Home Diseases Irritable Bowel Syndrome (IBS): Symptoms, Causes, Treatment

Irritable Bowel Syndrome (IBS): Symptoms, Causes, Treatment

by Josephine Andrews
Published: Last Updated on 147 views


Irritable bowel is caused by a functional disorder of the intestine. Typical symptoms are abdominal pain, bloating and diarrhea or constipation. They are often aggravated by stress. The disease can be very distressing, but it is not dangerous. For a reliable diagnosis, the doctor must rule out other possible causes. Here you can read everything you need to know about symptoms, triggers and treatment options for irritable bowel syndrome.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.


Irritable bowel: brief overview

  • Most common symptoms: abdominal pain, diarrhea and/or constipation, flatulence
  • Possible causes: Disturbed barrier function of the intestinal wall, disturbed intestinal activity, increased immune activity in the intestinal wall, increased pain perception
  • Diagnosis: inflammatory bowel diseases, food intolerance, gastrointestinal infections, gynecological causes must be ruled out for the diagnosis of irritable bowel syndrome (exclusion diagnoses).
  • Treatment: Always an individual treatment concept with medication, herbal remedies, homeopathics, probiotics , change in diet, stress reduction

Irritable bowel: symptoms

In the case of an irritable bowel (colon irritabile), the bowel function is disturbed. As a result, the stool changes: patients often suffer from diarrhea or constipation.

In some patients, however, the bowel movements are unchanged. They mainly suffer from pain or flatulence, a bloated stomach and outgoing intestinal gas. These symptoms occur in combination with diarrhea and constipation.

Irritable Bowel Symptoms: The Four Types of Illness

Depending on which symptoms are in the foreground, irritable bowel syndrome is divided into four types of disease:

  • diarrhea type
  • constipation type
  • pain type
  • flatulence type.

In addition to these four main forms, mixed types also occur. In addition, one type of disease can also change into another or they alternate with each other. For example, diarrhea and constipation can even occur on the same day.

In all four types of disease, the following additional irritable bowel symptoms often occur:

  • bloating
  • Feeling that the bowels do not empty completely when having a bowel movement
  • deposits of mucus on the stool

Irritable bowel pain

Abdominal pain is a major symptom of irritable bowel syndrome. The pain can occur in different places in the abdomen and have different character, for example:

  • constant burning or stabbing pain
  • rather cramping pains in waves
  • Stitch-like pains
  • dull pain, like a constant feeling of pressure in the lower abdomen

The abdominal pain caused by irritable bowel syndrome is caused on the one hand by the irritated intestinal mucosa and on the other hand by the stretching of the intestinal wall due to the increased gas formation. The intestinal muscles react to this with contractions.

Diarrhea in irritable bowel syndrome

In irritable bowel patients of the diarrhea type, the stool is very soft to liquid. The number of bowel movements increases to more than three a day. Some irritable bowel patients with diarrhea also suffer from a sudden, strong urge to defecate. They therefore hardly dare to move further away from a toilet.

Constipation in irritable bowel syndrome

Conversely, if you have irritable bowel syndrome, you may experience symptoms of constipation. Those affected have very hard stools, which are reminiscent of sheep’s feces. These patients are often only able to go to the toilet three or fewer times a week.

Flatulence and bloating in irritable bowel syndrome

With any healthy digestion, gases are formed in the intestine. In irritable bowel syndrome, however, they can form in excess as a result of disturbed intestinal movements and food utilization. This is particularly uncomfortable for the patient, as their intestinal wall reacts more than usual to the stretching stimulus caused by the gas bubbles. Cramping abdominal pain is often the result.

If the intestinal wind cannot escape sufficiently, a bloated abdomen forms, which can feel like a drum and is painful.

Other changes in bowel movements

Although the various symptoms usually improve after a bowel movement, some IBS patients find the bowel movement itself painful.

In addition, many sufferers have the feeling that the bowel could not be emptied properly. This tempts some to use laxatives. However, such medications do not help and can intensify the irritation. If laxatives are really needed, they should be considered a short-term solution because of the possible side effects.

Mucus deposits on the stool are also common in irritable bowel syndrome.


Irrespective of whether patients with IBS have diarrhea or constipation, they often suffer from a permanent feeling of fullness. This usually improves after a bowel movement, but can also occur if the person concerned has not eaten at all and the bowel is relatively empty.

