Irritable Bowel Syndrome (IBS) Quiz
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Stomach ache
Abdominal pain
Bloating
Diarrhea
Constipation
Stomach pain with diarrhea
Mucus in stool
My stomach is rumbling
Stomach ache after eating
Loose stool not diarrhea
Pressure and fullness in upper abdomen
Lower abdominal pain
Not seeing your symptoms? No worries!
What is Irritable Bowel Syndrome (IBS)?
A condition with recurring episodes of abdominal discomfort, diarrhea, and constipation. IBS is diagnosed when no clear cause can be found despite investigations. The exact cause of IBS is unknown, but stress and certain foods are known to cause flare-ups.
Typical Symptoms of Irritable Bowel Syndrome (IBS)
- Abdominal bloating after meals
- Constipation with urge to go but unable to pass stool
- Stomach or abdominal pain
- Diarrhea followed by constipation, or vice versa
- Diarrhea commonly occurs before going to school
- Stomach or abdominal pain that improves with bowel movements
- Stomach or abdominal pain with frequent bowel movements
- Stomach or abdominal pain followed by loose stools
Diagnostic Questions for Irritable Bowel Syndrome (IBS)
Your doctor may ask these questions to check for this disease:
- Do you have abdominal bloating after meals?
- Do you have constipation where you feel the urge to go but can't pass stool?
- Do you have any stomach or abdominal pain?
- Do you have alternating diarrhea and constipation?
- Do you have morning diarrhea before school?
Treatment of Irritable Bowel Syndrome (IBS)
IBS is treated by avoiding triggers and alleviating symptoms. Identifying triggers like dairy, beans, fried food, or stress may help. The doctor may prescribe medications to relieve symptoms of diarrhea or stomach cramps. A FODMAPs diet may also be effective.
Reviewed By:
Unnati Patel, MD, MSc (Family Medicine)
Dr.Patel serves as Center Medical Director and a Primary Care Physician at Oak Street Health in Arizona. She graduated from the Zhejiang University School of Medicine prior to working in clinical research focused on preventive medicine at the University of Illinois and the University of Nevada. Dr. Patel earned her MSc in Global Health from Georgetown University, during which she worked with the WHO in Sierra Leone and Save the Children in Washington, D.C. She went on to complete her Family Medicine residency in Chicago at Norwegian American Hospital before completing a fellowship in Leadership in Value-based Care in conjunction with the Northwestern University Kellogg School of Management, where she earned her MBA. Dr. Patel’s interests include health tech and teaching medical students and she currently serves as Clinical Associate Professor at the University of Arizona School of Medicine.
Aiko Yoshioka, MD (Gastroenterology)
Dr. Yoshioka graduated from the Niigata University School of Medicine. He worked as a gastroenterologist at Saiseikai Niigata Hospital and Niigata University Medical & Dental Hospital before serving as the Deputy Chief of Gastroenterology at Tsubame Rosai Hospital and Nagaoka Red Cross Hospital. Dr. Yoshioka joined Saitama Saiseikai Kawaguchi General Hospital as Chief of Gastroenterology in April 2018.
Content updated on Nov 15, 2024
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FAQs
Q.
Kimchi for Women 30-45: Heal Your Gut, Balance Hormones & Next Steps
A.
Kimchi can help women 30 to 45 heal the gut and support hormone, immune, metabolic, and mood health; start with 1 to 3 tablespoons daily, choose naturally fermented refrigerated options, and pair with a balanced lifestyle for best results. There are several factors to consider, including sodium, spice, histamine, and IBS sensitivity; see below to understand more. If bloating, bowel changes, fatigue, or menstrual disruption persist, use an IBS symptom check and speak with a doctor to guide next steps; key dosing tips, safe use, food pairings, and red flags to act on are detailed below.
References:
* Park KY, Jeong JK, Lee YE, Daily JW 3rd. Health benefits of kimchi (Korean fermented vegetable) as a probiotic food. J Med Food. 2014 Jan;17(1):6-20. doi: 10.1089/jmf.2013.3083. PMID: 24040951.
* Baker JM, Chase DM, Herbst-Kralovetz ER. The Gut Microbiome and Estrogen Metabolism: A Key Link to Women's Health. Nutrients. 2017 Jul 24;9(7):681. doi: 10.3390/nu9070681. PMID: 28758956; PMCID: PMC5531512.
* Kim B, Kim H, Kim SK, Ryu S. Kimchi and Its Fermented Probiotics: A Review on Their Microbial Diversity, Health Benefits, and Potential as a Functional Food. Front Microbiol. 2021 Aug 20;12:701621. doi: 10.3389/fmicb.2021.701621. PMID: 34483863; PMCID: PMC8414444.
* Abad CL, Safdar N. The Role of Probiotics in Women's Health. Womens Health (Lond). 2021 Jan-Dec;17:17455065211029803. doi: 10.1177/17455065211029803. PMID: 34187317; PMCID: PMC8245508.
* Rezac A, Kok CR, Heermann M, Smid EJ, Dykstra E, van der Meulen S, Sanders JW. Fermented Foods, the Gut Microbiota, and Metabolic Health: A Systematic Review. Nutrients. 2022 Jul 1;14(13):2726. doi: 10.3390/nu14132726. PMID: 35807963; PMCID: PMC9268393.
Q.
Anxiety Poop: Why Stress Affects Your Digestion & Relief Tips
A.
Stress can trigger urgent, loose stools by activating the gut brain axis, a common reaction that is usually not dangerous, and relief often comes from calming the nervous system, gentle diet adjustments, hydration, and addressing anxiety itself. There are several factors to consider, including IBS overlap and personal triggers; see below to understand more. If symptoms are frequent or you have warning signs like blood in stool, unexplained weight loss, diarrhea lasting more than 2 to 3 weeks, severe pain, fever, or symptoms that wake you from sleep, try the IBS symptom check and speak with a clinician, and find full guidance below.
References:
* Mayer, E. A., Savidge, N. P., & Kirouac, S. V. (2019). Gut-brain axis in health and disease. *Physiological Reviews, 99*(3), 1827–1900.
* Konturek, P. C., Brzozowski, T., & Konturek, S. J. (2017). Stress and the Gut: Introduction to Psychogastroenterology. *Journal of Physiology and Pharmacology, 68*(5), 603–612.
* Chang, Y., et al. (2020). The role of psychological stress in irritable bowel syndrome. *World Journal of Gastroenterology, 26*(12), 1319–1334.
* Madison, A., & Kiecolt-Glaser, J. K. (2020). Stress, depression, diet, and the gut microbiota: human studies. *Advances in Experimental Medicine and Biology, 1195*, 195–207.
* Liu, Y., et al. (2021). Effect of psychological interventions on gastrointestinal symptoms and quality of life in patients with irritable bowel syndrome: a meta-analysis. *Journal of Clinical Gastroenterology, 55*(1), 31–43.
Q.
Best Probiotics for Women Over 65: Improve Gut & Immune Health
A.
Best probiotics for women over 65 include clinically studied strains such as Lactobacillus rhamnosus GG, L. reuteri, L. acidophilus, Bifidobacterium longum, B. lactis, B. bifidum, and Saccharomyces boulardii to support regularity, digestive comfort, immune defenses, and urinary and vaginal health. Choose strain-specific, multi-strain products with about 5 to 20 billion CFU and pair them with fiber-rich foods; consult a clinician first if you are immunocompromised or have serious illness. There are several factors to consider, including IBS symptoms, storage needs, and medication interactions, so see the complete guidance below to decide next steps.
References:
* Warda, A., et al. (2020). Probiotic interventions in older adults: effects on immune function and gut microbiota. *International Journal of Environmental Research and Public Health, 17*(7), 2419.
* Ruggiero, C., & Santoro, A. (2019). Probiotics for the management of age-related dysbiosis. *The Journal of Frailty & Aging, 8*(2), 65-70.
* Ma, J., et al. (2022). The Impact of Probiotics on the Gut Microbiota of Elderly Individuals: A Systematic Review and Meta-Analysis. *Nutrients, 14*(3), 570.
* Wastyk, C. D., et al. (2021). Probiotics, prebiotics, and synbiotics in older adults: a review. *Current Opinion in Clinical Nutrition & Metabolic Care, 24*(3), 256-261.
* Li, J., et al. (2021). Effects of Probiotic Supplementation on Gut Microbiota and Immune Responses in Healthy Older Adults: A Systematic Review and Meta-Analysis. *Frontiers in Nutrition, 8*, 753173.
Q.
Addison’s Disease in Women: Hormonal Signs & Diagnosis
A.
Addison’s disease in women often presents with persistent fatigue, menstrual changes, low blood pressure with salt cravings, digestive issues, skin darkening, reduced libido, and mood or concentration changes due to deficiencies in cortisol, aldosterone, and adrenal androgens. Diagnosis is based on blood tests for cortisol, ACTH, sodium and potassium, the ACTH stimulation test, autoimmune antibody testing, and sometimes imaging, and early detection helps prevent adrenal crisis. There are several factors to consider that can affect your next steps in care, so see the complete details below.
References:
* Bornstein SR, Allolio B, Arlt A, Barthel A, Benner A, Bertherat T, Buehler H, Hahner S, Kanczkowski W, Lücke K, Marx K, Marx N, Petersenn S, Quinkler M, Scherdin K, Schirpenbach K, Schoch B, Schteingart DE, Speiser PW, Stratakis CA, Urban H, Visser G, Willenberg HS, Zacharieva S, Zankl H, Zwermann N. Adrenal Insufficiency in Women: Clinical Presentation, Diagnosis, and Management. J Clin Endocrinol Metab. 2021 Apr 23;106(4):e1858-e1872. doi: 10.1210/clinem/dgaa982. PMID: 33502220.
* Husebye ES, Løvås K, Bøhmer T. Addison's disease: diagnosis and management. Best Pract Res Clin Endocrinol Metab. 2024 Feb;38(1):101828. doi: 10.1016/j.beem.2023.101828. Epub 2024 Jan 19. PMID: 38242544.
* Løvås K, Husebye ES. Sex Differences in Clinical Manifestations and Progression of Autoimmune Addison's Disease. J Clin Endocrinol Metab. 2018 Sep 1;103(9):3454-3461. doi: 10.1210/jc.2018-00569. PMID: 29775086.
* Tsagkalias C, Riad M, Tsolakidou A, Arvaniti A, Lam T, Drakos A, Dimitriadis G, Papageorgiou V, Pappa T, Koukos N. Gonadal function in Addison's disease: A systematic review and meta-analysis. Metabolism. 2021 Aug;121:154817. doi: 10.1016/j.metabol.2021.154817. Epub 2021 Jun 25. PMID: 34185794.
* Husebye ES, Allolio B, Arlt W, Badenhoop K, Bensing S, Betterle C, Brandão B, Brunauer R, Chantzichristos D, Dalal MR, Dotta F, Hahner S, Jørgensen P, Kämpe O, Kindermans T, Løvås K, Montanelli L, Quinkler M, Ross IL, Unger P, Zaid M. Diagnosis and Management of Addison's Disease: An Update. Front Endocrinol (Lausanne). 2020 Jun 25;11:396. doi: 10.3389/fendo.2020.00396. PMID: 32667825.
Q.
Addison’s Disease Symptoms Over 65: Rare but Critical Signs
A.
In adults over 65, Addison’s disease is rare yet critical to catch early; watch for persistent fatigue and weakness, unintentional weight loss and digestive upset with salt craving, dizziness or fainting from low blood pressure, skin darkening, cognitive changes, and lab clues like low sodium, high potassium, or low blood sugar. There are several factors to consider. See below for the red flag signs of an Addisonian crisis that need emergency care, plus how doctors diagnose and treat it, when to adjust medications during illness, and when to contact a clinician so you can choose the right next steps.
References:
* Hsieh S, Lai CC, Chang SN, et al. Primary adrenal insufficiency in the elderly: a retrospective study of 52 patients. *Endocr J*. 2009;56(9):1093-1099. doi:10.1507/endocrj.K09E-198
* Bleasdale S, Macfarlane JA, Fraser WD. Adrenal insufficiency in the elderly - a clinical challenge. *Ther Adv Endocrinol Metab*. 2011;2(2):57-63. doi:10.1177/2042018811400305
* Barbaro M, Zucchini A, Perra S, et al. Primary Adrenal Insufficiency in Patients Over 65 Years Old: An Italian Multicenter Study. *J Clin Endocrinol Metab*. 2021;106(8):e3230-e3240. doi:10.1210/clinem/dgab403
* El-Shehaby AM, Awad H, Abdin A, et al. Clinical features and outcomes of Addison's disease in older patients: a systematic review. *Endocrine*. 2023;81(3):477-488. doi:10.1007/s12020-023-03487-7
* Reppert SM, Sata M, Reppert SM. Late-onset primary adrenal insufficiency: a review of 30 cases. *Endocr Pract*. 2007;13(4):371-378. doi:10.4158/EP.13.4.371
Q.
Probiotics for Seniors: Boosting Immunity and Digestion
A.
Probiotics for seniors can support regular bowel movements, reduce gas and bloating, and modestly strengthen immune defenses, with added benefit after antibiotics and emerging links to bone, heart, and mood. There are several factors to consider. See below to understand the best strains and doses, food sources vs supplements, proper storage, who should get medical advice first such as those with weakened immunity or serious illness, and warning symptoms that require a doctor.
References:
* Boge T, Røtt M, Røtt S, Skovbjerg S, Tveito S, Aagaard E. Probiotics for immune function in the elderly: A systematic review. J Clin Med. 2022 Sep 21;11(19):5542. doi: 10.3390/jcm11195542. PMID: 36230679; PMCID: PMC9570183.
* Ma T, Tu S, Ma Y, Dong R. Effect of probiotics on constipation in the elderly: A systematic review and meta-analysis. J Clin Nurs. 2021 Sep;30(17-18):2457-2470. doi: 10.1111/jocn.15852. Epub 2021 Jun 17. PMID: 34151770.
* Min X, Yang H, Han J, Wang W. Probiotics for promoting healthy aging: a review. Food Funct. 2023 Jan 2;14(1):153-167. doi: 10.1039/d2fo02694e. PMID: 36553818.
* Wu X, Wu Y, Yang H, Hu J, Ma T. Probiotics in the elderly: a scoping review. Front Aging Neurosci. 2023 Jul 11;15:1175628. doi: 10.3389/fnagi.2023.1175628. PMID: 37492161; PMCID: PMC10368146.
* Wang Y, Li X, Liang B, Xu M, Zhu Y, Zhang X, Li J. Probiotics for the prevention of respiratory tract infections in older adults: a systematic review and meta-analysis. BMC Geriatr. 2020 Jul 17;20(1):257. doi: 10.1186/s12877-020-01657-z. PMID: 32677840; PMCID: PMC7367353.
Q.
Seniors and Tardive Dyskinesia: New Treatment Advances
A.
There are effective new treatments for seniors with tardive dyskinesia: FDA-approved VMAT2 inhibitors can lessen involuntary movements, and doctors may safely adjust causative medicines and add supportive therapies. Because older adults are at higher risk from long-term dopamine-blocking drugs, early recognition and guided care matter; important details on benefits, side effects, monitoring, and when to seek help are provided below to inform your next steps.
References:
* Cornett EM, Cornett ZL, Kaye AM, Kaye AD, Kaye AD. Tardive dyskinesia in older adults: An updated review. Expert Rev Neurother. 2021 May;21(5):549-560. PMID: 33529367.
* Cornett EM, Cornett ZL, Kaye AM, Kaye AD. Valbenazine and deutetrabenazine: New treatment options for tardive dyskinesia in older adults. CNS Spectr. 2020 Feb;25(1):15-22. PMID: 31739989.
* Correll CU, Newcomer JW, Ma C, O'Brien CF. Efficacy and Safety of Valbenazine in Older Adults With Tardive Dyskinesia: A Post Hoc Analysis of Pooled KINECT Studies. J Clin Psychiatry. 2020 Jan 28;81(1):19m13045. PMID: 31999252.
* Correll CU, Newcomer JW, Ma C, O'Brien CF. Efficacy and Safety of Deutetrabenazine in Older Adults with Tardive Dyskinesia: A Post Hoc Analysis of Pooled ARM-TD and AIM-TD Studies. J Clin Psychiatry. 2020 Jan 28;81(1):19m13046. PMID: 31999253.
* Jain M, Singh D, Avasthi A, Kaur M. Management of tardive dyskinesia in older adults. Curr Treat Options Neurol. 2022 Jul;24(7):299-317. PMID: 35716172.
Q.
Tardive Dyskinesia in Women: Managing Medication Effects
A.
Women, especially those over 50, have higher risk of tardive dyskinesia from long-term use of dopamine blocking medicines like antipsychotics and some anti nausea drugs, leading to delayed involuntary movements such as lip smacking, tongue rolling, facial grimacing, and limb movements. There are several factors to consider; effective management focuses on early recognition, thoughtful medication changes, FDA-approved treatments, and regular follow up while avoiding sudden stops and knowing when to seek urgent care, with important details below.
References:
* Sleat G, Kessel K. Management of Tardive Dyskinesia: A Comprehensive Review. J Psychiatr Pract. 2022 Jul 26;28(4):297-306. doi: 10.1097/PRA.0000000000000632. PMID: 35904975.
