IBS (Irritable Bowel Syndrome)

IBS (Irritable Bowel Syndrome): Overview

Alternative names: Spastic Colon

Irritable bowel syndrome (IBS) is a common disorder of the intestines affecting perhaps 20% of the adult population that leads to pain, gassiness, bloating, and changes in bowel habits.  Other symptoms include constipation, diarrhea, or a painful but unsuccessful urge to move the bowels.

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Through the years, IBS has been called by many names – colitis, mucous colitis, spastic colon, spastic bowel, and functional bowel disease.  Most of these terms are inaccurate.  Colitis, for instance, means inflammation of the large intestine (colon).  IBS, however, does not cause inflammation and should not be confused with another disorder, ulcerative colitis.

Often IBS is just a mild annoyance, but for some people it can be disabling.  They may be unable to go to social events, to go to work, or to travel even short distances.

Transparent bloated abdomen of woman with IBS highlighting colon
Irritable bowel system affects the large intestine (colon) and causes diarrhea, constipation, pain, bloating, gas, cramping.

The colon, which is about 6 feet long, connects the small intestine with the rectum and anus.  The major function of the colon is to absorb water and salts from digestive products that enter from the small intestine.  Two quarts of liquid matter enter the colon from the small intestine each day.  This material may remain there for several days until most of the fluid and salts are absorbed into the body.  The stool then passes through the colon by a pattern of movements to the left side of the colon, where it is stored until a bowel movement occurs.  Movements of the colon propel the contents slowly back and forth but mainly toward the rectum.  A few times each day strong muscle contractions move down the colon pushing fecal material ahead of them.  Some of these strong contractions result in a bowel movement.

Ordinary events such as eating and distention from gas or other material in the colon can cause the colon to overreact in a person with IBS, or certain medicines and foods may trigger spasms.  Sometimes the spasm delays the passage of stool, leading to constipation.  Chocolate, milk products and large amounts of alcohol are frequent offenders.  Caffeine causes loose stools in many people, but it is more likely to affect those with IBS.  Researchers also have found that women with IBS may have more symptoms during their menstrual periods, suggesting that reproductive hormones may exacerbate the problem.  People with IBS sometimes pass mucus with their bowel movements.

Causes and Development

Transparent torso and head showing enteric nervous system, brain
With 100-200 million neurons, our gut's enteric nervous system or 'second brain' (yellow) can influence how we think and feel.

The exact cause of IBS is not known, but appears to related to faulty communication between the brain and an oversensitive intestinal tract.  Synaptic receptors in the gut's nervous system react to any stimulation.  In those with IBS, the brain receives faulty 'status updates' from the gut and, in response, sends back the wrong 'commands'.  These commands may, for example, speed up the transition of food through the digestive system, leading to diarrhea, or slow it down too much, leading to constipation.

Researchers at Cedars-Sinai Medical Center in Los Angeles think they may have identified one possible cause of this mysterious and very common condition, and found an effective way to treat it.  The Cedars-Sinai researchers found that 78% of the IBS patients they tested had what they called small intestinal bacterial overgrowth (SIBO), a condition in which excessive amounts of bacteria are present in the small intestine.

The researchers treated the patients who tested positive for SIBO with a 10-day course of antibiotics.  Tests at the end of that time found that 25 of 47 patients had no bacterial overgrowth present, and that 12 of them had no IBS symptoms, while the symptoms were "significantly reduced" in the other 13.  The symptoms were also reduced in the patients in which some SIBO was still detected, suggesting that if treatment had been continued until it was completely eliminated, perhaps with an alternative antibiotic, better results would have been obtained.

Signs and Symptoms

Bleeding, fever, weight loss, and persistent severe pain are not symptoms of IBS but may indicate other problems.

Eating causes contractions of the colon and normally this response may cause an urge to have a bowel movement within 30 to 60 minutes after a meal.  In people with IBS, the urge may come sooner and be accompanied by cramps and diarrhea.  The strength of the response is often related to the number of calories consumed, particularly the amount of fat in a meal.  Fat in any form (animal or vegetable) is a strong stimulus of colonic contractions.

Treatment and Prevention

Most people with IBS, however, are able to control their symptoms through medications prescribed by their physicians, diet and stress management.

