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Irritable Bowel

National Digestive Diseases Information Clearinghouse

What is irritable bowel be mucus in it, which is a fluid that moist­

ens and protect passages in the digestive
syndrome (IBS)? system. Some people with IBS experience
Irritable bowel syndrome is a disorder diarrhea, which is frequent, loose, watery,
National ­characterized most commonly by cramping,
Institute of stools. People with diarrhea frequently feel
Diabetes and abdominal pain, bloating, constipation, an urgent and uncontrollable need to have
Digestive and diarrhea. IBS causes a great deal of a bowel movement. Other people with
and Kidney
Diseases discomfort and distress, but it does not per­ IBS alternate between constipation and
manently harm the intestines and does not diarrhea. Sometimes people find that their
INSTITUTES lead to a serious disease, such as cancer. symptoms subside for a few months and
OF HEALTH Most people can control their symptoms then return, while others report a constant
with diet, stress management, and pre­ worsening of symptoms over time.
scribed medications. For some people,
however, IBS can be disabling. They may
be unable to work, attend social events, What causes IBS?
or even travel short distances. Researchers have yet to discover any spe­
cific cause for IBS. One theory is that
As many as 20 percent of the adult pop­ people who suffer from IBS have a colon,
ulation, or one in five Americans, have or large intestine, that is particularly sensi­
symptoms of IBS, making it one of the tive and reactive to certain foods and stress.
most common disorders diagnosed by The immune system, which fights infection,
­doctors. It occurs more often in women may also be involved.
than in men, and it begins before the age
of 35 in about 50 percent of people.

What are the symptoms

of IBS?
Abdominal pain, bloating, and discomfort
are the main symptoms of IBS. However,
symptoms can vary from person to person.
Some people have constipation, which
means hard, difficult-to-pass, or infrequent
bowel movements. Often these people
report straining and cramping when trying
to have a bowel movement but cannot
­eliminate any stool, or they are able to
eliminate only a small amount. If they are
U.S. Department
of Health and
able to have a bowel movement, there may
Human Services
• Normal motility, or movement, may Cells that line the inside of the bowel
not be present in the colon of a person work as transporters and carry the
who has IBS. It can be spasmodic or serotonin out of the GI tract. People
can even stop working temporarily. with IBS, however, have diminished
Spasms are sudden strong muscle receptor activity, causing abnormal
­contractions that come and go. levels of serotonin to exist in the GI
tract. As a result, they experience
• The lining of the colon called the
problems with bowel movement,
epithelium, which is affected by the
motility, and sensation—having more
immune and nervous systems, regu­
sensitive pain receptors in their GI
lates the flow of fluids in and out of
the colon. In IBS, the epithelium
appears to work properly. However, • Researchers have reported that IBS
when the contents inside the colon may be caused by a bacterial infection
move too quickly, the colon loses its in the gastrointestinal tract. Studies
ability to absorb fluids. The result is show that people who have had gas­
too much fluid in the stool. In other troenteritis ­sometimes develop IBS,
people, the movement inside the otherwise called post-infectious IBS.
colon is too slow, which causes extra
• Researchers have also found very mild
fluid to be absorbed. As a result, a
­celiac disease in some people with
person develops constipation.
symptoms similar to IBS. People with
• A person’s colon may respond celiac ­disease cannot digest gluten,
strongly to stimuli such as certain a substance found in wheat, rye, and
foods or stress that would not bother barley. People with celiac disease can­
most ­people. not eat these foods without becoming
very sick because their immune sys­
• Recent research has reported that
tem responds by damaging the small
serotonin is linked with normal gastro­
intestine. A blood test can determine
intestinal (GI) functioning. Serotonin
whether celiac disease may be present.
is a neurotransmitter, or chemical,
(For information about celiac dis­
that delivers ­messages from one part
ease, see the NIDDK’s Celiac Disease
of your body to another. Ninety-five
fact sheet.)
percent of the serotonin in your body
is located in the GI tract, and the
other 5 percent is found in the brain.