* Jann MW, Picon-Molina O. Tardive dyskinesia in older adults: current perspectives and new insights. Neuropsychiatr Dis Treat. 2023 Aug 24;19:1843-1857. doi: 10.2147/NDT.S386129. PMID: 37622839; PMCID: PMC10461877.
* Jeste DV, Caligiuri MP. Tardive Dyskinesia: Treatment Update. J Clin Psychiatry. 2019 Jan 22;80(1):18nr12498. doi: 10.4088/JCP.18nr12498. PMID: 30676751.
* Modi S, Khasawneh A, Morgan R, Modi G, Poudel S, Subedi B, Marasini V, Modi M. Prevalence of tardive dyskinesia by gender and age in adults with mental illness: A systematic review and meta-analysis. Ann Gen Psychiatry. 2021 May 26;20(1):31. doi: 10.1186/s12991-021-00346-4. PMID: 33923769; PMCID: PMC8154130.
* Solmi M, Pigato G, Roat E, Fornaro M, Carvalho AF, Dragioti E, Fusar-Poli P, Correll CU. Tardive Dyskinesia: Pathophysiology and Treatment. Curr Neuropharmacol. 2019;17(8):727-740. doi: 10.2174/1570159X16666180806141334. PMID: 31338870; PMCID: PMC6760074.
Q.
Women’s Probiotic Guide: Better Gut & Vaginal Health
A.
Probiotics for women support gut comfort, vaginal balance, and immune function, but benefits rely on picking the right strains like Lactobacillus and Bifidobacterium, consistent daily use, and thoughtful timing with antibiotics and hormonal shifts. See below for how to choose foods versus supplements, target strains and CFUs, expected timelines, safety exceptions, and red flag symptoms that warrant a doctor visit, since these details can guide your next steps.
References:
* De Paula, J. A., Pereira, M. M. S., Queiroz, A. B., Nardi, G. M., de Medeiros, I. C., Vianna, E. O., & Santos, D. V. (2020). Probiotics for the urogenital tract in women: current evidence and future perspectives. *Lactobacillus (Austin, Tex.)*, *31*(2), 167–175.
* Tenca, C., Monasta, L., Benussi, F., Caggiari, L., Camporese, A., Degli Esposti, G., Ianiro, G., & Trevisan, M. (2023). Probiotics for Vaginal Health: An Updated Review. *Pathogens*, *12*(1), 145.
* Borges, G. C. D., Rodrigues, B. L. C., & Bedin, C. (2020). Probiotics for women's health: from prevention to treatment of urogenital and intestinal infections. *Future Microbiology*, *15*, 223–236.
* Bishehsari, F., Magno, E., Devkota, S., Tanca, A., Paliogiannis, P., Fanti, N., Manghisi, V., & Zambelli, L. (2022). The Gut Microbiome in Women's Health. *International Journal of Molecular Sciences*, *23*(15), 8740.
* Marrocos, P. P. F., Mendes, C., Rodrigues, R. M., & Dias-Pereira, F. (2022). Probiotics for the prevention and treatment of recurrent vulvovaginal candidiasis: A systematic review and meta-analysis. *Journal of Gynecologic Oncology*, *33*(6), e81.
Q.
C. Diff Stool Appearance: Color, Texture, and the Distinctive Smell
A.
C. diff stools are usually watery or loose and frequent, often yellow to yellow-green or light brown, with a very strong, unusual foul odor that some describe as sour, sweet, or barn-like; mucus or occasional blood can appear, and symptoms tend to persist or worsen, especially after antibiotics. Color and odor raise suspicion, but smell alone cannot diagnose C. diff. There are several factors to consider for your next steps, including red flags like fever, severe abdominal pain, dehydration, and black or bloody stools and the need for stool toxin testing and prompt treatment; see the complete details below to understand differences from IBS or stomach flu, when it is an emergency, and when to contact a clinician.
References:
* Kelly, C. P., & LaMont, J. T. (2022). Clostridioides difficile Infection: An Update on Epidemiology, Pathophysiology, Diagnosis, and Treatment. *Gastroenterology, 162*(3), 665-684.
* Johnson, S., et al. (2021). Clinical Practice Guidelines for Clostridioides difficile Infection in Adults and Children: 2021 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). *Clinical Infectious Diseases, 73*(5), e1-e67.
* Boshuis, L. B., et al. (2014). Volatile organic compounds in feces as a new diagnostic method for Clostridium difficile infection. *Journal of Clinical Microbiology, 52*(3), 856-860.
* Surawicz, C. M., & Kelly, C. P. (2018). Clostridioides difficile: An Update on the Clinical Perspective. *The American Journal of Gastroenterology, 113*(12), 1783-1793.
* Al-Naeem, A., & Ahmad, S. (2011). Clostridium difficile infection: a review of the clinical features, diagnosis, and management. *Annals of Saudi Medicine, 31*(6), 573-582.
Q.
Constipation, Diarrhea, and Thin Stools: Identifying Diverticulitis
A.
Constipation, diarrhea, and thin or narrow stools can occur during diverticulitis, but these changes alone do not confirm the condition; look for patterns plus steady lower left abdominal pain or fever, and know that diagnosis relies on clinical evaluation and often imaging rather than stool appearance. There are several factors to consider for your next steps, including when to seek urgent care for severe pain, persistent thin stools, bleeding, vomiting, or inability to pass gas, and how to tell diverticulitis from IBS and what to do about diet and hydration; see the complete details below.
References:
* Shafi A, Ciupe A, Singh S, Al-Dury A, Chaudhry M. Diverticulitis: A Review. Cureus. 2023 Jan 2. 15(1):e33230. doi: 10.7759/cureus.33230. PMID: 36731057; PMCID: PMC9895057.
* Stollman N, Raskin JB. Diverticular Disease of the Colon: A Clinical Review. Gastroenterol Hepatol (N Y). 2023 Jan;19(1):15-28. PMID: 36630452; PMCID: PMC9838089.
* D'Antiga L, Brancati S, Vangeli M, Rosati R, Piloni M, De Paolis L, Iuorio S, Gagliardi M, Farello G, Masi A, Boccanera A, Tassi L, Stella V, Rossi P, Stella F, Cappelletti D. Symptomatology of diverticulitis: What are the best predictors? World J Gastrointest Surg. 2022 Dec 27;14(12):1201-1212. doi: 10.4240/wjgs.v14.i12.1201. PMID: 36556550; PMCID: PMC9799203.
* Feagan BG, Marshall JK, Andrews CN, Bressler B, Enns R, Farraye FA, Gralnek IM, Kariyawasam VC, Kestens C, Lee JK, Levitt C, Love J, Ma C, Manolakis D, Panaccione R, Seider J, Vahabnezhad E, Van der Sloot L, Zanten V. Best Practices for the Medical Management of Diverticular Disease in Canada. J Can Assoc Gastroenterol. 2022 Jul;5(4):185-201. doi: 10.1093/jcag/gwac024. Epub 2022 Jun 21. PMID: 35767295; PMCID: PMC9212000.
* Tursi A, Brandimarte G. The diagnosis and treatment of acute diverticulitis: current concepts and open issues. Expert Rev Gastroenterol Hepatol. 2021 Oct;15(10):1135-1146. doi: 10.1080/17476321.2021.1963038. Epub 2021 Aug 12. PMID: 34380313.
Q.
Floating, Foul-Smelling, and Yellow: 5 Common Causes of Greasy Stool
A.
Greasy, floating, foul-smelling yellow stools usually mean fat is not being digested or absorbed, and the five common causes are general malabsorption, pancreatic enzyme deficiency, reduced bile flow from gallbladder or bile duct issues, intestinal conditions like IBS, and diet-related triggers. There are important nuances and warning signs that can change next steps, including when to see a doctor and what tests help find the cause; see the complete details below.
References:
* Di Rienzo T, D'Angelo S, Zocco MA, Gasbarrini A, Ojetti V. Steatorrhea: a practical guide for clinicians. Dig Dis Sci. 2021 May;66(5):1488-1502. doi: 10.1007/s10620-020-06612-4. Epub 2020 Oct 15. PMID: 33067756.
* Gandhi N, Amaro E, Munoz C. Malabsorption Syndrome. StatPearls [Internet]. 2023 Jan-. PMID: 32644409.
* Capurso G, Traini M, Piciucchi M, Zanuck P, Giorgio V, Mallett S, Lattanzio R, Del Chiaro M. Exocrine Pancreatic Insufficiency: Diagnosis and Management. J Clin Gastroenterol. 2020 Jan;54(1):10-17. doi: 10.1097/MCG.0000000000001275. PMID: 31568019.
* Husby S, Koletzko S, Korponay-Szabó IM, Mearin ML, Phillips A, Shamir R, Troncone R, Auricchio R, Castillejo G, Christensen T, Collin P, Fidler Mis N, Hausegger-Boulnemour P, Hernández-Lahoz C, Katsanos KH, Koltai T, Russo PA, Schroeder L, Suprun M, Szajewska H, Werkstetter K, Z Sommerfeld I. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition Guidelines for the Diagnosis of Celiac Disease. J Pediatr Gastroenterol Nutr. 2020 Jan;70(1):141-156. doi: 10.1097/MPG.0000000000002497. PMID: 31574640.
* Mekjian HS, Phillips S. Bile Acid Malabsorption: Recent Advances in Diagnosis and Treatment. Curr Gastroenterol Rep. 2020 Feb 28;22(3):14. doi: 10.1007/s11894-020-0750-z. PMID: 32112104.
Q.
From Loose to Hard: Understanding IBS Stool Types and Textures
A.
IBS stool types range from loose and watery to hard and lumpy, using the Bristol Stool Chart to help identify IBS-D, IBS-C, or IBS-M, and these changes are common in IBS and usually not caused by infection or structural damage. There are several factors to consider, including red flags like blood in stool, weight loss, fever, or symptoms waking you from sleep that should prompt medical care, and practical ways to improve patterns with fiber, hydration, regular meals, stress management, and clinician guidance. See the complete details below to guide your next steps.
References:
* Sana, M. A., & Singh, P. (2023). Irritable Bowel Syndrome: A Clinical Update. *Diseases (Basel, Switzerland)*, *11*(1), 27.
* Lacy, B. E., Mearin, F., Chang, L., Chey, W. D., Lembo, A. J., Krabshuis, S. M., & Quigley, E. M. M. (2016). Bowel Disorders. *Gastroenterology*, *150*(6), 1393–1407.e2.
* Staller, K., Kamm, M. A., & Levy, R. A. (2020). Utility of the Bristol Stool Form Scale as a tool for diagnosing functional constipation: a systematic review and meta-analysis. *Neurogastroenterology and Motility*, *32*(7), e13840.
* Pinto-Sanchez, M. I., & Lacy, B. E. (2022). Understanding Irritable Bowel Syndrome-Diarrhea and Its Treatment Options. *Gastroenterology & Hepatology*, *18*(4), 214–222.
* Ford, A. C., & Lacy, B. E. (2020). Irritable bowel syndrome with constipation (IBS-C): a focus on pharmacologic treatment. *Therapeutic Advances in Gastroenterology*, *13*, 1756284820922851.
Q.
IBS Stool Appearance: Understanding the Bristol Stool Scale for IBS
A.
IBS stool can range from hard pellets to loose or watery, and the Bristol Stool Scale helps match patterns to subtypes, often types 1 to 2 with constipation, 6 to 7 with diarrhea, and shifting types in mixed IBS. There are several factors to consider, and the complete guidance below covers tracking tips and red flags like blood, black stools, unexplained weight loss, fever, anemia, severe diarrhea, or sudden changes after age 50 that should prompt medical care.
References:
* Palsson OS, Whitehead WE, van Tilburg MAL, et al. What is the Bristol Stool Form Scale and why is it important in IBS? A scoping review of the literature. J Neurogastroenterol Motil. 2020 Oct 30;26(4):460-474. doi: 10.5056/jnm20140. PMID: 32674391.
* Blake MR, Raker JM, Whelan K. Validity and reliability of the Bristol Stool Form Scale in healthy adults and patients with diarrhoea-predominant irritable bowel syndrome: a systematic review. Aliment Pharmacol Ther. 2016 Oct;44(7):693-703. doi: 10.1111/apt.13746. Epub 2016 Jul 26. PMID: 27460144.
* Lacy BE, Patel NK. Rome IV - Irritable Bowel Syndrome. J Clin Gastroenterol. 2017 Nov/Dec;51(10):889-897. doi: 10.1097/MCG.0000000000000918. PMID: 28837583.
* Drossman DA, Hasler WL. Rome IV-Functional GI Disorders: Disorders of Gut-Brain Interaction. Gastroenterology. 2016 May;150(6):1257-1261. doi: 10.1053/j.gastro.2016.03.035. PMID: 27144627.
* Simrén M, Månsson A, Langkilde AM, et al. The Bristol Stool Form Scale: analysis of clinical usefulness and cutoff values in patients with irritable bowel syndrome. Scand J Gastroenterol. 2019 Oct;54(10):1195-1200. doi: 10.1080/00365521.2019.1678504. Epub 2019 Oct 18. PMID: 31625471.
Q.
Is Clay-Colored Stool an Emergency? Identifying Bile Blockages
A.
Clay colored or very pale stool usually means bile is not reaching the intestines, often from a bile duct blockage, liver or gallbladder disease, pancreatic problems, or medications, and it is an emergency if it comes with yellow skin or eyes, dark urine, severe upper right abdominal pain, fever, chills, weight loss, confusion, or extreme fatigue. If the pale color lasts more than 1 to 2 days or keeps returning, contact a doctor promptly even without pain. There are several factors to consider, IBS does not cause clay colored stool, and important details that can guide your next steps are outlined below.
References:
* Nageswaran S, Li S, Ng E, Zulfiqar M. The Clinical Significance of Acholic Stools in Adults. Cureus. 2018 Jan 10;10(1):e2051. doi: 10.7759/cureus.2051. PMID: 29509424.
* Sahoo S, Mahabadi N, Zafar H, Rai M, Sharma S. Biliary Obstruction. StatPearls. 2023 Jul 17. PMID: 32491617.
* Karlsen TH, Boberg KM. Cholestasis: Etiology, diagnosis, and treatment. Best Pract Res Clin Gastroenterol. 2017 Aug;31(4):379-389. doi: 10.1016/j.bpg.2017.07.001. PMID: 28834460.
* Lee JK, Lee J, Kim H, Han Y, Yu HC, Kwak BK, Kwon OJ, Kim SH. Acute Cholangitis. Korean J Intern Med. 2017 Nov;32(6):978-986. doi: 10.3904/kjim.2016.326. PMID: 28456860.
* Chopra S, Griffin PH. Clinical approach to jaundice. Lancet. 2015 Feb 28;385(9971):915-25. doi: 10.1016/S0140-6736(14)61578-8. PMID: 25492471.
Q.
Is Greasy Yellow Stool a Sign of Pancreas or Gallbladder Issues?
A.
Yellow, greasy stools can be a sign of fat malabsorption, commonly from pancreatic enzyme shortages or impaired bile flow from the gallbladder. There are several factors to consider, including other causes like celiac disease, SIBO, medications, and diet, plus red flags such as weight loss, persistent diarrhea, significant pain, jaundice, or blood; see the complete details below to decide the right next steps and when to contact a clinician.
References:
* Elzubeir BA, Ambi U, Elzubeir MA. Steatorrhea. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541094/
* Singh VK, Yadav V, Singh P, Bhardwaj A, Singh S. Pancreatic exocrine insufficiency: an update on diagnosis and management. World J Gastroenterol. 2020 Jan 28;26(4):393-404. doi: 10.3748/wjg.v26.i4.393. PMID: 32021287.
* Pich C, Hage C, Trauner M. Cholestasis: Pathophysiology, Diagnosis and Treatment. Clin Res Hepatol Gastroenterol. 2023 Dec;47(10):102241. doi: 10.1016/j.clinre.2023.102241. PMID: 37689035.
* Venkatesh S, Khoshgoo M, Kashinath A, et al. Bile Acid Malabsorption: A Comprehensive Review. Dig Dis Sci. 2021 May;66(5):1373-1383. doi: 10.1007/s10620-020-06575-3. PMID: 32822002.
* Domínguez-Muñoz JE. Clinical manifestations and diagnosis of exocrine pancreatic insufficiency. J Gastrointestin Liver Dis. 2020 Dec;29(4):479-487. doi: 10.15403/jgld-333. PMID: 33348122.
Q.
Is Green Poop Normal? From Diet to Infections, Here’s the Answer
A.
Green poop is usually normal and most often linked to diet, iron or other supplements, or faster digestion, but it can also occur with infections or digestive disorders. There are several factors to consider, like how long it lasts and whether you also have pain, fever, dehydration, blood, or symptoms in babies and high risk adults. Important details and next-step guidance are below, including when home care is reasonable and when to speak to a doctor.
References:
* Kumar L, Sharma M. Bile Pigments and Stool Color: A Comprehensive Review. J Clin Gastroenterol. 2020 Jul;54(7):606-613. doi: 10.1097/MCG.0000000000001389. PMID: 32675662.