For many people, eating a proper diet lessens IBS symptoms.  Before changing your diet, it is a good idea to keep a journal noting which foods seem to cause distress.


IBS causes a great deal of discomfort and distress, but it does not cause permanent harm to the intestines and does not lead to intestinal bleeding of the bowel, serious organic diseases or to cancer.  No link has been established between IBS and inflammatory bowel diseases such as Crohn's disease or ulcerative colitis.

Signs, symptoms & indicators of IBS (Irritable Bowel Syndrome):

Symptoms - Abdomen

Abdominal pain relieved by BM

One of the most common IBS symptoms is abdominal pain, cramping or bloating that is partially or completely relieved by having a bowel movement.

Moderate/significant/severe abdominal pain or mild abdominal discomfort

IBS can cause the intestines to contract when the digestive tract responds to triggers such as stress and certain foods.  This contraction can cause severe abdominal pain.

Mild/severe/major/moderate left iliac pain after meals

The pain is generally located in the lower abdomen, although the location and type of pain can vary.  Emotional stress and eating can exacerbate the pain, whereas a bowel movement often provides some relief.

Abdominal pain reduced by eating

A bowel movement often provides some relief to IBS symptoms.

Meals worsen epigastric pain

IBS can be a source of long-term abdominal pain or discomfort; the symptoms of IBS are usually worse after eating and tend to come and go.

Symptoms - Bowel Movements

Occasional/regular/frequent painful urge to defecate

Uncoordinated intestinal contractions can result in under-digested food arriving in the rectum more often than is normal, causing people with IBS-D (Irritable Bowel Syndrome with Diarrhea) to experience sudden, frequent, and painful urges to defecate.  IBS sufferers may also have a hypersensitive gut and rectum and therefore feel urgency and pain more acutely than the average person.

Occasional/frequent mucus in stools

Mucus in the stool is one of the most common symptoms of IBS, and yet research on the subject is limited.  The mucus is generally associated with inflammation but researchers lack a specific explanation.  Some smaller studies have shown that over half of IBS sufferers report having mucus, and that it is more common in men than women.

Green/orange stool color

Irritable Bowel Syndrome can lead to faster movement of bile through the intestinal tract, which impairs nutrient absorption and changes the normal makeup of stool.  This in turn can affect the color of stool, making it green or orange.

Occasional/frequent/constant bowel movement changes

IBS causes variations in the amount of time that stool remains in the intestines, thus changing its water content and giving it a consistency ranging from loose and watery to hard and dry.  About 20% of patients with IBS experience alternating periods of diarrhea and constipation.

Regular/frequent episodes of diarrhea

IBS is a condition affecting the colon, which normally absorbs water from stool.  IBS can cause rapid stool transit, less water absorption, and therefore loose and watery stool with frequent bouts of diarrhea.

(Very) frequent stools

IBS-D (Irritable Bowel Syndrome with Diarrhea) leads to increased stool water content, softer/looser stools, and more frequent urges to defecate.

Recent onset/chronic diarrhea or diarrhea for 1-3 months

Most people with IBS have intermittent bouts of diarrhea.

No significant diarrhea

IBS often reduces the amount of time that stool remains in the intestines, and therefore also the amount of water that is absorbed.  This results in very loose and watery stool, and frequent episodes of diarrheaNot having diarrhea as a symptom therefore strongly suggests that IBS may not be the problem.

Not suffering from diarrhea

IBS often reduces the amount of time that stool remains in the intestines, and therefore also the amount of water that is absorbed.  This results in very loose and watery stool, and frequent episodes of diarrheaNot having diarrhea as a symptom therefore strongly suggests that IBS may not be the problem.

It should be noted, however, that some suffers (especially those with IBS-CIrritable Bowel Syndrome with Constipation) will suffer from the opposite problem: stool remains for a longer time in the intestines, more water is absorbed, stool becomes hard and dry, and constipation results.  Many patients suffer from both diarrhea and constipation.