Risk of confusion with other diseases

The symptoms of irritable bowel syndrome are non-specific. This means that they also occur in a large number of other diseases. Before the diagnosis of irritable bowel syndrome is made, these must therefore be ruled out. Possible other causes for the symptoms are

  • Food intolerance, including lactose, fructose, sorbitol or gluten
  • Inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease
  • gastrointestinal infections
  • Gynecological diseases, including ovarian cancer

Danger! misleading symptoms

The following symptoms are not typical irritable bowel symptoms. They need to be checked out by a doctor as soon as possible, as they may be suffering from potentially dangerous illnesses.

  • Diarrhea, which occurs mainly at night
  • Fever (acute or chronic-recurrent)
  • blood in the stool
  • Severe unwanted weight loss

Irritable bowel: causes and risk factors

There are numerous hypotheses about the development of irritable bowel syndrome, but so far there is only little reliable evidence.

However, scientists were able to identify a whole series of typical changes in the intestines of those affected. These changes do not only occur in irritable bowel syndrome, but also occur, for example, in chronic inflammatory bowel diseases. This includes:

Disturbed intestinal peristalsis (motility disorder)

It is assumed that in the case of irritable bowel syndrome, the natural movement of the intestines is disturbed. This means that the movements to transport the digested food are not optimal.

The intestinal peristalsis is regulated by an independent nervous system with which the intestinal wall is equipped. This is also referred to as the “abdominal brain”.

The abdominal brain senses when food enters the intestine and stretches the wall. Together with the messenger substance serotonin , the intestinal nervous system controls digestion. It stimulates the intestinal muscles to alternately contract and relax.

In irritable bowel syndrome, the nervous system gives incorrect instructions to the intestinal muscles. As a result, the muscles contract too quickly, too slowly or at the wrong moment, or they no longer relax properly. The chyme is therefore transported too quickly in some patients. Then not enough water can be extracted from it in the large intestine . The result is diarrhea.

The opposite is also possible: If the muscles move too slowly, constipation can occur. Irritable bowel cramps, on the other hand, occur, among other things, when the muscles contract too much and for too long or no longer relax properly.

Increased permeability of the intestinal mucosa

An unnaturally high permeability of the intestinal mucosa (leaky gut) can also trigger irritable bowel symptoms. In the intestinal mucosa, cells that are normally adjacent to each other are closely connected to each other by a kind of adhesive bridge (tight junction). They seal the connection between the cells tightly so that no foreign substances or pathogens can get between the cells.

As long as these adhesion bridges between the cells are intact, the entirety of the intestinal mucosa cells form an effective barrier. It prevents foreign substances from penetrating the body uncontrollably from the intestinal cavity.

In people with irritable bowel syndrome, these bonding bridges break down more quickly than normal. As a result, the cells are no longer so firmly connected, which weakens the barrier function of the intestinal mucosa. For example, foreign substances or pathogens can more easily penetrate the intestinal mucosa and trigger an immune reaction there.

Increased immune activity in the intestinal mucosa

There is increased immune activity in tissue samples from the intestinal mucosa of affected people. For example, more defense cells of the immune system and their messenger substances can be detected in the mucous membrane. It is not yet known why the increased activity occurs in irritable bowel syndrome.

Infections of the gastrointestinal tract as a cause of irritable bowel syndrome

Several studies show that an irritable bowel syndrome can sometimes be the result of a gastrointestinal infection. In particular, an irritable bowel syndrome with severe diarrhea then occurs. Certain bacteria, such as Campylobacter jejuni, may be more responsible than other species. However, only about one in ten cases of irritable bowel syndrome can be traced back to a previous gastrointestinal infection.

Disturbed intestinal flora

A disturbed intestinal flora can also contribute to an irritable bowel syndrome. If the natural mix of beneficial bacteria in the gut becomes unbalanced, it can impair bowel function and increase gas formation. Causes of a disturbed intestinal flora can be medications such as antibiotics, but also gastrointestinal infections.

Helpful gut bacteria
Various gut bacteria taken orally can help with irritable bowel syndrome, such as Bifidum MIMBb75.

Disturbed serotonin balance

The serotonin balance could also be disturbed in irritable bowel syndrome. The messenger substance serotonin is responsible, among other things, for how pain is perceived. If the nervous system of the intestine is activated in an irritable bowel syndrome, it cannot optimally regulate how many messenger substances it releases. It can happen that those affected perceive their intestines more than usual and feel pain.

