Table of ContentsView AllTable of ContentsSelf-ChecksA “Positive Diagnostic Strategy"Subtypes of IBSRome IV CriteriaPhysical Exam and Lab Tests for IBSImagingDifferential DiagnosesFrequently Asked QuestionsNext in IBS GuideIrritable Bowel Syndrome (IBS) Diet: Foods to Eat and What to Limit
Table of ContentsView All
View All
Table of Contents
Self-Checks
A “Positive Diagnostic Strategy”
Subtypes of IBS
Rome IV Criteria
Physical Exam and Lab Tests for IBS
Imaging
Differential Diagnoses
Frequently Asked Questions
Next in IBS Guide
Diagnosingirritable bowel syndrome(IBS) can often be about confirming what youdon’thave, as much as it is about confirming that you meet the diagnostic criteria for IBS.
As afunctional gastrointestinal disorder, there isn’t any identified structural or tissue problem. Rather, IBS is a problem of function, specifically of bowel function.
IBS is achroniccondition that causes abdominal pain and abnormal stools—symptoms that are consistent with many other gastrointestinal issues.Many of the tests that your healthcare provider orders, including blood work and imaging, will help to rule out other gastrointestinal problems. By doing so, your IBS diagnosis is more conclusive.
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There is no way for you to definitively determine if you have IBS yourself, which is why it is highly recommended that you make an appointment with your primary care healthcare provider if you are experiencing recurrent symptoms.
It’s helpful to start keeping a simplefood and symptom diary, so you have a log of exactly what you’ve been experiencing and for how long.
Keep track of what you eat and when, and how your body responds. Additionally, record when you have pain, diarrhea, and/or constipation. You may also want to record stressors, because of the connection of the gut with your brain.
You should log any other symptoms you experience like bloating, flatulence (gas), and acid reflux. Even symptoms like fatigue, headaches, heart palpitations, and bladder urgency should be recorded, especially if you consistently experience them along with the more obviousIBS symptoms.
The information you record might help your provider to make a diagnosis. You can use our Doctor Discussion Guide below to help you talk about your symptoms with a professional.
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That means that people should be given a physical exam, some lab tests, and minimal diagnostic testing if they present with abdominal pain and altered bowel habits that have lasted more than six months. The caveat? Certain “alarm features” need more testing to rule out more serious problems.
“Alarm features” include:
Traditionally, IBS is divided into diarrhea, constipation, or alternating subtypes. Symptoms can range from mild to severe, with normal bowel movements on some days. On days when you experience abnormal bowel movements, look for one of the following types:
IBS with constipation (IBS-C),mostly constipation with discomfort:
IBS with diarrhea (IBS-D),mostly diarrhea with discomfort:
IBS-M (mixed bowel habits) or IBS-A(alternating bowel habits), alternating loose stools and constipation with discomfort:
IBS-U:Undefined with symptoms that vary
Because IBS is considered afunctional disorder, in that there is no visible disease process, healthcare providers often use the Rome IV (“Rome 4”) criteria to diagnose IBS.
According to these criteria, IBS is diagnosed if symptoms have been present at least one day per week during the last three months and started six or more months ago.
Symptoms must consist of recurrentabdominal painwith two or more of the following being true:
While the Rome IV Criteria is a helpful resource, many primary care healthcare providers prefer that a more thorough investigation be done and may refer you to agastroenterologist.
Gastroenterologists use their knowledge of the workings of the entiredigestive systemand their experience in the various disorders of the gastrointestinal system to come up with a comprehensive diagnosis and treatment plan.
So that you get the proper treatment, the ACG recommends that certain disorders be ruled out. To do that, they recommend:
Should your symptoms or family medical history warrant it, your healthcare provider might recommend additional testing to be sure that you do not have another condition that mimics IBS, such as inflammatory bowel disease (IBD) or colon polyps.
