If you’re experiencing digestive symptoms like stomach pain, bloating, or unpredictable changes in bowel habits, it’s natural to wonder what might be causing these issues. Conditions like Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD) are common causes of digestive discomfort, but they’re quite different in terms of symptoms, causes, and treatments. Understanding the distinctions between IBS and IBD can help you take the right steps toward finding effective relief and improving your quality of life. IBS Clinics can help you better understand the triggers behind your gut symptoms with our premium IBS tests that help identify intolerances to over 200 common foods.
In this article, we’ll walk you through the key differences between IBS and IBD, helping you identify which condition your symptoms may align with. We’ll also explore how each condition is diagnosed, what treatment options are available, and how to manage symptoms in a way that fits your lifestyle. For more information on popular IBS medications, you may also like to read our article on Buscopan IBS. Whether you’re just beginning to explore what might be causing your symptoms or looking for ways to better manage an existing diagnosis, this guide aims to provide clarity and reassurance.
What Are IBS and IBD?
Understanding the difference between IBS (Irritable Bowel Syndrome) and IBD (Inflammatory Bowel Disease) is a key step in managing digestive health. While the symptoms of these conditions can seem similar, IBS and IBD differ significantly in their causes and effects on the body.
Irritable Bowel Syndrome (IBS)
IBS is a functional disorder of the digestive system, which means it affects how your gut works without causing visible damage or inflammation. People with IBS often experience symptoms like cramping, bloating, and changes in bowel habits, including diarrhoea, constipation, or a mix of both. Unlike IBD, IBS doesn’t cause inflammation or permanent damage to the intestines. It’s often triggered by factors like stress, diet, and gut sensitivity, making it a condition that’s manageable through lifestyle adjustments and symptom-based treatments.
Inflammatory Bowel Disease (IBD)
IBD, on the other hand, is a term that describes chronic inflammatory conditions affecting the digestive tract. The inflammation caused by IBD can lead to damage and structural changes in the gut over time, and it typically requires more intensive treatment than IBS. The two main types of IBD are:
- Crohn’s Disease: Crohn’s can affect any part of the digestive tract, from the mouth to the anus, and often impacts deeper layers of the intestinal wall. Symptoms vary widely but may include abdominal pain, severe diarrhoea, fatigue, and weight loss.
- Ulcerative Colitis: Unlike Crohn’s, ulcerative colitis is limited to the large intestine (colon) and rectum. It causes continuous inflammation of the colon’s inner lining, leading to symptoms such as abdominal pain, rectal bleeding, and an urgent need to have a bowel movement.
To summarise then, while IBS is a functional issue that affects the gut’s ability to move food effectively, IBD involves actual inflammation and can lead to physical damage in the digestive tract. Knowing which condition you might have is essential, as it determines the best approach to managing symptoms and improving your overall gut health.
IBS vs IBD Symptoms: How Do They Differ?
While IBS and IBD share some overlapping symptoms, there are distinct differences that set them apart. Understanding these can help clarify which condition you may be experiencing.
IBS Symptoms
In IBS, symptoms are primarily related to how the digestive tract functions rather than any visible inflammation or damage. Abdominal pain and cramping are common, often felt in the lower abdomen and typically relieved after a bowel movement.
Many people with IBS experience bloating and gas, leading to a frequent feeling of fullness or distension. A key sign of IBS is a noticeable change in bowel habits. This may include frequent diarrhoea, constipation, or a combination of both, with some individuals alternating between them. Symptoms tend to fluctuate and may worsen with specific triggers, such as stress, certain foods, or hormonal shifts.
Unlike IBD, IBS does not cause any physical damage or inflammation in the gut, which means it’s usually managed by lifestyle and dietary adjustments rather than medication.
IBD Symptoms
IBD symptoms are driven by inflammation in the digestive tract, which can lead to structural changes and even long-term damage if left untreated. Untreated IBD can lead to serious, long-term damage in the digestive tract.
People with IBD often experience persistent abdominal pain, severe fatigue, and a frequent, urgent need for bowel movements. Because IBD includes Crohn’s disease and ulcerative colitis, the specific symptoms can vary.
- Crohn’s Disease: This condition can affect any part of the digestive tract, from the mouth to the anus, often leading to pain and persistent diarrhoea. Crohn’s can also result in weight loss and malnutrition due to difficulty absorbing nutrients, as inflammation disrupts the gut’s ability to digest food effectively.
- Ulcerative Colitis: Unlike Crohn’s, ulcerative colitis is limited to the large intestine and rectum. It typically causes continuous episodes of diarrhoea, often mixed with blood or mucus, along with an urgent need to use the bathroom. For many, the pain is concentrated in the lower abdomen and left side, where the inflammation tends to be most severe.
