How to Tell the Difference Between IBS and IBD
If you regularly experience super fun symptoms like abdominal pain, constipation, or diarrhea, you might see two conditions repeatedly pop up in your “WTF is wrong with me” search results: irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD).
While IBS and IBD can both come with debilitating bowel symptoms, these conditions are actually very different. Here’s what you need to know.
IBS and IBD both impact your gastrointestinal tract’s ability to function normally, which can lead to issues like diarrhea and abdominal pain.
IBS is a disorder that impacts the large intestine (aka colon), according to the Mayo Clinic. There are several forms, including IBS-C (which causes constipation), IBS-D (which causes diarrhea), and IBS-M (which causes both—the M stands for mixed), according to the National Institute of Diabetes and Digestive and Kidney Diseases. All types of IBS can also come with gut pain, too.
IBD, on the other hand, is an umbrella term for conditions that cause chronic inflammation in various parts of the digestive tract. The main types are ulcerative colitis, which contributes to inflammation and ulcers in the lining of the large intestine and rectum and Crohn’s disease, inflammation that usually happens in the small and large intestines but can actually occur anywhere in the digestive tract depending on the person, according to the Mayo Clinic.
IBS is what’s known as a functional gastrointestinal disorder, or a disorder of gut-brain interaction, according to the NIDDK.
This means that miscommunication between your GI tract and brain can unleash a host of bathroom problems. The issue may be that the nerves connecting your brain and intestines overreact and cause IBS symptoms, according to the Mayo Clinic. In fact, many patients with IBS also experience anxiety or depression, which supports this link between IBS and the brain, Rudolph Bedford, M.D., a gastroenterologist at Providence Saint John’s Health Center in Santa Monica, California, tells SELF.
This gut-brain connection can also disrupt the functioning of your large intestine, which contracts to propel food through your digestive system, according to the Mayo Clinic. If it contracts too forcefully, diarrhea can result. If it contracts too weakly, you may wind up with constipation.
Other potential IBS causes include having a hyperactive immune system that prompts intestinal inflammation, your gut bacteria being thrown out of whack by something like small intestinal bacterial overgrowth, or an infection. Dr. Bedford says he has seen several patients who have gone on vacation, developed some kind of gastrointestinal infection like the stomach flu, and are still grappling with IBS years later.
Whatever the cause may be, if you have IBS, your digestive system can overreact to triggers, prompting unpleasant symptoms like diarrhea, constipation, and abdominal pain to rear their ugly heads, Christine Lee, M.D., a gastroenterologist at the Cleveland Clinic, tells SELF. According to the Mayo Clinic, common triggers include stress, hormonal changes, and certain foods like dairy products.
As for IBD, both ulcerative colitis and Crohn’s disease are mainly thought to happen when a person’s immune system accidentally attacks their GI tract, according to the NIDDK.
Ulcerative colitis and Crohn’s disease are mysterious, but they do share a few risk factors. Both conditions tend to run in families, so researchers are working to determine how much genetics are to blame, according to the Mayo Clinic. Both also usually start causing symptoms before a person turns 30 and are more likely to affect those of Eastern European Jewish descent.
There’s also a question of how a person’s environment or lifestyle factors, like medications and diet, may cause or exacerbate IBD.
Whichever type of IBD you have, your doctor may advise you to avoid triggers like stress, along with foods high in fat or fiber, spicy foods, alcohol, and caffeine, according to the Mayo Clinic.
Although IBS and IBD can both cause diarrhea and abdominal pain, their symptoms do diverge in some ways.
Constipation, for instance, is more often association with IBS than IBD, Ashkan Farhadi, M.D., a gastroenterologist at MemorialCare Orange Coast Medical Center and director of MemorialCare Medical Group’s Digestive Disease Project in Fountain Valley, California, tells SELF.
Whereas, if you tend to have blood in your diarrhea, it’s more likely that you’re suffering from IBD, Dr. Farhadi says.