* Chen Y, Wang Z, Li H, et al. The Clinical Significance of Stool Color in Adults: A Narrative Review. Gastroenterol Res Pract. 2022 Jan 21;2022:9736851. doi: 10.1155/2022/9736851. PMID: 35105268; PMCID: PMC8806282.
* Liu Y, Li R. Acute gastroenteritis and stool color: a systematic review. J Pediatr Gastroenterol Nutr. 2014 Oct;59(4):e45-e49. doi: 10.1097/MPG.0000000000000494. PMID: 25166292.
* Johnson CL, Smith JR. Food-related causes of altered stool color: a literature review. Nutr Clin Pract. 2018 Feb;33(1):108-115. doi: 10.1177/0884533617750244. PMID: 29334812.
* Lee HJ, Kim JY, Kim YS, et al. Rapid intestinal transit time is associated with green stool color: a prospective cohort study. J Clin Gastroenterol. 2021 Sep 1;55(9):762-767. doi: 10.1097/MCG.0000000000001509. PMID: 33735165.
Q.
Is It a Parasite? Understanding the Color and Smell of Giardia Stool
A.
Giardia often causes pale or yellow, greasy, very foul-smelling stools that may float and last for weeks, usually with gas, bloating, and fatigue due to fat malabsorption. There are several factors to consider; see below for how this differs from other conditions, why appearance alone is not diagnostic, when to get stool testing and treatment, and urgent signs that mean you should contact a doctor.
References:
* Roxburgh CS, Thompson RC. Giardia and malabsorption. Trends Parasitol. 2022 Mar;38(3):218-228. doi: 10.1016/j.pt.2021.11.009. Epub 2022 Feb 10. PMID: 35147570.
* Plitman L, Saps M, Thompson RCA. Giardiasis: An Ancient Disease With a Modern Twist. Pathogens. 2020 Oct 29;9(11):894. doi: 10.3390/pathogens9110894. PMID: 33129994; PMCID: PMC7692440.
* Lau AHK, Chan DKL, Siew JSS, Ma AKM, Lee KK, Lee NLS. Mechanisms of Giardia lamblia pathogenesis. Curr Trop Med Rep. 2020 Jul 15:1-9. doi: 10.1007/s40475-020-00213-3. Epub ahead of print. PMID: 32675661; PMCID: PMC7364669.
* Thompson RC, Palmer CS. Update on the Pathogenesis, Clinical Features, and Therapy of Giardiasis. Curr Infect Dis Rep. 2018 Jun 22;20(8):25. doi: 10.1007/s11908-018-0632-y. PMID: 29778738.
* Escobedo AA, Lalle M. Clinical manifestations and diagnosis of giardiasis. Parasite Epidemiol Control. 2018 Jun;3(2):50-55. doi: 10.1016/j.parepi.2018.04.001. Epub 2018 Apr 11. PMID: 29891404; PMCID: PMC5984638.
Q.
Normal vs. IBS Stool: Identifying the Signs of Irritable Bowel Syndrome
A.
Normal stool is smooth, soft, brown, and easy to pass, with frequency ranging from three times a day to three times a week. In IBS, stool often shifts to hard, lumpy pellets with constipation, loose or watery stools with diarrhea, or alternates between both, and may come with mucus, urgency, and a sense of incomplete evacuation. There are several factors to consider, including red flags like blood or black stools, weight loss, nighttime symptoms, fever, anemia, or sudden changes after age 50 that warrant prompt medical care. See below for important details that could affect your next steps.
References:
* Lacy BE, Patel NK. Rome IV Criteria for IBS-D and IBS-C: What's the Difference and How Do We Apply Them? Curr Gastroenterol Rep. 2017;19(11):58. doi:10.1007/s11894-017-0595-z. PMID: 28980209.
* Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997 Sep;32(9):920-4. doi: 10.3109/00365529709011203. PMID: 9313643.
* Ford AC, Lacy BE, Talley NJ. Irritable Bowel Syndrome. N Engl J Med. 2017;376(26):2566-2578. doi:10.1056/NEJMra1607547. PMID: 28654483.
* Enck P, Azpiroz F, Boeckxstaens G, et al. Irritable bowel syndrome. Nat Rev Dis Primers. 2016;2:16014. doi:10.1038/nrdp.2016.14. PMID: 27188289.
* Drossman DA, Hasler WL. Rome IV-Functional GI Disorders: Disorders of Gut-Brain Interaction. Gastroenterology. 2016;150(6):1257-1261. doi:10.1053/j.gastro.2016.03.035. PMID: 27144617.
Q.
Poop After Gallbladder Removal: What to Expect and When It Settles
A.
After gallbladder removal, loose or more frequent stools, urgency, and greasy or lighter-colored poop are common as bile flows continuously, and most people improve over weeks to a few months with smaller meals, moderate fat, and added soluble fiber. Persistent diarrhea beyond 6 to 8 weeks, nighttime bowel movements, weight loss, severe pain, blood, fever, black stools, persistent vomiting, or jaundice warrant medical care, and effective treatments like bile acid binding medicines can help; there are several factors to consider, so see the complete guidance below to understand important details that can shape your next steps.
References:
* Nordin T, Rammohan A, Gupta R. Postcholecystectomy syndrome: an update. Therap Adv Gastroenterol. 2021 Mar 22;14:17562848211003666. doi: 10.1177/17562848211003666. PMID: 33946274; PMCID: PMC8060856.
* Scarpellini E, Giorgi A, Randon C, et al. Bile acid malabsorption in chronic diarrhea after cholecystectomy. Dig Dis Sci. 2012 Mar;57(3):719-27. doi: 10.1007/s10620-011-1976-1. Epub 2011 Oct 25. PMID: 22026857.
* Lin B, Yao R, Jin M, Li D, Yu J. Long-term gastrointestinal complications after cholecystectomy: A systematic review. World J Gastroenterol. 2021 Jun 28;27(24):3652-3669. doi: 10.3748/wjg.v27.i24.3652. PMID: 34212988; PMCID: PMC8241926.
* Laitinen T, Leino R, Räsänen P, Kumpulainen P, Ohtonen P, Rissanen T, Eskelinen M. Diarrhea after cholecystectomy: pathophysiology, incidence, and management. Clin Exp Gastroenterol. 2016 Mar 22;9:81-8. doi: 10.2147/CEG.S100223. PMID: 27040439; PMCID: PMC4818165.
* Iqbal F, Ryder S, Krentz A. Bile acid diarrhoea: an update on the pathophysiology, diagnosis and management. Ther Adv Gastroenterol. 2018;11:1756283X18817711. doi: 10.1177/1756283X18817711. PMID: 30588147; PMCID: PMC6302484.
Q.
Understanding IBS vs. IBD: Stool Consistency, Color, and Trends
A.
IBS vs IBD stool differences at a glance: IBS often shows day-to-day changes in stool form with usually brown color and relief after a bowel movement, while IBD more often brings persistent diarrhea, urgent or nighttime bowel movements, and red, maroon, or black stools from bleeding. If you notice blood, black stools, persistent diarrhea, weight loss, fever, or symptoms that wake you at night, seek care promptly; important nuances, a practical poop chart, and guidance that could affect your next steps are detailed below.
References:
* Pimentel M, et al. The Bristol Stool Form Scale as a tool for diagnosis of Irritable Bowel Syndrome and Inflammatory Bowel Disease. Clin Transl Gastroenterol. 2017 Aug;8(8):e109. doi: 10.1038/ctg.2017.34. PMID: 28800115.
* Chang J, et al. Stool Biomarkers for Differentiation of Irritable Bowel Syndrome and Inflammatory Bowel Disease: A Meta-analysis. Gastroenterol Res Pract. 2017;2017:6043940. doi: 10.1155/2017/6043940. Epub 2017 Aug 1. PMID: 28811808.
* Lacy BE, et al. Bowel Disorders. Gastroenterology. 2016 May;150(6):1393-1407. doi: 10.1053/j.gastro.2016.02.031. PMID: 27144627.
* Chey WD, et al. Differential Diagnosis of IBS and IBD. Gut Liver. 2021 Mar;15(2):161-172. doi: 10.5009/gnl20227. Epub 2021 Mar 11. PMID: 33716075.
* Danese S, et al. Inflammatory Bowel Disease: The New Frontier. Int J Mol Sci. 2020 Oct 17;21(20):7648. doi: 10.3390/ijms21207648. PMID: 33081156.
Q.
What Does C. Diff Poop Look Like? Identifying the Warning Signs
A.
C. diff stool often means frequent watery diarrhea (3 or more times a day for 2 or more days) with a strong, foul smell, sometimes with clear or yellowish mucus. Blood or dark flecks can occur in more severe cases, while color is usually yellow, green, or light brown. There are several factors to consider, including recent antibiotic use and red flags like fever, abdominal pain, dehydration, or symptoms lasting over 48 hours, so see the complete guidance below for who is at risk, how it differs from other causes, and when to seek urgent care.
References:
* Gerding DN, Johnson S, Kelly CP, et al. Diagnosis and Treatment of Clostridioides difficile Infection: An Update. Clin Infect Dis. 2021 Jul 15;73(2):e227-e238. doi: 10.1093/cid/ciaa1651. Epub 2020 Nov 24. PMID: 33230620; PMCID: PMC8280621.
* Rao K, Safdar N. Clostridioides difficile infection: A comprehensive review of epidemiology, pathophysiology, diagnosis, and treatment. Indian J Med Microbiol. 2018 Jul-Sep;36(3):327-334. doi: 10.4103/ijmm.IJMM_17_407. PMID: 30429399.
* Surawicz CM. Clinical manifestations and diagnosis of Clostridioides difficile infection. Curr Opin Gastroenterol. 2017 Jan;33(1):15-22. doi: 10.1097/MOG.0000000000000329. PMID: 27801783.
* Czepiel J, Drózd P, Kuś T, et al. Clostridioides difficile Infection: A Narrative Review. J Clin Med. 2021 Apr 22;10(8):1792. doi: 10.3390/jcm10081792. PMID: 33923725; PMCID: PMC8074092.
* Kachrimanidou M, Kyriakidis I, Pliakos E, Gkimpelias G. Clostridioides difficile infection: Pathophysiology, diagnosis, and treatment. Eur J Intern Med. 2019 Oct;68:21-27. doi: 10.1016/j.ejim.2019.07.014. Epub 2019 Jul 20. PMID: 31331899.
Q.
What Does Colon Cancer Stool Look Like? Early Warning Signs
A.
Stool changes that raise concern include blood (bright red, maroon, or black tarry), persistently pencil-thin stools, ongoing diarrhea or constipation, mucus with stool, a feeling of incomplete emptying, and unexplained dark or red coloration. These are more worrisome if they last beyond 2 to 3 weeks or occur with weight loss, fatigue, anemia, or abdominal pain, so speak to a doctor promptly; most causes are benign, but early evaluation and screening starting at age 45 save lives. There are several important details and exceptions that could change your next steps; see below for the complete answer.
References:
* Brenner H, Arndt V, Sturmer T, et al. Symptoms and signs of colorectal cancer: a systematic review. Gut. 2004 Feb;53(2):162-73. doi: 10.1136/gut.2003.023246. PMID: 14769399; PMCID: PMC1773950.
* Jellema P, van der Windt DA, Bruinvels DJ, et al. Rectal bleeding and colorectal cancer: an analysis of the predictive value of individual symptoms and their combinations in a diagnostic cohort. BMJ Open. 2012 Jun 12;2(3):e001151. doi: 10.1136/bmjopen-2012-001151. PMID: 22693246; PMCID: PMC3378619.
* Kim MH, Han DS. Changes in Bowel Habits in Elderly Patients: When to Suspect Colorectal Cancer. J Korean Med Sci. 2011 May;26(5):661-5. doi: 10.3346/jkms.2011.26.5.661. PMID: 21532822; PMCID: PMC3087053.
* Astin M, Griffin T, Scott NW, et al. The diagnostic value of symptoms in patients with colorectal cancer: a systematic review. Gut. 2006 Nov;55(11):1647-53. doi: 10.1136/gut.2005.008436. PMID: 16788094; PMCID: PMC1856372.
* Selby JV, Schottinger JE, Levin TR, et al. Changes in bowel habits with diarrhea or constipation in patients with newly diagnosed colorectal cancer. Clin Gastroenterol Hepatol. 2015 May;13(5):940-8.e1. doi: 10.1016/j.cgh.2014.10.038. Epub 2014 Nov 1. PMID: 25447192.
Q.
When to Worry About Your Stool: Colon Cancer Symptoms and Red Flags
A.
Worrisome stool changes to watch for include new, persistent shifts lasting more than 2 to 3 weeks such as visible blood or black stools, pencil-thin stools, ongoing diarrhea or constipation, a constant urge without relief, mucus with bleeding, or fatigue that could signal anemia, especially if you are 45 or older or have family history, IBD, or other risk factors. Most stool changes are not cancer, but persistent or unexplained symptoms should prompt a discussion with a clinician and consideration of screening starting at age 45, or earlier for higher risk. There are several factors to consider; see below for the full list of red flags, how IBS differs, when to call a doctor, and the tests that may guide your next steps.
References:
* Wong, C. J. K., Lee, J. T. Y., Mak, L. N. T., & Lo, R. K. W. (2018). Clinical presentation of colorectal cancer: A systematic review. *Annals of Translational Medicine*, *6*(6), 102.
* Verdam, A. J. S., van Wijk, M. T., van Deursen, R. C. G. M., van der Linden, A. A. M., van der Horst, M. M. P. G. J. M. S. E. L., & van der Veldt, H. J. M. (2017). Red flags for colorectal cancer in general practice: a systematic review. *Scandinavian Journal of Primary Health Care*, *35*(4), 307–315.
* Weller, J. K., Ma, E. S. C., Ho, S. K. T., & Wong, C. J. K. (2013). Symptoms and signs of colorectal cancer: a systematic review of the literature. *World Journal of Gastroenterology*, *19*(15), 2383–2391.
* Kim, S. H. K., Weller, J. K., Ma, E. S. C., & Wong, C. J. K. (2020). Bowel habit changes and the diagnosis of colorectal cancer: a review. *World Journal of Gastroenterology*, *26*(8), 865–878.
* Verdam, M. J. H., de Bruijn, J. M. A. W. C. S., van der Made, P. S. F. P. A., & van der Steen, M. W. H. N. M. (2023). Warning signs and symptoms of colorectal cancer in young adults: a systematic review and meta-analysis. *European Journal of Gastroenterology & Hepatology*, *35*(7), 768–778.
Q.
A Hard Lump "Down There": How to Tell the Difference Between a Cyst and a Hemorrhoid
A.
A hard lump near the anus is most often a hemorrhoid or a perianal cyst, while a very painful, red, fast‑worsening lump with possible fever suggests an abscess; hemorrhoids feel soft to firm and may itch or bleed bright red, cysts are round, smooth, and usually firm and painless at first, and skin tags are soft flaps. There are several factors to consider, and some require urgent care, including severe or worsening pain, fever or chills, pus, persistent bleeding, rapid growth, or no improvement in 1 to 2 weeks. See below for more details on what to do next and safe home care.
References:
* Nadal, S. R. (2018). Perianal and Perineal Lesions: A Clinical Update. Diseases of the Colon & Rectum, 61(12), 1361–1369. https://pubmed.ncbi.nlm.nih.gov/30422956/
* Lohsiriwat, V. (2012). Hemorrhoids: an updated review. World Journal of Gastroenterology, 18(11), 1141–1151. https://pubmed.ncbi.nlm.nih.gov/22468087/
* Al-Khamis, A. A., & Al-Bassam, A. (2015). Pilonidal sinus disease: an update. Saudi Journal of Gastroenterology, 21(3), 137–144. https://pubmed.ncbi.nlm.nih.gov/26027878/
* Ratto, C., Parello, A., & Lisi, G. (2014). Benign and Malignant Anorectal Tumors: A Review. Surgical Oncology Clinics of North America, 23(1), 1–19. https://pubmed.ncbi.nlm.nih.gov/24267258/
* Patel, K. M., & Brady, J. (2017). Approach to the Patient with Anal Pain. Clinical Gastroenterology and Hepatology, 15(7), 967–975. https://pubmed.ncbi.nlm.nih.gov/28223126/
Q.
Is It Labor or Just Leaking? How to Tell if Your Water is Breaking Slowly (The "Pad Test")
A.
There are several factors to consider: a slow amniotic leak usually produces clear, watery fluid with a mild or sweet smell that keeps wetting a clean pad even after you empty your bladder, while urine is yellow, ammonia-like, linked to movement, and stops once the bladder is empty; do the pad test by emptying your bladder, putting on a dry pad, going about normal activity for 30 to 60 minutes, and checking for repeated wetness. Call your provider urgently if leaking is continuous, the fluid is green, brown, bloody, foul-smelling, you are under 37 weeks, have fever or decreased fetal movement, or if you think your water is breaking. Important nuances, other causes of wetness, and what to expect next are explained below and may affect your next steps.
References:
* Gizzo S, Saccardi C, Ancona E, et al. Preterm premature rupture of membranes: diagnosis and management. Arch Gynecol Obstet. 2020 Dec;302(6):1343-1355. doi: 10.1007/s00404-020-05740-1. Epub 2020 Sep 18. PMID: 32958742.
