IBD Vs. IBS: What’s The Difference?

If you're dealing with stomach pain, bloating, diarrhea or constipation, you may wonder whether you have IBS or something more serious like IBD. These conditions can cause similar symptoms, like abdominal pain, cramping and changes in bowel habits. And they even have similar acronyms.

However, IBS (irritable bowel syndrome) and IBD (inflammatory bowel disease) they have important differences that affect diagnosis and treatment. Let's look at these two conditions and how to know when to seek care for your symptoms.

Key Takeaways: IBS vs. IBD

• IBS and IBD are different conditions, even though symptoms may overlap.
• Inflammatory bowel disease causes inflammation and damage in the digestive tract; irritable bowel syndrome does not.
• Blood in your stool, weight loss or fever may point to IBD rather than IBS.
• A gastroenterologist can help determine the cause of ongoing digestive symptoms. Early diagnosis can help prevent complications and improve quality of life.

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.

Frequently Asked Questions: IBS And IBD

Is IBS the same as IBD?

No. IBS affects how the digestive system functions, while IBD causes inflammation and damage in the digestive tract.

Does diet impact IBS or IBD?

"Diet has a lot to do with it," Dr. Steinberg said. "There's some concern that our diets have changed in the last 50 or 60 years to a point where they are altering our natural microbiome that the bacteria that exists happily in our colon are being affected by the foods we eat. And that's being explored with research.

"It's not uncommon for us to have a patient modify their diet to improve their symptoms. But I think that, also, we know that smoking affects inflammatory bowel disease a great deal. Certain dietary practices should be avoided in inflammatory bowel disease. So, probably, the biggest factor that affects both these conditions is what we eat."

Should I have more fiber in my diet if I have IBS or IBD?

"For my patients who have inflammatory bowel disease, I usually recommend a low-residue diet, meaning that the gut is already inflamed and unhappy with having to work extra hard so that a low-residue diet is actually preferred," Dr. Steinberg said. "Unlike what we normally tell people, we generally want them to have more fiber in their diet. In patients who have inflammatory bowel disease, we want them to actually have less fiber in their diet, so their intestine doesn't have to work as hard through an inflamed condition.

"Now, IBS is a little different. We actually want them to have fiber because we feel that that for a lot of patients promotes more regular bowel movements and reduces the length of time that things are not moving if they have a component of irritable bowel syndrome, which is constipation, and patients who have diarrhea, we'd sometimes even encourage fiber to pull water, to absorb water and to help bulk up the stool."

How does stress impact IBS or IBD?

Both IBS and IBD can be triggered by stress.

"Stress can alter the immune system and the inflammatory response," Dr. Steinberg said. "Patients who have stress are possible patients who have exacerbation of their inflammatory bowel disease. But stress is a major player in creating irritable bowel syndrome symptoms.

"In fact, patients who have anxiety, patients who have a lot of mental unsettledness can have this so-called brain-gut axis disconnection, meaning that there are nerve fibers within the intestines that are sensitized to things and signals coming down from the brain, and it alters motility and the functional ability of the bowel to do what it's supposed to do, which is pass things along almost like a conveyor belt. So, it jams up the conveyor belt, if you will, and causes this problem."