Stress as a trigger and reinforcer

Whether fear, nervousness, anger, grief or work stress: Under mental stress, irritable bowel symptoms often worsen. If the stress subsides again or if you relax in a targeted manner, the symptoms usually improve as well.

Acute stress has been shown to lead to changes in the gastrointestinal tract. Gastric juice production increases, intestinal movements increase and the local immune reaction in the intestine changes.

However, people react very differently to stress. While some sufferers have developed methods to deal with stress, others suffer enormously from the psychological and physical consequences. Persistent life stress is important for the prognosis of the disease: Patients with life stress show no improvement in their symptoms after six months. In contrast, 44 percent of patients without life stress show an improvement. The longer the history of the disease, the lower the chance of improvement.

Associated with concomitant diseases

There are some diseases that often occur together with an irritable bowel syndrome (comorbidities). It’s possible that patients with these disorders are more likely to develop irritable bowel syndrome. These diseases include:

  • depression
  • anxiety disorders
  • Chronic Fatigue Syndrome
  • fibromyalgia
  • fatigue syndrome
  • Chronic (head) pain

The diagnosis of irritable bowel syndrome is a so-called diagnosis of exclusion. This means that the doctor must first rule out other possible causes for the symptoms before one can assume irritable bowel syndrome.

The right contact person if irritable bowel syndrome is suspected is a specialist in internal medicine who specializes in diseases of the digestive tract: a gastroenterologist. At the doctor’s appointment, the doctor first inquires about your current symptoms and any previous illnesses (anamnesis). For example, the doctor might ask you the following questions:

  • Where exactly do you have pain and in which situations does it occur?
  • Do you have diarrhea or constipation?
  • Have you noticed a connection between the pain and certain foods?
  • Are you currently in a stressful life situation?
  • Have you noticed blood in your stool, do you have a fever and have you lost weight unintentionally? All of this would be atypical for IBS.

It is also useful to keep a 2-week stool diary (with at least one abnormal stool)/nutrition log and discuss the results with the doctor. In particular, a connection between certain foods and the symptoms can often be uncovered. There are also special questionnaires for irritable bowel syndrome.

Physical examination

The symptoms of irritable bowel syndrome primarily affect the digestive tract. That is why the abdomen is the focus of the physical examination. The doctor first listens to the abdomen with a stethoscope ( auscultation ). He can hear the intestinal activity, but also determine if the intestine moves little or not at all. In irritable bowel syndrome, the bowel often moves excessively.

The doctor then gently taps the abdominal wall with his fingers. The sound differs depending on whether the bowel is filled with stool or air. Since the intestines are increasingly filled with air when there is flatulence, a characteristic resonance occurs when tapping.

Finally, the doctor feels the abdomen with his hands, first superficially and then a little deeper. He can determine whether certain sections of the intestine are thickened and whether the examination causes pain.

abdominal ultrasound

The ultrasound examination of irritable bowel syndrome is only of limited value for assessing the intestines, since the intestinal gases interfere with the ultrasound image. However, other causes of the symptoms, such as diseases of the gallbladder, bile ducts, liver, kidneys and pancreas can be discovered. In addition, the doctor can use the ultrasound to see whether the intestinal wall is thickened. That would indicate inflammation.

laboratory tests

Various substances can be searched for in the blood, urine and stool in the laboratory. For example, they provide indications of inflammation or infection. In the case of irritable bowel syndrome, however, the laboratory values ​​​​are usually unremarkable.

Gastroscopy and colonoscopy

In many cases, if there are unclear symptoms of the digestive tract, a gastroscopy and colonoscopy must be carried out. During the examination, the doctor can also take a small sample ( biopsy ) of the mucous membrane. Irritable bowel syndrome shows certain changes in the intestinal mucosa. However, these also occur in chronic inflammatory bowel diseases (Crohn’s disease, ulcerative colitis).

Tests for food intolerance

Food intolerances such as lactose, fructose or sorbitol intolerance as well as celiac disease (gluten intolerance) cause symptoms that are similar to those of irritable bowel syndrome. They can be confirmed or ruled out with simple tests.