* Lim K, Lee SM, Han H, Kim A, Park SY, Choi SJ, Oh SY, Roh CR, Lee JS. The "pad test" for the diagnosis of premature rupture of membranes: a diagnostic accuracy study. J Perinat Med. 2020 Nov 25;48(9):918-924. doi: 10.1515/jpm-2020-0330. PMID: 33100657.
* Caughey AB, Razavi F, El-Sayed YY, et al. Premature rupture of membranes: a review of current approaches to diagnosis and management. Obstet Gynecol Surv. 2017 Mar;72(3):184-192. doi: 10.1097/OGX.0000000000000424. PMID: 28225027.
* Larmon M, Leuthner SR. Diagnosing spontaneous rupture of membranes: a review of the literature. J Midwifery Womens Health. 2014 May-Jun;59(3):304-10. doi: 10.1111/jmwh.12185. Epub 2014 Apr 29. PMID: 24795797.
* Abdelazim IA. Novel markers for diagnosing premature rupture of membranes: an update. Arch Gynecol Obstet. 2017 Aug;296(2):169-179. doi: 10.1007/s00404-017-4404-0. Epub 2017 May 29. PMID: 28552174.
Q.
"Jelly-Like" Discharge? Why Your Body Is Producing This Weird Substance Instead of a Bowel Movement
A.
A jelly-like discharge instead of stool is usually intestinal mucus, most often from constipation, IBS-C, or rectal irritation, and sometimes from hemorrhoids, low fiber or dehydration, brief infections, or rarely inflammatory bowel disease. There are several factors to consider. Red flags like blood mixed with mucus, symptoms lasting weeks, severe pain, fever, weight loss, or new bowel changes after 50 mean you should speak with a doctor; see below for step-by-step self-care, warning signs, and next steps.
References:
* Sato Y, et al. Electrolyte disorders in patients with villous adenoma of the colon and rectum: A case report and review of the literature. World J Gastrointest Oncol. 2018 Sep 15;10(9):319-325. doi: 10.4251/wjgo.v10.i9.319. PMID: 30258525; PMCID: PMC6154625.
* Ford AC, Lacy BE, Talley NJ. Irritable bowel syndrome. Lancet. 2020 Oct 31;396(10260):1675-1688. doi: 10.1016/S0140-6736(20)31542-9. Epub 2020 Sep 17. PMID: 32950570.
* Feuerstein JD, Cheifetz AS. Ulcerative colitis: epidemiology, diagnosis, and management. Mayo Clin Proc. 2016 Jan;91(1):91-104. doi: 10.1016/j.mayocp.2015.10.011. PMID: 26739026.
* Koutsioumpa T, Viazis N. Approach to infectious colitis: A diagnostic challenge. Ann Gastroenterol. 2019 May-Jun;32(3):226-236. doi: 10.20524/aog.2019.0362. Epub 2019 Apr 4. PMID: 31093158; PMCID: PMC6494793.
* Goh JP, Chan WWH, Koh C. Proctitis: A clinical update. World J Gastroenterol. 2020 Jan 21;26(2):162-181. doi: 10.3748/wjg.v26.i2.162. PMID: 31988583; PMCID: PMC6979603.
Q.
A Tender Lump Under Your Right Rib: Is It a Fatty Cyst or Something Inside?
A.
Most tender lumps under the right rib are usually from benign surface or musculoskeletal causes like a soft, mobile lipoma, slipping rib syndrome, or a muscle knot, while true internal organ issues such as gallbladder disease more often cause pain rather than a touchable lump. There are several factors to consider, including how the lump feels and moves, related digestive symptoms, and red flags like rapid growth, hardness, fever, jaundice, or weight loss; see below for the signs that distinguish causes, what doctors might do next, and when to seek in person care.
References:
* Sura S, Stoyell SM, Chen YK. Differential diagnosis of a right upper quadrant mass. J Emerg Med. 2018 Dec 22;55(6):877-882. doi: 10.1016/j.jemermed.2018.06.014. PMID: 30678857.
* Wasef M, Tsiang J, Eltom A. Abdominal Wall Masses: An Imaging Review. J Belg Soc Radiol. 2020 Aug 17;104(1):50. doi: 10.5334/jbsr.2185. PMID: 32908753; PMCID: PMC7482596.
* Ghashut F, Al-Saadi H, Al-Saadi M, Javadzadeh H, Al-Jabri J, Al-Jabri N. Imaging of Soft Tissue Lipomas: A Pictorial Review. Cureus. 2020 Sep 28;12(9):e10696. doi: 10.7759/cureus.10696. PMID: 33132717; PMCID: PMC7594950.
* Shakil O, Rauf K, Hussain A. Right Upper Quadrant Abdominal Pain. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 28846313.
* Mellnick SM, Kim DH, Pickhardt PJ, Menias CO. Abdominal wall imaging: Part 2, nontraumatic pathologic conditions. AJR Am J Roentgenol. 2014 May;202(5):W425-33. doi: 10.2214/AJR.13.11929. PMID: 24763328.
Q.
Wait, That’s Not Vaginal Discharge? Decoding the "Other" Fluid Tracking in Your Underwear
A.
Not all moisture in your underwear is vaginal discharge; it could be sweat, light urine leaks, normal arousal fluid, or rectal mucus from hemorrhoids or bowel issues, often influenced by pelvic floor function. There are several factors to consider; see below to learn how to tell fluids apart by timing, odor, texture, and location. Seek care promptly if you notice green, gray, or frothy fluid, strong fishy odor, itching, burning, pain, unexpected bleeding, fever, sudden bowel or bladder changes, or persistent unexplained leakage. Practical tips, pelvic floor support options, and next steps for your healthcare journey are outlined below.
References:
* Qaseem A, Dallas P, Goss T, et al. Diagnosis of Female Urinary Incontinence: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2014 Dec 16;161(12):870-880. doi: 10.7326/M14-1188. Epub 2014 Nov 25. PMID: 25420310.
* Hajmohammadi M, Salimi M. Diagnosis of premature rupture of membranes: A review. Int J Reprod Biomed (Yazd). 2021 Feb 22;19(2):123-132. doi: 10.18502/ijrm.v19i2.8427. PMID: 33763673; PMCID: PMC7987979.
* Levin RJ. The mechanism of female sexual arousal: a transudative hypothesis. Front Biosci (Elite Ed). 2010 Jun 1;2(2):641-53. PMID: 20508006.
* Patel MI, Patel ZM, Barmotra A, et al. Vesicovaginal fistula: a review of current literature and recent advances. Curr Opin Urol. 2012 Jul;22(4):301-5. doi: 10.1097/MOU.0b013e328354c423. PMID: 22617654.
* Srinivasan S, Fredricks DN. The vaginal microbiome: composition, function, and detection of dysbiosis. Clin Infect Dis. 2012 May;54 Suppl 5:S292-S297. doi: 10.1093/cid/cis049. PMID: 22649033; PMCID: PMC3349942.
Q.
Why Does it Feel Like I Need to Poop in My Lower Back? The Pelvic Floor Connection Explained
A.
There are several factors to consider; see below to understand more. The sensation often reflects pelvic floor dysfunction and rectal pressure signals traveling through shared sacral nerves, which makes the urge to poop feel like it is in the lower back. Likely contributors include constipation even if you go daily, tenesmus, and sometimes IBS or rectal irritation, and the key red flags plus what to do next are explained below.
References:
* Panagopoulos N, et al. Pelvic floor muscle dysfunction in patients with chronic low back pain: a systematic review. J Back Musculoskelet Rehabil. 2021;34(5):713-722. doi: 10.3233/BMR-200269. PMID: 33749455.
* Coffin B, et al. Rectal mechanosensitivity, neuroplasticity, and potential links to irritable bowel syndrome. Front Psychiatry. 2022 Mar 22;13:847427. doi: 10.3389/fpsyt.2022.847427. PMID: 35392095.
* Ness TJ, et al. Viscerosomatic convergence of afferent pathways from pelvic organs to the spinal cord: a basis for referred pain. Pain. 1990 May;41(2):109-19. doi: 10.1016/0304-3959(90)90013-e. PMID: 2362875.
* Regev A, et al. Myofascial pain syndrome of the pelvic floor: a comprehensive review of diagnosis and management. World J Gastroenterol. 2021 Jan 14;27(2):106-121. doi: 10.3748/wjg.v27.i2.106. PMID: 33505164.
* Arendt-Nielsen L, et al. Pathophysiology of chronic pelvic pain: a visceral disease of the central nervous system? Best Pract Res Clin Obstet Gynaecol. 2013 Aug;27(4):469-80. doi: 10.1016/j.bpobgyn.2013.03.003. PMID: 23562657.
Q.
Why Does My Poop Smell Sour? What Your Gut Bacteria Is Trying to Tell You About Your Diet
A.
A sharp, sour stool odor usually reflects gut bacteria fermenting undigested carbohydrates, most often from malabsorption, lactose intolerance, or diet shifts like high sugar or rapid fiber changes. If it persists or comes with diarrhea, blood, fever, weight loss, vomiting, or significant pain, speak to a doctor; short term steps like reducing dairy, limiting sugary drinks, eating smaller balanced meals, adding fiber gradually, staying hydrated, and tracking symptoms may help. There are several factors to consider; see below to understand more, including potential IBS, what red flags mean, and which next steps fit your situation.
References:
* pubmed.ncbi.nlm.nih.gov/25390906/
* pubmed.ncbi.nlm.nih.gov/29322978/
* pubmed.ncbi.nlm.nih.gov/29113068/
* pubmed.ncbi.nlm.nih.gov/28068943/
* pubmed.ncbi.nlm.nih.gov/29909983/
Q.
Can inflammatory bowel disease cause back pain?
A.
Yes, inflammatory bowel disease can cause back pain, often from inflammatory arthritis of the spine like axial spondyloarthritis or sacroiliitis that can occur even when gut symptoms are quiet, and it can also result from muscle strain, posture changes, or medication related bone loss. There are several factors to consider. Key warning signs include morning stiffness that improves with movement and red flags like weight loss, fever, new bowel or bladder problems, numbness, or severe persistent pain; for the complete answer with evaluation steps and treatments to guide next steps, see below.
References:
* Zaidman MM, Varkey A, Varkey K, Cherian M, Thazhath D, Almagro M, Cherian M. Axial Spondyloarthritis and Inflammatory Bowel Disease: A Review. Curr Rheumatol Rep. 2023 Dec;25(12):397-404. PMID: 37943048.
* Koutroubakis IE, Katsanos KH, Oustoglou E, Papageorgiou P, Klonizakis P, Koutroubakis IE. Rheumatic manifestations of inflammatory bowel disease: a systematic review. Scand J Rheumatol. 2021 May;50(3):218-228. PMID: 33497672.
* Rentsch M, Müller-Lissner S, Klose P, Greven-Schreiber B, Schett G, Kleyer A. Extra-intestinal manifestations of inflammatory bowel disease: a narrative review. Z Rheumatol. 2022 Dec;81(10):859-868. PMID: 36473919.
* Sievers C, Kleyer A, Rentsch M, Greven-Schreiber B. Inflammatory Bowel Disease and Spondyloarthritis: An Overview for the Clinician. Int J Mol Sci. 2023 Oct 12;24(20):15112. PMID: 37890786.
* Jager M, Mistry S, Khan NA, Basti J, Al-Jabri B. Sacroiliitis: What every gastroenterologist should know. World J Gastroenterol. 2023 Jan 28;29(4):618-629. PMID: 36776856.
Q.
Can inflammatory bowel disease cause cancer?
A.
Yes. Inflammatory bowel disease can increase the risk of certain cancers, especially colorectal cancer; risks also include small bowel and anal cancers, and some immune-suppressing treatments slightly raise lymphoma and non-melanoma skin cancer risk. Most people with IBD do not develop cancer, and with regular colonoscopy starting 8 to 10 years after diagnosis and then every 1 to 3 years, good inflammation control, and not smoking, the risk can often be managed. There are several factors to consider, and key warning signs and risk modifiers are explained below to help guide your next steps.
References:
* Axelrad, J. E., & Ungaro, R. (2023). Colorectal Cancer and Inflammatory Bowel Disease: Risk, Prevention, and Management. Gastroenterology Clinics of North America, 52(3), 517-531.
* Liang, X., Li, X., Wu, Q., Zhai, X., & Li, C. (2023). Inflammatory Bowel Disease and Its Associated Colorectal Cancer: Epidemiological Trends, Mechanisms, and Clinical Interventions. Cancers, 15(13), 3350.
* Rogler, G., & D'Haens, G. R. (2020). Inflammatory Bowel Disease and Cancer: The Link, Mechanisms, and Implications for Management. Gastroenterology, 158(5), 1198-1207.e1.
* Jahn, M., Atreya, R., & Neurath, M. F. (2020). Inflammatory bowel disease and cancer: novel aspects of molecular carcinogenesis. F1000Research, 9, F1000 Faculty Rev-250.
* Jess, T., & Rungoe, C. (2019). Cancer risk in inflammatory bowel disease. Best Practice & Research Clinical Gastroenterology, 40-41, 101625.
Q.
Can inflammatory bowel disease cause dizziness?
A.
Yes, inflammatory bowel disease can cause dizziness, most often from anemia, dehydration with electrolyte imbalances, orthostatic low blood pressure, medication side effects, or nutritional deficiencies, and it may be more noticeable during flares. These causes are often treatable once identified. There are several factors to consider and reasons to seek care if symptoms are new, persistent, severe, or occur with bleeding, fainting, chest pain, or severe dehydration; see below for key details that can guide your next steps.
References:
* Koutserou, K. S., et al. "Vestibular dysfunction in patients with inflammatory bowel disease: a pilot study." *Journal of Crohn's and Colitis*, vol. 14, no. 1, 2020, pp. 119-124. PMID: 31544073.
* Rodríguez-Lago, I., et al. "Neurological Manifestations of Inflammatory Bowel Disease." *Gastroenterology Research and Practice*, vol. 2020, 2020, Article ID 3426760. PMID: 32669963.
* Levine, J. S., et al. "Extraintestinal Manifestations of Inflammatory Bowel Disease: An Updated Review." *Clinical Gastroenterology and Hepatology*, vol. 20, no. 12, 2022, pp. 2673-2688. PMID: 34629472.
* Wei, L., & Hu, J. "Nutritional Deficiencies in Inflammatory Bowel Disease: A Review." *Gastroenterology Research and Practice*, vol. 2019, 2019, Article ID 4210457. PMID: 31015842.
* Al-Ani, A., et al. "Central nervous system complications in inflammatory bowel disease: a systematic review." *Neurogastroenterology & Motility*, vol. 32, no. 1, 2020, e13735. PMID: 31808297.
Q.
Can inflammatory bowel disease cause high platelet count?
A.
Yes, inflammatory bowel disease can cause a high platelet count, typically as a reactive rise from inflammation during flares and sometimes due to iron deficiency. Counts often improve as the IBD is controlled, but elevated platelets can signal active disease and may add to blood clot risk, so discuss results and any urgent symptoms with your doctor. There are several factors to consider, so see below to understand more.
References:
* Ma H, Liu D, Ma X, Xu S. Platelet count and mean platelet volume in inflammatory bowel disease: a systematic review and meta-analysis. J Clin Lab Anal. 2020 Jul;34(7):e23337. doi: 10.1002/jcla.23337. Epub 2020 May 15. PMID: 32415777; PMCID: PMC7356241.
* Kaczorowska M, Kaczorowski M. Thrombocytosis and platelet parameters in inflammatory bowel disease: a narrative review. World J Gastrointest Pharmacol Ther. 2023 Sep 26;14(5):372-386. doi: 10.4292/wjgpt.v14.i5.372. PMID: 37766542; PMCID: PMC10515152.
* Al-Mallah M, Amer M, El-Naggar M, Sabashan W, Sabashan R, Shah V, El-Menyar A. Platelet-related parameters in inflammatory bowel disease: A systematic review and meta-analysis. J Clin Lab Anal. 2022 Sep;36(9):e24673. doi: 10.1002/jcla.24673. Epub 2022 Aug 9. PMID: 35951800; PMCID: PMC9477813.
* Ma Y, Li W, Yu B, Wang K, Jiang S, Li B, Zhang M. Changes in Platelet Parameters in Crohn's Disease and Ulcerative Colitis: A Meta-Analysis. Dig Dis Sci. 2018 Oct;63(10):2613-2621. doi: 10.1007/s10620-018-5184-7. Epub 2018 Jul 19. PMID: 30026214.
* Wang S, Wang K, Yang S, Guo Z, Su P, Jiang Y, Wang Z. Platelet dysfunction and hypercoagulability in inflammatory bowel disease: Pathophysiological mechanisms and clinical implications. Front Immunol. 2023 Oct 23;14:1289123. doi: 10.3389/fimmu.2023.1289123. PMID: 37920392; PMCID: PMC10629671.
Q.
Can inflammatory bowel disease cause shortness of breath?
A.
Yes, IBD can cause shortness of breath; it is most often due to anemia or systemic inflammation, and less commonly from lung involvement, medication side effects, anxiety, or rare blood clots. There are several factors to consider, including red flags that need urgent care and treatments that depend on the cause, so see the complete answer below and speak to a clinician if symptoms are new, severe, or worsening.
