Irritable bowel syndrome (IBS) causes chronic and sometimes debilitating symptoms like abdominal pain, diarrhea, and constipation. Because of these symptoms, people with IBS often struggle with relationships, body image, and issues at work.

People with IBS are more likely to have depression and report a lower quality of life. IBS can interfere with so much in a person’s life. It can affect work productivity and get in the way of socializing and other daily activities. That’s why it’s so important that treatment plans for IBS address mental health and social issues in addition to physical ones.

The Gut Microbiome and IBS

Recent research has highlighted the important role that the gut microbiome may play in irritable bowel syndrome. The gut microbiome refers to the trillions of microorganisms, including bacteria, viruses, and fungi, that live in our digestive tract. In people with IBS, studies have found differences in the composition and diversity of gut bacteria compared to those without IBS. These alterations in gut microbiota may contribute to IBS symptoms and overall gut health.

Some key findings on the gut microbiome in IBS include:

- Reduced diversity of gut bacteria in some IBS patients
- Changes in the relative abundance of certain bacterial groups
- Increased intestinal permeability or "leaky gut"
- Alterations in gut immune function and inflammation

While the exact mechanisms are still being studied, these microbiome changes may affect gut motility, visceral sensitivity, and brain-gut interactions in IBS. Strategies to improve gut health, like dietary changes, probiotics, and prebiotics, aim to positively influence the gut microbiome. However, more research is still needed to fully understand the complex relationship between the gut microbiome and IBS symptoms.

Coping with symptoms

The pain, diarrhea, and constipation from IBS can be a lot to worry about, but there are things you can do to help make it more manageable and less stressful.

Figure out where the nearest bathroom is: Part of the anxiety of IBS is that you never know when you’re going to need to find a toilet, fast. Knowing where it is ahead of time can help reduce stress.
Avoid your triggers: Keep a journal for a few weeks to see if there are certain foods that bring on symptoms, like dairy, coffee, or alcohol. If you notice a pattern, discuss with your doctor and plan not to eat those foods when you aren’t at home. Checking a restaurant’s menu before going there can help make sure you’ll have something you can safely eat.
Adjust what you eat: Your doctor may suggest you eat more fiber and avoid foods high in FODMAPs (a group of hard-to-digest carbohydrates).
Don’t rely on other people for rides: If your IBS flares up, you might want to head home before everyone else. It’s a good idea to have your own way of getting home so you can leave when you need to.
Carry an emergency kit: In a perfect world, you’ll always be near a bathroom exactly when you need it. When that isn’t possible, always having extra underwear, toilet paper, wet wipes, and a large plastic bag will help you out until you can get home.
Focus on healthy habits: Being more physically active, reducing your stress, and getting enough sleep may also help with symptoms.
Try cognitive behavioral therapy (CBT): This talk therapy approach focuses on changing your thought patterns as a way to reduce symptoms.
Consider prescription medications: Depending on whether you have diarrhea, constipation, or abdominal pain, you might be prescribed certain medications, including antibiotics, laxatives, antidepressants, or opioid agonists.
Learn about probiotics: This is a newer potential treatment area for IBS, so there isn’t a hard-and-fast rule about how to use probiotics. They are believed to improve the mix of bacteria in your gut (called your gut microbiome).

Dr. Rx

Acceptance is an important part of living with IBS. Accept that although things will likely never be perfect and symptoms may never completely disappear, they will almost certainly get somewhat better with treatment. —Dr. Adam Pont

Can IBS cause anxiety and depression?

Maybe. Mental health issues may contribute to IBS, and IBS may make depression and anxiety worse. An estimated 36% of people with IBS have depression and 44% have anxiety, according to a review of studies published in the journal BMC Gastroenterology.

Some researchers believe that IBS can impact the central nervous system and immune system. This may be how IBS leads to depression or anxiety. The research has been mixed about the association and is ongoing.

Because IBS and mental health issues often occur together, treatment plans may include screening patients for depression or anxiety and incorporating medication and cognitive behavioral therapy (CBT).

Pro Tip

The coping strategies that you can learn through cognitive-behavioral therapy (CBT) are very powerful. When the CBT process is successful, it essentially “re-wires” your cognitive responses to stressors/ triggers. In some cases, this can be as powerful as the response to medication. —Dr. Pont

IBS and sex

Being intimate when you have IBS can be stressful. Recent studies have shown that people with IBS report more sexual dysfunction than people without IBS. Here are some of the reasons why you might not feel like having sex—and ways to overcome them.

