What is Irritable Bowel Syndrome?

Time to read 9 min

Commonly also known as IBS, Irritable Bowel Syndrome causes discomfort in the belly, as well as an issue with your bowel movements. You may feel pain in the belly, and the stool also may keep varying between thin to hard. This can manifest as a diarrhea or constipation and is not a life threatening situation. Ir can however be a condition that may need to be managed over a long time frame and can impact the day-today lives of people.  

In medical terms, it is a disorder of the large intestine and many people live with it by making changes to their diet and lifestyle, without really needing any medical intervention. A small percentage of people find themselves burdened with the symptoms severely like cramping, pain, bloating, gas and diarrhea and/or constipation.   

Types Of IBS 

There are mainly four kinds of IBS. They are:  

  • IBS with constipation (IBS-C) : As the name suggests, in this condition, the IBS is accompanied with constipation.
  • IBS with diarrhea (IBS-D) : In this case, the IBS manifests as diarrhea and is easily identifiable.
  • IBS (IBS-M) : As mentioned in the intro section above, it is possible that for a few people, IBS comes on as a mix of both constipation and diarrhea.
  • IBS Unsubtyped (IBS-U) : A certain section of people may not fit into any of these categories easily, and hence are categorised as Unsubtyped. 

Note: IBS-Alternating (IBS-A) : When IBS keeps alternating between diarrhea and constipation, it is also referred to by this name. So, in many ways it will be a movement between IBS-C and IBS-D. 

Statistics From Around The World 

Globally around 10 to 20% of the population is said to have IBS, even though it is also believed that it is one of the most grossly underdiagnosed conditions. It is one of the most common condition diagnosed by gastroenterologists worldwide, it affects both men and women equally.  

In the US, it affects women more than men. It likely manifests in their late teens to the the early 40s.  

An interesting comparison point mentioned about this condition is the variation in its diagnosis in India, as compared to that of the Western countries.  In India, it is normal to pass stools once or more every day, whereas in the West, it could just be a few times a week or a day. 4.2 to 7.9% of the Indian population is said to have this condition, of which only another 10-20% seek medical help.  

Causes And Risk Factors 

Researchers have not been able to place the exact cause of IBS till now, while many things have been known to trigger the various symptoms associated with it. The intestinal muscles react to any mild stimulation as they have become hypersensitive. Therefore the bowel muscles get into a spasm resulting in constipation or diarrhea. A few of the factors have been identified as below: 

Infection: Infections can trigger IBS; especially after a severe diarrhea as a result of a viral or bacterial infection. An overgrowth of bacteria in the intestine, leading to an infection, can also trigger symptoms of IBS. 

Intestinal Inflammation: Few patients with IBS have been found to have microscopic inflammation in the bowels. An increased immune system activation is detected in the intestines in such people, which triggers the pain and diarrhea. 

Intestinal muscle contractions: The intestine walls have a lining of muscle layers, which contract as they help move the food through the digestive system. If these contractions are stronger and/ or longer than normal, they can cause gas, bloating and diarrhea. If these intestinal contractions are weaker than normal, they can slow the passage of the food in the tract, and this leads to hard, dry stools. 

Nervous system dysfunction: Any form of abnormality in the digestive system nerves can cause discomfort, as the abdomen feels stretched due to gas or stool. This indicates a poor signal coordination between the brain and the intestines, which in turn brings about changes in the digestive process. This can result in pain, diarrhea or constipation. 

Variation in Microflora: Our gut has good bacteria, called as Microflora and these are essential for a good digestive system and overall health. People affected by IBS will have an unhealthy variation in the Microflora. 

Food intolerance and allergy: People having hypersensitive reactions to food and are intolerant to certain foods like sugar and gluten have also been known to have IBS.  

Genetic factors: One study concluded that 33% of the IBS patients had a family history of the same. Hence, it may appear that genetics too is a risk factor associated with IBS. 

A few of the other risk factors associated with IBS are being young in age, female, and mental health issues like depression or anxiety. 

