where psychological processes can significantly affect the gastrointestinal system.

  • Gut-Brain Axis: This is the bi-directional communication network between the central nervous system and the gut. Emotional and cognitive centers in the brain can directly influence gut function, and vice versa.
  • Stress and Emotions: Stress, anxiety, and depression are not just in the mind; they can manifest physically in the gut, exacerbating IBS symptoms.

Examples of Psychosomatic Influence

  • Anxiety-Induced Symptoms: For instance, a person with anxiety might experience increased bowel movements or pain during periods of high stress.
  • Depression and Gut Health: Depression can slow down the digestive process, leading to symptoms like constipation and bloating.

Addressing the Psychosomatic Aspect

  • Mindfulness-Based Stress Reduction (MBSR): This therapy focuses on mindfulness meditation to reduce stress and improve IBS symptoms.
  • Gut-Directed Psychotherapy: Specifically designed to improve the psychological and physical symptoms of IBS.

Seeking Support

  • Mental Health Professionals: Consulting with psychologists or psychiatrists who specialize in treating chronic illness can be beneficial.
  • Support Groups: Sharing experiences with others who have IBS can provide emotional support and practical advice.

Further Resources

Diagnosing IBS

There is no single test for diagnosing IBS as the condition has many possible causes and triggers. To diagnose IBS, your doctor will likely start by doing a physical exam and a review of your medical history. Your doctor may also order tests, such as blood work, stool tests, or imaging studies, to rule out other conditions with similar symptoms.

The diagnosis of IBS is based on the Rome IV criteria, which includes abdominal pain for the past three months that occurs at least one day per week on average. The abdominal pain must be characterized by two or more of the following:

  • Related to bowel movements
  • Associated with a change in how often you poop
  • Associated with how the poop looks (constipation or diarrhea)

Managing and Treating IBS Symptoms

The main treatment goals for IBS are to reduce your symptoms and improve your quality of life. Your healthcare provider should take a holistic approach to treatment that includes lifestyle, diet, medical, and stress management modifications.

Lifestyle Modifications for Reducing IBS Symptoms

Lifestyle changes can help reduce and manage IBS symptoms. Regular exercise, adequate sleep, and stress management techniques, such as yoga, breathing exercises, meditation, and mindfulness, may all be beneficial. 

Your doctor may also recommend mental health therapy to help change your thought patterns that can trigger your IBS. Making small changes in lifestyle over time can help improve your symptoms.

Dietary Changes for Managing IBS

Dietary modifications are often the first line of treatment for IBS. Eating smaller, more frequent meals, avoiding trigger foods, limiting caffeine, and increasing fiber intake can all help reduce symptoms.

Note that what works for one person may not work for another. For example, you may feel more abdominal pain after drinking milk, but your friend with IBS does not. 

Experiment with different dietary changes and keep a food diary to help identify which foods trigger your symptoms. If your diary shows that eating an apple led to abdominal pain and bloating, reduce or eliminate apples from your diet. Finding the right balance of foods is key to managing IBS symptoms.

The low-FODMAP diet is a popular dietary approach for managing IBS symptoms. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. The idea behind the low-FODMAP diet is to restrict certain foods for a period of time then reintroduce them one at a time to identify trigger foods. 

The low-FODMAP diet can be difficult to follow, and you should only follow it temporarily. It is important to work with a registered dietitian to ensure you’re still getting adequate nutrition while avoiding problem foods.

Role of Diet in Detail

Diet plays a crucial role in managing IBS symptoms. Understanding and adapting one’s diet can lead to significant improvements.

The Low-FODMAP Diet: Phases and Success Stories

The Low-FODMAP diet is a dietary approach specifically designed to help people with IBS identify food triggers. FODMAPs (Fermentable Oligo-, Di-, Monosaccharides And Polyols) are short-chain carbohydrates that are poorly absorbed in the small intestine and can cause IBS symptoms.

Phases of the Low-FODMAP Diet

  1. Elimination Phase
    • Duration: Typically lasts 3-8 weeks.
    • Process: During this phase, all high-FODMAP foods are removed from the diet. This includes foods like onions, garlic, certain fruits, wheat products, and dairy products with lactose.
    • Objective: The goal is to significantly reduce IBS symptoms during this phase.
  2. Reintroduction Phase
    • Gradual Process: High-FODMAP foods are reintroduced one at a time, in a controlled manner.
    • Monitoring Symptoms: Each food is tested individually for about 3 days, and symptoms are closely monitored to see if any specific food triggers a reaction.
    • Customization: The end goal is to identify which FODMAPs (if any) trigger symptoms, allowing for a personalized diet that balances symptom management with dietary freedom.

Success Stories and Case Studies

  • A study published in the Journal of Gastroenterology and Hepatology found significant improvement in IBS symptoms in over 70% of participants following a low-FODMAP diet.
  • Monash University, which pioneered the low-FODMAP diet, shares numerous success stories on their website. For instance, one individual reported a remarkable improvement in quality of life and a significant reduction in IBS symptoms after adhering to the diet.