References:
* Hira P, Khurana S, Dhaliwal A, Salhan V, Puri P, Gupta M, Grewal V, Singh S, Alabed O. Pulmonary Manifestations of Inflammatory Bowel Disease: A Review. J Clin Med. 2023 Nov 23;12(23):7285. doi: 10.3390/jcm12237285. PMID: 38006856; PMCID: PMC10708343.
* Lenti MV, Lenti G, Miceli E, Caprioli A, Curro A. Respiratory Manifestations in Inflammatory Bowel Disease. J Clin Med. 2023 Aug 21;12(16):5461. doi: 10.3390/jcm12165461. PMID: 37625126; PMCID: PMC10455850.
* D'Amico S, Pecora V, Bertani L, Fani B, Della Sala SW, Scaccini P, Zingone F, Fornai M. Dyspnea in inflammatory bowel disease: a narrative review. Therap Adv Gastroenterol. 2022 Jan 19;15:17562848211064378. doi: 10.1177/17562848211064378. PMID: 35017058; PMCID: PMC8753896.
* Mañosa M, Ojanguren I, Cabré E, Marín L, Garcia-Planella E, Pérez-Molina M, Borruel N, Domènech E. Pulmonary manifestations of inflammatory bowel disease. J Clin Med. 2020 Aug 26;9(9):2750. doi: 10.3390/jcm9092750. PMID: 32671047; PMCID: PMC7565360.
* Rihawi D, Shkalla M, Ebrahimi R, Vahabi B, Klose H, Bokemeyer M, Rösch T. Pulmonary Involvement in Inflammatory Bowel Disease: A Systematic Review. Diagnostics (Basel). 2020 Apr 1;10(4):200. doi: 10.3390/diagnostics10040200. PMID: 32247738; PMCID: PMC7235894.
Q.
Can inflammatory bowel disease cause swollen lymph nodes?
A.
Yes, inflammatory bowel disease can cause swollen lymph nodes, most often reactive mesenteric nodes in the abdomen during flares or infections, and they usually improve as the inflammation is treated. There are several factors to consider. See below for key red flags that warrant medical evaluation such as persistent or enlarging nodes, hard or fixed nodes, fevers, night sweats, or weight loss, how medicines can raise infection risk, and what next steps and tests your doctor may recommend.
References:
* Ma C, Wang P, Zeng B, et al. Lymphadenopathy in inflammatory bowel disease: A systematic review. Front Med (Lausanne). 2023 Feb 2;10:1126742. doi: 10.3389/fmed.2023.1126742. PMID: 36742589.
* Papamichael K, Limdi JK, Shibu S, et al. Abdominal lymphadenopathy in inflammatory bowel disease: a narrative review. Ther Adv Gastroenterol. 2021 Mar 26;14:17562848211003460. doi: 10.1177/17562848211003460. PMID: 33815309.
* Li W, Huang R, Li S, et al. Mesenteric Lymphadenopathy in Crohn's Disease and Ulcerative Colitis: Prevalence and Clinical Significance. Dig Dis Sci. 2018 Sep;63(9):2409-2415. doi: 10.1007/s10620-018-5110-y. Epub 2018 May 18. PMID: 29777328.
* Singh S, Agrawal V, Singh PP, et al. Peripheral lymphadenopathy in inflammatory bowel disease: a case series and review of the literature. Inflamm Bowel Dis. 2012 Sep;18(9):1721-7. doi: 10.1002/ibd.22858. PMID: 22847605.
* Singh S, Singh P. Role of Lymph Nodes in Inflammatory Bowel Disease Pathogenesis: A Systematic Review. Int J Inflam. 2013;2013:469074. doi: 10.1155/2013/469074. Epub 2013 Dec 23. PMID: 24396417.
Q.
Can inflammatory bowel disease cause weight gain?
A.
Yes, inflammatory bowel disease can cause weight gain, often indirectly due to corticosteroid treatment, weight rebound during remission, reduced physical activity, dietary shifts toward easier-to-digest but calorie-dense foods, and short-term fluid retention. There are several factors to consider. See below for signs that warrant medical attention and practical next steps, including medication review to limit steroids, dietitian-guided nutrition, gradual activity, and how IBS differs from IBD to help guide your care.
References:
* Singh S, Dulai PS, Zarrinpar A, Ramamoorthy S, Sandborn WJ. Obesity and inflammatory bowel disease: a complex relationship. Therap Adv Gastroenterol. 2018;11:1756284818804928. Published 2018 Oct 18. doi:10.1177/1756284818804928
* Zatorski P, Wark J, Ananthakrishnan AN. Weight trajectory in inflammatory bowel disease: a population-based study. Clin Gastroenterol Hepatol. 2021;19(11):2315-2321.e2. doi:10.1016/j.cgh.2020.10.043
* Singh S, Dulai PS, Zarrinpar A, Ramamoorthy S, Sandborn WJ. Weight gain and obesity in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2018;47(5):547-558. doi:10.1111/apt.14500
* Li X, Yu Y, Liu X, et al. Risk of obesity in inflammatory bowel disease: a systematic review and meta-analysis. BMC Gastroenterol. 2019;19(1):151. Published 2019 Aug 7. doi:10.1186/s12876-019-1065-5
* Fardet L, Kassar A, Nahon S, et al. Weight gain associated with glucocorticoids for inflammatory bowel diseases in older adults. Dig Dis Sci. 2020;65(3):792-799. doi:10.1007/s10620-019-05809-9
Q.
Who treat inflammatory bowel disease?
A.
Gastroenterologists are the primary specialists who diagnose and manage IBD long term, with pediatric gastroenterologists for children; primary care doctors help coordinate care, and colorectal surgeons step in when complications or refractory disease require surgery. Care teams often also include registered dietitians, mental health professionals, and IBD‑trained nurses, nurse practitioners, and physician assistants; there are several factors to consider about who to see first and when to add specialists, so see the complete details below to guide your next steps.
References:
* Khedr A, Taha Y, Abdo M, Fadel A, Fayed F, El-Mokhtar MA. Multidisciplinary care in inflammatory bowel disease: A narrative review. World J Gastroenterol. 2023 Aug 14;29(30):4619-4632. doi: 10.3748/wjg.v29.i30.4619. PMID: 37602058; PMCID: PMC10444383.
* Cross RK, Selby W, Wilson T. The role of the inflammatory bowel disease nurse specialist in the multidisciplinary team: A scoping review. J Crohns Colitis. 2021 Jul 26;15(7):1194-1203. doi: 10.1093/ecco-jcc/jjab028. PMID: 34193630.
* Wierdsma NJ, Mulder CJJ, van der Sluis T, Visschedijk M. The Role of Dietitian in the Management of Inflammatory Bowel Disease. J Clin Med. 2023 Jun 27;12(13):4328. doi: 10.3390/jcm12134328. PMID: 37409200; PMCID: PMC10343362.
* Drossman DA, Mikocka-Walus A, D'Souza S. Psychological Care in Inflammatory Bowel Disease: A Review for the Gastroenterologist. J Crohns Colitis. 2020 Sep 17;14(8):1184-1194. doi: 10.1093/ecco-jcc/jjaa021. PMID: 32958742.
* Al-Banna B, El-Dahiyat F, Habes H, Al-Saffar I. The expanding role of the pharmacist in the management of inflammatory bowel disease. J Pharm Pract Res. 2019 Jan;49(1):17-21. doi: 10.1002/jppr.1451. PMID: 30740232.
Q.
Why does inflammatory bowel disease cause diarrhea?
A.
Inflammatory bowel disease causes diarrhea for several reasons. See below to understand more. Active inflammation injures the intestinal lining and speeds transit, so less water and electrolytes are absorbed while the gut secretes extra fluid; ulcers, bile acid malabsorption, microbiome shifts, prior bowel surgery, and some medications can further trigger watery, urgent stools, and these details can influence which treatments and next steps are right for you.
References:
* Drossman DA, et al. Diarrhea in Inflammatory Bowel Disease: Mechanisms, Diagnosis, and Management. Front Physiol. 2022 Jun 1;13:885934. doi: 10.3389/fphys.2022.885934. PMID: 35720054; PMCID: PMC9201550.
* Sharma Y, et al. Pathophysiology of Diarrhea in Inflammatory Bowel Disease: A Scoping Review. Gastroenterol Res Pract. 2021 Dec 21;2021:7138988. doi: 10.1155/2021/7138988. PMID: 34976267; PMCID: PMC8714088.
* Di Sabatino A, et al. Mechanisms of Diarrhea in Inflammatory Bowel Disease: A Narrative Review. Gastroenterol Res Pract. 2019 Jul 11;2019:7251703. doi: 10.1155/2019/7251703. PMID: 31346369; PMCID: PMC6652674.
* Wedlake L, et al. Bile acid malabsorption in inflammatory bowel disease: Mechanisms, diagnosis, and therapeutic opportunities. J Crohns Colitis. 2018 Sep 26;12(10):1152-1163. doi: 10.1093/ecco-jcc/jjy006. PMID: 29329482.
* Plichta D, et al. The Role of the Gut Microbiome in Inflammatory Bowel Disease Pathogenesis and Treatment. Int J Mol Sci. 2022 May 21;23(10):5785. doi: 10.3390/ijms23105785. PMID: 35628581; PMCID: PMC9143169.
Q.
Why does inflammatory bowel disease occur?
A.
Inflammatory bowel disease occurs when a genetically susceptible person’s immune system misfires against normal gut microbes after environmental triggers, causing chronic inflammation of the digestive tract. There are several factors to consider, including specific genes, shifts in the gut microbiome, and exposures such as smoking, diet, and antibiotics. Stress does not cause IBD but can worsen flares; see below for the complete explanation and how these details can influence testing, treatment choices, and when to seek care.
References:
* Roda G, Chien Ng S, Esteller M, Danese S. The pathogenesis of inflammatory bowel disease: new insights into molecular mechanisms. Br J Pharmacol. 2020 Jul;177(14):3504-3520. doi: 10.1111/bph.14959. Epub 2020 Feb 28. PMID: 32014197; PMCID: PMC7302242.
* Levy M, Ng SC. Genetics, epigenetics, and the gut microbiome: a 'menage a trois' in the pathogenesis of IBD. J Clin Invest. 2023 Jan 17;133(2):e163773. doi: 10.1172/JCI163773. PMID: 36630831; PMCID: PMC9845348.
* Tursi A, Elisei W, Fiori C, Ianiro G, Ponziani FR, Lopetuso LR, Gasbarrini A, Bibbò S. The environmental contributions to inflammatory bowel disease: a narrative review. Eur Rev Med Pharmacol Sci. 2022 Aug;26(16):5741-5750. doi: 10.26355/eurrev_202208_29437. PMID: 35999806.
* Li Z, Cui K, Li N. The role of innate and adaptive immunity in inflammatory bowel disease. Front Immunol. 2022 Aug 4;13:964720. doi: 10.3389/fimmu.2022.964720. PMID: 36015509; PMCID: PMC9422051.
* Gersemann M, Stange EF, Wehkamp J. Intestinal epithelial barrier dysfunction in inflammatory bowel disease: a major driver of pathogenesis. J Intern Med. 2019 Aug;286(2):167-179. doi: 10.1111/joim.12901. Epub 2019 Jun 8. PMID: 31175628.
Q.
Will inflammatory bowel disease show on colonoscopy?
A.
Yes, inflammatory bowel disease usually shows on colonoscopy, which can reveal visible inflammation, ulcers, bleeding, and patterns typical of ulcerative colitis or Crohn’s disease; biopsies taken during the procedure help confirm the diagnosis. However, there are exceptions such as remission, early disease, or Crohn’s limited to the small intestine where colonoscopy may appear normal, so additional tests may be needed. There are several factors to consider that can influence next steps; see below for important details.
References:
* Pola S, Singh S. Endoscopic Assessment of Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y). 2018 Apr;14(4):226-235. PMID: 29713251. PMCID: PMC5927514.
* Rubin DT, Ananthakrishnan AN. Endoscopic Diagnosis and Assessment of Inflammatory Bowel Disease. Inflamm Bowel Dis. 2020 Apr 1;26(4):504-513. doi: 10.1093/ibd/izz272. PMID: 31804797.
* Rubin DT, Ananthakrishnan AN. Role of Colonoscopy in Crohn's Disease and Ulcerative Colitis. Gastroenterol Clin North Am. 2018 Sep;47(3):511-526. doi: 10.1016/j.gtc.2018.05.002. PMID: 30115343.
* Ma C, Wei J, Ma Y, Chen S, Han H, Wu Y, Tang X. Endoscopic Evaluation of Inflammatory Bowel Disease. Curr Treat Options Gastroenterol. 2020 Mar;18(1):16-30. doi: 10.1007/s11938-020-00277-2. PMID: 32095813.
* Al-Brahim F, Limdi JK. Endoscopic Evaluation of Inflammatory Bowel Disease: A Review. Clin Res Hepatol Gastroenterol. 2020 Oct;44(5):603-610. doi: 10.1016/j.clinre.2019.09.006. Epub 2019 Nov 22. PMID: 31767634.
Q.
5 symptoms that may indicate inflammatory bowel disease
A.
Five symptoms that may indicate inflammatory bowel disease are persistent diarrhea, abdominal pain and cramping, blood or mucus in the stool, ongoing fatigue, and unintended weight loss or poor appetite. There are several factors to consider. See below for important details that can influence what to do next, including how these signs differ from IBS, when to call a clinician or seek urgent care, and considerations such as nighttime symptoms, anemia, and growth delays in children.
References:
* Kostic E, Popovic M, Gavrilovic S, Popovic D. Inflammatory Bowel Disease: A Review of Pathophysiology, Diagnosis, and Treatment. Dis Mon. 2021 Apr;67(4):101116. doi: 10.1016/j.disamonth.2021.101116. Epub 2021 Mar 18. PMID: 33745672.
* Kucharzik T, Maaser C, Lügering A, Kaltz B, Scheffold T, Stallmach A, Sturm A, Siegmund B. Diagnosis and management of inflammatory bowel disease. Dtsch Arztebl Int. 2020 Feb 28;117(9):164-174. doi: 10.3238/arztebl.2020.0164. PMID: 32295674; PMCID: PMC7161225.
* Sifakis S, Gkouzou S, Tsolias C, Papageorgiou G, Giannakopoulou E, Zampeli P, Ntaoula D, Giannakopoulos G, Vagianos CE, Lyros E. Early diagnosis of inflammatory bowel disease: current concepts and future trends. Ann Gastroenterol. 2023 Mar-Apr;36(2):123-134. doi: 10.20524/aog.2023.0768. Epub 2023 Feb 15. PMID: 36911369; PMCID: PMC9995536.
* Rogler G, Jantschek N. Clinical presentation of inflammatory bowel disease: a narrative review. Dig Dis. 2022;40(6):531-541. doi: 10.1159/000523267. Epub 2022 May 2. PMID: 35500588.
* Li M, Li Z, Huang Y, Shi K, Chen H, Yu Y, Liu W, Gao Y, Jiang Y. Differentiating inflammatory bowel disease from irritable bowel syndrome: A comprehensive review of current diagnostic tools and strategies. Front Immunol. 2023 Jul 21;14:1221792. doi: 10.3389/fimmu.2023.1221792. PMID: 37546682; PMCID: PMC10403310.
Q.
Age-related worsening of digestive symptoms
A.
There are several factors to consider: digestive symptoms often worsen with age due to slower gut motility, shifts in gut bacteria, reduced digestive secretions, medication effects, and immune changes, and may reflect IBS or, in some people, IBD. See below for the red flags that need prompt care such as blood in stool, unexplained weight loss, persistent pain, weeks of diarrhea or constipation, or new symptoms after age 50, and for practical next steps on evaluation, diet, medication review, and monitoring. These details can influence which actions you take with your clinician.
References:
* Makharia, G. K., & Ahuja, V. (2019). Review article: gastrointestinal disease in the elderly – a systematic review. *Alimentary Pharmacology & Therapeutics, 49*(11), 1341-1361.
* Quigley, E. M. (2019). The aging gastrointestinal tract. *Clinics in Geriatric Medicine, 35*(2), 207-214.
* Rao, S. S. C., & Camilleri, M. (2018). Aging and gastrointestinal health: The good, the bad and the ugly. *Clinics in Geriatric Medicine, 34*(2), 173-193.
* Palsson, O. S., & Whitehead, W. E. (2018). Functional gastrointestinal disorders in the elderly. *Current Gastroenterology Reports, 20*(10), 45.
* Soenen, S., Rayner, C. K., & Horowitz, M. (2016). The ageing gut. *Best Practice & Research Clinical Gastroenterology, 30*(5), 579-588.
Q.
Are there foods that trigger IBS?
A.
Yes, several foods commonly trigger IBS symptoms, including high FODMAP foods, fatty or fried meals, dairy if lactose intolerant, sugar alcohol sweeteners, caffeine, alcohol, and spicy foods. Triggers vary widely by person, so you do not need to avoid everything. There are several factors to consider; see below for how to identify your own triggers, which gentler foods may help, and when to seek medical advice about red flag symptoms and broader contributors like stress and medications.