   Irritable Bowel Syndrome

How is IBS diagnosed? – When it starts, there is a change
in the form of the stool or the way
If you think you have IBS, seeing your
it looks.
­doctor is the first step. IBS is gener­
ally diagnosed on the basis of a complete • Certain symptoms must also be
­medical history that includes a careful ­present, such as
description of symptoms and a physical – a change in frequency of bowel
examination. movements
– a change in appearance of bowel
There is no specific test for IBS, although
diagnostic tests may be performed to rule
– feelings of uncontrollable urgency
out other problems. These tests may
to have a bowel movement
include stool sample testing, blood tests,
– difficulty or inability to pass stool
and x rays. Typically, a doctor will perform
– mucus in the stool
a sigmoidoscopy, or colonoscopy, which
– bloating
allows the doctor to look inside the colon.
This is done by inserting a small, flexible • Bleeding, fever, weight loss, and per­
tube with a camera on the end of it through sistent severe pain are not symptoms
the anus. The camera then transfers the of IBS and may indicate other prob­
images of your colon onto a large screen for lems such as inflammation, or rarely,
the ­doctor to see better. cancer.
If your test results are negative, the doctor The following have been associated with a
may diagnose IBS based on your symp­ worsening of IBS symptoms
toms, including how often you have had
abdominal pain or discomfort during the • large meals
past year, when the pain starts and stops in • bloating from gas in the colon
relation to bowel function, and how your
bowel ­frequency and stool consistency have • medicines
changed. Many doctors refer to a list of • wheat, rye, barley, chocolate, milk
specific symptoms that must be present products, or alcohol
to make a diagnosis of IBS.
• drinks with caffeine, such as coffee,
Symptoms include tea, or colas
• Abdominal pain or discomfort for
at least 12 weeks out of the previous • stress, conflict, or emotional upsets
12 months. These 12 weeks do not Researchers have found that women with
have to be consecutive. IBS may have more symptoms during
• The abdominal pain or discomfort has their menstrual periods, suggesting that
two of the following three features: reproductive hormones can worsen IBS
– It is relieved by having a bowel problems.
movement. In addition, people with IBS frequently suf­
– When it starts, there is a change fer from depression and anxiety, which can
in how often you have a bowel worsen symptoms. Similarly, the symptoms
movement. associated with IBS can cause a person to
feel depressed and anxious.

   Irritable Bowel Syndrome

What is the treatment A medication available specifically to treat
IBS is alosetron hydrochloride (Lotronex).
for IBS? Lotronex has been reapproved with sig­
Unfortunately, many people suffer from nificant restrictions by the U.S. Food and
IBS for a long time before seeking medical Drug Administration (FDA) for women
treatment. Up to 70 percent of people with severe IBS who have not responded to
suffering from IBS are not receiving conventional therapy and whose primary
medical care for their symptoms. No cure symptom is diarrhea. However, even in
has been found for IBS, but many options these patients, Lotronex should be used
are available to treat the symptoms. Your with great caution because it can have seri­
doctor will give you the best treatments for ous side effects such as severe constipation
your particular symptoms and encourage or decreased blood flow to the colon.
you to manage stress and make changes to
your diet. With any medication, even over-the-
­counter medications such as laxatives
Medications are an important part of and fiber supplements, it is important to
relieving symptoms. Your doctor may follow your doctor’s instructions. Some
­suggest fiber supplements or laxatives for people report a worsening in abdominal
constipation or medicines to decrease bloating and gas from increased fiber
­diarrhea, such as Lomotil or loperamide intake, and laxatives can be habit forming
(Imodium). An antispasmodic is com­monly if they are used too frequently.
prescribed, which helps to control colon
muscle spasms and reduce abdominal pain. Medications affect people differently,
Antidepressants may relieve some symp­ and no one medication or combination of
toms. However, both antispasmodics and medications will work for everyone with
antidepressants can worsen constipation, IBS. You will need to work with your
so some doctors will also prescribe medica­ doctor to find the best combination of
tions that relax muscles in the ­bladder and medicine, diet, counseling, and support to
intestines, such as Donnapine and Librax. control your symptoms.
These medications contain a mild sedative,
which can be habit forming, so they need to
be used under the guidance of a physician.