If this happens, they may recommend one of these other common gastrointestinal procedures:
Once certain conditions have been ruled out and the criteria of the Rome IV criteria are met, your healthcare provider can confidently diagnose you as having IBS.
Colonoscopy and Irritable Bowel Syndrome (IBS): What to Know
There are a number of common digestive health problems that share some of the same symptoms as IBS. For instance, celiac disease (an autoimmune response to eating gluten) and food intolerances (gastrointestinal responses to certain foods) often have symptoms that are similar to IBS.
Meanwhile,IBD(Crohn’s disease andulcerative colitis) andcolon cancercan also share some symptoms. The difference is that people with these diseases many times experience rectal bleeding or other “alarm signs” listed above, in addition to abdominal pain, gas, bloating, diarrhea, and constipation. People with IBS usually do not have rectal bleeding unless it is fromhemorrhoids.
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Frequently Asked QuestionsIBS tends to run in families and a genetic predisposition may put someone at a higher risk of developing this condition.Lifestylerisk factorsinclude a high stress level, anxiety, and depression.Obesity, alcohol use, smoking, lack of exercise, and poor diet may not cause IBS but can increase flare-ups.Dietary management is a large part of IBS treatment. Figuring out trigger foods and avoiding them, eating appropriately timed and proportioned meals, and following a low-FODMAP diet can help keep flare-ups under control.Over-the-counter and prescription medications, such as antibiotics, antidepressants, and antispasmodics, may be used to manage symptoms and promote normal digestive function.FODMAP is the acronym for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols, which are fermentable carbohydrates that are not easily absorbed during digestion. As a result, they cause an increase of fluid and gas in the bowel, which leads to bloating and other symptoms associated with IBS. A low-FODMAP diet is a process for identifying a person’s trigger foods so they can be avoided.You can still eat a variety of foods on thelow-FODMAP dietincluding, but not limited to, lactose-free milk, almond milk, hard cheeses like feta or brie, bananas, blueberries, grapefruit, carrots, chives, cucumbers, avocado, pineapple, bell peppers, spinach, brown rice, oats, quinoa, almonds, pecans, peanuts, pumpkin seeds, sesame seeds, beef, chicken, eggs, fish, and turkey.
IBS tends to run in families and a genetic predisposition may put someone at a higher risk of developing this condition.Lifestylerisk factorsinclude a high stress level, anxiety, and depression.Obesity, alcohol use, smoking, lack of exercise, and poor diet may not cause IBS but can increase flare-ups.
Dietary management is a large part of IBS treatment. Figuring out trigger foods and avoiding them, eating appropriately timed and proportioned meals, and following a low-FODMAP diet can help keep flare-ups under control.Over-the-counter and prescription medications, such as antibiotics, antidepressants, and antispasmodics, may be used to manage symptoms and promote normal digestive function.
FODMAP is the acronym for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols, which are fermentable carbohydrates that are not easily absorbed during digestion. As a result, they cause an increase of fluid and gas in the bowel, which leads to bloating and other symptoms associated with IBS. A low-FODMAP diet is a process for identifying a person’s trigger foods so they can be avoided.
You can still eat a variety of foods on thelow-FODMAP dietincluding, but not limited to, lactose-free milk, almond milk, hard cheeses like feta or brie, bananas, blueberries, grapefruit, carrots, chives, cucumbers, avocado, pineapple, bell peppers, spinach, brown rice, oats, quinoa, almonds, pecans, peanuts, pumpkin seeds, sesame seeds, beef, chicken, eggs, fish, and turkey.
