Understanding the Differences Between IBD and IBS

We’ve all experienced digestive discomfort. Bloating, painful cramps, being unable to go, going too much … you get the gist.

But if these symptoms occur on the regular, you may be dealing with a chronic condition.

Two common causes of gastrointestinal distress are irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). While their names sound similar, IBS and IBD are very different conditions. To get an accurate diagnosis, you need a good understanding of the issues you’re having. This will help your healthcare provider figure out what’s going on and how to treat it.

“It’s a mistake to assume that IBS and IBD are the same or even similar,” says gastroenterologist Jessica Philpott, MD. “That’s why it’s never a good idea to diagnose yourself. You might miss out on getting the right care for your condition.”

The critical difference between IBS and IBD

Inflammation — that’s the key distinction between IBS and IBD.

Inflammation is how your immune system defends your body against invaders. But too much inflammation can be destructive.

IBD involves inflammation, and IBS doesn’t. Let’s delve deeper.

IBD: An autoimmune disease

IBD is a group of autoimmune diseases that includes Crohn’s disease and ulcerative colitis. When you have IBD, your immune system mistakenly attacks your body, which causes chronic and harmful inflammation.

“With IBD, your intestines are the main victim of your immune system,” says Dr. Philpott. “But because IBD is a systemic inflammatory condition, the inflammation affects the rest of your body, too. It can also attack areas outside your intestines, such as your skin, joints and eyes.”

IBS: A group of symptoms

IBS, on the other hand, isn’t a disease and doesn’t involve inflammation. It’s a syndrome, or group of symptoms. It’s caused by a dysfunctional gut-brain axis — the two-way physical and chemical connection between your gut and brain. IBS affects your digestive tract and how quickly food moves through your intestines. But it doesn’t cause physical symptoms elsewhere in your body.

That doesn’t mean that having IBS is a walk in the park — far from it — just that it doesn’t have the potential implications for your health that IBD does.

“Irritable bowel syndrome can hugely impact your quality of life,” Dr. Philpott notes, “but it’s not destructive to your GI tract like IBD, and it doesn’t threaten your overall health.”

IBS vs. IBD symptoms

IBS and IBD are both digestive conditions, and they do share some symptoms. This can sometimes can make it hard to identify which one you’re dealing with and which treatment is best.

Symptoms common to both IBS and IBD include:

• Abdominal pain and cramping.
• Bloating and gassiness.
• Constipation.
• Diarrhea.
• Urgent bowel movements.

If you have IBS, you may experience:

• Frequent changes in bowel habits, like diarrhea one day and constipation the next.
• Symptoms triggered by stress or large meals.

If you have IBD, the inflammation can cause additional symptoms like:

• Anemia (low iron).
• Bloody stools or bleeding from your rectum (bottom).
• Eye inflammation.
• Fatigue.
• Joint pain.
• Rashes.
• Weight loss.

Can you have IBS and IBD?

Yes. IBD doesn’t cause IBS, but experts believe that having IBD can increase your risk of developing IBS.

“IBD and IBS are not mutually exclusive,” Dr. Philpott says. “Between 30% and 50% of people with IBD, such as Crohn’s or ulcerative colitis, also have irritable bowel syndrome at the same time. It can be tricky because sometimes you don’t know if your symptoms are from Crohn’s or IBS.”

On the flip side, no evidence suggests that having IBS increases your risk of developing IBD. All that said, though, healthcare providers don’t yet fully understand the causes of IBS and IBD, and there’s currently no substantial research on having both.

Diagnosing GI issues

IBS is the most common disorder diagnosed by gastroenterologists, affecting at least 10% of adults in the United States. It requires a clinical diagnosis, which is based on your symptoms, health history and a physical exam. No test or scan can confirm IBS, and even a colon exam won’t show signs of disease or abnormality — but your provider may order them to rule out other conditions.

“We want to exclude other causes of your symptoms before we diagnose IBS,” Dr. Philpott says, “so we usually do some lab tests to make sure we’re dealing with IBS and not something else.”