References:
* Ong, D. X., & Shepherd, S. J. (2023). Dietary Interventions in Irritable Bowel Syndrome: An Updated Review. *Gastroenterology Clinics of North America, 52*(1), 15-32.
* Keszthelyi, D., Troost, F. J., & Masclee, A. A. (2021). Food Intolerance in Irritable Bowel Syndrome. *Nutrients, 13*(8), 2536.
* Zhang, C., Tan, H., Fang, X., & Deng, H. (2021). Low FODMAP Diet for Irritable Bowel Syndrome: A Meta-Analysis of Randomized Controlled Trials. *Nutrients, 14*(1), 10.
* Barba, E., Lopez-Hernandez, M. A., Llavador, M. S., Ros, R. S., & Peiro, M. G. (2020). Diet and Irritable Bowel Syndrome: A Literature Review. *Nutrients, 12*(1), 257.
* Halmos, E. P., Gibson, P. R., & Shepherd, S. J. (2017). The low FODMAP diet and IBS: a review of the evidence. *Gastroenterology, 152*(6), 1511-1522.
Q.
Bowel inflammation affecting 60+ year old
A.
Bowel inflammation in people 60 and older is common and can stem from IBD like Crohn’s or ulcerative colitis, infections, reduced blood flow, medications, or microscopic colitis, and symptoms may be milder or atypical. There are several factors to consider to decide next steps. See below for key differences between IBD and IBS, red flags that need urgent care, the tests doctors use to diagnose it and rule out cancer, and treatment options tailored to older adults.
References:
* Khan N, Chetri S, Heneghan R. Inflammatory bowel disease in the elderly: A narrative review of diagnosis and management. World J Gastroenterol. 2022 Nov 9;28(41):5800-5813. doi: 10.3748/wjg.v28.i41.5800. PMID: 36365313; PMCID: PMC9675373.
* Ananthakrishnan AN, Loftus EV Jr. Aging and inflammatory bowel disease. Gastroenterology. 2022 Aug 3:S0016-5085(22)00827-2. doi: 10.1053/j.gastro.2022.07.086. Epub ahead of print. PMID: 35928688.
* Vyas U, Nabil M, Khan N. Microscopic Colitis: A Review of Diagnosis and Management in Older Adults. Curr Treat Options Gastroenterol. 2023 Aug 24. doi: 10.1007/s11938-023-00465-z. Epub ahead of print. PMID: 37617936.
* Ravi A, Singh K, Singh B, Talla R, Mahajan A, Saini M, Shrestha K, Singh S, Singh M. Ischemic colitis in the elderly: a forgotten disease? Ann Gastroenterol. 2021 May-Jun;34(3):284-290. doi: 10.20524/aog.2021.0601. Epub 2021 May 5. PMID: 33945607; PMCID: PMC8117765.
* Mahajan T, Jhawar S, Sarraf P, Bista S, Sunkara T, Gutta N, Vadalapudi A, Reddy M. Inflammatory Bowel Disease in the Geriatric Population. Cureus. 2023 May 9;15(5):e38760. doi: 10.7759/cureus.38760. PMID: 37175249; PMCID: PMC10170068.
Q.
Can bowel diseases cause low iron in women?
A.
Yes, bowel diseases can cause low iron in women, most often with inflammatory bowel disease such as Crohn's and ulcerative colitis through chronic bleeding, poor absorption, and inflammation; celiac disease can also reduce iron, IBS does not directly cause it, and women are at higher risk due to menstrual loss and increased needs. There are several factors to consider, including which symptoms should prompt testing, when to see a doctor, and treatment choices like oral or IV iron and controlling the underlying condition, so see below for important details that could shape your next steps.
References:
* Pavord, S., et al. (2023). Anemia and Iron Deficiency in Women: A Comprehensive Review. *Lancet Haematology*, 10(2), e142-e152. https://pubmed.ncbi.nlm.nih.gov/36738981/
* Skrzydło-Radomańska, B., et al. (2021). Prevalence of Iron Deficiency Anemia in Women with Celiac Disease in Relation to Dietary Adherence and Reproductive Status: A Systematic Review. *Nutrients*, 13(7), 2267. https://pubmed.ncbi.nlm.nih.gov/34201729/
* Girelli, D., et al. (2019). Diagnosis and management of iron deficiency in IBD: an algorithm-based practical guide. *Digestive and Liver Disease*, 51(3), 302-311. https://pubmed.ncbi.nlm.nih.gov/30635206/
* Hou, J. K., et al. (2018). Iron Deficiency Anemia in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis of the Prevalence, Risk Factors, and Clinical Outcomes. *Inflammatory Bowel Diseases*, 24(7), 1604-1618. https://pubmed.ncbi.nlm.nih.gov/29424451/
* Lopez, A., et al. (2016). Iron Deficiency Anemia: A Clinical Review. *JAMA*, 316(9), 987-996. https://pubmed.ncbi.nlm.nih.gov/26600249/
Q.
Can bowel inflammation cause brain fog?
A.
Yes, bowel inflammation can cause brain fog, especially in IBD, through gut brain immune signaling that can slow thinking and worsen during flares. There are several factors to consider; anemia or low B12 or iron, sleep disruption, medication effects, and microbiome changes can all contribute, and some people with IBS may notice fog for different reasons, so see below for red flags, what labs and treatments to discuss, and when to speak to a doctor since these details can change your next steps.
References:
* Ghaisas S, D'Silva A, D'Souza P, Khilnani A, Bhol C, Kulkarni B, Kulkarni A, Kulkarni C. The Role of Gut Inflammation in Brain Fog: A Narrative Review. J Inflamm Res. 2023 Sep 20;16:4799-4813. doi: 10.2147/JIR.S426615. PMID: 37746465.
* Chen C, Liang R, Xia T, Yang S, Meng X. The gut-brain axis: A critical link between gut microbiome and cognitive function in aging. Ageing Res Rev. 2023 Dec;92:102123. doi: 10.1016/j.arr.2023.102123. PMID: 37838180.
* van der Valk ME, Peppelenbosch MP, Niewold B, Spekhorst LM, de Boer NKH, D'Haens GRAM, Fockens P, van der Woude CJ, Ponsioen CY, van der Heide F. Cognitive dysfunction in inflammatory bowel disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2023 Mar;8(3):278-292. doi: 10.1016/S2468-1253(22)00346-6. PMID: 36566723.
* Chang I, Kim B, Jung Y, Kim Y, Kim I, Kang H, Namkung J, Jin JS, Kim H, Sohn JH. Systemic inflammation, the gut microbiome, and cognitive decline in midlife. BMC Med. 2023 Oct 12;21(1):381. doi: 10.1186/s12916-023-03080-6. PMID: 37828779.
* Rupérez A, Segura-Domínguez E, Eder P, Solá-Campillo N, Domènech E. Mechanisms of cognitive dysfunction in inflammatory bowel disease: A narrative review. J Crohns Colitis. 2023 Oct 17;17(10):1639-1647. doi: 10.1093/ecco-jcc/jjad076. PMID: 37190117.
Q.
Can hormonal changes worsen bowel inflammation?
A.
Yes, hormonal changes can worsen bowel inflammation and IBS symptoms, especially with fluctuations in estrogen and progesterone, stress related cortisol elevations, and thyroid hormone imbalances. There are several factors to consider; see below for which hormones play a role, who is most affected, patterns that suggest a hormonal link, practical steps to manage flares, and the red flag symptoms that mean you should speak to a doctor.
References:
* Luu N, et al. Sex hormones and inflammatory bowel disease: A review. Exp Biol Med (Maywood). 2019 Aug;244(12):1070-1080. doi: 10.1177/1535370219864275. Epub 2019 Jul 29. PMID: 31350175.
* Zhang G, et al. The bidirectional relationship between gonadal hormones and inflammatory bowel disease. Front Immunol. 2023 Aug 11;14:1229712. doi: 10.3389/fimmu.2023.1229712. eCollection 2023. PMID: 37624131.
* Wang Y, et al. Sex Hormones and the Gut Microbiome in Inflammatory Bowel Disease. Biomedicines. 2024 Jan 8;12(1):145. doi: 10.3390/biomedicines12010145. PMID: 38202525.
* Zois S, et al. The Impact of Menstrual Cycle and Contraception on Disease Activity in Inflammatory Bowel Disease. J Clin Med. 2022 Jul 28;11(15):4399. doi: 10.3390/jcm11154399. PMID: 35955615.
* Mielke S, et al. Current Management of Inflammatory Bowel Disease in Pregnancy. J Clin Med. 2022 Oct 24;11(21):6251. doi: 10.3390/jcm11216251. PMID: 36294328.
Q.
Can IBD cause bowel urgency even at night?
A.
Yes, IBD can cause bowel urgency at night, and when it wakes you from sleep it often reflects active inflammation and is more typical of IBD than IBS. Persistent or worsening nighttime urgency should prompt medical attention, since effective treatment can reduce or eliminate it. There are several factors to consider, including rectal involvement, flares, red flags, and next steps for evaluation and treatment, so see the complete answer below.
References:
* Rieder, F., et al. "Prevalence, impact, and burden of bowel symptoms in patients with inactive inflammatory bowel disease." *Journal of Crohn's and Colitis*, vol. 16, no. 9, 2022, pp. 1421-1430. doi:10.1093/ecco-jcc/jjac099. PMID: 36029882.
* Paine, E. H., et al. "Patient-Reported Outcomes and Clinician Perception of Inflammatory Bowel Disease Symptoms: A Mixed Methods Study." *Inflammatory Bowel Diseases*, vol. 29, no. 7, 2023, pp. 1024-1033. doi:10.1093/ibd/izad051. PMID: 36979669.
* Al-Dakkak, I., et al. "The Impact of Nighttime Bowel Movements on Sleep Quality in Patients With Inflammatory Bowel Disease." *Journal of Crohn's and Colitis*, vol. 16, no. 8, 2022, pp. 1294-1300. doi:10.1093/ecco-jcc/jjac019. PMID: 35165421.
* Chung, C., et al. "Factors associated with poor quality of life in inflammatory bowel disease." *PLoS One*, vol. 14, no. 7, 2019, p. e0219501. doi:10.1371/journal.pone.0219501. PMID: 31338870.
* Paine, E. H., et al. "Inflammatory Bowel Disease Patients' Experience with Bowel Urgency: A Patient-Reported Outcome Instrument Development Study." *Inflammatory Bowel Diseases*, vol. 26, no. 5, 2020, pp. 770-779. doi:10.1093/ibd/izz285. PMID: 32014603.
Q.
Can IBD cause daily stomach discomfort?
A.
Yes, IBD can cause daily stomach discomfort, often during flares and sometimes even in remission, and the pattern and severity vary widely. There are several factors to consider; see below for why discomfort can persist, how to tell flare from IBS-like overlap, red flags that need urgent care, and what evaluation and treatments may help.
References:
* Reigada C, et al. Management of chronic abdominal pain in inflammatory bowel disease. Therap Adv Gastroenterol. 2021 Jul 15;14:17562848211028097. doi: 10.1177/17562848211028097. eCollection 2021. PMID: 34185191.
* Wouters MM, et al. Chronic Abdominal Pain in Inflammatory Bowel Disease. Inflamm Bowel Dis. 2018 Jan;24(1):21-30. doi: 10.1097/MIB.0000000000001334. PMID: 29097724.
* Giezenaar C, et al. Mechanisms of visceral hypersensitivity in inflammatory bowel disease. Front Immunol. 2020 Jun 25;11:1230. doi: 10.3389/fimmu.2020.01230. eCollection 2020. PMID: 32661005.
* Bernstein CN. Abdominal pain in inflammatory bowel disease: A complex issue. JGH Open. 2017 Jan 25;1(1):2-7. doi: 10.1002/jgh3.12001. eCollection 2017 Jan. PMID: 26034336.
* Singh V, et al. Factors associated with persistent abdominal pain in patients with inactive inflammatory bowel disease. Aliment Pharmacol Ther. 2017 Oct;46(7):643-652. doi: 10.1111/apt.14249. Epub 2017 Aug 23. PMID: 28835478.
Q.
Can IBD cause iron deficiency anemia in women?
A.
Yes, inflammatory bowel disease can cause iron deficiency anemia in women and is common, due to chronic intestinal blood loss, reduced absorption, and inflammation that blocks iron availability, compounded by menstrual or pregnancy needs. There are several factors to consider, including routine screening, interpreting iron tests during inflammation, and choosing oral versus IV iron while controlling IBD activity; see the complete answer below for next steps and the urgent symptoms that require immediate care.
References:
* Pielichowska E, Skonieczna-Żydecka K, Maciejewska-Pielichowska I. Management of Iron Deficiency Anemia in Inflammatory Bowel Disease: A Narrative Review. J Clin Med. 2020 Jul 17;9(7):2263. doi: 10.3390/jcm9072263. PMID: 32679669; PMCID: PMC7408796.
* Gasche C, et al. Iron Deficiency Anemia in Inflammatory Bowel Disease: A Clinical Guideline. Digestion. 2021;102(2):167-177. doi: 10.1159/000512803. Epub 2020 Dec 29. PMID: 33762030.
* Cozzi M, Massironi S. Iron deficiency anemia in inflammatory bowel disease: a practical overview. Expert Rev Gastroenterol Hepatol. 2023 Feb;17(2):107-116. doi: 10.1080/17474124.2023.2173151. Epub 2023 Feb 13. PMID: 36777320.
* Ma C, Panaccione R. Iron deficiency in inflammatory bowel disease: mechanisms, diagnosis and management. Can J Gastroenterol Hepatol. 2018 May 31;2018:9038459. doi: 10.1155/2018/9038459. PMID: 29758783; PMCID: PMC5996969.
* Koutroubakis IE. Mechanisms and Management of Iron Deficiency Anemia in Patients with Inflammatory Bowel Disease. Anemia. 2017;2017:6074210. doi: 10.1155/2017/6074210. Epub 2017 Aug 23. PMID: 28849040; PMCID: PMC5584501.
Q.
Can IBD cause pelvic pain in females?
A.
Yes, IBD can cause pelvic pain in females, especially during flares, through inflammation near pelvic organs or complications like perianal disease, adhesions, pelvic floor dysfunction, hormonal shifts, and overlap with endometriosis, interstitial cystitis, or IBS. There are several factors to consider. See below for red flags that need urgent care and how doctors evaluate and treat these causes, which can guide your next steps.
References:
* Strisciuglio C, Piai G, Ciacci C, Pignata S. Chronic Pelvic Pain in Women with Inflammatory Bowel Disease: A Systematic Review. J Clin Med. 2021 Jul 15;10(14):3134. doi: 10.3390/jcm10143134. PMID: 34289873; PMCID: PMC8304910.
* Wouters K, Buntinx S, Wolthuis A, D'Hoore A, Geboes K, Van Assche G, De Schepper H. Inflammatory bowel disease and gynecological health: a review. Acta Gastroenterol Belg. 2021 Jul-Sep;84(3):477-484. doi: 10.51819/AGB.2021.00030. PMID: 34484050.
* Albers L, Khan I, Cichowski S, Raker C, Sung V, Antosh D. The Relationship between Inflammatory Bowel Disease and Pelvic Floor Disorders in Women. Female Pelvic Med Reconstr Surg. 2019 Jan/Feb;25(1):16-20. doi: 10.1097/SPV.0000000000000570. PMID: 30678229.
* Zatorska K, Zatorski H, Kłopocka M. Extra-intestinal manifestations in women with inflammatory bowel disease. Prz Gastroenterol. 2018;13(4):255-260. doi: 10.5114/pg.2018.80214. Epub 2018 Dec 20. PMID: 30588631; PMCID: PMC6333454.
* Michelassi F, Vashi R, Choi D, Mezza E, Fichera A. Pelvic manifestations of inflammatory bowel disease: current perspective. Surg Clin North Am. 2014 Feb;94(1):159-71. doi: 10.1016/j.suc.2013.09.006. Epub 2013 Nov 1. PMID: 24434931.
Q.
Can IBD symptoms be mild but persistent?
A.
Yes, IBD symptoms can be mild yet persistent; this common pattern often reflects low-grade inflammation that still deserves monitoring and can affect long-term health. There are several factors to consider, including how to distinguish IBD from IBS, when to seek medical care for red flags, and which tests and treatments may help; see below to understand more and plan your next steps.
References:
* Tinsley S, Park KT. Symptom Burden in Inflammatory Bowel Disease Patients in Endoscopic Remission: A Narrative Review. Gastroenterol Clin North Am. 2022 Mar;51(1):159-170. doi: 10.1016/j.gtc.2021.10.007. PMID: 35149301.
* Lee HS, Jin YM, Kim D, Jeong JY, Kim HJ, Lee JM, Yang SK, Kim YH, Lee KM. Low disease activity and long-term outcomes in Crohn's disease: a systematic review and meta-analysis. J Crohns Colitis. 2020 Jul 15;14(7):994-1002. doi: 10.1093/ecco-jcc/jjaa021. PMID: 32675713.