Symptoms - Food - General

Weak/loss of appetite

There are several mechanisms through which IBS can cause weak appetite:

  • Loss of appetite due to indigestion and subsequent acid reflux, which is common with IBS
  • Feeling overly full or bloated as a result of IBS
  • Feeling stressed or anxious because of IBS: the release of adrenaline puts the body into 'fight or flight' mode and redirects resources away from the digestive system
  • The abdominal pain that often results from IBS can cause loss of appetite

Symptoms - Gas-Int - General

Bloating caused by many/bloating caused by specific foods

Irritable Bowel Syndrome can be triggered by certain foods.  During IBS flare-ups the movement of undigested food through the intestines can become impaired, and gas production increased.  Both of these can cause bloating, which is very common among IBS sufferers.  In one study of 337 IBS patients, 83% reported bloating.

(Frequent) meal-related bloating

Bloating can occur at any time for IBS sufferers but especially after or during a meal as the digestive system will be under an increased workload.

(Excessive/severe) flatulence

The altered digestion found in IBS will usually lead to higher gas production.  If intestinal transit is too quick, food is only partially digested.  Natural bacteria residing in the gut will cause fermentation of this food, producing gas.  Fast-moving bowel contents may also lead to pockets of trapped gas, worsening the problem.  Some studies suggest that the populations of gut bacteria in IBS patients differ from the normal, with more 'bad' than 'good' bacteria, which can cause excess flatulence.

Regular/frequent unexplained nausea

IBS can lead to nausea in various ways:

  • IBS commonly causes indigestion and subsequent acid reflux, which can cause nausea
  • Feeling stressed or anxious as a result of IBS can cause nausea
  • The abdominal pain often present in IBS may result in nausea
  • IBS can cause constipation, which can put stress on the liver, and liver problems can cause nausea
Recent onset/chronic nausea or nausea for 1-3 months

Ongoing IBS can lead to chronic nausea in various ways:

  • IBS commonly causes indigestion and subsequent acid reflux, which can cause nausea
  • Feeling stressed or anxious as a result of IBS can cause nausea
  • The abdominal pain often present in IBS may result in nausea
  • IBS can cause constipation, which can put stress on the liver, and liver problems can cause nausea
Absence of meal-related bloating

Bloating is extremely common in IBS sufferers, with one study of 337 IBS patients finding that 83% experienced bloating.  Therefore, the absence of meal-related bloating would tend to rule out IBS, although not completely.

Conditions that suggest IBS (Irritable Bowel Syndrome):



Chronic Fatigue / Fibromyalgia Syndrome

Research has shown that IBS frequently co-exists with CFS and fibromyalgia.  Depending on the study quoted, between 34% and 73% of CFS/FMS sufferers have Irritable Bowel Syndrome.



October, 2013: Researchers from the Alimentary Pharmabiotic Centre at University College Cork reported that psychological factors such as anxiety and depression may be the central drivers of IBS, rather than the inflammation originating in the gut itself.  The most commonly-diagnosed psychiatric disorder in IBS patients is depression: one study reported that 38% of IBS patients had clinically-confirmed depression.  It is believed that IBS results from a complex interplay between psychological and biological factors.

Symptoms - Gas-Int - General

(Severe) irritable bowel syndrome (confirmed)

Irritable bowel syndrome can only be confirmed by having a medical professional perform the recommended diagnostic tests.


Interstitial Cystitis

Interstitial cystitis often occurs alongside Irritable Bowel Syndrome.  In fact, several studies suggest that interstitial cystitis patients are 100 times more likely to have irritable bowel syndrome than those without.

Risk factors for IBS (Irritable Bowel Syndrome):


Past and future vaccination or past vaccinations

Studies from Europe indicate that there may be a link between the MMR (measles/mumps/rubella) vaccine and irritable bowel syndrome.


Symptoms - Food - Intake

(Low/high) dairy product consumption

Johne's disease is an infection that cows pass on to humans as irritable bowel syndrome.  Johne's disease has no cure and costs dairy producers over $1.5 billion each year [Source: USDA].  The bacterium, Mycobacterium avium paratuberculosis (MAP) causing Johne's is not killed by pasteurization and is passed onto consumers in milk, cheese and ice cream.

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IBS (Irritable Bowel Syndrome) suggests the following may be present:


Allergy to Foods (Hidden)

The presence of food allergy is concealed in a variety of diagnoses including irritable bowel syndrome.