Physical discomfort/pain: When people have IBS, they are often more sensitive to pain. As a result, they can have more discomfort during sex. Talk to your doctor about this since there might be a solution, such as using lubricants.
Embarrassment: Nothing kills desire like worrying you are going to pass gas in the middle of sex or that you’re going to need to rush to the bathroom. This is where being in a loving, trusting relationship comes in. If the person you’re with knows about your medical issue, you should feel more comfortable and not have to hide any symptoms.
Mental health issues: Depression can affect your sex drive due to feelings of hopelessness and fatigue. Antidepressants might also impact your sex drive, so discuiss any issues with your doctor because there are many different medications you can try.
Erectile dysfunction: Men with IBS are more likely to have erectile dysfunction, according to the International Journal of Impotence Research. Your doctor can figure out what is causing the erectile dysfunction and suggest a treatment plan.

Dating someone with IBS

Dating is not easy for many people, but when someone has IBS it can be even harder. People may feel a lot of shame and worry about having the disease. For instance, it can be embarrassing when you stay in the bathroom for a long period of time during a date or suddenly have to rush off a phone call or FaceTime.

Choose activities carefully. If you have IBS and are dating, try to avoid IBS triggers. If eating usually brings on diarrhea, plan afternoon outings to a museum instead of going to a restaurant.
Plan what you’ll eat. Order foods that are less likely to trigger an attack. Choose restaurants that you know have food you can eat.
Wait for the right time to discuss IBS. When you trust the person and the time seems right, you can explain the disease and how it impacts your life.
Fight feelings of shame. You’ve probably been conditioned to feel uncomfortable talking about anything related to the bathroom, but try to remind yourself that nearly every single person has had diarrhea or been constipated. Start by being honest about your emotions (“I’m embarrassed to say this, but I really want to be honest with you…”) and stick to the facts as much as you can.

If you are the person in a relationship with someone who has IBS, be patient and understanding. You don’t want them to feel more stressed, which can make IBS symptoms even worse.

Cognitive behavioral therapy for IBS

Because there may be a brain-gut connection with IBS, some treatment plans include forms of talk therapy. Cognitive behavioral therapy (CBT) has been shown to improve both the symptoms of IBS (both pain and bowel function) and also quality of life, according to a review in Psychology Research and Behavior Management.

Studies show that from 42–72% of people with IBS who follow a structured CBT treatment plan have a significant improvement in their symptoms. A CBT plan may include the following components:

Education: A therapist helps educate you about the gut-brain connection and explains the role of mental health in IBS. This can help you understand how and why the therapy works.
Relaxation strategies, such as breathing techniques, can engage the parasympathetic nervous system, which helps regulate digestion and other bodily functions. This can help the gut and may reduce your sensitivity to pain.
Cognitive restructuring. Being hyper-focused on symptoms and obsessing over when they might be triggered can cause stress, which can bring on more symptoms. The goal of cognitive restructuring is to learn specific techniques to notice these thoughts and replace them with more positive ones.
Coping skills, like acceptance, can help you feel like there is something you can do even though the IBS can’t be solved.
Exposure techniques are when you put yourself in situations that you usually try to avoid because of IBS, like eating at restaurants. By gradually increasing your exposure to these stressors, they should become less threatening as you start to feel more in control.

See all treatment options

Pro Tip

One very encouraging study from 2008 showed that a primarily self-directed course of CBT (with a few in-person sessions with a therapist) is just as effective, and possibly more effective, than standard multi-session therapist-directed treatment. 72% of patients reported adequate relief and improvement of symptoms in the self-directed group. This has been confirmed in more recent studies (2021). —Dr. Pont

IBS support groups

Talking to others with IBS can help you feel less alone and also give you insight into how others manage their symptoms. Here are some worth looking into:

IBS Patient Support Group: This online group is a place to ask questions and weigh in on other people’s questions. Topics range from diet and nutrition to managing symptoms.
IBS Support Facebook Group: This group has more than 84,000 members sharing how they manage the physical and emotional aspects of the disease.

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The stories shared below are not written by Buoy employees. Buoy does not endorse any of the information in these stories. Whenever you have questions or concerns about a medical condition, you should always contact your doctor or a healthcare provider.

Adam Pont, MD, PhD.

Gastroenterology Fellow, New York Presbyterian Hospital/Columbia

Dr. Pont is currently a fellow in Gastroenterology at New York Presbyterian Hospital/Columbia, where he also completed his residency in Internal Medicine. Dr. Pont received his medical degree and PhD at the New York University School of Medicine. He earned his BS in Biological Systems Engineering at the University of Nebraska-Lincoln.

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References

Pittayanon R, Lau JT, Yuan Y, et al. Gut Microbiota in Patients With Irritable Bowel Syndrome-A Systematic Review. Gastroenterology. 2019;157(1):97-108. https://www.gastrojournal.org/article/S0016-5085(19)40579-8/fulltext
Chong PP, Chin VK, Looi CY, Wong WF, Madhavan P, Yong VC. The Microbiome and Irritable Bowel Syndrome - A Review on the Pathophysiology, Current Research and Future Therapy. Front Microbiol. 2019;10:1136. https://www.frontiersin.org/articles/10.3389/fmicb.2019.01136/full