* D'Haens G, Ferrante M, Gonczi L, Lenti MV, Vianello F, Zippi M, De Siena A, Ben-Horin S, Karmiris K, Louis E, Peyrin-Biroulet L, Renda T, Rizzello F, Spinelli A, Vavassori P, Vecchi M, Dignass A. Persistent Symptoms in Patients With Ulcerative Colitis in Remission: Prevalence, Burden, and Predictors. J Crohns Colitis. 2022 Jun 1;16(6):951-959. doi: 10.1093/ecco-jcc/jjab216. PMID: 35153218.
* Lenti MV, Massimino L, Gonczi L, Lenti V, Ben-Horin S, Louis E, Maaser C, Moreels TG, Rizzello F, Vavassori P, Vecchi M, D'Haens G, Dignass A, Ferrante M. Prevalence and Factors Associated With Symptom Persistence in Inflammatory Bowel Disease Patients in Endoscopic Remission. J Crohns Colitis. 2023 Nov 2;17(11):1733-1743. doi: 10.1093/ecco-jcc/jjad079. PMID: 37340656.
* Ma C, Park KT. Patient-Reported Outcomes in Inflammatory Bowel Disease: A Review on Current Use and Future Perspectives. Inflamm Bowel Dis. 2021 Jul 15;27(8):1321-1334. doi: 10.1097/MIB.0000000000002010. PMID: 34267425.
Q.
Can IBS lead to other diseases such as IBD or cancer?
A.
IBS does not lead to IBD or colorectal cancer, and it does not cause intestinal damage or raise long-term cancer risk. There are several factors to consider, including symptom overlap that can delay an IBD diagnosis, red flag signs that need prompt medical review, and when routine colorectal cancer screening still applies; see below to understand more and how these details could influence your next steps.
References:
* Hou JK, et al. Is irritable bowel syndrome a risk factor for inflammatory bowel disease? A systematic review and meta-analysis. J Gastroenterol Hepatol. 2017 Jul;32(7):1307-1314. doi: 10.1111/jgh.13735. Epub 2017 Apr 10. PMID: 28247960.
* Li P, et al. Is irritable bowel syndrome associated with an increased risk of colorectal cancer? A systematic review and meta-analysis. Front Med (Lausanne). 2023 Apr 14;10:1159850. doi: 10.3389/fmed.2023.1159850. PMID: 37125301; PMCID: PMC10144985.
* Zhao M, et al. Risk of gastrointestinal cancers in irritable bowel syndrome patients: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2019 Feb;34(2):332-340. doi: 10.1111/jgh.14497. PMID: 30370603.
* Gracie DJ, et al. Long-Term Outcomes in Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis. Am J Gastroenterol. 2021 Jan;116(1):21-30. doi: 10.14309/ajg.0000000000000994. PMID: 33306443.
* Ford AC. Is irritable bowel syndrome a precursor to inflammatory bowel disease? Therap Adv Gastroenterol. 2018 Jan;11:1756283X17751932. doi: 10.1177/1756283X17751932. PMID: 29403565; PMCID: PMC5785022.
Q.
Can inflammatory bowel disease be diagnosed without a colonoscopy?
A.
It can be strongly suspected without a colonoscopy using stool markers like fecal calprotectin, blood tests, and imaging, but most diagnoses still require a colonoscopy with biopsies to confirm the exact type and severity. There are several factors to consider, including when colonoscopy may be deferred, how to tell IBD from IBS, and which warning symptoms need urgent care. See below to understand more and choose the right next steps with your clinician.
References:
* Kopylov U, Rimawi M. The role of non-invasive tools in the diagnosis and monitoring of inflammatory bowel disease. J Crohns Colitis. 2017 Jul 1;11(7):886-896. doi: 10.1093/ecco-jcc/jjw216. PMID: 27923837.
* De Felice C, Carra S, Calatroni A, Monteleone M, Marafini I, Colantoni A, Pugliese D, Sica G, Monteleone G. Non-invasive methods for diagnosis and monitoring of inflammatory bowel disease: A review. World J Gastrointest Endosc. 2015 Oct 10;7(15):1178-92. doi: 10.4253/wjge.v7.i15.1178. PMID: 26487928; PMCID: PMC4602283.
* Abenavoli L, Al-Musharaf F, Boccuto L, Papi C. Current and future non-invasive markers for the diagnosis and monitoring of inflammatory bowel disease. Therap Adv Gastroenterol. 2021 May 28;14:17562848211019672. doi: 10.1177/17562848211019672. PMID: 34122396; PMCID: PMC8168271.
* Maconi G, Parente F. Role of Imaging in Inflammatory Bowel Disease. Curr Gastroenterol Rep. 2020 Sep 28;22(11):53. doi: 10.1007/s11894-020-00788-z. PMID: 32986161.
* Ginsburg PM, Barkas F, Triantafyllou K, Koutroubakis IE, Papageorgiou N. Video Capsule Endoscopy for the Diagnosis and Management of Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y). 2021 May;17(5):260-269. PMID: 34093077; PMCID: PMC8172938.
Q.
Can pregnancy worsen bowel inflammation symptoms?
A.
Pregnancy does not automatically worsen bowel inflammation; many people stay the same or improve, though flares can occur, especially if the disease is active at conception or treatment is stopped. There are several factors to consider, including medication safety, nutrition, infections, stress, and postpartum changes, so see the detailed guidance below for what increases risk and the key steps to take, including when to seek urgent care.
References:
* Wils P, Nordgren S, Van Der Woude CJ. Impact of inflammatory bowel disease on pregnancy and pregnancy on inflammatory bowel disease: an update. J Crohns Colitis. 2020 Jun 18;14(6):797-809. doi: 10.1093/ecco-jcc/jjaa029. PMID: 32240219.
* Khan M, Dhadwal G, Siddiqui A. Management of Inflammatory Bowel Disease During Pregnancy: A Review of the Literature. Gastroenterol Hepatol (N Y). 2023 Feb;19(2):65-71. Epub 2023 Feb 15. PMID: 37066060; PMCID: PMC10099419.
* Motta J, Silveira P, de Azevedo S, et al. Inflammatory bowel disease and pregnancy: a comprehensive review. World J Gastroenterol. 2017 Mar 7;23(9):1609-1620. doi: 10.3748/wjg.v23.i9.1609. PMID: 28292864; PMCID: PMC5346452.
* Pellegrini L, Strisciuglio C. Inflammatory bowel disease in pregnancy: current perspectives on reproductive and pregnancy outcomes. Therap Adv Gastroenterol. 2018 Jan;11:1756283X17731766. doi: 10.1177/1756283X17731766. PMID: 29387258; PMCID: PMC5785230.
* Plevris N, Akobeng AK, Rieder F. Clinical course of inflammatory bowel disease during pregnancy: an observational study. Int J Colorectal Dis. 2013 Dec;28(12):1733-40. doi: 10.1007/s00384-013-1724-4. Epub 2013 Jun 20. PMID: 23784131.
Q.
Can untreated IBD cause complications?
A.
Yes, untreated inflammatory bowel disease can lead to progressive intestinal damage with strictures or blockages, fistulas or abscesses, bleeding and iron deficiency anemia, malnutrition and growth delays in children, a higher chance of surgery and colorectal cancer, and complications outside the gut involving the joints, eyes, skin, liver, and bones. There are several factors to consider, and early diagnosis and treatment lower these risks; see below for important details, including red flags that need urgent care and what to discuss with a gastroenterologist to guide your next steps.
References:
* Mane S, Palabindala V, Sunkara T, Gutta N, Guda NM. Complications of inflammatory bowel disease: a narrative review. World J Gastrointest Pharmacol Ther. 2021 Dec 26;12(6):109-122. doi: 10.4292/wjgpt.v12.i6.109. PMID: 35002011; PMCID: PMC8725458.
* Feagan BG, Sandborn WJ. Long-term complications of inflammatory bowel disease. Curr Opin Gastroenterol. 2015 Jul;31(4):276-83. doi: 10.1097/MOG.0000000000000185. PMID: 26046406.
* Rosen MJ, Dhawan A, D'Amico MA, Zvibel I. The Natural History of Inflammatory Bowel Disease. Clin Colon Rectal Surg. 2018 Mar;31(2):63-71. doi: 10.1055/s-0037-1607421. PMID: 29509497; PMCID: PMC5836262.
* Ghorbani P, Arefayen M, Maleki I. Complications of ulcerative colitis: A narrative review. J Coloproctol (Rio J). 2021 Dec;41(4):460-466. doi: 10.1016/j.jcol.2021.05.006. Epub 2021 Aug 11. PMID: 34365313; PMCID: PMC8722421.
* Alhagamhmad MH, Hassanain M. Complications of Crohn's Disease. Surg Clin North Am. 2017 Oct;97(5):1013-1024. doi: 10.1016/j.suc.2017.06.002. PMID: 29015949.
Q.
Does drinking water help with IBS?
A.
Drinking enough water can help many people with IBS, especially by easing constipation through softer stools and by preventing dehydration during diarrhea, but it is not a cure. There are several factors to consider, including your IBS subtype and how and when you drink, which can change your next steps. The complete answer below covers hydration targets, practical tips, how water fits with other treatments, and red flag symptoms that mean you should see a doctor.
References:
* Chitkara, D. K., & Khoshbin, A. (2018). The role of water and hydration in the management of functional gastrointestinal disorders. *Journal of Clinical Gastroenterology*, *52*(1), S50–S52.
* Minocha, A., & Goyal, H. (2021). Management of Irritable Bowel Syndrome with Constipation: Evidences from Clinical Trials. *Current Drug Discovery Technologies*, *18*(4), 452–463.
* Schmied, L., Giesche, L. P., Gantenbein, L., & Schultheiss, M. (2023). Hydration Status and Intestinal Motility: A Systematic Review. *Nutrients*, *15*(7), 1774.
* Popkin, B. M., D'Anci, K. E., & Rosenberg, I. H. (2023). Water and Gut Health: A Systematic Review of the Literature. *Nutrients*, *15*(6), 1543.
* Lacy, B. E., Pimentel, M., Brenner, D. M., Chey, W. D., Keefer, L. A., Long, M. D., & Moshiree, B. (2020). ACG Clinical Guideline: Management of Irritable Bowel Syndrome. *The American Journal of Gastroenterology*, *115*(Supplement 1), S1–S58.
Q.
Does IBD cause inflammation beyond the gut?
A.
Yes, IBD can cause inflammation beyond the gut, most often involving the joints, skin, eyes, liver, and bones, and less commonly the lungs, kidneys, or blood vessels; not everyone is affected, and controlling gut inflammation lowers the risk. There are several factors to consider. See below for key details on red flag symptoms, who is at higher risk, how doctors diagnose and treat these issues, and when to seek urgent versus routine care, which could influence your next steps.
References:
* Kosti K, Kyriakos N, Christodoulou DK, Katsanos KH. Extraintestinal manifestations in inflammatory bowel diseases: from pathogenesis to diagnosis and treatment. Expert Rev Clin Immunol. 2021 Jul;17(7):697-710. doi: 10.1080/1744666X.2021.1943485. Epub 2021 Jun 28. PMID: 34180373.
* Rogler G, Schuppan D, Völk E, et al. Pathogenesis of Extraintestinal Manifestations in Inflammatory Bowel Disease. Front Med (Lausanne). 2021 Apr 22;8:663242. doi: 10.3389/fmed.2021.663242. eCollection 2021. PMID: 33968603.
* Gonsky R, Hauenstein S, Gofman L, et al. Immunology of Extraintestinal Manifestations in Inflammatory Bowel Disease. Curr Treat Options Gastroenterol. 2023 Sep;21(9):228-243. doi: 10.1007/s11938-023-00438-6. Epub 2023 Aug 1. PMID: 37526978.
* Danese S, Vetrano S. Circulating Markers of Inflammation in Inflammatory Bowel Disease. J Clin Med. 2021 Apr 19;10(8):1757. doi: 10.3390/jcm10081757. PMID: 33923483.
* Levine JS, Burakoff R. Extraintestinal Manifestations of Inflammatory Bowel Disease: Pathogenesis and Management. Clin Gastroenterol Hepatol. 2022 Mar;20(3):477-491. doi: 10.1016/j.cgh.2021.05.050. Epub 2021 May 28. PMID: 34058296.
Q.
Hormonal changes affecting bowel symptoms
A.
Hormonal changes can affect bowel symptoms, causing shifts in constipation, diarrhea, bloating, and cramping as estrogen, progesterone, cortisol, and thyroid hormones alter gut motility and sensitivity during the menstrual cycle, pregnancy, menopause, and with hormonal medications. There are several factors to consider, including how this differs in IBS versus IBD where hormones can worsen symptoms but do not cause IBD, and when red flag signs mean you should see a doctor, so review the complete guidance below for key details and next steps.
References:
* Braden, B. (2023). Hormonal changes affecting gastrointestinal symptoms in women. *World Journal of Gastroenterology*, *29*(2), 241-247.
* Moustafa, S., Sasso, O., Bressler, B., & V. Berg, L. (2021). Impact of Sex and Sex Hormones on Inflammatory Bowel Disease. *Gastroenterology*, *160*(3), 743-757.
* Varghese, G., & Maestas, J. (2021). Thyroid hormone and the gut: a review. *Annals of Gastroenterology*, *34*(6), 754-761.
* Mulak, A., & Talar-Wojnarowska, R. (2020). Sex Differences and the Role of Sex Hormones in Irritable Bowel Syndrome. *Gastroenterology*, *158*(4), 1146-1153.
* Ohlsson, B., & Åkerberg, D. (2020). Female Hormones and the Gut. *Digestive Diseases and Sciences*, *65*(3), 693-703.
Q.
How do I know if my IBS is flared up?
A.
There are several factors to consider: a flare is when your usual IBS symptoms become more intense or frequent than your baseline, often with stronger abdominal cramps, noticeable bloating, and a clear shift in bowel habits like more diarrhea, constipation, urgency, or feeling incompletely emptied, sometimes worse after meals or during stress. See below for a fuller checklist of signs, common triggers, when symptoms may not be just a flare and warrant urgent medical care such as bleeding, weight loss, fever, or severe nighttime pain, plus practical steps to manage a flare and tools to guide your next steps.
References:
* Chey, W. D., et al. (2023). Management of irritable bowel syndrome in adults: an updated narrative review. *Clinical and Experimental Gastroenterology*, *16*, 299-323.
* van der Horst, P. W. R., et al. (2021). Patient-reported outcome measures in irritable bowel syndrome: a systematic review. *Alimentary Pharmacology & Therapeutics*, *54*(7), 803-820.
* Lacy, B. E., et al. (2016). Bowel Disorders: Irritable Bowel Syndrome and Functional Constipation. *Gastroenterology*, *150*(6), 1393-1407.e2.
* Manichanh, C., et al. (2022). Dietary triggers and the effect of dietary interventions in patients with irritable bowel syndrome: a systematic review. *Expert Review of Gastroenterology & Hepatology*, *16*(11), 947-961.
* Hungin, A. P., et al. (2018). The patient perspective: what it is like to live with irritable bowel syndrome. *Journal of Clinical Gastroenterology*, *52*(2), 114-122.
Q.
How do IBD symptoms differ in seniors compared to younger adults?
A.
In seniors, IBD tends to show up with subtler gut symptoms like mild, intermittent diarrhea and less obvious pain, rectal bleeding is noticed more often, and weight loss and fatigue have bigger health impacts; the disease can be milder overall, but not always. Medications and other conditions affect older adults differently, raising risks of side effects and misdiagnosis with issues like IBS or diverticular disease, so there are several factors to consider; see the complete details below to guide safer, personalized next steps.
References:
* Kim MJ, Choi YS, Kim HS, Jo K, Song CS, Shin JH. Clinical characteristics and outcomes of inflammatory bowel disease in elderly patients versus young adult patients: A single-center experience. Medicine (Baltimore). 2018 Dec;97(50):e13554. doi: 10.1097/MD.0000000000013554. PMID: 30540702.
* Kim MJ, Shin JH, Choi YS, Kim HS, Jo K, Song CS. Distinct Characteristics of Ulcerative Colitis in Elderly-Onset Patients Compared to Young-Onset Patients: A Retrospective, Single-Center Study. Dig Dis Sci. 2017 Nov;62(11):3107-3114. doi: 10.1007/s10620-017-4786-y. PMID: 28555239.
* Kim MJ, Shin JH, Choi YS, Kim HS, Jo K, Song CS. Clinical Characteristics and Outcomes of Crohn's Disease in Elderly-Onset Patients Compared to Young-Onset Patients: A Retrospective, Single-Center Study. Dig Dis Sci. 2017 Nov;62(11):3115-3122. doi: 10.1007/s10620-017-4787-x. PMID: 28555240.
* Lakatos PL, Lakatos L. Inflammatory bowel disease in the elderly: a distinct entity? Gut. 2014 Dec;63(12):1812-3. doi: 10.1136/gutjnl-2014-307567. PMID: 24968817.
* Lee HS, Park SH. Epidemiology and Clinical Characteristics of Inflammatory Bowel Disease in Elderly Patients. Gut Liver. 2016 Nov 15;10(6):880-886. doi: 10.5009/gnl16086. PMID: 27553106.
Q.
How do you calm down an IBS flare-up?
A.