Hypercoagulation (Thickened Blood)

Hypercoagulation may be a major causative factor for Irritable Bowel Disease because it deprives the bowel of blood.


Bacterial Dysbiosis

Some bacterial infections of the small bowel increase passive intestinal permeability.  IBS has been studied in patients with diarrhea, cramps and specific food intolerances.  Abnormal fecal flora has been a consistent finding, with a decrease in the ratio of anaerobes to aerobes, apparently due to a deficiency of anaerobic flora.  Previous exposure to antibiotics – metronidazole in particular – was associated with the development of this disorder.


Recommendations for IBS (Irritable Bowel Syndrome):

Amino Acid / Protein


The enterocytes of the small intestines are the body's largest consumers of glutamine, accounting for about 40-50% of glutamine consumption.

Botanical / Herbal

Peppermint Oil

Enteric-coated Peppermint oil has been used in treating the irritable bowel syndrome in Europe for many years.  In one double-blind cross-over study, it was shown to significantly reduce the abdominal symptoms.


Other herbs and products used with varying success include: fennel, dandelion, skullcap, licorice, peppermint, valerian, slippery elm, cranberry, glutamine, MSM, magnesium, and gamma-oryzanol.

Licorice Root

Licorice root extract can help with IBS as it is anti-inflammatory and is said to soothe irritated intestinal mucous membranes by stimulating mucus production.  It has also been shown to improve circulation within the digestive tract, and researchers in Ireland have found that licorice root can relieve symptoms of ulceration, often seen in IBS patients.

Valerian Root

Valerian root is recognized for its sedative, tranquilizing and calming effect on the nervous system.  It is effective against muscle spasms and cramps, including those in the digestive tract that are caused by IBS.


The leaves and roots of the dandelion are high in 'bitters' (sesquiterpene lactones) and tannins.  These bitters are responsible for dandelion's effectiveness against digestive disorders such as IBS, stimulating the functions of the stomach, liver and bile.  They also increase urine production, help remove toxins and metabolic waste, and increase production of digestive enzymes which help to calm indigestion and other symptoms of IBS.

Chinese Skullcap

Chinese skullcap is particularly valued for its anti-inflammatory qualities and is known to provide relief to those with IBS.

Cranberry Juice

Although it is not a cure for IBS, the antioxidants and flavonoids found in cranberry juice can help calm inflammation in the stomach and digestive tract due to IBS.  Cranberry juice is also rich in vitamin C, which aids digestion by helping the liver to break down fat more efficiently and move fatty foods through the system more quickly.

Slippery Elm

Slippery Elm is derived from the inner bark of the Slippery Elm tree.  It is used in the treatment of IBS because its mucilage-like consistency is believed to soothe irritated tissue in the digestive system.  It is also thought to help with constipation and diarrhea by softening and adding smooth bulk to stool.  Patients using Slippery Elm report significantly increased bowel movement frequency along with less straining, abdominal pain, bloating, and flatulence.

Gamma Oryzanol

Gamma oryzanol is a remedy for many gastrointestinal disorders, including IBS.  Studies have shown that it helps regulate the nervous system and stimulate anti-oxidant activity to protect the mucous lining of the gastrointestinal tract.

American Skullcap

American skullcap supports the nerves that regulate the function of the intestinal muscles and is considered to be an analgesic which, when consumed, can provide extensive pain relief to IBS patients.


There are quite a few people who use marijuana to control the symptoms of abdominal pain and nausea associated with irritable bowel syndrome.  Some make the claim that this helps more than any other thing they have tried.


High/Increased Fiber Diet

Dietary fiber may lessen IBS symptoms in many cases.  High-fiber diets may cause gas and bloating, but within a few weeks these symptoms often go away as the body adjusts to the diet: IBS can be treated in most cases simply by increasing the intake of dietary fiber and eliminating food allergies.

The synthetic polymers methylcellulose and polycarbophil have been found to be the most effective fibers or bulk-forming laxatives for use in the treatment of Irritable Bowel Syndrome (IBS).  Neither are found naturally in food sources.  Methylcellulose is used as a food additive/thickener.  Both are available over the counter in commercial products such as Citrucel (methylcellulose) and Fibercon (polycarbophil), among others.

