IBS vs IBD: knowing the difference

By Island Hospital   |   Aug 24, 2020 4:04:07 PM

It’s easy to get confused over Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD). Both of them are abbreviated and sound the same, and both have the word ‘bowel’. Not only that, both conditions affect the bowel and share common symptoms such as abdominal pain and diarrhoea.

While these two conditions have similarities, they are two very different conditions that are treated differently. Knowing the difference could help you make a more informed decision when deciding to seek treatment, especially if your symptoms indicate that you may have IBD. IBD is known to be the more severe of the two conditions if left untreated, as it can cause damage to the digestive system.

Irritable Bowel Syndrome (IBS) is a disorder that affects the large intestine with little known about what causes it or what can cure it. Fortunately, it is a benign condition and does not lead to serious health complications.

IBS patients may experience diarrhoea, constipation, or alternating bouts of both diarrhoea and constipation. The abdominal discomfort, constipation or diarrhoea is usually caused by the contractions of the bowel wall. A slow contraction causes constipation, while a long-lasting one causes diarrhoea. A sensitive bowel wall also sends faulty signals to the brain that causes more intense pain than a normal stomach ache as a result of the body overreacting to the symptoms. Frequent passing of gas / excess gas is also a common symptom of IBS.

Inflammatory Bowel Disease (IBD) is a gastrointestinal disorder commonly associated with abdominal pain, diarrhoea and rectal bleeding. The bleeding and inflammation can cause weight loss and nutritional deficiencies such as iron deficiency anemia (due to blood loss). Patients with IBD may also experience bloody diarrhoea and an increased urgency in their bowel movement.

There are two types of IBD, one known as ulcerative colitis (UC) and another called Crohn’s disease. A patient with ulcerative colitis will experience inflammation only in their colon/large intestine, while a patient with Crohn’s disease may experience inflammation involving more than just the intestine, it could affect any part of their digestive system from the mouth to the anus.

The precise cause of Irritable Bowel Syndrome (IBS) is not known, it may be caused by a problem in the nerves that connect the brain and stomach or imbalance of gut bacteria.

While it is difficult to know what causes it, it is easier to find out what triggers a person’s symptoms and help them manage their IBS effectively. There are a few factors that are linked to IBS symptoms, such as muscle contractions, abnormalities in the nervous system or stress.

Food: While IBS is not necessarily caused by a certain diet or food allergy, many people experience their symptoms worsening when certain types of food or beverages are consumed. Common examples are foods that stimulate the stomach and bowel, such as coffee, tea, acidic fruits and dairy products. In order to avoid aggravating your symptoms, your doctor will work together with you to find out what foods act as a trigger for your IBS symptoms and help you find an alternative to your diet.

Hormones: Women have a higher rate of experiencing IBS compared to men, especially during menstrual periods where patients may experience IBS symptoms concurrent with their period.

Nervous system abnormalities: There may be abnormalities in the nerves that connect the brain and your intestines, causing you to experience greater discomfort or pain than normal when food or gas passes through your intestines. Because the signals are poorly coordinated, the body becomes hypersensitive and overreacts with stronger pain, diarrhoea or constipation.

Muscle contractions: When food moves in your digestive tract, the muscles of the intestine walls contract and expand accordingly. Strong contractions can cause diarrhoea, while weak contractions slow the passage of food down, causing constipation and bloating.

Stress: People with IBS are known to experience frequent or worse symptoms during periods of stress. Stress is known to cause gastrointestinal reactions and may also aggravate the hypersensitive connection between the stomach and brain to trigger a person’s IBS symptoms. Stress is not the cause of symptoms, however; it only makes the symptoms occur more frequently or worsen.

Similar to IBS, IBD is a disorder with unknown cause. Inflammation is caused when the immune system triggers a response in the body to fight against the things that harm it. When the response lingers and does not go away, the inflammation also remains and becomes chronic inflammation.

IBD is an autoimmune disorder, meaning the inflammation in IBD patients is caused by the body’s immune system attacking harmless bacteria in the gut. What exactly causes their body to behave that way in the first place is still unknown. There is also a genetic predisposition involved in IBD, as patients are at a higher risk of developing IBD if their family members have the disorder.