Treatment Options for IBS
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Aziz I, Simrén M. The overlap between irritable bowel syndrome and organic gastrointestinal diseases.Lancet Gastroenterol Hepatol. 2021;6(2):139-148. doi:10.1016/S2468-1253(20)30212-0Lacy BE, Pimentel M, Brenner DM, et al.ACG clinical guideline: Management of irritable bowel syndrome.Am J Gastroenterol.2021 Jan 1;116(1):17-44. doi: 10.14309/ajg.0000000000001036Johns Hopkins Medicine.Irritable Bowel Syndrome (IBS).Palsson OS, Whitehead W, Törnblom H, Sperber AD, Simren M.Prevalence of Rome IV functional bowel disorders among adults in the United States, Canada, and the United Kingdom.Gastroenterology. 2020;158(5):1262-1273.e3. doi: 10.1053/j.gastro.2019.12.021Kamboj AK, Oxentenko AS.Clinical and histologic mimickers of celiac disease.Clin Transl Gastroenterol.2017;8(8):e114. doi:10.1038/ctg.2017.41Cedars-Sinai.Irritable Bowel Syndrome (IBS).Beyder A, Mazzone A, Strege PR, et al.Loss-of-function of the voltage-gated sodium channel nav1. 5 (Channelopathies) in patients with irritable bowel syndrome.Gastroenterology. 2014;146(7):1659-1668. doi:10.1053/j.gastro.2014.02.054Klem F, Wadhwa A, Prokop LJ, et al.Prevalence, risk factors, and outcomes of irritable bowel syndrome after infectious enteritis: a systematic review and meta-analysis.Gastroenterology. 2017;152(5):1042-1054.e1 doi:10.1053/j.gastro.2014.02.054Camilleri M, Ford AC.Pharmacotherapy for irritable bowel syndrome.J Clin Med.2017;6(11):101. doi:10.3390/jcm6110101Camilleri M, Ford AC.Pharmacotherapy for irritable bowel syndrome.J Clin Med.2017;6(11):101. doi:10.3390/jcm6110101Harvard Health Publishing.Try a FODMAPs diet to manage irritable bowel syndrome.
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Aziz I, Simrén M. The overlap between irritable bowel syndrome and organic gastrointestinal diseases.Lancet Gastroenterol Hepatol. 2021;6(2):139-148. doi:10.1016/S2468-1253(20)30212-0Lacy BE, Pimentel M, Brenner DM, et al.ACG clinical guideline: Management of irritable bowel syndrome.Am J Gastroenterol.2021 Jan 1;116(1):17-44. doi: 10.14309/ajg.0000000000001036Johns Hopkins Medicine.Irritable Bowel Syndrome (IBS).Palsson OS, Whitehead W, Törnblom H, Sperber AD, Simren M.Prevalence of Rome IV functional bowel disorders among adults in the United States, Canada, and the United Kingdom.Gastroenterology. 2020;158(5):1262-1273.e3. doi: 10.1053/j.gastro.2019.12.021Kamboj AK, Oxentenko AS.Clinical and histologic mimickers of celiac disease.Clin Transl Gastroenterol.2017;8(8):e114. doi:10.1038/ctg.2017.41Cedars-Sinai.Irritable Bowel Syndrome (IBS).Beyder A, Mazzone A, Strege PR, et al.Loss-of-function of the voltage-gated sodium channel nav1. 5 (Channelopathies) in patients with irritable bowel syndrome.Gastroenterology. 2014;146(7):1659-1668. doi:10.1053/j.gastro.2014.02.054Klem F, Wadhwa A, Prokop LJ, et al.Prevalence, risk factors, and outcomes of irritable bowel syndrome after infectious enteritis: a systematic review and meta-analysis.Gastroenterology. 2017;152(5):1042-1054.e1 doi:10.1053/j.gastro.2014.02.054Camilleri M, Ford AC.Pharmacotherapy for irritable bowel syndrome.J Clin Med.2017;6(11):101. doi:10.3390/jcm6110101Camilleri M, Ford AC.Pharmacotherapy for irritable bowel syndrome.J Clin Med.2017;6(11):101. doi:10.3390/jcm6110101Harvard Health Publishing.Try a FODMAPs diet to manage irritable bowel syndrome.