Smaller, More Frequent Meals

Large meals can cause cramping and diarrhea for those with IBS.  Symptoms may be eased if you eat smaller meals more often or just eat smaller portions.  This should help, especially if your meals are low in fat and high in carbohydrates such as pasta, rice, whole-grain breads and cereals, fruits, and vegetables.

Digestive Aids

Digestive Enzymes

People with spastic colon are often fiber-intolerant and have a tendency to like fats because they produce a feeling of wellbeing.  They often respond well – sometimes even dramatically so – to a multiple digestive enzyme formula.

Hydrochloric Acid (Trial)

Make sure your hydrochloric acid production is sufficient.



Research suggests that IBS can be caused by an unhealthy imbalance of gut bacteria (Small Intestinal Bacteria Overgrowth or SIBO).  Non-absorbable antibiotics were found to:

  • help normalize the bacterial balance
  • make harmful bacteria less dangerous
  • reduce inflammation
  • preserve healthy bacteria in the colon
  • protect the intestinal lining from bacterial infection



Calcium promotes the contraction of the gut muscles and reduces the amount of water in the intestines, which contributes to better-formed stools.  It is important to note that there are two types of supplemental calcium, which for IBS can have either a laxative or constipating effect: Calcium carbonate contains no magnesium and can help with diarrhea in those with IBS-D; Calcium citrate contains magnesium and can therefore cause diarrhea, so it is recommended for those with constipation (IBS-C).


Magnesium is commonly used for treating abdominal cramps and constipation and is therefore useful for IBS-C.  Magnesium attracts water, softening stool and making it easier to pass.  It also relaxes the intestinal muscles which helps to smooth contractions.

MSM (Methyl Sulfonyl Methane)

MSM helps to ease bowel discomfort, normalize bowel function, increase the amount of sulfur in the stomach, and thereby rebalance stomach microbes.


A study involving zinc supplementation in inflammatory bowel disease illustrated the importance of taking adequate supplementation, but not too much.  In this study, excess amounts of zinc caused tissue injury and impaired wound healing [Cario et al. 2000].  However, relative zinc deficiencies, especially in the elderly, are common in the United States [Andrews et al. 1999].

Oxygen/Oxidative Therapies

Ozone / Oxidative Therapy

Proponents of ozone therapy claim that it kills bad bacteria in the gut, helps to neutralize excess acid, balances the metabolic rate, improves vitamin and mineral absorption, and thereby reduces symptoms of IBS such as diarrhea and constipation.


Stress Management

Stress stimulates colonic spasm in people with IBS.  Stress reduction (relaxation) training or counseling and support help relieve IBS symptoms in some people.


Vitamin A

Vitamin A is important for a healthy gut.  Vitamin A deficiency can worsen diarrhea symptoms in IBS because of reduced mucous membrane health.  Diarrhea can also cause loss of vitamin A, which leads to a vicious cycle.

Vitamin B12 (Cobalamine)

Vitamins B12, A, D, E and K along with calcium and a lactose-free diet are often recommended by clinicians treating IBS.

Vitamin D

Vitamin D can inhibit the inflammatory mediators that develop in the intestinal wall after a gastrointestinal infection, and helps ease the symptoms of IBS.  A 2012 study involving 37 patients found that 26 reported easing of IBS symptoms following supplementation with vitamin D.

Vitamin E

Vitamin E is a unique antioxidant containing a lubricating oil which is thought to prevent constipation.  It also has a soothing and calming effect on the bowel, helping to reduce the inflammation associated with IBS.

Vitamin K

Those with IBS should ensure adequate vitamin K intake as a deficiency can worsen the symptoms of IBS, including bloody stool, indigestion and diarrhea.

Preventive measures against IBS (Irritable Bowel Syndrome):


Dairy Products Avoidance

Mycobacterium paratuberculosis (Para-T) RNA (a bacteria causing Johne's disease in cows) was found in 100% of Crohn's disease patients, compared with 0% of controls.

This bacteria becomes cultured in milk, and is not destroyed by pasteurization.  Para-T crosses the species barrier to infect and cause disease in humans.  Occasionally, the milk-borne bacteria will begin to grow in the human host, and irritable bowel syndrome and Crohn's disease results.  The USDA estimates that 30% of America's dairy herds contain cows infected with Para-T.

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