Inflammatory Bowel Disease is different from Celiac disease, which is also an autoimmune disease where the immune system attacks the body. When a person with Celiac disease eats gluten, their body responds by attacking their small intestine and inflammation occurs as a result. The cause for inflammation in Celiac disease is specific, while the cause of inflammation for IBD is still not known.

Do you have prolonged symptoms?
When your abdominal pain, diarrhoea or even vomiting is prolonged over a span of days or weeks, you should get medical help from a gastroenterologist. Patients with IBS will have their bowel habits change frequently, experiencing a mix of diarrhoea and constipation depending on their symptoms.

Black, tarry stools and blood!
Bleeding when passing stool will vary depending on the location. If the blood is from the upper digestive tract, the blood will likely have turned the stool black and caused it to become like tar. This indicates ulcers or irritation in parts of your stomach or esophagus, around the upper digestive tract. It could be a sign of blood complications in the digestive system, which demands urgent medical attention.

Bright red blood is often caused by bleeding in the lower digestive tract and is more commonly associated with rectal bleeding and Inflammatory Bowel Disease (IBD).
Those with IBD may discover bright red blood when they pass their stools from time to time, depending on the inflammation and bleeding. They will also experience a severe urgency to go to the toilet at times when the disorder flares up, combined with very severe abdominal cramp/pain and diarrhoea that may be bloody.

If there is blood in your stools or vomit, then it is urgent for you to seek help immediately as it could be a sign of a more complex gastrointestinal disorder.

Frequent symptoms from time to time, even if the pain is not severe.Even though your symptoms may not be severe enough to interfere with your daily life, frequent symptoms that persist over the course of every few days (or weeks) are still worth consulting a doctor over. It is safer for a person to identify and learn how to manage their condition early before their risk of other diseases increase. This is especially true for patients who have IBD, as the inflammation can lead to a number of other serious complications such as intestinal bleeding, a bowel rupture, colon cancer and even arthritis.

I’m in a period of good health, my symptoms have not been present for a while!
A patient with IBS will continue to learn more about their condition if they consult their doctor, as they may encounter different triggers that can cause their symptoms to return. A period of good health for an IBS patient is certainly cause for relief, provided they are managing their condition and triggers well.

IBD is different case, as it is a chronic disease. There will be a period of time where its symptoms will “deactivate” with no pain or complications, followed by a period where the inflammation flares up and the symptoms return. Regardless of whether your disorder is currently active or not, it is better to consult a gastroenterologist so you can have a better idea of your condition and learn not to make it worse.

Treatment for IBS puts emphasis on relieving symptoms so you can live as close to a good and healthy life as possible without triggering your condition. A personalised treatment plan will be created for you, as the disorder affects everyone differently.

While each person has a different experience with foods that trigger IBS, here are some common triggers that you can take note of:
  • Oily and high-fat foods: Foods that are low in fiber can make constipation worse for IBS patients, your doctor may recommend more fiber in your diet. However, an increased fiber intake can also result in bloating, hence it depends on how each person’s body reacts to their diet.
  • Caffeine: Caffeine is known to stimulate the intestines, which may aggravate IBS symptoms.
  • Processed foods: Processed foods can also worsen constipation in IBS patients.
  • Dairy products: Milk can be a trigger for IBS symptoms, even if the person is not lactose intolerant.
  • Cabbages, broccoli, beans and onions: Certain vegetables or foods that cause bloating may make symptoms worse.

It is recommended to keep track of the food you eat and monitor your symptoms; it will make it easier for your doctor to help you come up with a plan with the least restrictions on your daily life.

As an alternative, your doctor may recommend a low FODMAP (fermentable oligo-, di-, mono-saccharides and polyols) diet. FODMAPs are carbohydrates that resist digestion, which makes them a common cause of digestive issues in individuals with IBS. A low FODMAP diet will help reduce bloating, gas and pain.

Stress management is also a key part of treatment, as individuals with IBS have been known to suffer from mental health issues such as depression or anxiety.

Surgery is not required for patients with IBS.

Treatment for IBD will focus on reducing the inflammation that causes the symptoms, which will ultimately lead to relief of the symptoms and a reduced risk of other complications.

