It’s easy to mix up inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) because the names sound very similar, and some people with IBD can also have IBS, but these gastrointestinal conditions are two very different medical issues. IBS and IBD do have some similar symptoms, including stomach pain, bloating, diarrhea and constipation, but that’s pretty much where the similarities end. Although they are both chronic conditions, IBS and IBD have very different treatments and getting the correct diagnosis is key to properly managing the symptoms. Here are the differences:
Irritable Bowel Syndrome
IBS is known as a functional disease, meaning you may have a group of symptoms, but diagnostic tests and procedures may not show any physical explanation for those symptoms. The symptoms of IBS and their intensity vary from person to person. Symptoms can occur after eating a large meal or can be induced by stress. They can temporarily be relieved by having a bowel movement. IBS is largely managed by gastroenterologists with non-operative treatment plans.
Unlike IBD, IBS cannot be confirmed by visual examination or with diagnostic tests because it does not cause inflammation in the digestive tract. Your doctor may use blood and stool tests, x-ray, endoscopy, or other tests to rule out other diseases. People with IBS would typically present with stomach pain for at least one day a week for the past three months. The pain is usually associated with a bowel movement. Other symptoms of IBS include gassiness, nausea or the feeling of needing to have a bowel movement.
The causes of IBS are not clear. People with IBS usually try to treat it with dietary changes, however, there is no specific diet that works for everyone with IBS. Your doctor may also prescribe medications to help with diarrhea or constipation if those are symptoms you’re trying to manage. Other treatments that may help relieve IBS include stress management, acupuncture, and relaxation training.
Inflammatory Bowel Disease
IBD is a term used to describe a group of autoimmune disorders (the body attacks its own organs) where the intestines become inflamed. The occurrence of IBD is increasing yearly in the United States. IBD is broken up into three main classes: Crohn’s disease, ulcerative colitis, and indeterminant colitis. Unlike IBS, with IBD there is physical damage such as inflammation, ulcers and bleeding. These may require tests of blood and stool, a colonoscopy, imaging studies like CAT scans or MRIs, or a biopsy in order for your physician to make a diagnosis.
The symptoms unique to IBD that are caused by inflammation in the gut can include blood in the stool or black stools, weight loss or loss of appetite, and fever. The medical treatment of IBD aims at controlling the inflammation caused by the body, and surgery is occasionally needed. According to David Schwartzberg, MD, Colorectal & IBD Surgeon at Mather Colorectal Surgery, “patients are best served by seeing specialists who manage and can perform complex operations on patients with IBD to have the best outcomes and get the patient back to living their lives.”
Crohn’s disease can cause pain, fever, bleeding, bloating, ongoing abdominal infections, recurrent abscesses around the anus, unintended weight loss and an inability to eat. Crohn’s disease can occur in any portion of the gastrointestinal tract starting from the mouth, through the stomach, small intestine, colon, rectum, anus and peri-anal area. Crohn’s disease is further divided into stricturing disease (intestinal narrowing), penetrating disease (fistula/abnormal connection between organs) and inflammatory disease. Unfortunately, the majority of patients with Crohn’s disease will need an operation during their life (but new medications designed to help patients avoid surgery are becoming more effective), and optimal treatment occasionally involves a variety of medications, including steroids and biologics, and repeat operations. “Crohn’s disease is managed by a team that is dedicated to treating patients with IBD and consists of colorectal surgeons, gastroenterologists, dieticians, stoma therapists and many other members of the IBD team,” said Dr. Schwartzberg.
Ulcerative colitis is a disease that is confined to the large intestine (the colon and rectum) and can cause diarrhea, pain, fever, bleeding and unintended weight loss. Most patients do not need surgery to remove their colon and rectum; however, patients may need to be on long-acting medications that may additionally include the use of steroids and/or biologics.
“For patients who do need surgery, it is performed in stages (different operations) and involves removing the colon and rectum, which removes the disease ulcerative colitis, and then creating an ileo-pouch-anal-anastomosis, or ‘J-pouch,’ which allows the patient to not have an ileostomy bag (bag on the skin to collect stool),” Dr. Schwartzberg said. “Occasionally, the J-pouch does not work and specialized centers, like Mather Colorectal, can re-do the J-pouch so the patient can again live without an ileostomy bag,” said Dr. Schwartzberg. Ulcerative colitis is managed by a team that is dedicated to treating patients with IBD and consists of colorectal surgeons, gastroenterologists, dieticians and stoma therapists.
Indeterminant colitis is part of IBD; however, its symptoms and results of the tests make it impossible to tell which type of IBD the patient has, despite an extensive workup. Luckily, the majority of treatments for Crohn’s disease and ulcerative colitis are similar, so regardless of which type of IBD the patient has, the patient can still be treated by the IBD team. Often times, years after the diagnosis of Indeterminant colitis, the patient is eventually considered to have Crohn’s disease or ulcerative colitis.
Like IBS, the causes of IBD are unknown. It is thought that bacteria or viruses may trigger the body’s immune system to produce an inflammatory reaction in the intestinal tract. Some combination of hereditary, genetic, or environmental factors may also play a role in the development of IBD.