  • With the H2 breath test, various carbohydrate intolerances can be determined.
  • To diagnose celiac disease, the blood is tested for certain antibodies and a tissue sample from the mucous membrane of the small intestine is analyzed under the microscope.
  • The so-called lactulose-mannitol test can be used to find out whether the barrier function of the intestine is disturbed (leaky gut syndrome).

Diagnostic criteria: irritable bowel syndrome

According to the recommendations of the German Society for Digestive and Metabolic Diseases (DGVS), irritable bowel syndrome is present when the following three points are met in a patient:

  • The patient suffers from chronic bowel-related complaints, i.e. those that last at least one day a week, such as abdominal pain or flatulence, which are usually accompanied by changes in bowel movements such as diarrhea or constipation.
  • The quality of life is significantly impaired due to the symptoms.
  • There are no changes characteristic of other clinical pictures that could explain the symptoms.

Irritable bowel: treatment

There is no universal therapeutic approach for treating irritable bowel syndrome. What can improve the symptoms depends on the different symptoms, but also on the different triggers and the individual patient.

Irritable bowel patients should therefore pay close attention to how their body reacts. It makes sense to record complaints as well as nutrition and other influencing factors such as stress and psychological strain in a kind of diary. This is the fastest way to become an expert on your own illness.

Always make changes to therapy in small increments. With a little patience, you can work with your doctor to find out which treatment strategy makes the most sense for you.

Irritable bowel syndrome: therapy for diarrhea

Diarrhea in irritable bowel syndrome can be treated with various medications. The most frequently used are tanning agents, the active ingredient loperamide or so-called bile acid binders.

Tannins are released when black tea or oak bark tea is steeped for a long time before drinking. But you can also buy it as a capsule in the pharmacy. They counteract inflammatory processes in the intestine, reduce secretion and slow down intestinal movement.

Loperamide is a synthetically produced substance that is remotely related to opium, but which acts almost exclusively locally on the intestine and calms the overexcited intestinal muscles. As a result, the stool stays longer in the large intestine, so that more liquid can be extracted from it and it becomes firmer again. However, loperamide should only be taken for a short time and strictly according to the dosage instructions, otherwise the drug would lead to severe constipation.

Bile acid scavengers like cholestyramine attach to bile acids. and thus prevent their diarrhea-promoting effect. Unfortunately, since bile acids play an important role in fat digestion, the drugs also impede the absorption of fat-soluble vitamins (A, D, E, K) and drugs.

Water-soluble fibers such as psyllium, locust bean gum and pectin can also stop diarrhea. In order to compensate for the loss of liquid, one should increase the liquid intake accordingly. In the case of severe diarrhea or if a child suffers from irritable bowel syndrome, electrolyte mixtures from the pharmacy may be useful.

Irritable bowel: therapy for constipation

If irritable bowel syndrome is causing a constipation, sometimes just physical exercise can help get the bowels moving again. In addition, sufferers should drink two to three liters of fluid a day. Since this alone is usually not enough, additional dietary fibers such as psyllium husks and water-absorbing substances such as macrogol can be used

Laxatives from the pharmacy are, for example, the active ingredients bisacodyl and sodium picosulfate. They are usually used as suppositories or mini enemas.

Irritable Bowel: Treatment of cramps and pain

If constipation is accompanied by cramps, herbal medications can help. For example, peppermint and cumin oils , which are taken in capsule form. In this way, they reach their site of action in the intestine undamaged. Aniseed and fennel can also soothe the intestines.

If herbal medicines are not enough, the antispasmodic agent butylscopolamine has proven itself. It is often used in conjunction with the pain reliever acetaminophen . Other active ingredients with an antispasmodic effect are mebeverine or trospium chloride. Unlike the herbal preparations mentioned, these may not be used permanently.

Irritable bowel: What helps against flatulence?

Irritable bowel syndrome can result in excessive gas build-up due to disrupted food utilization and altered bowel movement. In people with irritable bowel syndrome, these often do not go away spontaneously and can also trigger cramp-like symptoms and bloat the abdomen.

Herbal remedies against flatulence such as caraway and peppermint oil, fennel or anise not only have an acute effect, but can also be taken preventively and over the long term. If they are not sufficient, defoaming drugs such as simethicone and dimethicone relieve the symptoms.

Fennel for flatulence
Fennel can help with acute flatulence and also prevent it. Anise, caraway and peppermint oil also soothe the intestines.