Anti-inflammatory drugs will be administered to help reduce the inflammation in your digestive system, which medicine you take will depend on where the inflammation is located. It is best to consult your doctor before buying any drugs on your own, as some patients can have their symptoms worsen with the wrong drug. Always check with your doctor first.

Immune system suppressors or immunosuppressants are drugs that hinder the immune response in the digestive system, reducing the chemicals that cause inflammation. As the name implies, immunosuppressants will suppress your immune system so you may be more susceptible to diseases and infections. The drugs may also produce side effects such as headaches or nausea, so it is recommended to consult your doctor so he/she can prescribe suitable drugs for your condition.

Biologics (also known as biological medicines) are another class of treatment that have been effective in IBD treatment in recent years. Biologics are antibodies that target specific proteins and stop those proteins from causing inflammation. Unlike immunosuppressants, biologics only target the specific proteins that have been identified to cause IBD-related inflammation and do not affect entire body’s immune system.

Surgery is considered as a last-resort option for patients with IBD if none of the above treatment options relieve their symptoms and their condition persists or grows in severity. With the advancement of medicine, surgery is typically not needed and only reserved for the most severe of IBD cases.

The type of surgery carried out will vary depending on the type of IBD the patient has.
  • For patients with ulcerative colitis, surgery will be carried out to remove the colon of the patient and also the rectum if needed. The surgery is done not only to cure ulcerative colitis, but also to eliminate the risk of colon cancer.
  • Patients with Crohn’s disease may go through surgery to remove the inflamed parts of their digestive system and also relieve their symptoms. The type of surgery depends on the part of the body that is inflamed.

Does IBS or IBD increases the risk of colorectal cancer in a person?

A patient with IBS does not have an increased risk of colorectal cancer, as the condition does not cause any damage to the intestines. The risk of colorectal cancer in a person with IBS is the same as a person without IBS.

For a patient with IBD, the short but unfortunate answer is yes. IBD, particularly the ulcerative colitis variant, increases the risk of colon cancer due to the damage to the colon wall caused by inflammation.

Is it true that IBD can cause arthritis?

Yes, the inflammation caused by IBD can also affect other organs. A person who has IBD may also experience inflammation in the joints (arthritis) and eyes, along with skin conditions, kidney disorders and liver diseases. The most common disease IBD patients face outside of their digestive system is arthritis.

How can I tell if I have IBS or IBD?

IBS is considered to have more mild and less severe symptoms compared to IBD, which can cause severe pain, bleeding and intense urge to go to the bathroom. The easiest way to tell is to consult a gastroenterologist, who will be able to ask you questions about your condition and help determine which of the two conditions you have. You may be required to go through a series of tests to eliminate the possibility of other diseases.

Can I still drink alcohol if I have IBS or IBD?

There are patients with IBS who experience aggravated symptoms with alcohol, making alcohol a possible trigger for IBS in certain people. However, even if it is not a trigger for IBS, moderation should be practised as alcohol irritates the digestive system. Uncontrolled alcohol intake may cause IBS-related constipation or diarrhoea.

Patients with IBD are advised to reduce or avoid alcohol consumption even if it doesn’t cause their symptoms to flare up. Alcohol gastritis can cause stomach pain, heartburn (acid reflux), ulcers and even inflammation; all of which are conditions IBD patients will want to avoid.

Is it possible to have IBS and IBD?

Yes, it is possible for a patient to have both IBS and IBD. Due to the similarity of symptoms and severity of IBD, IBS is usually identified after a patient’s IBD has been treated and the symptoms of IBS appear while the patient is considered to have remission of IBD.

If you have received treatment for IBD but still find yourself experiencing abdominal discomfort or bloating, then there is a possibility that you may have both IBS and IBD. Consulting a gastroenterologist is the best way to identify whether you have both IBS and IBD.

Will my IBD and IBS continue on forever?

Yes, both IBS and IBD are disorders that will continue being present in your life. The good news is that both conditions can be treated so you can live a life that is normal; so long as the symptoms are managed well. With proper treatment, IBS patients will be able to avoid their triggers, become aware of what causes their IBS to act up and live without triggering their symptoms. IBD patients can work together with their doctor to identify what kind of treatment works best to keep their IBD in remission as long as possible.

Can I get pregnant and have children even with IBS and IBD?

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Dr.Doreen Koay Siew Ching

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