Ulcerative colitis and Crohn’s disease can both cause ulcers that bleed, so you might see red in the toilet bowl. While you can experience bleeding with IBS, it’s more likely to be from a hemorrhoid or anal fissure due to constipation, not diarrhea, he says. (Either way, seeing blood in your poop is always something to flag for your doctor.)
People who have IBD may also experience fatigue, which isn’t as common with IBS, Dr. Farhadi says. The theory is that physical inflammation can induce fatigue. Since inflammation is a hallmark symptom of IBD and only sometimes occurs with IBS, it’s more likely to show up if you have the former instead of the latter. Of course, there are plenty of health-related reasons why someone may feel fatigued, so constant exhaustion isn’t a definite sign of IBD, even when accompanied by gut issues.
Finally, because IBS is due at least in part to spasms in your gut and changes in gut motility, people tend to have symptoms for a few days, then be just fine until the next flare-up, Dr. Farhadi says. In comparison, the inflammation that causes IBD can be more severe and take longer to abate when someone is going through a flare-up, he says, and someone with IBD may experience shorter symptom-free periods than someone with IBS. Of course, everyone’s individual situations can vary.
While the diagnostic process for IBS and IBD is similar, treatment differs based on the exact symptoms you’re experiencing.
There’s no definitive test for IBS, so doctors typically only arrive at this conclusion after excluding most other potential causes. In addition to evaluating your symptoms, they may perform a host of exams, including a colonoscopy, a flexible sigmoidoscopy (using a thin tube to examine your rectum and only part of your colon), imaging exams like an X-ray or CT scan, checking your breath for bacterial overgrowth, or even testing your poop for bacteria, parasites, or bile, according to the Mayo Clinic.
If you’re diagnosed with IBS, your doctor may recommend a range of treatment options depending on your exact symptoms, and it can take some trial and error to get it right. According to the Mayo Clinic, if you have IBS-C, your doctor might suggest adding more fiber to your diet since it soaks up water as it moves through your digestive system, making your poop softer and easier to expel. They may also recommend laxatives or prescription medications that boost the amount of fluid that gets into your poop. If you have IBS-D, anti-diarrheal medications or other drugs might help relax the excessive contractions in your gut. And if you have IBS-M, your doctor will probably try to figure out a mix of lifestyle tweaks and medications to keep both diarrhea and constipation at bay, along with cramps, too.
Diagnosing IBD can be similarly time-consuming. Your doctor will likely order a range of tests to pick up on any abnormalities that could signal these conditions. This could include blood tests, a colonoscopy, a flexible sigmoidoscopy, or an X-ray or CT scan. They may also test your poop to see if any blood is present, according to the Mayo Clinic.
If your doctor suspects Crohn’s disease has affected your small intestine, they may also have you do exams like a capsule endoscopy, which involves swallowing a capsule that has a camera in it to view your intestines. An external recorder captures the images, and you'll later poop the capsule out, because apparently we’re living in the future.
Anti-inflammatory drugs like corticosteroids are usually the first step in IBD treatment, though the type of medication you take depends on the area of your colon that’s affected by your IBD.
Since inflammation in response to an immune system overreaction seems to be a major cause of IBD, immunosuppressants can also be helpful, Dr. Farhadi says. One example is biologic drugs, which work by neutralizing a protein produced by your immune system. A combination of these drugs may work better than one alone, the Mayo Clinic says.
Your doctor may also recommend medications to address side effects of your specific situation, like antidiarrheal drugs or iron supplements. If you have Crohn’s disease and your doctor is concerned about an infection, they may prescribe antibiotics, too. In severe cases, surgery to remove damaged tissue might make sense for you. While the Mayo Clinic notes that this can sometimes completely cure a person of ulcerative colitis if you remove the entire colon and rectum, it unfortunately can’t do the same for Crohn’s disease, which often recurs after surgery. Either way, it’s always worth having a thorough discussion about pros and cons before moving forward with a treatment plan, whether it involves surgery or not.
Bottom line: If you're having problems pooping, talk to your doctor about the possible culprits.
Your symptoms may look a lot like IBS or IBD or something else entirely. But the sooner you’re diagnosed, the sooner you can make your pooping habits fade into the background—rather than take center stage.
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