   Irritable Bowel Syndrome

How does stress affect IBS?
Stress—feeling mentally or emotionally What does the colon do?
tense, troubled, angry, or overwhelmed— The colon, which is about 5 feet long,
can stimulate colon spasms in people with connects the small intestine to the rec­
IBS. The colon has many nerves that con­ tum and anus. The major function of
nect it to the brain. Like the heart and the the colon is to absorb water, nutrients,
lungs, the colon is partly controlled by the and salts from the partially digested
autonomic nervous system, which responds food that enters from the small intes­
to stress. These nerves control the nor­ tine. Two pints of liquid matter enter
mal contractions of the colon and cause the colon from the small intestine each
abdominal discomfort at stressful times. day. Stool volume is a third of a pint.
People often experience cramps or “but­ The difference between the amount
terflies” when they are nervous or upset. of fluid entering the colon from the
In people with IBS, the colon can be overly small intestine and the amount of stool
responsive to even slight conflict or stress. in the colon is what the colon absorbs
Stress makes the mind more aware of the each day.
sensations that arise in the colon, making
the person perceive these sensations as Colon motility—the contraction of the
unpleasant. colon muscles and the movement of
its contents—is controlled by nerves,
Some evidence suggests that IBS is affected hormones, and impulses in the colon
by the immune system, which fights infec­ muscles. These contractions move the
tion in the body. The immune system is contents inside the colon toward the
affected by stress. For all these reasons, rectum. During this passage, water
stress management is an important part and nutrients are absorbed into the
of treatment for IBS. Stress management body, and what is left over is stool. A
options include few times each day contractions push
• stress reduction (relaxation) train­ the stool down the colon, resulting in a
ing and relaxation therapies such as bowel movement. However, if the mus­
­meditation cles of the colon, sphincters, and pelvis
do not contract in the right way, the
• counseling and support contents inside the colon do not move
correctly, resulting in abdominal pain,
• regular exercise such as walking
cramps, constipation, a sense of incom­
or yoga
plete stool movement, or diarrhea.
• changes to the stressful situations
in your life
• adequate sleep

   Irritable Bowel Syndrome

Can changes in diet away within a few weeks. (For information
about diets for people with celiac disease,
help IBS? please see the NIDDK’s Celiac Disease fact
For many people, careful eating reduces sheet.) Increasing fiber intake by 2 to 3
IBS symptoms. Before changing your grams per day will help reduce the risk of
diet, keep a journal noting the foods that increased gas and bloating.
seem to cause distress. Then discuss your
findings with your doctor. You may want Drinking six to eight glasses of plain water
to consult a registered dietitian who can a day is important, especially if you have
help you make changes to your diet. For diarrhea. Drinking carbonated beverages,
instance, if dairy products cause your symp­ such as sodas, may result in gas and cause
toms to flare up, you can try eating less of discomfort. Chewing gum and eating too
those foods. You might be able to toler­ quickly can lead to swallowing air, which
ate yogurt better than other dairy products also leads to gas.
because it contains bacteria that supply Large meals can cause cramping and diar­
the enzyme needed to digest lactose, the rhea, so eating smaller meals more often,
sugar found in milk products. Dairy prod­ or eating smaller portions, may help IBS
ucts are an important source of calcium symptoms. Eating meals that are low
and other nutrients. If you need to avoid in fat and high in carbohydrates such as
dairy products, be sure to get adequate pasta, rice, whole-grain breads and cere­
nutrients in the foods you substitute, or als (unless you have celiac disease), fruits,
take supplements. and vegetables may help.
In many cases, dietary fiber may lessen
IBS symptoms, particularly constipation. Is IBS linked to other
However, it may not help with lowering
pain or decreasing diarrhea. Whole grain
health problems?
breads and cereals, fruits, and vegetables As its name indicates, IBS is a syndrome—a
are good sources of fiber. High-fiber diets combination of signs and symptoms. IBS
keep the colon mildly distended, which has not been shown to lead to a serious
may help prevent spasms. Some forms ­disease, including cancer. Through the
of fiber keep water in the stool, thereby years, IBS has been called by many names,
preventing hard stools that are difficult to among them colitis, mucous colitis, spas­
pass. Doctors usually recommend a diet tic colon, or spastic bowel. However, no
with enough fiber to produce soft, painless link has been established between IBS
bowel movements. High-fiber diets may and inflammatory bowel diseases such as
cause gas and bloating, although some Crohn’s disease or ulcerative colitis.
people report that these symptoms go

