Gas, bloating, cramps, an urgent need for a bathroom. Is it irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD)?

Although the symptoms are similar, these are very different conditions—and they call for very different responses. The quicker you find out which one you have, the better.


The symptoms of IBS include cramps, bloating, abdominal pain, diarrhea and constipation. It’s an incredibly common ailment—10% to 15% of adults have it, although only about 5% to 7% are actually diagnosed. You’re more likely to have IBS if you’re a woman (although men get it, too), if you’re under age 45 or if you have a close family member who has it.

IBS is diagnosed mainly based on your symptoms, such as pain and discomfort in your abdomen at least three times a month over the last three months. Doctors may recommend a colonoscopy to get a look at inflammation and to rule out colon cancer. There’s no known cause—or cure—for the disorder, but diet and stress play a role and symptoms can be treated. The primary treatment includes lifestyle changes…

  • Dietary changes. Going on a “low FODMAP” diet can have tremendous benefits for many people with IBS. You eliminate certain hard-to-digest foods which may include dairy, beans, onions and garlic, cruciferous vegetables such as broccoli and cabbage, and certain fruits. (Everyone is different—onions may be a culprit for you but milk is fine or vice-versa.) Cutting back on alcohol and artificially sweetened drinks can help too.
  • Fiber supplements, especially psyllium, help relieve constipation.
  • Meditation and other stress-relieving techniques, including hypnosis, help, too. So can exercise.

To relieve pain and cramping, consider peppermint oil. Over-the-counter medication such as loperamide (Imodium) can control diarrhea.

If lifestyle approaches don’t work, talk to your doctor about prescription medications. A drug called lubiprostone (Amitiza) may help if your primary IBS symptom is constipation—it appears to be more effective in women than men, however. For severe pain, as well as depression, antidepressants may be prescribed.


IBD is less common than IBS—it affects about one million Americans—but it’s much more serious, often causing severe and even life-threatening symptoms. Symptoms of IBD include an urgent need to use the bathroom, diarrhea, severe abdominal pain, fever, loss of appetite, weight loss and anemia. The causes of IBD aren’t known—it’s not related to diet, but it does tend to run in families.

IBD has two main types—ulcerative colitis and Crohn’s disease. For both forms, diagnosis is based primarily on your symptoms—colonoscopy to see the inflamed areas in the colon, upper gastrointestinal (GI) endoscopy and CT and X-ray scans to see the inflamed areas of the small intestine. IBD can lead to serious medical issues, including an increased risk for stroke and cancer.

Ulcerative colitis is a chronic disease in which the immune system mistakes food and other harmless substances in the intestine for foreign invading substances and sends white blood cells into the lining of the intestines. That causes inflammation and ulcers (sores) on the inner lining of the large intestine, aka the colon. The symptoms—including bloody diarrhea and abdominal discomfort—usually begin gradually and get worse. Most people with ulcerative colitis start having symptoms between the ages of 15 and 30 or when they are 60 or older. You’re more likely to get it if you have a close family member who also has it. It’s also more likely to affect white people of European origin and people of Jewish heritage.

Ulcerative colitis can’t be cured, but it often goes into remission for long periods. Some medications such as corticosteroids and immune modulators are effective for relieving the symptoms and helping you stay in remission. Lifestyle changes including stress-reduction techniques (such as biofeedback, meditation, deep breathing, hypnosis), exercise, probiotics and a healthy diet are important parts of a treatment plan as well.

Surgery to remove part of the colon is sometimes needed if you develop colon cancer or serious bleeding or have worsening symptoms despite the drugs. In very severe cases, surgery to remove the entire colon may be needed.

Crohn’s disease is a chronic disease that causes patchy areas of inflammation anywhere in the digestive tract. It most commonly affects your small intestine and the beginning of your large intestine. Crohn’s disease usually begins gradually and can become worse over time…but it also can go into remission for long periods. The symptoms usually begin between the ages of 20 and 29. If you have a close relative with Crohn’s disease, you’re more likely to get it. Serious complications of Crohn’s disease include intestinal obstructions, anal fissures, fistulas, abscesses and malnutrition. While Crohn’s itself is not deadly, the complications can result in medical emergencies—and even death.

Crohn’s disease can’t be cured, but the symptoms can be treated with prescription medications (such as powerful anti-inflammatories, corticosteroids and immune modulators) to help you feel better and help you stay in remission. For severe symptoms, you may need to “rest” your bowel by following a liquid diet occasionally and temporarily. More than half of all people with Crohn’s disease eventually need surgery to remove part of the intestines to treat complications. (To learn natural ways to manage this disease, see Bottom Line’s article, “7 Steps to Controlling Crohn’s Disease.”)

Bottom line: While IBS is uncomfortable and sometimes embarrassing, it doesn’t lead to permanent damage to the colon or to other serious diseases—and changing your diet and lifestyle can often bring significant relief. IBD, however, is a chronic condition that can lead to serious complications.

If you have symptoms of either condition, see your primary care doctor. The sooner you are diagnosed and treated, the better your chances of remission and avoiding complications.

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