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IBS vs. IBD: What's the Difference?

December 21, 2023

Women with IBD or IBS clutching her stomach.

At some point in time, you’ve probably caught a stomach bug that caused diarrhea. Or maybe you remember overindulging on sweets and then feeling sick to your stomach with belly pain and bloating. These things happen, but they go away soon enough.

If, however, you regularly experience stomach pain and a change in bowel movements — and it’s not because of the stomach flu or eating too much candy — it’s time to see a doctor. You could have irritable bowel syndrome (IBD) or inflammatory bowel disease (IBD). But what’s the difference?

Ari Young, MD, a gastroenterologist with Atlantic Health System, explains the difference between these two gastrointestinal (GI) disorders and how each is diagnosed.

What is irritable bowel syndrome (IBS)?

Irritable bowel syndrome, or IBS, is a chronic (long-term) disorder of the GI tract, which stems from dysfunction of the gut-brain interaction.

If you have IBS, you may experience abdominal pain, bloating and changes in bowel habits (either constipation, diarrhea or a mix of both).

Two main types of IBS

IBS is characterized into subtypes based on your pattern of bowel habits.

If you’re predominately constipated, it’s called IBS-C. If you predominately have diarrhea, you are considered to have IBS-D. However, it is possible to alternate between both diarrhea and constipation.

How is IBS diagnosed?

There is no single test to diagnose IBS, but your doctor may order a colonoscopy or other diagnostic test to rule out other alternative GI disorders.

Instead, IBS is diagnosed by the type and frequency of your symptoms. Doctors use the Rome IV Criteria, which requires:

  • Recurrent abdominal pain occurring at least one day a week for three consecutive months.
  • The abdominal pain is associated with two or more of the following:
    • Related to having a bowel movement (defecation).
    • Change in bowel frequency.
    • Change in appearance of stool (for example, hard-to-pass dry lumps or loose and watery).
  • Symptoms should have started at least six months before diagnosis.

What is inflammatory bowel disease (IBD)?

Inflammatory bowel disease, or IBD, is a term used to identify a spectrum of disorders involving the GI tract, which result from overaction of your body’s immune system.

If you have IBD, you may experience abdominal pain, diarrhea, blood in your stool and/or unexplained weight loss. Depending on the type of IBD, you also may experience urgency or feel the need to use the bathroom but are unable to go (tenesmus).

Two main types of IBD

Crohn’s disease can cause inflammation anywhere along the GI tract, from the mouth to the anus. It often involves the small intestine, where ulcers (small sores) develop. Severe inflammation can lead to strictures (areas of narrowing of the intestine) or fistulas (formation of an abnormal connection between the bowel and nearby structures).

Ulcerative colitis can also cause inflammation and ulcers, although it’s limited to the large intestine (colon and rectum).

Learn more about these IBD types >

How is IBD diagnosed?

Unlike IBS, symptoms are only a clue to the diagnosis. Diagnosis requires an evaluation by a gastroenterologist, which may include a colonoscopy (internal exam of the large intestines using a flexible scope with a light and camera on the end) with biopsies (examination of intestinal tissue cells under a microscope).

Additional testing may also include sending blood and stool samples to a laboratory to look for signs of inflammation and having a CT scan, MRI or video capsule endoscopy (swallowing a small pill camera) to evaluate your small intestines.

Currently, there’s no cure for either condition — but that doesn’t mean there’s no hope.

IBS symptoms can be managed through diet, medication and stress management techniques such as psychotherapy and meditation. IBD, on the other hand, requires medical interventions, including a variety of medications that help promote healing of the GI tract and, in some cases, surgery.

With the help of a skilled gastroenterologist, you can live a full, happy life with IBS or IBD.

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