Additional Resources for the Low-FODMAP Diet

  • Monash University FODMAP: Offers extensive resources on the low-FODMAP diet, including food lists, recipes, and success stories.
  • The IBS Network: Provides guidance and support for those trying the low-FODMAP diet, including how to manage the diet in everyday life.
  • IBS-Diet: A helpful resource for understanding the low-FODMAP diet, with food lists and tips for successful implementation.

Common Trigger Foods for IBS

  1. High-FODMAP Vegetables and Fruits
    • Onions and garlic
    • Apples, pears, and peaches
    • Cauliflower, mushrooms, and asparagus
  2. Lactose-Containing Dairy Products
    • Milk
    • Soft cheeses
    • Ice cream
  3. Gluten-Containing Grains
    • Wheat, barley, and rye
    • Breads and pastas made from these grains
  4. Certain Legumes and Pulses
    • Beans
    • Lentils
    • Chickpeas
  5. Sweeteners
    • High-fructose corn syrup
    • Artificial sweeteners like sorbitol and xylitol
  6. Processed Foods
    • Fast food
    • Chips and snacks
    • Processed meats
  7. Caffeinated and Alcoholic Beverages
    • Coffee and some teas
    • Beer, wine, and spirits
  8. Spicy Foods
    • Dishes with high levels of chili or other strong spices

Healthy Alternatives

  1. Low-FODMAP Vegetables and Fruits
    • Green onions (green part only) and chives
    • Oranges, grapes, and bananas
    • Carrots, zucchini, and spinach
  2. Lactose-Free Dairy or Alternatives
    • Lactose-free milk
    • Hard cheeses (like cheddar)
    • Almond, soy, or coconut milk
  3. Gluten-Free Grains
    • Rice, quinoa, and oats
    • Gluten-free breads and pastas
  4. Gentler on Gut Legumes
    • Canned lentils (in small amounts)
    • Firm tofu
    • Tempeh
  5. Natural Sweeteners
    • Maple syrup (in moderation)
    • Raw honey (in moderation)
    • Stevia
  6. Whole and Unprocessed Foods
    • Homemade meals with fresh ingredients
    • Unprocessed meats and fish
    • Homemade popcorn or rice cakes for snacks
  7. Non-Caffeinated and Non-Alcoholic Beverages
    • Herbal teas (like peppermint or ginger tea)
    • Water with a slice of lemon or lime
    • Non-alcoholic beer and wine options
  8. Mild Flavors
    • Herbs like basil, thyme, and parsley
    • Mild spices like turmeric and cumin

Resources on Trigger Foods and Healthy Alternatives for IBS

  1. Monash University FODMAP Research
    • Overview: Monash University is a leader in IBS research, particularly regarding the low-FODMAP diet.
    • Resource Link: Monash University FODMAP
    • Key Takeaway: Offers a comprehensive guide on FODMAPs, including a list of high and low-FODMAP foods, and provides a mobile app to help manage the diet.
  2. American Journal of Gastroenterology – Dietary Triggers of IBS Symptoms
    • Study Overview: This journal often publishes studies on the dietary management of IBS.
    • Resource Link: American Journal of Gastroenterology
    • Key Takeaway: Provides scientific articles and research papers on how various foods can trigger IBS symptoms.
  3. International Foundation for Gastrointestinal Disorders (IFFGD)
    • Overview: IFFGD offers a wealth of information on IBS, including diet and nutrition.
    • Resource Link: IFFGD
    • Key Takeaway: Contains articles and tips on identifying trigger foods and making dietary changes to manage IBS.
  4. IBS Diets Website
    • Overview: Dedicated to providing information specifically on diet and IBS.
    • Resource Link: IBS Diets
    • Key Takeaway: Includes lists of foods to eat and avoid, along with recipes and diet tips for IBS management.
  5. Harvard Health Publishing – Dietary Strategies for IBS
    • Overview: Offers expert advice on managing IBS through diet.
    • Resource Link: Harvard Health – IBS Diet
    • Key Takeaway: Provides practical dietary strategies and explains the role of fiber, gluten, and FODMAPs in IBS.
  6. Gastroenterology & Hepatology – Role of Diet in IBS
    • Study Overview: This peer-reviewed journal publishes research on gastrointestinal health, including diet’s role in IBS.
    • Resource Link: Gastroenterology & Hepatology
    • Key Takeaway: Offers insights from clinical studies on how different diets impact IBS symptoms.
  7. The IBS Network
    • Overview: The UK’s national charity for IBS, providing tips and support for managing the condition.
    • Resource Link: The IBS Network
    • Key Takeaway: Provides practical advice and support for those living with IBS, including dietary management.