Irritable bowel: Homeopathy & Co.

There are a number of homeopathic preparations that are said to have a soothing or preventive effect. The following resources are used, among others:

  • Bismuth oxide nitrate (Bismuthum subnitricum)
  • Cerium oxalicum
  • Zeweed flower (Cina artemisia)
  • Cyclamen (cyclamen)
  • ginseng
  • Also: Schuessler salt, potassium sulfuricum

The concept of homeopathy and its specific effectiveness are controversial in science and not clearly proven by studies.

Irritable bowel: therapy with probiotics

Probiotics are viable gut bacteria that can be taken as dietary supplements. They should bring a disturbed intestinal flora back into balance. Whether and if so which probiotics help with irritable bowel syndrome has not yet been fully clarified. However, there is evidence that various bacteria such as Bifidobacterium bifidum MIMBb75 may actually help.

Experts suspect that the effectiveness depends on the particular form of the disease. For example, there is evidence that probiotic treatment is particularly effective if irritable bowel syndrome was preceded by a gastrointestinal infection.

Irritable bowel: Help through relaxation

An irritable bowel syndrome is often triggered or exacerbated by stress and acute or chronic overload. Those affected should observe whether psychological or physical stressful situations aggravate the irritation syndrome symptoms. Here, too, a diary can help to recognize such connections.

As far as possible, the known stressors should be avoided. But that is not always possible. It is therefore important to learn how to deal with stressful situations and to actively reduce stress. Targeted stress management, but also procedures such as autogenic training , progressive muscle relaxation or yoga can help to prevent or alleviate the symptoms.

antidepressants and psychotherapy

Irritable bowel syndrome is also often associated with psychological symptoms such as depression or anxiety disorders. They are associated with stress and can thus promote and intensify irritable bowel syndrome. If the psychological symptoms are treated as part of psychotherapy or with antidepressants, the irritable bowel symptoms often improve as well.

In addition, antidepressants partially influence the muscles of the gastrointestinal tract and can have a pain-relieving effect.

Irritable bowel: nutrition

In patients with irritable bowel syndrome, the intestine reacts much more sensitively to all influences. This also applies to nutrition. Food that is difficult to digest can overwhelm it more easily than a healthy intestine.

However, there is no general recommendation for the diet for irritable bowel syndrome: Different rules apply to diarrhea than to constipation. Also, each sufferer responds differently to different foods.


It is also true for fiber that not every irritable bowel patient responds well to it. They seem to help with constipation in particular. Liquid fiber may also benefit patients with diarrhea or bloating as the main symptom.

Diet tips for irritable bowel syndrome

The following dietary rules have been found helpful for some IBS sufferers:

  • Eat slowly.
  • Don’t swallow too much air unnecessarily.
  • Many small portions are better than a few large ones.
  • Drink enough. Non-carbonated mineral water, for example, is good.
  • Fatty foods, legumes, strong spices, sometimes coffee, alcohol, nicotine or dairy products can cause symptoms.
  • Some people are also sensitive to white flour products, convenience products and various sugar substitutes.
  • Pay attention to the composition of the food and what time of day you eat.
  • Eat regularly and always at fixed times.
  • Do not eat too much, especially in the evening.
  • Take your time with your meals, try to eat them in a calm atmosphere.

Warmth for the stressed stomach

A hot water bottle on your stomach can relieve pain and cramps and soothe your bowels.

Irritable bowel: course of the disease and prognosis

Irritable bowel syndrome (IBS) or irritable colon is one of the most common gastrointestinal diseases in Europe. The disease often occurs for the first time between the ages of 20 and 30. Women are affected about twice as often as men.

Irritable bowel can progress very differently from person to person. The symptoms can also increase and decrease again, stop completely, but also return. In some patients with IBS, diarrhea, constipation, pain and bloating alternate. The disease often significantly affects the quality of life.

If those affected can find out what triggers their symptoms, they have a better prognosis. Around 34 percent of patients manage to alleviate their symptoms through targeted behavioral changes and therapeutic measures, or they even become completely symptom-free.

However, if irritable bowel syndrome persists for a long time, the prognosis is usually worse. About every second affected person develops chronic irritable bowel syndrome and suffers from the symptoms for many years or even his entire life. There is currently no treatment that can completely cure the disease. However, there is also no evidence that other serious diseases are caused by irritable bowel syndrome.

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