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I Wish People Would Understand That IBD and IBS Are Not The Same

Real Talk

May 27, 2022

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Lucas Ottone/Stocksy United

Lucas Ottone/Stocksy United

by Holly Fowler


Medically Reviewed by:

Kelsey Trull, PA-C


by Holly Fowler


Medically Reviewed by:

Kelsey Trull, PA-C


While the two health conditions share similar symptoms and abbreviations, the effects they have on daily life cannot be equated.

I have ulcerative colitis (UC), a form of inflammatory bowel disease (IBD). After having lived with this health condition for over 14 years, I’ve noticed that acquaintances often confuse IBD with irritable bowel syndrome (IBS), and even use the two terms interchangeably.

I’m here to tell you they are not the same thing.

Some confusion is understandable. Their abbreviations are similar, and both affect the gastrointestinal tract, producing painful and sometimes debilitating gastrointestinal symptoms. Both are worsened by stress and food sensitivities. Both make social activities difficult, and they can spike anxiety when a bathroom is out of reach.

That said, they’re very different health conditions. I was first diagnosed with IBS 10 years before being diagnosed with IBD. Having experienced both conditions, I wish people would understand that IBD and IBS are not the same.

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The differences between IBD and IBS

IBS is a functional gastrointestinal disorder, meaning there are no problems with the structure of the gut.

Symptoms of IBS include:

  • gas
  • bloating
  • nausea
  • diarrhea
  • constipation

The root cause of IBS is unknown, but common triggers of these symptoms can include:

  • stress
  • certain foods
  • hormonal changes
  • some medications

It’s the most common condition seen by gastroenterologists, affecting some 10 to 15 percent of the population.

On the other hand, IBD, which includes UC and Crohn’s disease, is a chronic and complex immune-mediated inflammatory disease, meaning that your body has an atypical immune response to environmental triggers. This type of response causes inflammation and sores, damaging the lining of the gastrointestinal (GI) tract.

Those of us living with IBD want to feel seen and understood. When people say, ‘I have IBS, too,’ it diminishes what we experience.

According to the Centers for Disease Control and Prevention (CDC), UC primarily affects the colon (also known as the large intestine), while Crohn’s can involve any part of the GI tract.

Symptoms of IBD include persistent:

  • diarrhea
  • urgency
  • pain
  • rectal bleeding or mucus production
  • weight loss
  • anemia

Only about 1.3 percent of the U.S. population has IBD, though people with a family history of the disease are more likely to develop it themselves. Diagnosing and treating IBD is also much more complicated than it is with IBS.

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The path to diagnosis

Because there’s no structural damage in IBS, there’s also no specific test for it. Doctors typically diagnose IBS quickly, based on past medical history and current symptoms, and by ruling out other possible diagnoses.

For many people, arriving at an IBD diagnosis can be a long and tiresome process. A 2009 study found that, for 44 percent of people who are eventually diagnosed with UC or Crohn’s, it took 1 to 4 years to reach that diagnosis. Similarly, 46 percent of study participants visited three or more doctors before being diagnosed.

Testing for IBD can include blood and stool tests, imaging studies like MRIs or CT scans, and more invasive procedures like a colonoscopy or endoscopy.

I was lucky in that my diagnosis of UC was unusually quick. I woke up one day with an upset stomach, and treated it like a simple stomach flu. After a week of this with my pain only getting worse, I was admitted to the hospital.

Because my father had been diagnosed with Crohn’s 6 years earlier, I immediately underwent a sigmoidoscopy and was diagnosed with IBD.

Differences in treatment

IBS is typically resolved by modifying diet and lifestyle with steps, like adding more fiber, getting more exercise, and reducing stress.

For IBS, doctors may also recommend adding a probiotic, or they may prescribe medications, like:

  • antidiarrheals
  • antibiotics
  • antispasmodics
  • laxatives

IBD often requires one or more medications to heal the lining of the GI tract, reduce the inflammation and its associated symptoms, and maintain remission. These medications include:

  • steroids
  • biologics
  • aminosalicylates
  • immunomodulators

In about a quarter to a third of UC cases, and even higher numbers for Crohn’s, surgery may be necessary.

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Why does this distinction matter?

Those of us living with IBD want to feel seen and understood. When people say “I have IBS, too,” it diminishes what we experience.

IBS symptoms come and go and are manageable with diet and lifestyle, but Crohn’s and UC flares can last months without relief in sight.

An IBD flare can be debilitating and disrupt everyday life, making it difficult to complete simple errands, like buying groceries or picking up the kids from school. We may even require the support of a therapist or peer group for our mental or emotional health to successfully manage our daily lives.

Depending on the severity of the flare, some IBD warriors may need to take extended time away from work or school to focus on their health.

There’s no cure for IBD, which means it’s a lifelong disease. People with IBD face the long-term consequences that it brings, like:

  • medication side effects
  • social ramifications of missing out on parties, making new friends, and keeping old ones
  • disappointment of missed family celebrations and other events
  • missed days at work that hold us back from promotions and raises
  • mental and emotional toll that we carry with us like social anxiety, stress, and frustration.

Clearing the confusion

When someone confuses IBS and IBD, I may or may not explain the differences, depending on how I am feeling in the conversation. If I do, my explanation usually goes something like this:

“I’m sorry to hear that you have IBS. I know that must be painful and difficult for you. I appreciate your empathy, and I understand how you could equate IBS with IBD. But they’re actually quite different: IBS is a collection of gastrointestinal symptoms that can usually be controlled by switching up your diet and lifestyle.

“IBD is an autoimmune disease that causes inflammation in the GI tract and often requires medication or surgery. The symptoms can be so frequent and severe that it causes me to miss out on many family, social, and work events. There’s no cure, so I’ll have this disease for the rest of my life.”

I don’t want to have to constantly explain my condition this way to everyone I encounter, though. If more people understood the difference between IBD and IBS, it might not have to be such an exhausting — and fairly intimate — conversation to have.

Medically reviewed on May 27, 2022

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About the author

Holly Fowler

Holly Fowler lives in Los Angeles with her husband and their dog, Kona. She loves hiking, trying the latest gluten-free hot spot in town, and working out as much as her ulcerative colitis allows. When she isn’t seeking out gluten-free vegan desserts, you can find her working behind the scenes of her website, Colitiscope Nutrition, and Instagram.

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