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Irritable Bowel Syndrome: How to Treat It

Making changes to your diet can help relieve symptoms as can taking medications.
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Written by
Adam Pont, MD, PhD.
Gastroenterology Fellow, New York Presbyterian Hospital/Columbia
Last updated January 19, 2021

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What is irritable bowel syndrome?

Irritable bowel syndrome (IBS) is a common, chronic disorder of the gut (primarily the large intestine) that causes abdominal pain and changes in your bowel movements. There are three types of IBS, based on whether you have diarrhea, constipation, or both.

Although there is no cure for IBS, there are many treatments available to address symptoms.

IBS is different from inflammatory bowel disease (IBD). IBS does not increase your risk of getting colon cancer.

What does an IBS attack feel like?

Pro Tip

A misconception about IBS is that it’s “all in your head.” Although IBS symptoms are likely influenced by interactions between the brain and gut, the symptoms and disease are very real and bothersome. —Dr. Adam Pont

Symptoms of IBS vary, depending on the type you have: constipation-predominant (IBS-C), diarrhea-predominant (IBS-D), or mixed (IBS-M; alternating between constipation and diarrhea).

All forms of IBS cause abdominal pain at least once a week. You may have more frequent bowel movements (more than three daily), or less frequent (less than three a week).

You may have to push harder to get stool out, or feel like you can’t empty your bowel. You may feel sudden urges to have bowel movements, causing you to rush to the toilet.

The appearance and texture of your stool may change, either becoming very loose and watery (diarrhea), or very hard and pebble-like (constipation). You might feel bloated or gassy.

IBS is a chronic disease, meaning that symptoms last for months or years (although the symptoms usually come and go over time).

Main symptoms

  • Belly pain more than once a week, often related to bowel movements.
  • Diarrhea.
  • Constipation.
  • Stool becomes frequent (more than 3 times a day) or less frequent (less than 3 times a week).

Other IBS symptoms you may have

  • Needing to push harder to get stool out.
  • Feeling like there is stool remaining, even after straining to have a bowel movement.
  • Sudden urge to have a bowel movement, possibly causing you to rush to the toilet.
  • Abdominal bloating.
  • Excess gas.
  • Worsening of symptoms after eating.

IBS causes

Although the exact causes of IBS are not known, research suggests that communication between the brain and the gut is not functioning normally.

Food may move too slowly through the digestive tract, for example, or you may feel higher levels of pain when there is a normal amount of gas.

Though it’s unclear how, psychological distress (such as trauma, anxiety, or depression) may play a role.

Psychological stress or trauma may lead to changes in the gut lining or affect the types of healthy bacteria that are in the gut. This could possibly lead to more intestinal infections or inflammation, which may change the way the intestines contract and move, causing IBS symptoms.

What is the best treatment for irritable bowel syndrome?

Dr. Rx

A collaborative approach where you and your doctor discuss your symptoms and potential treatments will be most successful. It will make it easier for them to help you. And, hopefully, make you feel more confident about the treatment plan. —Dr. Pont

Your doctor will discuss your diet to see if any foods or drinks trigger your symptoms that you should avoid. They may recommend fiber supplements, regular exercise such as walking or yoga, and ways to manage life stressors (including getting enough sleep).

If these do not control your symptoms, your doctor may prescribe medication.

Options include anti-spasmodics (for belly pain and cramps), gut-specific antibiotics for diarrhea, and antidepressants to treat anxiety or depression.

There are different medications specifically for treating IBS-C and IBS-D.

Your doctor may also suggest seeing a specialist for cognitive behavioral therapy, which can help with managing stress and dealing with IBS symptoms.

Risk factors

  • More common in women.
  • Tends to affect people under the age of 50.
  • Having had infectious gastroenteritis.
  • Having mental health issues (particularly anxiety and depression).
  • Having certain chronic pain syndromes such as fibromyalgia or chronic fatigue syndrome.
  • People with close relatives who have IBS may have an increased risk of it.

Can IBS be left untreated?

If you are having symptoms of IBS, see your doctor. Depending on your symptoms and medical history, they may refer you to a specialist in digestive diseases (gastroenterologist).

It is especially important if you notice any of the following “red flag” symptoms. These may mean you have a disease other than IBS.

  • Weight loss (if not dieting)
  • Blood in the stool (you can see it or found in a stool test)
  • Fever
  • Abdominal lump or mass
  • Enlarged lymph nodes
  • Anemia due to low iron
  • Waking up at night because of your symptoms
  • Symptoms started recently and are quickly worsening
  • You are older than 50 and have never been screened for colon cancer
  • Antibiotic use within the last 6 months
  • Family members have had colon cancer or inflammatory bowel disease (IBD)

Pro Tip

IBS does not increase your risk of colon cancer. And you will not need more frequent colon cancer screening than a similar patient who does not have IBS. —Dr. Pont

Does IBS go away?

Treatment for IBS will not cure the disease but can significantly improve your symptoms.

Follow your doctor's advice about diet and stress management. And take all medication as directed. Also, keep track of your symptoms so treatment can be adjusted as needed.

A good relationship with your doctor is key for successfully managing your IBS symptoms. You should trust your doctor and feel they are taking your condition seriously.

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Gastroenterology Fellow, New York Presbyterian Hospital/Columbia

Dr. Pont is currently a fellow in Gastroenterology at New York Presbyterian Hospital/Columbia, where he also completed his residency in Internal Medicine. Dr. Pont received his medical degree and PhD at the New York University School of Medicine. He earned his BS in Biological Systems Engineering at the University of Nebraska-Lincoln.

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