Changes You Should Not Ignore if You Have IBS

Is it common for IBS symptoms to return after a person has been symptom-free for over a year?
IBS is best thought of as a life-long disorder, just like migraine or asthma. You will always be predisposed to abdominal (tummy) problems but that doesn’t mean to say they will be there all the time. Your tummy is your “‘weak spot,” so that is the area that will likely suffer first for instance when you are ill, eat the wrong thing, or are otherwise stressed. Many patients find it frustrating that they can’t identify why they are having a bad time. It is perhaps best not to try too hard to find the reason as there are probably lots of triggers that we don’t even know about yet.

The symptoms of irritable bowel syndrome (IBS) can be hard to manage. Symptom episodes may continue to interfere with normal activities well after an initial diagnosis and treatment. That can be discouraging and a cause of worry. It’s reassuring to know that having IBS does not put you at an increased risk of developing other digestive disorders or diseases. However, the overlap is possible. 

Learn more about overlapping conditions with IBS

Despite this, there are times when it may be best for your healthcare provider to review your symptoms and how they affect you. Here are suggestions for when to seek additional guidance from a medical professional.

Learn more about the symptoms of IBS

Developments of Concern

Wrong beliefs about IBS may lead to distress, more healthcare provider visits, and unneeded tests. It helps to know, IBS:

  • Does not cause physical damage
    • Does not increase the risk of colon cancer, inflammatory bowel disease (IBD), diverticulitis, or other gut disorders

On the other hand, IBS does not protect you from acquiring another disorder or condition. It also can coexist with another disorder.

Two situations provide alerts that another disease might be present:

  • The presence of an “alarm” symptom or sign
  • Clinical or family history linked to increased personal risk

Alarm Symptoms – An “alarm” symptom, sometimes also called a “red flag,” simply means a symptom not explained by IBS, which calls for additional investigation. These are symptoms and signs of an underlying disease that physically damages the gut.

Sometimes the most alarming of such symptoms, namely bleeding, turns out to be un-alarming after all, but you should always let your healthcare provider know. Small amounts of bright red blood usually turn out to be from a hemorrhoid or small tear (fissure) in the anal passage. Rarely, it could be due to another condition that requires treatment. On the other hand, large amounts of red blood or black, tarry-colored stool calls for urgent medical attention.

Here are some typical signs that call for special attention:

  • New symptom onset at age of 50 or older
  • Blood in the stools (red blood or black, tarry stool)
  • Fever, shaking chills, or night sweats
  • Nighttime symptoms that wake you up
  • Unintentional weight loss
  • Change in your typical IBS symptoms (like new and different pain)
  • Recent use of antibiotics
  • Family history of other GI diseases, like cancer, inflammatory bowel disease, or celiac disease

Learn more about alarm symptoms

Increased Personal Risk – Sometimes there is a factor in your life that may put you at greater than average risk of acquiring a serious intestinal disease. For example, if a parent or sibling has had colon cancer or even a precancerous colonic polyp, then your risk of polyps is greater than normal. Inflammatory bowel disease (ulcerative colitis and Crohn’s disease) tends to occur in families. Celiac disease, where essential nutrients fail to be absorbed, has its greatest prevalence among the descendants of people born in Northern Europe.

IBS patients are as likely as anyone to suffer an intestinal infection, which may add to and confuse the symptoms. You should be suspicious of an infection if:

  • You have been traveling to tropical or developing parts of the world
  • Friends and family are infected
  • You have been exposed to possibly contaminated drinking water

Let your healthcare provider know about any of these concerns.

When to See your Healthcare Provider

IBS follows an unpredictable course. There may be periods of relative calm, mixed back and forth with periods of pain or discomfort, and chaotic bowel habits that interfere with your life. However, if the basic pattern of your bowel symptoms changes or one of the situations described above occurs, a visit to your healthcare provider is in order.

Sometimes a drug you are taking for another purpose or something new in your diet may be responsible for the change, and your healthcare provider can help you determine that. A visit also provides your healthcare provider with the opportunity to review your diet, exercise habits, and drug regimen, and perhaps recommend changes.

Learn more about working with your healthcare provider

Putting it all Together

IBS is long-term (chronic) and tends to repeatedly come and go over time. It does not predispose you to other GI diseases. However, IBS does not protect you from other digestive conditions, and overlap is possible. New and different symptoms may make you suspicious that something new is happening.

You should visit your healthcare provider if you become aware of alarm symptoms or of a factor that might put you more than normally at risk of another disease. Your healthcare provider may review your symptoms and determine if further testing or treatment is necessary.

Usually, if the original diagnosis was sound, recurrent, but similar symptoms do not signify a new disease.

Adapted from IFFGD Publication: Changes You Should Not Ignore if You Have IBS Updated by: Walter Chan, MD, MPH, Director, Center for Gastrointestinal Motility, Assistant Professor, Harvard Medical School, Gastroenterology, Hepatology and Endoscopy, Boston, MA; Adapted from: W. Grant Thompson MD, FRCPC, FACG, Professor Emeritus, Faculty of Medicine, University of Ottawa, Ontario, Canada; Edited by: Darren Brenner, MD, Associate Professor of Medicine and Surgery, Northwestern University – Feinberg School of Medicine, Chicago, IL

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IFFGD is a nonprofit education and research organization. Our mission is to inform, assist, and support people affected by gastrointestinal disorders.

Our original content is authored specifically for IFFGD readers, in response to your questions and concerns.

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