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Aziz I, Simrén M. The overlap between irritable bowel syndrome and organic gastrointestinal diseases.Lancet Gastroenterol Hepatol. 2021;6(2):139-148. doi:10.1016/S2468-1253(20)30212-0Lacy BE, Pimentel M, Brenner DM, et al.ACG clinical guideline: Management of irritable bowel syndrome.Am J Gastroenterol.2021 Jan 1;116(1):17-44. doi: 10.14309/ajg.0000000000001036Johns Hopkins Medicine.Irritable Bowel Syndrome (IBS).Palsson OS, Whitehead W, Törnblom H, Sperber AD, Simren M.Prevalence of Rome IV functional bowel disorders among adults in the United States, Canada, and the United Kingdom.Gastroenterology. 2020;158(5):1262-1273.e3. doi: 10.1053/j.gastro.2019.12.021Kamboj AK, Oxentenko AS.Clinical and histologic mimickers of celiac disease.Clin Transl Gastroenterol.2017;8(8):e114. doi:10.1038/ctg.2017.41Cedars-Sinai.Irritable Bowel Syndrome (IBS).Beyder A, Mazzone A, Strege PR, et al.Loss-of-function of the voltage-gated sodium channel nav1. 5 (Channelopathies) in patients with irritable bowel syndrome.Gastroenterology. 2014;146(7):1659-1668. doi:10.1053/j.gastro.2014.02.054Klem F, Wadhwa A, Prokop LJ, et al.Prevalence, risk factors, and outcomes of irritable bowel syndrome after infectious enteritis: a systematic review and meta-analysis.Gastroenterology. 2017;152(5):1042-1054.e1 doi:10.1053/j.gastro.2014.02.054Camilleri M, Ford AC.Pharmacotherapy for irritable bowel syndrome.J Clin Med.2017;6(11):101. doi:10.3390/jcm6110101Camilleri M, Ford AC.Pharmacotherapy for irritable bowel syndrome.J Clin Med.2017;6(11):101. doi:10.3390/jcm6110101Harvard Health Publishing.Try a FODMAPs diet to manage irritable bowel syndrome.
Aziz I, Simrén M. The overlap between irritable bowel syndrome and organic gastrointestinal diseases.Lancet Gastroenterol Hepatol. 2021;6(2):139-148. doi:10.1016/S2468-1253(20)30212-0
Lacy BE, Pimentel M, Brenner DM, et al.ACG clinical guideline: Management of irritable bowel syndrome.Am J Gastroenterol.2021 Jan 1;116(1):17-44. doi: 10.14309/ajg.0000000000001036
Johns Hopkins Medicine.Irritable Bowel Syndrome (IBS).
Palsson OS, Whitehead W, Törnblom H, Sperber AD, Simren M.Prevalence of Rome IV functional bowel disorders among adults in the United States, Canada, and the United Kingdom.Gastroenterology. 2020;158(5):1262-1273.e3. doi: 10.1053/j.gastro.2019.12.021
Kamboj AK, Oxentenko AS.Clinical and histologic mimickers of celiac disease.Clin Transl Gastroenterol.2017;8(8):e114. doi:10.1038/ctg.2017.41
Cedars-Sinai.Irritable Bowel Syndrome (IBS).
Beyder A, Mazzone A, Strege PR, et al.Loss-of-function of the voltage-gated sodium channel nav1. 5 (Channelopathies) in patients with irritable bowel syndrome.Gastroenterology. 2014;146(7):1659-1668. doi:10.1053/j.gastro.2014.02.054
Klem F, Wadhwa A, Prokop LJ, et al.Prevalence, risk factors, and outcomes of irritable bowel syndrome after infectious enteritis: a systematic review and meta-analysis.Gastroenterology. 2017;152(5):1042-1054.e1 doi:10.1053/j.gastro.2014.02.054
Camilleri M, Ford AC.Pharmacotherapy for irritable bowel syndrome.J Clin Med.2017;6(11):101. doi:10.3390/jcm6110101
Harvard Health Publishing.Try a FODMAPs diet to manage irritable bowel syndrome.
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