   Irritable Bowel Syndrome

Hope Through Research
Points to Remember The NIDDK conducts and supports
• IBS is a disorder that interferes with research into many kinds of digestive
the normal functions of the colon. ­disorders including IBS. Researchers
The symptoms are crampy abdominal are studying gastrointestinal motility and
pain, bloating, constipation, and diar­ sensitivity to find possible treatments for
rhea. IBS. These studies include the structure
and contraction of gastrointestinal muscles,
• IBS is a common disorder found as well as the mechanics of fluid movement
more often in women than men. through the intestines. Understanding the
• People with IBS have colons that are influence of the nerves, hormones, and
more sensitive and reactive to things inflammation in IBS may lead to new treat­
that might not bother other people, ments to better control the symptoms.
such as stress, large meals, gas,
­medicines, certain foods, caffeine,
or alcohol. The U.S. Government does not endorse or favor any
specific commercial product or company. Trade,
• IBS is diagnosed by its signs and proprietary, or company names appearing in this
symptoms and by the absence of document are used only because they are considered
­other diseases. necessary in the context of the information provided.
If a product is not mentioned, the omission does not
mean or imply that the product is unsatisfactory.
• Most people can control their symp­
toms by taking medicines such as
laxatives, antidiarrhea medicines,
antispasmodics, or antidepressants;
reducing stress; and changing their
• IBS does not harm the intestines
and does not lead to cancer. It is
not related to Crohn’s disease or
ulcerative colitis.

   Irritable Bowel Syndrome

For More Information National Digestive Diseases
International Foundation for Functional Information Clearinghouse
Gastrointestinal Disorders
P.O. Box 170864 2 Information Way
Milwaukee, WI 53217–8076 Bethesda, MD 20892–3570
Phone: 1–888–964–2001 Phone: 1–800–891–5389
Fax: 414–964–7176 Fax: 703–738–4929
Email: Email:
Internet: Internet:
The National Digestive Diseases
Information ­Clearinghouse (NDDIC)
You may also find additional information on this topic is a service of the National Institute
using the following databases:
of Diabetes and Digestive and Kidney
The NIDDK Reference Collection is a collection Diseases (NIDDK). The NIDDK is part of
of thousands of materials produced for patients and
health care professionals, including fact sheets, bro­ the National Institutes of Health under
chures, and audiovisual materials. Visit the U.S. Department of Health and
Human Services. Established in 1980, the
MedlinePlus brings together a wealth of information Clearinghouse provides information about
from the National Library of Medicine, the National
Institutes of Health, and other government agencies digestive ­diseases to people with digestive
and health-related organizations. MedlinePlus offers ­disorders and to their families, health
easy access to medical journal articles, a ­medical
dictionary and medical encyclopedia, health informa­
care ­professionals, and the public. The
tion in Spanish, hospital and physician directories, NDDIC answers inquiries, develops and
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als, links to hundreds of clinical trials, and the latest
health news. Visit with professional and patient organi­zations
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resources about digestive diseases.
This publication may contain information about
medications used to treat a health condition. When
this publication was prepared, the NIDDK included This publication is not copyrighted. The Clearing­
the most current information available. Occasion­ house encourages users of this fact sheet to duplicate
ally, new information about medication is released. and ­distribute as many copies as desired.
For updates or for questions about any medications,
please contact the U.S. Food and Drug Administra­ This fact sheet is also available at
tion at 1–888–INFO–FDA (463–6332), a toll-free call,
or visit their website at Consult your
doctor for more information.


National Institutes of Health

NIH Publication No. 07–693

September 2007

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