Key Differences in Symptoms and Triggers
In short, IBS involves changes in gut function without inflammation or physical damage, while IBD is marked by inflammation that can cause lasting structural changes to the gut. IBS symptoms tend to respond well to lifestyle and dietary changes, whereas IBD often requires prescribed medications to reduce inflammation and protect the gut lining. Understanding these distinct symptom patterns can be a helpful first step toward determining the right diagnosis and managing symptoms effectively.
What Does IBS Pain Feel Like Compared to IBD Pain?
The pain associated with IBS and IBD can feel very different due to the distinct nature of each condition. In IBS, pain is usually experienced as cramping or a dull ache, often in the lower abdomen. This discomfort is commonly accompanied by bloating, gas, and a feeling of fullness, and it tends to come and go, often easing after a bowel movement.
IBS pain is linked to how the gut muscles contract, which can cause discomfort when food moves through the digestive tract too quickly or too slowly. While it can be quite uncomfortable, IBS pain does not result from physical damage or inflammation in the gut.
In contrast, IBD pain is typically sharper and more intense because it stems from actual inflammation in the digestive tract. People with IBD often describe the pain as deep or stabbing, with some experiencing significant discomfort on the left or right side of the abdomen, depending on which part of the gut is inflamed.
This pain is often persistent and may not ease with bowel movements, as it’s linked to inflamed or ulcerated areas in the intestines. Unlike IBS, where pain may be triggered by diet or stress, IBD pain can flare up unexpectedly due to the underlying inflammatory process, sometimes requiring medications to help reduce inflammation and alleviate pain.
IBS vs IBD: Which Is Worse?
When comparing IBS and IBD, the two conditions differ significantly in severity and impact on daily life. While IBS can cause uncomfortable symptoms like cramping, bloating, and unpredictable bowel habits, it does not lead to physical damage or inflammation in the digestive tract.
Symptoms of IBS, though bothersome, can often be managed through dietary changes, stress reduction, and medications that target specific symptoms. IBS is generally considered a functional disorder, meaning it affects the way the gut works but doesn’t cause structural damage, making its long-term complications less severe than those associated with IBD [1].
In contrast, IBD is a chronic inflammatory condition that can cause physical damage to the digestive system, with potential complications that can be life-altering if left untreated. For instance, in Crohn’s disease, ongoing inflammation can lead to strictures, or narrowed sections of the intestine, which can block the passage of food. This may also result in painful abscesses or fistulas—abnormal tunnels that form between different parts of the intestine or between the intestine and other organs, sometimes requiring surgical intervention.
In ulcerative colitis, persistent inflammation can cause ulcers, which are open sores that bleed and can lead to significant discomfort. Severe cases may carry risk of colonic rupture. Additionally, the risk of colorectal cancer is higher in people with long-standing ulcerative colitis, making regular medical monitoring essential [2].
Given these differences, IBD is generally considered more severe than IBS due to the risk of complications and the potential for permanent damage to the digestive tract. Effective management of IBD often requires a combination of medications, lifestyle adjustments, and, in some cases, surgery to control inflammation and protect the gut lining. For people with IBD, early and consistent treatment can be essential for reducing the risk of these complications and maintaining a healthier digestive system.
Can You Have Both IBS and IBD?
Yes, it is possible to have both IBS and IBD, although they are distinct conditions with different underlying causes. In some cases, people with IBD may also experience symptoms of IBS, especially when their IBD is in remission. For instance, while inflammation in IBD may be under control with treatment, the gut can still be sensitive, leading to symptoms similar to IBS, such as bloating, cramping, and changes in bowel habits. This overlap is known as “IBS-like symptoms in IBD” and is relatively common, especially in people with long-standing IBD [3].
Managing Both IBS and IBD Symptoms
When IBS and IBD co-occur, managing both conditions requires a tailored approach to address inflammation and sensitivity simultaneously. For IBD, medications such as anti-inflammatory drugs, immunosuppressants, or biologics are typically prescribed to control inflammation and prevent flare-ups. However, these medications don’t usually address IBS-like symptoms, which require different strategies.
For managing IBS symptoms, dietary adjustments like the low-FODMAP diet may help reduce bloating and discomfort, though it’s essential to do this under the guidance of a healthcare provider, as restrictive diets may not be suitable for everyone with IBD. Stress management techniques, such as mindfulness, relaxation exercises, or cognitive behavioural therapy (CBT), can also help control IBS-like symptoms by reducing the impact of stress on the gut.
Having both IBS and IBD can be challenging, but with a well-rounded treatment plan that addresses both inflammation and gut sensitivity, it’s possible to manage symptoms and improve quality of life. Working closely with healthcare professionals who understand the nuances of both conditions can be invaluable in finding the right balance of treatments and lifestyle adjustments.
Diagnosing IBS vs IBD: What Tests Are Used?
Diagnosing IBS and IBD involves different approaches, as each condition affects the digestive system in unique ways. While IBS is typically diagnosed through a process of exclusion, IBD requires tests that look for inflammation and physical changes in the gut.
Tests for Diagnosing IBS
IBS is diagnosed based on symptoms and by ruling out other conditions, as it doesn’t cause visible damage to the digestive tract. Doctors may perform blood tests and stool tests to check for infections or inflammatory markers that could suggest IBD or other conditions.
Because IBS is a functional disorder, imaging and invasive tests like colonoscopies aren’t typically required unless there are red-flag symptoms, such as significant weight loss or blood in the stool, which might indicate another condition. Instead, doctors often rely on symptom history and criteria like the Rome IV Criteria to confirm an IBS diagnosis.
The Rome IV Criteria provide guidelines for diagnosing IBS by focusing on symptom patterns rather than visible signs of disease. According to these criteria, IBS may be diagnosed if a person has experienced recurrent abdominal pain at least one day per week over the past three months, along with changes in bowel movements, such as pain relief after a bowel movement, changes in stool frequency, or alterations in stool form. These criteria help doctors distinguish IBS from other digestive disorders and are widely used in clinical practice to ensure a consistent approach to diagnosis.
Tests for Diagnosing IBD
In contrast, diagnosing IBD often involves a more extensive examination of the digestive tract to identify inflammation, ulcers, or other physical changes. Common tests for IBD include:
- Blood Tests: Used to check for high levels of inflammatory markers, such as C-reactive protein (CRP) and elevated white blood cell counts, which may indicate inflammation in the body.
- Stool Tests: Used to detect calprotectin, a protein associated with intestinal inflammation, helping to differentiate between IBS and IBD.
- Colonoscopy: This is a key tool in diagnosing IBD, allowing doctors to examine the colon directly and, if necessary, take biopsies of the intestinal tissue to look for inflammation, ulcers, or other damage.
- Imaging: Techniques like CT scans or MRI enterography provide detailed images of the digestive tract, helping to assess areas beyond the reach of a colonoscopy, particularly in Crohn’s disease, which can affect any part of the gut.
Can IBD Be Missed on a Colonoscopy?
Yes, it is possible for IBD to be missed on a colonoscopy, especially in cases of Crohn’s disease. Crohn’s can affect any part of the digestive tract, including areas beyond the colon, such as the small intestine, which a standard colonoscopy may not reach. In these cases, additional imaging tests like MRI or CT scans may be necessary to detect inflammation in areas that a colonoscopy cannot access. For ulcerative colitis, which is confined to the colon and rectum, a colonoscopy is typically effective in identifying inflammation, though early or mild cases may occasionally be harder to diagnose.
Do You Have IBS, IBD, or Another Condition? A Quick Checklist
If you’re unsure whether your digestive symptoms point to IBS, IBD, or another condition, this checklist may help clarify some differences. While this isn’t a substitute for medical advice, it can offer a starting point for understanding your symptoms and preparing for a discussion with a healthcare provider.
Checklist:
- Abdominal Pain
- IBS: Cramping or dull pain, often relieved after a bowel movement.
- IBD: Sharp or intense pain, not necessarily linked to bowel movements and often persistent.
- Bowel Movement Changes
- IBS: Fluctuates between diarrhoea and constipation or involves urgency without bleeding.
- IBD: Frequent, urgent diarrhoea with blood or mucus, particularly in ulcerative colitis.
- Visible Inflammation Symptoms
- IBS: No visible signs of inflammation.
- IBD: Symptoms like fever, fatigue, joint pain, or skin issues may accompany digestive symptoms, due to inflammation affecting other parts of the body.
- Triggers
- IBS: Symptoms may worsen with certain foods, stress, or hormonal changes.
- IBD: Symptoms can flare unpredictably and are less directly tied to food triggers.
- Weight Loss or Nutrient Absorption Issues
- IBS: Weight loss is less common, though discomfort with eating may affect appetite.
- IBD: Unintended weight loss, anaemia, and nutrient deficiencies are more likely due to chronic inflammation affecting nutrient absorption.
Tips for Discussing Symptoms with Your Healthcare Provider
When you meet with a healthcare provider, it can be helpful to:
- Bring a Symptom Diary: Record your symptoms, their frequency, and any possible triggers.
- Note Recent Infections or Family History: These can help your provider rule out other conditions.
- Mention Other Symptoms: If you have symptoms outside of the digestive tract, such as fatigue or joint pain, bring these up, as they may indicate IBD or another inflammatory condition.
This checklist and preparation can help you have a more productive conversation with your healthcare provider, guiding them towards a more accurate diagnosis and the best path forward for managing your symptoms.
Treatment Options for IBS and IBD
Managing IBS and IBD involves different approaches due to the unique characteristics of each condition. Here’s an overview of treatment options available for both IBS and IBD, including support from a functional medicine perspective.
Treatment Options for IBS
For IBS, treatments focus on managing symptoms and improving gut function without the need to address inflammation or structural damage. Key approaches include:
Dietary Changes
Many people with IBS benefit from a low-FODMAP diet, which restricts certain fermentable carbohydrates known to trigger bloating, gas, and cramping. Other dietary adjustments, like gradually increasing fibre intake or avoiding specific trigger foods, may also help manage symptoms.
Stress Management
Because IBS is closely linked to the gut-brain connection, stress management is an essential part of treatment. Techniques like mindfulness, cognitive behavioural therapy (CBT), and relaxation exercises can reduce the impact of stress on the gut, helping to relieve symptoms.
Medications
Certain medications can target specific IBS symptoms. Antispasmodics may be used to reduce cramping, while laxatives or fibre supplements can help regulate bowel movements in those with constipation-predominant IBS. Medications like loperamide may be recommended for diarrhoea.
Treatment Options for IBD
Since IBD involves chronic inflammation and physical damage to the digestive tract, treatment focuses on reducing inflammation, promoting healing, and preventing flare-ups:
Anti-inflammatory Medications
Drugs like aminosalicylates (5-ASA) are commonly prescribed to reduce inflammation in the intestines, especially in cases of mild to moderate ulcerative colitis.
Medications like corticosteroids, thiopurines, or biologics are often used to suppress the immune response that drives inflammation in IBD. Biologics, in particular, target specific pathways in the immune system and are often effective for moderate to severe cases.
Surgery
In cases where medications aren’t effective, surgery may be required. This can involve removing damaged sections of the intestine, as is sometimes necessary in Crohn’s disease, or removing the colon in severe cases of ulcerative colitis.
How a Functional Medicine Practitioner Can Help
A functional medicine practitioner takes a holistic approach, aiming to address the root causes of symptoms rather than focusing solely on symptom management. In treating both IBS and IBD, a functional medicine practitioner may offer:
Personalised Dietary Plans
Beyond standard dietary guidelines, a functional medicine practitioner may use advanced testing to identify food sensitivities and create a tailored nutrition plan. They often focus on whole foods, anti-inflammatory nutrients, and gut-friendly foods, which can benefit both IBS and IBD sufferers.
Gut Microbiome Support
Probiotics, prebiotics, and targeted supplements may be recommended to improve gut microbiome health, which is often disrupted in both IBS and IBD. Functional medicine practitioners can guide you through using these supplements safely, aiming to rebalance the gut bacteria to reduce symptoms.
Nutritional Supplementation
For individuals with IBD, functional medicine practitioners may suggest supplements to address nutrient deficiencies due to malabsorption, such as vitamin D, B12, and iron, supporting overall health and energy levels.
Stress and Lifestyle Support
Recognising the role of stress in gut health, functional medicine often includes stress management strategies and recommendations for physical activity, sleep hygiene, and mind-body practices to improve resilience and reduce symptom severity.
With a combination of standard medical care and functional medicine’s holistic approach, individuals with IBS and IBD may experience better symptom control, improved gut health, and an overall enhanced quality of life.
Living a Healthy Life with IBS or IBD
Managing IBS or IBD effectively is essential to living a healthy, fulfilling life with either condition. While the journey is different for each person, adopting certain lifestyle adjustments can make daily life more manageable, improving comfort, energy levels, and overall well-being.
Lifestyle Tips for Managing IBS
For those with IBS, lifestyle adjustments can often make a significant difference in managing symptoms:
- Mindful Eating: Eating smaller, more frequent meals and avoiding triggers like caffeine, alcohol, and highly processed foods can help prevent discomfort. Many people find relief by following a low-FODMAP diet under the guidance of a nutritionist.
- Regular Exercise: Moderate exercise, such as walking, yoga, or swimming, can improve digestion and reduce stress, which is closely linked to IBS symptoms. Exercise also promotes regular bowel movements, which can help with constipation-predominant IBS [4].
