IBD Vs. IBS: What’s The Difference?

It's easy to confuse IBD (inflammatory bowel disease) and IBS (irritable bowel syndrome). After all, both affect the digestive system. They share similar symptoms, such as abdominal pain, cramping and changes in bowel habits. And they even have similar acronyms.

However, IBD and IBS are fundamentally different. Let's look at these two conditions and how to know when to seek care for your symptoms.

What Is Inflammatory Bowel Disease?

"IBD is an umbrella term for chronic inflammatory diseases that cause visible damage to the gastrointestinal (GI) tract or gut," said Eric Steinberg, MD, a gastroenterologist with Franciscan Physician Network Specialty Center Crown Point. "This damage may include pockets of infection, narrowing of the bowel or abnormal passageways known as fistulas that form between organs."

The two main IBD types include:

• Crohn's disease – May affect any part of the GI tract from the mouth to the anus. Crohn's can penetrate deep into the tissue layers.
• Ulcerative colitis – Affects only the colon (large intestine) and rectum. Inflammation is limited to the inner most lining of the colon.

"IBD is considered an autoimmune condition, meaning that the body's immune system mistakenly attacks healthy tissues in the gut, causing ongoing inflammation," said Dr. Steinberg. "Although the exact cause is unknown, we believe it's a combination of genetics, environmental triggers and immune system responses."

IBD is less common than IBS, affecting about 3 million Americans.

What Is Irritable Bowel Syndrome?

IBS is a functional disorder with no visible inflammation or gut damage. "Functional disorder" means symptoms happen because the gut isn't working correctly.

Experts don't know exactly what causes IBS. It may involve a breakdown in how the gut, brain and nervous system interact. Genetics and other factors likely play a role, too. Stress can aggravate IBS symptoms but doesn't cause them.

IBS is common, affecting between 25 and 45 million people in the United States.

Similarities And Differences Between IBD And IBS

IBD and IBS share some symptoms. However, many aspects of these diseases differ, including who's at risk, the diagnosis process, treatment options and possible complications.

Who's at risk for IBD or IBS

Anyone can get IBD or IBS. However, some people are at greater risk for these conditions.

Your risk of getting IBD is higher if you:

• Are white
• Are young (IBD is typically diagnosed before age 35)
• Have a family history of IBD
• Smoke
• Use nonsteroidal anti-inflammatory medicines, such as ibuprofen (Advil) and naproxen sodium (Aleve)

Your risk of getting IBS is higher if you:

• Are female
• Are young (IBS is most common before age 50)
• Have a family history of IBD
• Have a history of anxiety or depression

It is possible to have both IBD and IBS. Experts believe that having IBD can increase your risk of getting IBS. However, there isn't evidence to suggest that having IBS increases your risk of developing IBD.

Symptoms of IBD and IBS

Both IBD and IBS can cause the following:

• Abdominal pain, cramping and bloating
• Changes in bowel activity — both conditions can cause diarrhea and constipation

IBD can cause additional symptoms that aren't present in IBS. These include:

• Anemia (low iron)
• Bloody stool
•  Fatigue
• Fever
• In some women, more severe IBD symptoms before and during their period; difficulty getting pregnant during flare-ups
• Joint pain
• Loss of appetite leading to weight loss
• Skin problems, such as rashes

In both conditions, what you eat can affect your symptoms. No single diet works for everyone with either condition. Your doctor may recommend that you keep a food journal to identify your triggers.

Individuals with both IBD and IBS may experience times when symptoms are present and times when little or no symptoms are present. These conditions can be unpredictable — symptoms can vary daily or even year to year.

How Doctors Diagnose IBD And IBS

If you have symptoms of IBD or IBS, the first and most crucial step is to talk to your doctor.

"When patients come in with persistent digestive symptoms, we start with a thorough medical history and physical exam," said Dr. Steinberg. "From there, we may order blood work, stool tests, imaging or endoscopic procedures like colonoscopy to confirm a diagnosis and rule out other conditions."

These tests may include:

• Blood tests
• Stool sample test
• Endoscopic procedures, such as a colonoscopy to view the GI tract and take a tissue sample
• Imaging tests, such as an X-ray or magnetic resonance imaging (MRI)

Treatment approach

Treatment for IBD and IBS can include a combination of medicine and lifestyle changes.

IBD treatments include:

• Dietary changes to reduce symptoms
• Medicine to reduce inflammation, calm the immune system, relieve symptoms and prevent flare-ups
• Stress management techniques
• Surgery. About half of people with Crohn's disease and one-third of people with ulcerative colitis may need surgery within 20 years of diagnosis.

IBS treatments include:

• Dietary changes
• Medicine to help target symptoms such as diarrhea, constipation, pain and bloating
• Stress management

Living with IBD or IBS can be challenging emotionally as well as physically. It isn't uncommon for people to feel sad, anxious or depressed about how these conditions affect their lives. It's important to talk about your feelings with someone you trust, whether a friend, doctor or mental health therapist.

Complications of IBD and IBS

"IBD is associated with more serious complications than IBS," Dr. Steinberg said.

These include:

• Bowel obstructions (blockages)
• Deep ulcers (sores or breaks) in the lining of the colon and rectum
• Infections
• Malnutrition
• Precancerous changes in the colon and colon cancer

IBS complications are less complex but still affect your quality of life. They include:

• Mental health concerns such as anxiety and depression
• Hemorrhoids due to chronic constipation or diarrhea

Are You Concerned About GI Symptoms?

An early, accurate diagnosis is essential for people with IBD or IBS. Your primary care doctor can help you decide if an appointment with a gastroenterologist would help. Gastroenterologists offer specialty care for people with GI conditions such as IBD and IBS.

"If you or a loved one is experiencing GI symptoms, such as abdominal pain, cramping, bloating or blood in your stool, or even unexplained weight loss, it's important to see a gastroenterologist to determine the cause," advised Dr. Steinberg. "We're here to help."

Connect with Franciscan Health to schedule an appointment, get a second opinion or learn more about your treatment options.