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Irritable Bowel Syndrome: How to Manage IBS Symptoms

By Marisa Cohen
Reviewed by Daniel Lew, M.D.
August 18, 2022

An estimated 11% of people live with irritable bowel syndrome (IBS), a functional gastrointestinal (GI) disorder that’s characterized by chronic abdominal pain and bloating associated with diarrhea or constipation—or both. For people with other chronic health conditions, including psoriasis, multiple sclerosis, fibromyalgia, and others, the rate of IBS may be even higher.

The exact cause of irritable bowel syndrome is still unknown, but possible culprits include changes in the microbiome of the gut, the aftereffects of a stomach bug, anxiety or other mental health issues, or changes in the levels of serotonin, a brain chemical that helps regulate mood. Unlike the similarly named inflammatory bowel disease (IBD), which can cause many of the same symptoms as IBS, irritable bowel syndrome is not caused by inflammation in the GI tract.

7 Ways to Manage IBS

If you’re living with the painful and sometimes embarrassing symptoms of IBS, finding relief is likely at the top of your to-do list. You can help manage IBS symptoms with these strategies.

1. See a Gastroenterologist to Get the Correct Diagnosis

It can take an average of 6.6 years to be properly diagnosed with IBS, according to a survey by the International Foundation for Gastrointestinal Disorders. That’s because the symptoms of IBS overlap with many other conditions—in essence, IBS is a diagnosis of exclusion.

“IBS is frequently diagnosed after other conditions, including IBD, have been ruled out,” says Loren Galler Rabinowitz, M.D., a board-certified gastroenterologist at Beth Israel Deaconess Medical Center, in Boston, and a faculty member at Harvard Medical School.

You may need testing to determine whether the muscles used to have a bowel movement are working properly. That’s why seeing a specialist is key to getting a prompt and accurate diagnosis.

“It is important to see a gastroenterologist rather than just your primary care provider, as symptoms between IBD and IBS can overlap significantly, and it’s likely a patient will need a colonoscopy and other special testing to make the diagnosis,” says Alan Gingold, D.O., a board-certified gastroenterologist with Digestive Healthcare Center, in New Jersey.

2. Be Open with Your Doctor

Given that irritable bowel syndrome is a chronic disease and you may be managing your IBS over many years, it’s important to find a gastroenterologist you trust. And although it can feel a little awkward to talk about, well, poop, it’s crucial to be completely open with your doctor, whether that’s at diagnosis or any follow-up appointments.

In these conversations, it’s important to characterize the consistency of your stool. Referring to the Bristol Stool Chart can be helpful for talking to your doctor about what suggests constipation or diarrhea. Additionally, it’s important to identify how frequently you’re having stools, their relation to meals, and whether you’re having a complete evacuation, bloody stools, or nighttime stools.

“It can be hard to be honest about your pain or bowel symptoms, so making sure you feel safe and comfortable with your provider is incredibly important,” Rabinowitz says.

“It’s also good to remember that gastroenterologists discuss bowel habits with every patient, at every visit,” she continues. “So, while it might feel uncomfortable for you, it is quite routine for us—and an essential part of our job! If we don’t know how you feel, we might not be able to make a diagnosis as quickly, or escalate therapy if needed.”

3. Work Together to Find the Right Treatment and Lifestyle Plan

Once you have the correct diagnosis, you can work with your doctor to come up with a personalized plan for medication, diet, and therapy to manage your IBS.

There are many medications available for people with irritable bowel syndrome—including antibiotics, antidiarrheal medications, laxatives, soluble fibers, and antidepressants—to help treat specific symptoms of IBS. (Probiotics may also be beneficial, but there’s not yet enough evidence to make solid recommendations because of the vast array of different probiotics.) Your doctor can help you find the right medication or combination of medications depending on your symptoms and their severity.

“The first step towards improving quality of life is to establish a strong, therapeutic relationship with your treatment team,” Rabinowitz says. “Gastroenterologists have a passion for and specialized training in the care of patients with digestive issues—and we want to help you.”

4. Keep Track of Your Food Triggers

Whether your primary IBS symptom is diarrhea or constipation, there may be certain foods that can make it worse, including gluten, soy, and dairy products; high-fiber or “gassy” foods, such as cabbage and beans; and carbonated beverages. Different people with irritable bowel syndrome can have different triggers, so you may need to do some investigating to determine yours.

