IBS Symptoms: Know the Signs

Irritable bowel syndrome has a wide range of signs and symptoms that can be very frustrating for the patient. People with IBS may experience multiple digestive symptoms all at once, while some may only experience one predominant symptom. 

IBS is primarily associated with chronic abdominal pain associated with a change in bowel habits.  In some people, constipation is the predominant bowel irregularity.  In others, diarrhea predominates.  The remainder of patients has alternating constipation and diarrhea.

Whether it’s one or more symptoms, quality of life can be affected.  It is important to discuss your symptoms with a doctor to confirm the diagnosis of IBS and exclude more serious and life threatening conditions that may have overlapping symptoms.

Common IBS Signs and Symptoms

Abdominal Pain

The most common IBS symptom is abdominal pain or discomfort, which is often crampy, but sometimes can manifest as a dull ache or a sharp pain.

This type of pain is usually generalized, can occur in just the lower abdomen, or on one side of the abdomen. Pain can limit activities, but usually does not wake you from sleep. Pain often becomes more severe after meals and improves after a bowel movement.

Abdominal pain can be triggered or exacerbated by stress and anxiety.  In some people, certain foods and medications can make pain worse.

Constipation

Constipation refers to infrequent stools (less than 3 bowel movements a week) or hard pellet like or lumpy stool. People can often associate bloating, fullness, decreased appetite or straining with bowel movements. Constipation is often associated with anorectal disorders like hemorrhoids or anal fissures.

IBS with constipation (IBS-C) is the classification that is diagnosed when constipation is the predominant stool type. 

Diarrhea

Diarrhea refers to frequent stools with three or more stools per day or a soft, loose, or watery consistency.  People with diarrhea can have urgency and occasionally fecal incontinence (unintentional leakage of stool).  

Concerns about restroom access in public places may limit one’s ability to leave the house.  People with IBS-D often report the majority of bowel movements occurring in the morning after waking or regularly soon after meals.

IBS with diarrhea (IBS-D) is the diagnosis when diarrhea is the predominant stool type. 

Bloating

People who have irritable bowel syndrome tend to get bloated from gas produced by bacteria living in their intestines. Bloating tends to occur after meals and can worsen throughout the day.  Many people report “looking pregnant” by evening time.

Sometimes bloating is a result of alterations in the normal levels of gut bacteria. Sometimes it can develop as a result of foods that are eaten that are high in FODMAPs (carbohydrates that are fermented by gut bacteria and produce gas).

Learn more about IBS and Food Effects.

Gas Pains

Some patients report feeling intense stomach pains called “gas pains.” Patients with IBS often have visceral hypersensitivity, where the nerve receptors in the gut are more sensitive to typical levels of gas.  

Gas pain can occur anywhere in the abdomen, wherever there is trapped gas. Sometimes, prior abdominal surgeries can lead to scar tissue or adhesions, where the bowel can transiently get kinked and trap gas.  

Gas is normal for everyone, and passing gas up to 20 times a day is considered normal.  

Stress and Anxiety

Anxiety and stress can affect our digestive system and contribute to IBS symptoms. While the exact cause of IBS is unknown, it is thought to be a disorder of brain-gut interaction. In some people, anxiety and stress can lead to abdominal pain and diarrhea, while in others, constipation develops.

Depression and other mood disorders can interfere with one’s diet.  Depressed people sometimes limit food intake and lose weight and develop altered bowel motility.  Others may use food to cope with emotional distress, leading to overeating or unhealthy food choices. That can affect bowel habits, and lead to eating less than usual and losing weight. 

Fatigue

Many people with IBS complain about feeling tired throughout the day. Fatigue can develop due to poor eating habits, lack of adequate hydration, poor sleep, and comorbid psychiatric disorders.

Other Associated Symptoms and Medical Conditions

• Heartburn and acid reflux
• Indigestion
• Nausea and vomiting
• Excessive belching
• Anxiety
• Depression
• Interstitial cystitis
• Fibromyalgia

Women with IBS

Women with IBS symptoms may experience a change or fluctuation in bowel habits related to their menstrual cycles. They may have painful menstrual cycles or have pelvic pain that may be difficult to characterize as gastrointestinal or gynecologic pain as the two often overlap.  Women going through menopause may experience a change in bowel habits.

Childbirth, weakening of the pelvic floor, and pelvic organ prolapse can contribute to evacuation disorders which may lead to more severe difficulties with constipation or diarrhea.

• Related Article: IBS Symptoms in Men

Start an IBS Food and Symptoms Journal

To help aid in diagnosis and management of IBS, your doctor may recommend a symptoms and food journal. 

Documenting diet, medications, and bowel movements will help you and your doctor diagnose and classify your IBS. The doctor can recognize if there are any common triggers which may be eliminated to improve intestinal symptoms. 

It is important to take note of the details, such as:

• Diet and food diary – note food intolerances like fatty foods, dairy, gluten, spicy foods
• Bowel movements – form and frequency
• Time of symptoms occurring 
• Pain level and location
• Medications and dietary supplements
• Mood, anxiety, stress (work life, family life, financial insecurity)
• Activities like exercise, yoga, or meditation

Include any other pertinent details as that will help the doctor to diagnose the gastrointestinal symptoms.

Learn more about how to test for IBS.

You can track in any notebook or get a pre-made journal like this popular Food Sensitivity Journal that includes space for all the information: