Clarifying Common Misconceptions About IBS

Woman with stomachache on medical exam

You've experienced abdominal cramps, bloating, and diarrhea for far too long and you've finally made an appointment to see a gastroenterologist. After listening to your symptoms, the doctor says it sounds like you have irritable bowel syndrome, or IBS.

“Isn’t that a serious disease that requires surgery?” you ask. Fortunately, the answer is no. You are thinking of IBD—inflammatory bowel disease—a collective term that includes ulcerative colitis and Crohn’s disease, both of which are serious conditions needing life-long care.

With constant confusion between IBS and IBD, let's take a deeper dive into that grey zone and surface some clarification. Here’s what you need to know about the condition you have and the disease you don’t:

  • IBS is not a disease. IBS is actually a functional syndrome, meaning it’s a collection of symptoms indicating your bowel is not functioning properly. Although IBS shares many symptoms with IBD, it causes no permanent harm.
  • IBS is not an inflammatory condition. The intestines of people with IBS look completely normal, while the intestines of those with IBD look red, inflamed, and angry.
  • IBS is not a cause of heartburn. IBS does not cause symptoms above the belly button (outside of occasional nausea). Heartburn is the hallmark of gastroesophageal reflux disease (GERD). Bloating accompanied by an uncomfortable tummy and burping is the sign of functional dyspepsia, which may be considered a form of IBS with upper abdominal symptoms.
  • IBS is not a condition diagnosed with tests. Unlike IBD, IBS causes no changes to the lining of the intestines that are visible on X-ray, CT scan, or colonoscopy; tests of any kind will be normal. However, test results can rule out IBD or other conditions in people with symptoms of IBS. Because the symptoms of IBS are easily confused with those of small intestine bacterial overgrowth (SIBO), a breath test may be offered. If the results are positive, SIBO can be treated with antibiotics.
  • IBS is not an equal opportunity problem. The majority of those with IBS are women. IBS is also more prevalent in people who are anxious or depressed.
  • IBS is not a condition that always requires medication. Some people can control their symptoms by making dietary modifications, such as following the FODMAP elimination diet. That being said, some with IBS are helped by antidepressants or anti-anxiety medications. Surgery is not necessary.
  • IBS is not caused by a food allergy. No true allergy to food has been identified as playing a role in IBS. However, many patients with IBS feel better by avoiding certain foods. For some, it’s gluten—even though they test negative for celiac disease. For others, it’s certain carbohydrates that are more difficult to digest and that lead to bloating and diarrhea. These carbohydrates are called FODMAPs, which stands for fermentable oligo-, di- and monosaccharides, and polyols. Many IBS patients do well by eating a diet low in FODMAP foods. 
  • IBS is not a genetic disease. No genetic link or marker has ever been identified. IBS is acquired. 
  • IBS is not fatal. It does not lead to cancer, like IBD and celiac disease can. But with the help of a dietitian and a gastroenterologist, you should be able to live a relatively symptom-free life.

    Dr. Kirsch is a gastroenterologist at Cleveland Clinic's Independence Family Health Center.

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