- Stress Management: Techniques such as mindfulness, cognitive behavioural therapy (CBT), and relaxation exercises like deep breathing can help manage the gut-brain connection, which plays a significant role in IBS. Reducing stress can alleviate cramping, bloating, and other symptoms.
Lifestyle Tips for Managing IBD
Living with IBD requires strategies to manage inflammation and support overall health, especially during periods of remission:
- Balanced Nutrition: Eating a nutrient-dense diet is essential, especially for IBD patients at risk of nutrient deficiencies due to malabsorption. A well-rounded diet with enough protein, healthy fats, and vitamins can support healing and energy levels. During flare-ups, softer, low-fibre foods may be easier to tolerate.
- Hydration: Because IBD can lead to dehydration, especially during flare-ups, staying well-hydrated is crucial. Electrolyte drinks may be beneficial when diarrhoea is frequent, helping maintain electrolyte balance.
- Rest and Recovery: Fatigue is common with IBD, and prioritising rest, especially during flare-ups, can help the body recover. Building a regular sleep routine and allowing time for relaxation are essential to maintaining energy levels and immune function.
Can You Live Healthily with IBD?
Yes, it is possible to live a healthy life with IBD. With the right treatments and lifestyle choices, many people with IBD experience long periods of remission and maintain a high quality of life. Consistent medical care, including regular check-ups and monitoring for potential complications, is crucial. By working with a healthcare provider and considering holistic support, individuals with IBD can often manage symptoms effectively and avoid or minimise complications [5].
How a Functional Medicine Practitioner Can Help
A functional medicine practitioner can offer additional support to help people with IBS and IBD live more comfortably. They provide personalised dietary guidance, tailored nutrient support, and strategies for managing stress and inflammation holistically. In IBD, they may focus on supplementing any nutrient deficiencies, supporting gut healing, and balancing the gut microbiome to improve resilience against flare-ups. With a whole-person approach, functional medicine can be a valuable complement to traditional treatments, helping those with IBS or IBD live healthier lives with more energy and symptom relief.
Conclusion
Living with IBS or IBD can present unique challenges, but with the right approach, it’s entirely possible to lead a fulfilling and healthy life. Understanding the differences between these two conditions is a valuable first step toward finding effective treatments, making informed lifestyle choices, and ultimately managing symptoms. From dietary changes and stress management in IBS to anti-inflammatory treatments and holistic support for IBD, there are many ways to improve your quality of life.
At IBS Clinics, we offer comprehensive, personalised care tailored to meet your unique needs. Whether you’re looking for guidance in managing IBS symptoms or specialised support for IBD, our team is here to help you every step of the way. We provide advanced diagnostic options, expert dietary guidance, and holistic treatments that consider the whole person. To learn more about how we can support your journey to better digestive health, visit our How We Can Help You page.
References
- Canavan, C., West, J., & Card, T. (2014). “The epidemiology of irritable bowel syndrome.” Clinical Epidemiology, 6, 71-80. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930440/
- Baumgart, D. C., & Sandborn, W. J. (2012). “Crohn’s disease.” The Lancet, 380(9853), 1590-1605. Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60026-9/fulltext
- Simrén, M., et al. (2013). “Intestinal microbiota in functional bowel disorders and inflammatory bowel diseases.” American Journal of Gastroenterology, 108(12), 2002-2011. Available at: https://journals.lww.com/ajg/fulltext/2013/12000/intestinal_microbiota_in_functional_bowel.7.aspx
- Pedersen, N., et al. (2015). “Physical activity and diet in patients with inflammatory bowel disease.” Gastroenterology Research and Practice, 2015, 720139.
- Kappelman, M. D., et al. (2011). “Long-term outcomes of patients with Crohn’s disease treated in a tertiary referral center.” Inflammatory Bowel Diseases, 17(10), 2123-2130.
Author – Tracey Randell
At IBS Clinics, Tracey Randell, a renowned Nutritional Therapist and one of the few IFM Certified Practitioners in the UK, extends her specialised knowledge and unique approach to managing and treating IBS and other gut-related conditions effectively.
Tracey’s profound understanding of Functional Medicine allows her to connect the dots for complex health conditions, identifying and addressing the root causes to curate personalised and comprehensive health plans for her patients. Her holistic approach focuses on resolving underlying imbalances and optimising gut health, enabling the body to correct other issues and attain overall well-being.
At IBS Clinics, we are dedicated to being your partner in navigating your gut-related health concerns, offering expert care and individualised treatment plans to alleviate your IBS symptoms and enhance your quality of life.
You can read more about Tracey on our About page here.
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