What you need to know about irritable bowel syndrome

Woman holding her stomach in pain

An upset stomach can turn a pleasant day into an irritable one. No matter the reason, your stomach may be trying to tell you something!

Irritable bowel syndrome (IBS) is a chronic condition that causes abdominal pain associated with changes in the frequency or form of stool. It's different than ulcerative colitis or Crohn's disease, which are part of a family of conditions known as "inflammatory bowel disease." These conditions have very different treatments than irritable bowel syndrome. There are three main types of IBS: constipation-predominant, diarrhea-predominant, and mixed. IBS can cause a range of symptoms, including bloating, abdominal pain and changes in bowel movements — sometimes diarrhea, sometimes constipation and sometimes both.

Symptoms and diagnosis

Dr. Braden O`Neill
North York General Family Physician Dr. Braden O'Neill

“Although there are no known exposures that cause IBS, people are more likely to have it if they have other conditions that cause chronic pain and discomfort, such as fibromyalgia, acid reflux or mental health conditions such as depression and anxiety. But many people have IBS without any risk factors or other conditions,” explains Dr. Braden O'Neill, a Physician with North York General Hospital's Family Medicine Teaching Unit. Dr. O'Neill, a Rhodes Scholar, is also a Clinician-Researcher at our hospital.


“We don't know why some people get IBS and why some people don't, but the symptoms are very real. Thankfully there are clear diagnostic criteria and effective treatments that can improve symptoms,” says Dr. O'Neill. There are specific criteria for diagnosis, which include the presence of abdominal pain that is associated with a change in the frequency or form of bowel movements, for at least one day per week over the last three months.

“Doctors will also ask questions about other symptoms, such as rectal bleeding, diarrhea that wakes you up at night, or unintentional weight loss, that are not associated with IBS and may point to another cause.”


The treatment for IBS depends on the symptoms an individual has. Sometimes medicines can be helpful to improve symptoms of constipation or diarrhea.  As well, trying different foods or increasing water intake can make a big difference.

Can I eat this?

For many people with IBS, the best symptom improvement related to dietary changes comes from a process of trial and error. “There are no clear rules about one food being particularly bad for people with IBS,” explains Dr. O'Neill. “There is some evidence that a diet low in FODMAPS (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) may help some patients with IBS.”

Many common foods such as poultry, cow's milk, and apples are considered high in these compounds, and so it's best to discuss with your doctor or allied health provider about an approach to changing your diet if you have IBS.

Eat your fibre

“A high fibre diet is another key strategy that may help symptoms of IBS, and in general is good for your health,” says Dr. O'Neill. Another general tip is to increase fluid intake, and to avoid the amount of time spent straining to have a bowel movement, which can worsen hemorrhoids and fissures and cause even more pain and discomfort.

Probiotic supplements

There are many probiotic supplements available intended to treat IBS. There is some evidence suggesting that probiotics in general may be beneficial for reducing IBS symptoms, but it's unclear which probiotic, and at what dose, is helpful. Dr. O'Neill suggests a trial and error approach because unfortunately there is no clear evidence to support the use of one probiotic supplement over another.

Will IBS lead to inflammatory bowel disease (IBD) or colon cancer?

IBS does not lead to IBD and does not increase your risk of colon cancer. You should still get recommended screening for colon cancer based on your risk profile and ask your doctor for more information; they will help you navigate age-appropriate colon cancer screening.

“I think the important thing is that IBS is common,” says Dr. O'Neill. “There are effective treatments — and people with IBS that is inadequately controlled, or who are concerned about recurrent abdominal pain, should see their doctor to discuss further.”

Looking for a family physician within our community?
Please contact NYGH's Rudy and Rita Koehler Family Medicine Teaching Unit at 416-756-6980.

This article was first published in the June 2019 issue of The Pulse.

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