“The most effective way for patients to keep track of their triggers is a food diary,” Gingold says. “Writing down what you eat for each meal and listing what symptoms you experience after eating will help you and your doctor figure out which foods may exacerbate your symptoms.”

There is a common misconception that IBS is caused by a food allergy. In general, however, it’s food intolerances that can cause bloating and gas, making it important to have a food diary—and generally, food allergy testing is not needed.

5. Try an Elimination Diet

Many people manage their IBS by undergoing an elimination diet, which can be beneficial in helping you find out what makes your IBS better or worse. An example could be a low-FODMAP diet, where you eliminate and then reintroduce foods such as onions, garlic, beans, milk, bread, crackers, and certain vegetables and fruits. FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) is an acronym for specific carbohydrates that can lead to increased gas, bloating, and abdominal pain.

As you reintroduce foods that were eliminated, you can note any change in your IBS symptoms and choose to reincorporate that food into your diet or continue to avoid it.

You may also want to try eating five small meals rather than three larger meals. Eating smaller meals may not stimulate your digestive tract as much, making this dietary strategy less likely to cause an IBS response.

It’s helpful to consult with a nutritionist or dietitian who specializes in irritable bowel syndrome to help you find an eating plan that you enjoy but that will keep IBS symptoms from flaring, says Rabinowitz.

6. Consider Therapy to Manage Stress

Although stress doesn’t necessarily cause IBS, it can lead to flare-ups. When you experience stress—whether about work, past difficulties and trauma, or another stressor—your fight-or-flight system gets switched on, says David D. Clarke, M.D., a board-certified gastroenterologist in Portland, Oregon, and president of the Psychophysiologic Disorders Association.

“That system basically shuts down your digestive system, because if you have to fight something or run away from it, you want your blood circulating to your muscles, heart, and lungs, not your GI tract,” he says.

The brain and the gut are also connected in what’s known as the brain-gut axis. The brain-gut axis means that increased stress and anxiety can lead to upsets in the GI tract, but also irritation of the GI tract can lead to stress and anxiety (which can worsen GI symptoms). Research has shown that there is a high prevalence of brain-gut axis disorder in people with IBS. That’s also why treating stress can help you manage IBS symptoms.

There are many ways to manage stress, including mindfulness, meditation, and cognitive behavioral therapy (CBT), Rabinowitz says. CBT is an evidence-based intervention that focuses on changing faulty or unhelpful thinking, behavior, and emotional patterns through the use of healthy coping skills. Research suggests it may help improve IBS symptoms.

Some research also suggests that a different type of psychotherapy, called emotional awareness and expression training, may be successful in reducing symptoms of IBS, as well. This intervention, based on the idea that suppressing emotional stress may lead to physical effects like IBS symptoms, teaches people to better identify and express their stress-related emotions.

You can find the right therapist for you in a CBT provider directory or in the directory provided by your health insurance plan.

If these IBS management options don’t work, medications such as antidepressants may help. Besides restoring the brain-gut axis, some of the medications also can act as an antidiarrheal or a laxative to help with diarrhea or constipation, respectively.

7. Get Out and Exercise

Physical activity, such as going out for a walk or a jog, playing soccer with your kids, or taking a dance class, is another great way to manage stress. But the act of getting exercise can help relieve GI symptoms in and of itself, a 2011 study in The American Journal of Gastroenterology suggests. “Getting moving is good for gut health, no matter what your underlying issue is,” Rabinowitz says.

And if you can get moving out in the sunshine, even better. “I encourage my patients to get some fresh air. It is a great way to de-stress and pick up some extra vitamin D along the way—with proper SPF and skin protection, of course,” she says. Some early research suggests that many people with IBS are deficient in vitamin D and can improve their symptoms by getting more of it, whether that’s through sun exposure or supplementation.

While irritable bowel syndrome is not necessarily curable, it is treatable, Gingold says. By adjusting your diet, reducing stress, staying active, and maintaining a productive partnership with your medical provider, you can manage IBS—and greatly improve your quality of life.

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