Diagnosis- The Symptoms 

The range of symptoms that occur when you have IBS are:  

  • Constipation
  • Diarrhea (Either/Both/Alternating)
  • Intestinal cramps
  • Intestinal pain
  • Gas and/or bloating
  • Hard or loose stools, as maybe the case
  • Mucus in the stool 

A few of the people may also have urinary issues, or sexual problems, and in a few serious advanced or chronic cases, below symptoms are also seen which may also indicate some other underlying condition leading to IBS:   

  • Persistent pain and change in bowel habits
  • Weight loss
  • Diarrhea at night
  • Rectal bleeding
  • Iron deficiency anemia
  • Unexplained vomiting
  • Difficulty in swallowing 

Snippet Highlight: IBS by itself is not a serious condition and as mentioned above, most people get away without diagnosis and treatment unless certain symptoms persist. However, if any of the second set of symptoms persist it is better to immediately consult a doctor. 

Tests And Assessments 

There is no test that can be done to determine that you have IBS, and the doctor may have to understand the symptoms and run a few tests to work on an elimination theory for diagnosis. At first, the doctor may want to rule out possibilities of food intolerance, infection, any specific medications, enzyme deficiencies, or inflammatory bowel diseases like Crohn’s disease.   

Once all that is ruled out, the doctor may conduct a few other test to try and figure out the triggers. These tests are based on two factors namely: 

Rome criteria: Abdominal pain and discomfort at least once a week for the last three months, affecting the defecation and its frequency. 

Manning criteria: Here the focus is on the pain when stool is passed and on incomplete passing of stools. Mucus in the stool and any changes in the stool consistency (thick or thin) are also considered. 

Further, the tests that may be prescribed are:  

  1. Flexible sigmoidoscopy or colonoscopy: To check for signs of any blockage or inflammation in the intestines
  2. Upper endoscopy
  3. X-rays
  4. CT-Scan
  5. Blood tests: To identify or rule out anemia, thyroid problems, and any infection
  6. Stool tests: To check for bacteria or parasites, or bile form the liver. 

It is quite possible that the doctor may not prescribe any tests, if the cause/trigger is able to be identified easily and early treatment is giving relief. Certain tests are only for eliminatory purposes and few tests may only be prescribed when symptoms are persistent and chronic. 

Post-Diagnosis: The Path To Follow 

Since the IBS itself is of different types and triggers are multiple, the treatment too is rather individualistic. One medication cannot help all those who suffer from IBS. The treatment is mostly diet changes, lifestyle changes, and some common medications and supplements that are aimed at managing the symptoms. 

 In general the following changes are prescribed to try and control the symptoms: 

  • Less or no caffeine
  • Including more fibre
  • Ensuring hydration by drinking at least three to four glasses of water in a day, if not more.
  • No smoking
  • Stress reduction techniques
  • Limited or no intake of dairy products like milk and cheese
  • Regular exercise
  • Getting enough sleep 

If food intolerance has been found to be the trigger, the doctor may advise to avoid certain foods like milk, gluten, red peppers, red wine, etc. 

Medication- Conventional And Alternative Treatments 

Conventional Treatments

  • Fiber supplements: These bulking agents like wheat bran or corn fiber, etc. are taken with fluids to try and help the movement of food through the tract, and may also help relieve symptoms like constipation.
  • Probiotics: This helps introduce live good bacteria into the gut to help in digestion.
  • Laxatives: Over the counter laxatives are used to treat constipation and these may include magnesium hydroxide oral (Phillips' Milk of Magnesia).
  • Antibiotics: To try and control the growth of harmful gut bacteria, antibiotics may be prescribed, for a certain period with observation.
  • Anti-diarrheal medications: This may include over-the-counter medications for diarrhea, or as prescribed by the doctor. A bile acid binder may also be prescribed by the doctor, if the need is felt.
  • Anticholinergic (antispasmodic) medications: Certain medications to relieve painful bowel spasms may be prescribed as well.
  • Antidepressants: These may be used if depression has been found the underlying cause of IBS. 