Medications and Alternative Therapies for IBS

If lifestyle and diet modifications are not enough to reduce symptoms, your doctor may prescribe medications to help ease abdominal pain or other symptoms associated with IBS. These can include antispasmodics, proton pump inhibitors, laxatives, fiber supplements, antidepressants, and/or anti-anxiety medications.

Another approach to managing IBS is to add probiotics to your diet. Probiotics are beneficial bacteria that may help support healthy digestion and reduce IBS symptoms. Some fermented foods, such as yogurt, fermented sauerkraut, fermented pickles, miso, and kimchi, contain probiotics. 

You can also take a probiotic supplement. Research shows that the probiotics with the most benefits for IBS patients are Bifidobacterium infantis, Saccharomyces cerevisiae, and Lactobacillus plantarum. Talk to your healthcare provider before adding a probiotic supplement to your daily routine.

Advances in IBS Research

Stay informed about the latest research and potential future treatments.

1. Novel Medications

  • New Pharmaceutical Developments:
    • IBS-Specific Drugs: Medications targeting the serotonin receptors in the gut, which can affect gut motility and sensitivity, are being developed.
    • Anti-Inflammatory Agents: Since inflammation can play a role in IBS, new anti-inflammatory drugs are being researched.
  • Current Clinical Trials: Several drugs are in various stages of clinical trials, aiming to provide more effective relief with fewer side effects.

2. Alternative Therapies

  • Gut-Directed Hypnotherapy: This therapy focuses on reducing gut sensitivity and has shown promise in clinical trials.
  • Acupuncture and Herbal Medicine: Traditional Chinese Medicine approaches, including acupuncture and specific herbal remedies, are gaining attention for their potential in treating IBS symptoms.
  • Mindfulness-Based Therapies: Techniques like Mindfulness-Based Stress Reduction (MBSR) are being explored for their efficacy in reducing the impact of stress on IBS symptoms.

Resources on Emerging Treatments for IBS

  1. International Foundation for Gastrointestinal Disorders (IFFGD)
    • Overview: The IFFGD provides up-to-date information on IBS research and treatments.
    • Resource Link: IFFGD – IBS Treatment
    • Key Takeaway: Offers insights into the latest treatment options and ongoing research in IBS management.
  2. American College of Gastroenterology (ACG)
    • Overview: A professional organization providing clinical guidelines and research updates.
    • Resource Link: ACG – IBS
    • Key Takeaway: Provides access to clinical research papers and guidelines on IBS treatments, including novel therapies.
  3. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
    • Overview: NIDDK conducts and supports research on many of the most serious diseases affecting public health.
    • Resource Link: NIDDK – IBS
    • Key Takeaway: Offers comprehensive information on IBS, including updates on current research and emerging treatments.
  4. ClinicalTrials.gov
    • Overview: A database of privately and publicly funded clinical studies conducted around the world.
    • Resource Link: ClinicalTrials.gov – IBS Studies
    • Key Takeaway: Lists ongoing clinical trials for IBS, giving insights into emerging treatments and novel medications under investigation.
  5. PubMed
    • Overview: A free search engine accessing primarily the MEDLINE database of references and abstracts on life sciences and biomedical topics.
    • Resource Link: PubMed – IBS Research
    • Key Takeaway: Search for recent scientific publications on IBS to find detailed information about the latest research in the field.
  6. Mind Over Gut
    • Overview: Provides resources on psychological therapies for IBS.
    • Resource Link: Mind Over Gut – IBS Therapy
    • Key Takeaway: Explores alternative therapies such as gut-directed hypnotherapy and mindfulness-based therapies for IBS.

Coping with the Emotional Impact of IBS

Living with IBS can be a source of frustration and distress because the condition is unpredictable and symptoms may interfere with your everyday activities. It may also cause feelings of embarrassment due to its digestive nature. 

Seeking support from family, friends, and/or a mental health provider can help you cope with these emotions. Joining an IBS support group can also be helpful in connecting with others who understand what you are going through.

Bottom Line

IBS is a complex condition that can be difficult to manage. While the exact cause of IBS is unknown, there are many strategies available to help reduce symptoms, such as lifestyle modifications, dietary changes, medications, and probiotics. Working with your healthcare provider to develop an individualized plan can make all the difference in managing IBS and improving your quality of life.

The information provided on Health Food Radar is intended for general informational purposes only. While we strive to offer accurate and up-to-date content, we do not provide medical advice, diagnosis, or treatment. Always consult with a qualified healthcare professional before making any dietary or lifestyle changes, especially if you have underlying health conditions or concerns.

Lindsay Delk

Lindsay graduated from Auburn University with a BS in Nutrition and Food Science and completed her postgraduate dietetic internship at the University of Alabama at Birmingham. She has been a Registered Dietitian Nutritionist for over 20 years with experience in acute care and long-term care nutrition therapy, medical sales, renal nutrition, and mental health nutrition.

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