A sunset walk on the beach with your dog. Cross-country road trips. A music festival featuring your favorite artist. These joyful moments might require additional planning if you live with Irritable Bowel Syndrome (IBS).
IBS is a common disorder causing pain in the belly, bloating or discomfort, and irregularities like constipation, diarrhea, or both. It affects over 800 million people worldwide, about 11% of the world population, yet it can be difficult to get a diagnosis [1].
Even following a diagnosis, figuring out a management plan can be a challenge. Let’s dive into IBS, looking at common causes and triggers, their relationship to your gut microbiome, and some science-backed solutions that can bring relief.
Wait - what is IBS exactly?
Because they share similar symptoms (and acronyms), IBS can be confused with IBD - Inflammatory Bowel Disease. Both IBS and IBD are chronic gastrointestinal (GI) conditions with abdominal pain and irregular bowel movements. The causes and treatments are different, though. It’s important to talk with your practitioner to get an accurate diagnosis.
While the exact cause is unknown, IBS is linked to several factors (listed below). There is no cure, but there are treatments that can improve your quality of life. Because of the differing effects on your bowel movements, IBS can fall into one of three categories.
Different types of IBS
- IBS-D: diarrhea (loose and watery poop)
- IBS-C: constipation (hard and lumpy poop)
- IBS-M: mixture (both diarrhea and constipation) [2]
Knowing your specific type of IBS can make a big difference. It helps you and your practitioner find the best treatments: what works for one kind may not work for another.
Common IBS symptoms
Like the name suggests, Irritable Bowel Syndrome symptoms center around an irritated bowel (which might, in turn, make you feel irritated). These include:
- Abdominal pain, cramping, or bloating associated with bowel movements
- Diarrhea, constipation, or both
- A feeling of still needing to poop after you go
Sound familiar? You’re not alone.
About 30% of people experiencing these symptoms will seek medical help [1]. When they do, a practitioner might provide a diagnosis through:
- Evaluating your symptoms
- Ensuring you’re current with your colon cancer screening
- Ruling out other disorders using:
- Blood tests
- Stool tests
- Hydrogen breath tests [2]
IBS is a chronic (long-term) condition, but the frequency of symptoms can vary. Some people may have regular IBS symptoms, while others may only have flare-ups. Additionally, women are more affected by IBS than men [1], [3].
Let’s explore some specific triggers that might result in IBS.
Digging into IBS causes: what might be stirring up trouble in your gut
IBS is complex—with different factors like diet, hormones, and gut microbes all interacting in ways that can influence your symptoms. While there’s no single root cause, researchers have uncovered several key contributors that may help explain why IBS shows up—and what might be making it worse.
Diet
Your diet may play a major role in development and severity of IBS. Between 85-90% of people with IBS say that it gets worse when they eat specific foods [4]. This can complicate diagnosis because doctors will need to evaluate for a food allergy or intolerance [5]. A new scientific breakthrough suggests IBS pain might be similar to an allergic reaction in the gut [6].
Stress
Have you noticed symptoms getting worse during busy or emotional times?
In addition to the GI component, researchers know about a relationship between gut health and the brain/nervous system. The communication between the brain and the gut has been named the gut-brain axis and can impact (and be impacted by) both IBS and the gut microbiome [7], [8].
Because of this connection, stress can be a trigger for your IBS symptoms [9]. Research has also found that a traumatic event in childhood can kick-start IBS, and it is more prevalent in people with early trauma [10].
Hormonal changes
IBS is also linked to changes in hormone levels, which occur during menstruation and early menopause [11].
Gut-microbiome imbalances
Your gut is home to trillions of microorganisms. An imbalance of microbes in the gut (sometimes called dysbiosis) is associated with IBS [12]. Individuals with SIBO (small intestinal bacterial overgrowth) also have a microbial imbalance; if you have IBS, you should be screened for SIBO as well.
While the gut microbiomes of people with and without IBS differ, researchers are still working on accurately pinpointing why this is [13], [14].
Food poisoning
Around 10% of people who get food poisoning caused by a bacteria (aka infectious gastroenteritis) will later develop IBS. This is known as Post-Infectious IBS (PI-IBS). It can be caused by bacterial or viral infection (or even another microorganism known as protozoa) [15].
Genetics
The connection between your DNA and the risk of IBS is not as well-studied, but doctors have found that the risk is twice as high when a family member has IBS [16].
Science-backed ways to help manage your IBS
Some causes of IBS are out of your control (you can’t help who your family is), but there are a number of things you can do to manage symptoms.
Adjust your diet
Working with your practitioner and/or dietitian to identify any food allergies or intolerances is a great first step to alleviating IBS symptoms. Milk, wheat, soy, egg, peanuts/tree nuts, and fish/shellfish are the most common triggers for IBS, so eliminating those can help. The Paleolithic diet (focusing on lean meats, fish, fruits, vegetables, nuts, and seeds) has been successful for some patients [5].
The low FODMAP (fermentable oligosaccharide, disaccharide, monosaccharide, and polyol) diet is helpful in some cases [5], [17]. FODMAPs are hard-to-digest carbohydrates found in a variety of fruits, fruit juices, vegetables, dairy products, grains, and honey.
Important note: The FODMAP diet should only be used short-term. It can damage some beneficial gut microorganisms and, if used for too long, can lead to more imbalances. Your practitioner can help determine if this diet is right for you.
In general, adding more fiber to your meals helps your gut work smoothly and keeps beneficial microbes thriving, but with IBS, you may have to consider which type of fiber is best for you [18]. Soluble fiber (like nuts, seeds, and some fruit) tends to be better for those with IBS-C, while insoluble fiber (like wheat bran and whole grain) is better for people with IBS-D [4].
If you suffer from IBS, you may also benefit from adding certain probiotics to your diet [19]. For example, one study found that Bacillus coagulans strain LBSC (DSM17654) helped relieve bloating, abdominal pain, constipation, and diarrhea [20].
With insight into your gut microbiome, you can personalize those probiotics to help microbial populations affected by imbalances [12].
Make lifestyle changes
Our lives can be full of stressors, including workplace issues, financial problems, and career changes. Since stress can trigger IBS, forms of stress management, including mindfulness practices, may help alleviate symptoms. Making efforts to improve sleep habits can also help [21], [22].
Zoom out: consider holistic gut health
It’s good to look at the body as a whole because no one part exists on its own. The brain and nervous system interact with the gut, and immune responses impact the gut microbiome. Understanding each part of the system can lead to improved overall wellness.
Because of research into the gut microbiome, doctors know some microbes associated with IBS that could be targeted for treatment in future studies [12]. These include hydrogen sulfide producers like Desulfovibrio piger, which one study found are more abundant in people with IBS [13]. On the flip side, microbes that produce short-chain fatty acids (good for our gut), like Bifidobacterium, are less abundant in IBS patients. As experts learn more about how IBS impacts gut microbes, new technologies such as phage therapy (the use of viruses that attack specific bacteria) can be used in clinical trials [23].
IBS support when and how you need it
Living with IBS can be challenging, but there are ways you can control your symptoms. Finding the right diet, improving your mental health, and evaluating your overall gut health can have a major impact on long-term wellness.
In order to holistically understand your gut health, an Adult Gut Health Test can be used to evaluate your gut microbiome. If you’ve been diagnosed with a chronic condition like IBS, a Tiny+ Adult Membership can help you track changes to your microbiome as you explore different management options.
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