Alternative Treatments 

There are many studies conducted on the effect of the alternative treatments on IBS. One such study covered acupuncture, fiber, peppermint oil, herbal, traditional, yoga, massage, meditation, mind, relaxation, probiotic, hypnotherapy, psychotherapy, cognitive therapy, or behavior therapy and published the results. While soluble fibre was found to be effective, insoluble fibre was not so. 

Peppermint oil seemed to help relieve IBS symptoms, including abdominal pain. Certain herbal formula used in the trial was also found to be effective, while they still expressed certain doubts about the safety and effectiveness. Probiotics were found to provide good relief for people with IBS and neither did this have any great side effects.

Acupuncture Treatment 

The study above concluded that acupuncture is not really effective for all IBS patients, while a few may benefit in some way from it. Especially when the IBS is linked to the brain-gut disturbance, acupuncture treatment can be suggested as an alternative. However, there is no substantial evidence to prove that is effective. 

Mind-Body Therapies 

Since there is a mind-body link to many of the diagnosed IBS patients, mind and body therapies are a good way to approach the treatment. In the studies conducted, strong evidence is found to suggest that hypnotherapy can help patients with IBS. There is of course a chance that some patients are more “hypnotizable” than others. 

Using Cognitive Behavioral Therapy (CBT) to recognize the thoughts and behaviours of the IBS patients is a good way to provide them relief. Results of studies suggest that CBT can be used to treat IBS when possible. 

Ayurvedic Treatment 

Ayurveda considers IBS as a Vata issue caused by diet and lifestyle imbalances, even though there could also be some Pitta issues as well. In certain cases, Kapha imbalances are also seen. It is believed that the imbalances cause a disturbance in the interaction between the brain and the gut.  

Ayurveda prescribes stress reduction as one of the main therapies for Vata induced IBS. Suggested relaxation measures include meditation, pranayama,, doing asanas,  aromatherapy, gem therapy, color therapy and massage. A daily routine with good sleeping and eating habits along with some digestive tonics help relieve such IBS symptoms. Other remedies include medicinal ghee preparation, Triphala, nutmeg, asafoetida, ginger, Ashwagandha, sesame oil, fennel, clove, cardamom, Hingvashtaka chuma, and a mix of buttermilk with water in equal quantity along with asafoetida. 

In case of a Vata-Pitta combination IBS, the digestive system and the mind is managed using Aloe Vera, astringent herbs, cool nervines, turmeric, sandalwood powder, coriander, fennel, cardamom, licorice, etc. 


Without a doubt, it is obvious that nutrition is a big part of the treating IBS. Most of it is already covered above. In general follow these basic principles: 

  • Eat light, fresh food
  • Avoid cold, hard, dry and raw foods
  • Avoid processed, greasy and fried foods
  • Avoid foods that cause allergy
  • Include lot of fibre in the diet
  • Drink lots of water 


Unless symptoms are very severe that they are affecting the normal schedule, most people with IBS, can easily go about their daily life. Especially with diet and lifestyle changes and some basic prescribed medicines, it should not be difficult for such people to move around. 


It is truly a case of mind over matter here; if one is not obsessed about the issue, and can consciously bring about the necessary diet and lifestyle changes and ensure a proper daily routine, managing IBS becomes easier. 

Prevention- How to reduce risks 

  • Therapies: Regular practice of stress reduction therapies like meditation, Yoga, hypnosis, mindfulness, etc. or counselling if required can help prevent/manage IBS.
  • Regular exercise: Exercising daily, especially trying out relaxation exercises are important to prevent IBS. Tightening and relaxing the muscles in the body, one by one is a good counter to IBS.  

*Medical Disclaimer - The following information is for educational purposes only. No information provided on this website, including text, graphic, and images, are intended as substitutes for professional medical advice. Please consult with your doctor about specific medical advice pertaining to your condition(s)

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