Dr. Ajay B R, Consultant - Medical Gastroenterology, Aster Whitefield Hospital, Bengaluru

If you’re one of those people typing in “Why does my stomach hate me?” into a search bar, you are not the first. Digestive issues are fairly common, however not all of them are the same. In reality, not all of these conditions are what they seem, but one of the most common is irritable bowel syndrome (IBS). It shares many of the symptoms with other gut disorders, and the absence of any one single test to confirm the diagnosis of IBS, makes accurate diagnosis frustrating. So, what distinguishes IBS from everything else? These are six things you should know.

1. IBS Comes with a Pattern - IBS is chronic, meaning the symptoms usually persist or keep coming in intervals over months to years. The symptoms might include bloating, abdominal pain, diarrhoea, or even constipation, but the primary factors or triggers are food, stress and anxiety, medications and infections.
2. Diagnosis Made Through Process of Elimination - IBS is usually a clinical diagnosis and may require a few tests to rule out other pathologies presenting with similar symptoms. It is a diagnosis of exclusion - that other diseases presenting with similar complaints are excluded and then a diagnosis of IBS is made. But everyone who is suspected of IBS doesn't require tests. Most of the time, the doctor makes a clinical diagnosis based upon your clinical history and physical examination and if needed advises a few or more tests like blood tests, stool tests, ultrasound/CT scan, endoscopy and/or colonoscopy, depending upon your age and symptoms. All of these will help the doctor rule out certain pathological conditions like Inflammatory bowel disease, celiac disease, infections etc.
3. No Red Flags (But Still a Lot of Frustration) - If you have IBS, you will likely experience discomfort and disruption to daily life. However, serious alarm bells like rectal bleeding, weight loss, loss of appetite, repeated vomiting, and anaemia are very unlikely. If you do experience symptoms like these, though, it is important to investigate more serious health issues.
4. Stress Makes It Worse - The gut-brain connection is very real. IBS is super sensitive to emotional triggers. Everything from anxiety to excitement can cause flare-ups. Stress is known to aggravate many other gastrointestinal conditions, but for IBS patients, stress plays a particularly powerful role and is sometimes the reason.
5. Your Symptoms Fluctuate - IBS is a shapeshifter. One week, you’re bloated and constipated. The next time you’re racing to the toilet. This change between diarrhoea and constipation (or having one more than the other) is a key marker. Other disorders, such as Crohn’s or ulcerative colitis, tend to present a more stable pattern.
6. It Doesn’t Cause Structural Damage - IBS is a functional disorder, meaning that your intestines show no visible signs, but there is abnormal activity. Unlike conditions like Crohn’s, celiac, or colon cancer, IBS has no visible signs of inflammation, ulcers, or damage to the intestines. Therefore, scopes and scans often return normal results, while symptoms are present, everything else seems to suggest otherwise.

The Bottom Line

For those suffering from undiagnosed persistent gastrointestinal symptoms, if all tests show negative or inconclusive results, IBS is likely the main problem. The good news? It’s manageable. From dietary tweaks to stress management and medications, there are ways to get your gut back on your side.