Diagnosing IBD is more straightforward because the inflammation it causes damages the intestines. Healthcare providers look for evidence of that damage using tests, imaging and procedures.

But without an accurate diagnosis, you can’t find an effective treatment. If you suspect IBS or IBD or have ongoing digestive symptoms, see a healthcare provider. They’ll ask about your symptoms, like whether you:

• Have experienced abdominal discomfort or pain for at least 12 weeks during the past 12 months.
• Experience relief from your symptoms after you’ve pooped.
• Have frequent changes in the frequency or form of bowel movements.

They’ll also ask about your medical history and perform any tests, imaging and procedures necessary to make an accurate diagnosis.

Treating IBS and IBD

Both IBS and IBD are treatable but not curable. Each condition requires a different approach:

• IBS: Treat the symptoms and avoid triggers.
• IBD: Control inflammation and treat any damage from inflammation.

But if you have IBD, you may need treatment for both conditions in order to manage both your inflammation and your digestive issues.

Managing symptoms of IBS

Managing IBS often depends on your symptoms, but anti-diarrheal and constipation medicines can offer relief. Other treatments may include:

• Dietary changes: Your provider may recommend the low FODMAP diet, which eliminates food groups that typically trigger IBS symptoms.
• Lifestyle changes: Some people find relief from IBS symptoms by prioritizing exercise and good sleep habits, along with other treatments.
• Medication: No one drug will treat all cases of IBS. But antispasmodic medications can relieve intestinal spasms, and providers can prescribe an antibiotic for severe IBS-related diarrhea.
• Psychological therapy and antidepressants: Managing stress and mental health can decrease IBS flare-ups.

Treatment for IBD

The goal of treating IBD is to manage your body’s inflammatory response and repair any damage from inflammation. To do that, your provider will consider how severe your disease is, any other medical conditions you have and which areas of your body are affected.

Typically, treatment for IBD includes medication. But you may need surgery to remove damaged tissue and address complications of inflammation.

“We’re trying to control the body’s dysfunctional immune response,” Dr. Philpott says. “To do that, we often try to suppress or turn down the immune system using medication. That can be incredibly effective.”

These medications may be used to treat IBD:

• Anti-inflammatories like mesalamine can decrease inflammation of your intestines.
• Immunomodulators keep the immune system from causing ongoing inflammation.
  Biologic and advanced therapies are treatments that alter the immune response in people with moderate to severe disease. “For some people, they can positively alter the course of disease,” Dr. Philpott says.
• Corticosteroids can help with flare-ups and manage the inflammatory process. But they’re not recommended for the long term.
• Antibiotics are used after surgery or to treat secondary infections from Crohn’s disease. But they’re not usually as initial therapies for the disease.

“Without managing the inflammation, people with IBD can get progressively worse and develop complications,” Dr. Philpott adds.

Recognizing the gut-brain connection

Your gut and brain closely interact, sending messages back and forth. Mental health issues can cause intestinal distress and vice versa, so caring for your mental health may also help relieve digestive symptoms of IBS and IBD.

Research on the topic of the brain-gut axis shows that people with IBS can often manage their symptoms by managing their mental health. Cognitive behavioral therapy (CBT) is well-tested and can provide substantial, long-lasting improvement from IBS symptoms.

Researchers don’t yet fully understand the relationship between IBD and the brain, but an estimated 30% of people with IBD experience anxiety or depression. If you have IBD, psychological therapies can help you manage your mental health, which may reduce IBS symptoms or additional digestive distress.

Seeking help for GI issues

If you’re having chronic GI symptoms, don’t hesitate to make an appointment to see a healthcare provider. Even if the source of your issues isn’t severe, sometimes, simple diet and lifestyle changes can offer relief — but your provider can help you figure it out and rule out any other conditions.

“If you have gastrointestinal symptoms often and you’ve noticed them for six months or more, make an appointment,” Dr. Philpott advises. “It’s important to find out what’s going on because there are so many different treatments we can offer.”