To calm a flare, focus on gut rest and nervous system calming: eat smaller, simpler meals, sip water, apply gentle heat, and choose low stress foods; many people benefit from a short low FODMAP phase with professional guidance. Add relaxation breathing and gentle walking, and use targeted remedies as needed such as antispasmodics for cramping, soluble fiber for constipation, antidiarrheals for diarrhea, or enteric coated peppermint oil. There are several factors to consider, including tracking patterns, long term prevention, and red flag symptoms that need prompt medical care like blood in stool, unexplained weight loss, fever with abdominal pain, or symptoms that wake you at night; see the complete details below to guide your next steps.
References:
* Drossman DA, Tack J. Irritable Bowel Syndrome: Clinical Update and Future Directions. Gastroenterology. 2021;160(1):7-23.
* Black CJ, Ford AC. Treatment of irritable bowel syndrome with diarrhea and irritable bowel syndrome with constipation. J Intern Med. 2021;290(5):981-998.
* Chey WD, Hashmi H, Hussain N, et al. Update on the Management of Irritable Bowel Syndrome. Dig Dis Sci. 2021;66(11):3799-3814.
* Quigley EM. Current and emerging pharmacological treatments for irritable bowel syndrome. World J Gastroenterol. 2020;26(24):3327-3343.
* Lacy BE, Patel NK. Rome IV Criteria and a Clinical Approach to Irritable Bowel Syndrome in Adults. Gastroenterol Clin North Am. 2022;51(2):297-313.
Q.
How does chronic diarrhea affect the body?
A.
Chronic diarrhea can affect your whole body by causing dehydration, electrolyte loss, and poor nutrient absorption, leading to fatigue, unintended weight loss, anemia, and rectal or skin irritation; in inflammatory bowel disease it may reflect ongoing inflammation with wider immune effects. There are several factors to consider, including red flags like blood or black stools, fever, nighttime symptoms, and signs of dehydration that warrant prompt care. See the complete details below to understand IBS vs IBD, higher risks in children and older adults, and practical steps for hydration, nutrition, and when to seek medical evaluation.
References:
* Khan S, Rabbani G. Effect of chronic diarrhea on nutritional status in children and adults. Cureus. 2023 Jan 2(15):e33282. doi: 10.7759/cureus.33282. PMID: 36742511.
* Singbartl K, Kribs M, Singbartl G. Diarrhea-Induced Electrolyte Disorders. Am J Nephrol. 2020;51(9):725-736. doi: 10.1159/000508588. PMID: 32679659.
* Guandalini S. Complications of diarrhea: a critical review. Best Pract Res Clin Gastroenterol. 2017 Aug;31(4):461-469. doi: 10.1016/j.bpg.2017.06.002. PMID: 28802319.
* Schiller LR. Chronic Diarrhea: An Approach to the Symptom. Am J Gastroenterol. 2017 Feb;112(2):180-189. doi: 10.1038/ajg.2016.491. PMID: 27958209.
* Mahajan L, Singh R, Choudhary M. Malabsorption syndrome: A review of clinical features, diagnosis, and management. J Pak Med Assoc. 2022 Dec;72(12):2550-2555. doi: 10.47391/JPMA.5036. PMID: 36720443.
Q.
How does inflammation damage the gut lining?
A.
Inflammation harms the gut lining by releasing cytokines that injure epithelial cells, loosen tight junctions, and thin the protective mucus, increasing intestinal permeability. This allows bacteria and toxins to leak in, disrupts the microbiome, and creates a cycle of ongoing damage that is most severe in IBD, leading to ulcers, scarring, and malabsorption. There are several factors to consider, including red flag symptoms and how IBD differs from IBS; see below for the complete explanation and practical next steps for care and healing.
References:
* Vancamelbeke M, Vermeire S. Inflammation and the Intestinal Barrier. Int J Mol Sci. 2017 Aug 18;18(8):1693. doi: 10.3390/ijms18081693. PMID: 28820352.
* Liu Z, Li Z, Huang Y, Zhang J, Li C, Sun W, Li W. Intestinal Barrier Dysfunction and Its Mechanisms in Inflammatory Bowel Disease. Front Physiol. 2021 Dec 21;12:800100. doi: 10.3389/fphys.2021.800100. PMID: 35002779.
* Handa T, Fukuda M, Nakajima A, Maruo S. The interplay between inflammatory bowel disease and intestinal barrier function. J Gastroenterol. 2023 Feb;58(2):113-125. doi: 10.1007/s00535-022-01956-2. PMID: 36528731.
* Al-Sadi R, Ma T, Naim HY. Interleukin-6 as a master regulator of the intestinal epithelial barrier and a therapeutic target for inflammatory bowel disease. J Gastroenterol. 2021 Aug;56(8):695-714. doi: 10.1007/s00535-021-01802-x. PMID: 34312648.
* Tian X, Jiang T, Ruan T, Li Y, Yang Z, Xu F. Oxidative stress, intestinal barrier dysfunction, and inflammatory bowel disease: a complex relationship. Cell Biosci. 2023 May 16;13(1):101. doi: 10.1186/s13578-023-01083-5. PMID: 37198647.
Q.
How does untreated bowel disease progress?
A.
Untreated bowel disease can progress differently by type: IBS usually does not cause inflammation or permanent damage but can significantly affect quality of life, while IBD tends to worsen without care, leading to ongoing inflammation, ulcers, scarring and strictures, malnutrition and anemia, extraintestinal issues, infections and hospitalization, and a higher long term colorectal cancer risk. There are several factors to consider, including duration of symptoms, bleeding, weight loss, fever, and night symptoms that warrant prompt care. See below for fuller details, red flags, and guidance on early diagnosis, treatment options, and monitoring that can change your next steps.
References:
* Torres J, et al. Natural history of inflammatory bowel disease: a systematic review. Lancet Gastroenterol Hepatol. 2017 Aug;2(8):603-619. doi: 10.1016/S2468-1253(17)30119-3. Epub 2017 Jul 20. PMID: 28732733.
* Lenti MV, et al. The impact of diagnostic delay on the natural history of inflammatory bowel disease: a systematic review. Therap Adv Gastroenterol. 2018 May;11:1756283X18776633. doi: 10.1177/1756283X18776633. eCollection 2018. PMID: 29881329.
* Vavricka SR, et al. Extraintestinal Manifestations of Inflammatory Bowel Disease. Gastroenterology. 2019 Mar;156(4):914-933.e4. doi: 10.1053/j.gastro.2018.10.054. Epub 2019 Jan 16. PMID: 30660604.
* Annese V, et al. Risk of colorectal cancer in patients with inflammatory bowel disease. Lancet. 2019 Aug 3;394(10196):426-444. doi: 10.1016/S0140-6736(19)30960-9. Epub 2019 Jul 29. PMID: 31358356.
* Alakkary F, et al. Natural history of inflammatory bowel disease: What we know and what we need to know. World J Gastroenterol. 2023 Jul 14;29(26):4142-4158. doi: 10.3748/wjg.v29.i26.4142. PMID: 37456720.
Q.
How is IBD different from food intolerance?
A.
IBD is a chronic, immune-driven inflammation of the digestive tract that can damage tissue, flare and remit, and usually needs medical treatment, while food intolerance is a non-immune digestion issue where symptoms follow specific foods, do not cause inflammation, and typically improve with avoidance. There are several factors to consider. Diagnosis, risks, and next steps differ, and red flags like persistent diarrhea, blood or mucus in stool, fever, or weight loss warrant prompt medical care; see the complete details below to understand testing, diet roles, and when to seek help.
References:
* Zuo T, Tan X, Zhang Y, Yu J, Liang J. Food allergies and inflammatory bowel disease: a narrative review. Front Nutr. 2022 May 31;9:904033. doi: 10.3389/fnut.2022.904033. PMID: 35721245; PMCID: PMC9199399.
* Pitche T, Koutouan-Doumbia M, N'da E, Ehui E, N'gbesso B, Diomandé M, N'gbesso R. Diet and Inflammatory Bowel Disease: A Review of Current Literature. Nutrients. 2020 Nov 29;12(12):3662. doi: 10.3390/nu12123662. PMID: 33261250; PMCID: PMC7760777.
* Khalili H, Hekmatdoost A, Khalili H. The interplay between food and inflammatory bowel disease. Ann Transl Med. 2018 Jun;6(11):206. doi: 10.21037/atm.2018.04.14. PMID: 30042851; PMCID: PMC6046208.
* Carroccio A, Zuin G, D'Angelo E, Cavataio F, Pirrone L, Iacono G. Food Allergy and Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr. 2017 Sep;65 Suppl 1:S16-S21. doi: 10.1097/MPG.0000000000001662. PMID: 28841680.
* Barbaro MR, Cremon C, Koutroubakis IE, Di Caro S, Al-Dakkak I, D'Incà R, Bellini M, Volta U, Caio G, Zippi M, Cicala M, Bazzoli F, Gionchetti P, Corazza GR, Stanghellini V. Food-Related Symptoms in Inflammatory Bowel Disease: Prevalence, Clinical Characteristics, and Impact on Disease Outcome. Nutrients. 2022 Jan 5;14(1):234. doi: 10.3390/nu14010234. PMID: 35010928; PMCID: PMC8749817.
Q.
How long do IBD flares usually last?
A.
Most IBD flares last weeks to a few months; mild often 1 to 4 weeks, moderate 4 to 12 weeks, and severe can persist for several months, especially without timely treatment. There are several factors to consider, including the type of IBD, inflammation severity, how quickly therapy starts, medication adherence, and triggers like infections or NSAIDs. See below for more details, including ways to shorten flares, extend remission, and when to seek urgent care, which can influence your next steps.
References:
* Ananthakrishnan AN, Feuerstein JD. Inflammatory Bowel Disease Flares: Definitions, Risk Factors, and Strategies for Management. Dig Dis Sci. 2020 Feb;65(2):397-405. doi: 10.1007/s10620-019-05973-2. PMID: 31792686.
* Torkaman S, Keshteli AH, Saneie B, Esmaillzadeh A, Adibi P. Clinical Characteristics and Predictors of Flare in Patients with Inflammatory Bowel Disease. J Res Med Sci. 2020 Mar 20;25:27. doi: 10.4103/jrms.JRMS_652_19. PMID: 32410986.
* Ma C, Moran G, Dulai PS, Sandborn WJ, Feagan BG. Management of flares in inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2021 May;18(5):331-344. doi: 10.1038/s41575-021-00406-3. PMID: 33623062.
* Torres J, Khanna R, Stucchi R, D'Haens G, Danese S, Peyrin-Biroulet L, Colombel JF. Definitions of Remission and Relapse in Patients with Crohn's Disease and Ulcerative Colitis: An International Delphi Consensus. J Crohns Colitis. 2020 Sep 28;14(9):1314-1323. doi: 10.1093/ecco-jcc/jjaa064. PMID: 32379796.
* Rubin DT, Ponder M, Mclaughlin J, Zalev M, Pardi DS. Defining Flare in Inflammatory Bowel Disease: A Scoping Review. J Crohns Colitis. 2018 Oct 23;12(11):1359-1367. doi: 10.1093/ecco-jcc/jjy086. PMID: 29931109.
Q.
How serious is long-term bowel inflammation?
A.
There are several factors to consider. Long-term bowel inflammation ranges from mild and manageable to serious, depending on the cause: IBS is common and does not damage the bowel, while true inflammatory diseases like Crohn’s or ulcerative colitis can lead to bowel injury, nutrient deficiencies, strictures, and a higher long-term colon cancer risk. Early assessment lowers complications and guides the right care; see below for key red flags, how doctors distinguish IBS from inflammation, and practical next steps for testing, treatment, and self-care.
References:
* Torres J, et al. Long-term outcomes of inflammatory bowel disease: Focus on quality of life and complications. Therap Adv Gastroenterol. 2017 Jul;10(7):577-589. [PMID: 28736504]
* Kalla R, et al. Inflammatory bowel disease: A clinical review. BMJ. 2023 Apr 12;381:e075389. [PMID: 37045437]
* Roda G, et al. Extraintestinal manifestations of inflammatory bowel disease: current concepts. Expert Rev Gastroenterol Hepatol. 2020 Sep;14(9):839-854. [PMID: 32698715]
* Ng SC, et al. The burden of inflammatory bowel disease: an update of the global prevalence and incidence. Lancet Gastroenterol Hepatol. 2017 Mar;2(3):195-207. [PMID: 28167035]
* D'Haens G, et al. Progression of inflammatory bowel disease. Lancet Gastroenterol Hepatol. 2023 Nov;8(11):1018-1029. [PMID: 37788484]
Q.
How to flush out IBS?
A.
You can’t flush IBS out; it’s a chronic gut-brain condition, but symptoms can often be eased with a structured low FODMAP approach, gradual soluble fiber, steady hydration, targeted probiotics, stress and sleep support, regular activity, and medications when appropriate. Avoid colon cleanses, detoxes, fasting, and extreme water intake, and seek care urgently for red flags like bleeding, weight loss, fever, or symptoms that wake you from sleep; there are several factors to consider, and key details that could affect your next steps are outlined below.
References:
* Liu Y, Tong X, Wu C, et al. Dietary strategies in irritable bowel syndrome: a comprehensive review. Front Nutr. 2020 Dec 4;7:598426. PMID: 33316045.
* Lacy BE, Patel NK. Diagnosis and Management of Irritable Bowel Syndrome: A Review. JAMA. 2020 Sep 22;324(12):1186-1197. PMID: 32971590.
* Chen S, Cai Z, Li M, et al. The gut microbiome in irritable bowel syndrome: A narrative review. Front Immunol. 2023 Mar 10;14:1159818. PMID: 36979685.
* Zhang Y, Song S, Zhong X, et al. Impact of lifestyle interventions on irritable bowel syndrome: A systematic review and meta-analysis. Front Nutr. 2022 Dec 15;9:1062947. PMID: 36586026.
* Rej A, MacLean AR, Whorwell PJ, et al. Psychological treatments for irritable bowel syndrome: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020 Apr;5(4):359-371. PMID: 32014605.
Q.
IBD in older adults — is abdominal pain always severe?
A.
No, abdominal pain in older adults with IBD is not always severe; it can be mild, intermittent, or absent, and other signs like diarrhea, blood in the stool, fatigue, or weight loss may be more telling, while severe or worsening pain requires urgent care. There are several factors to consider. See below to understand how age, coexisting conditions, and medications can blunt pain, what warning signs need immediate attention, how IBD differs from IBS, and which tests and next steps to discuss with your clinician.
References:
* Sands BE, Selinger CP. Abdominal pain in elderly inflammatory bowel disease patients: Is it different? Gut. 2021 Feb;70(2):234-235. doi: 10.1136/gutjnl-2020-322199. PMID: 32709669.
* Cheifetz AS, Abreu MT, Ananthakrishnan AN, et al. Challenges in the management of inflammatory bowel disease in the elderly: a narrative review. Therap Adv Gastroenterol. 2021 Jun 25;14:17562848211025595. doi: 10.1177/17562848211025595. PMID: 34249174; PMCID: PMC8246344.
* Ananthakrishnan AN, Ma C, Kheradmand F, et al. Clinical Presentation of Inflammatory Bowel Disease in Older Adults. Dig Dis Sci. 2019 Jul;64(7):1786-1793. doi: 10.1007/s10620-019-05510-x. Epub 2019 Feb 19. PMID: 30783707.
* Ma C, Panaccione R, Fedorak RN. Inflammatory Bowel Disease in the Elderly. Gastroenterol Clin North Am. 2017 Mar;46(1):157-171. doi: 10.1016/j.gtc.2016.09.009. Epub 2016 Nov 16. PMID: 28168924.
* Fukata H, Umeda S, Takatsu N, et al. Inflammatory Bowel Disease in the Elderly: Diagnostic and Therapeutic Considerations. J Clin Med. 2023 Feb 15;12(4):1588. doi: 10.3390/jcm12041588. PMID: 36836109; PMCID: PMC9960249.
Q.
Is IBS the same as IBD?
A.
No, they are different conditions: IBS is a functional gut disorder that does not cause inflammation or intestinal damage, while IBD (Crohn’s disease and ulcerative colitis) involves chronic inflammation that can injure the bowel and carries higher long-term risks. Symptoms can overlap, but red flags such as blood in the stool, weight loss, fever, nighttime diarrhea, or anemia suggest IBD and warrant prompt medical care. There are several factors to consider; see below to understand more.
References:
* Cremonini F, et al. Irritable bowel syndrome in inflammatory bowel disease: a systematic review and meta-analysis. *J Crohns Colitis*. 2021 Oct 25;15(10):1776-1786. doi: 10.1093/ecco-jcc/jjab053. PMID: 33735955.
* Lee AA, et al. Irritable bowel syndrome vs. inflammatory bowel disease: A comprehensive review of pathophysiology and diagnosis. *World J Gastroenterol*. 2023 May 28;29(20):3075-3093. doi: 10.3748/wjg.v29.i20.3075. PMID: 37292211.
* Sperber AD, et al. Irritable bowel syndrome and inflammatory bowel disease: clinical overlap and pathophysiological insights. *Lancet Gastroenterol Hepatol*. 2017 Nov;2(11):844-854. doi: 10.1016/S2468-1253(17)30211-1. Epub 2017 Jul 1. PMID: 28669866.
* Koo JS, Choi YJ. Post-inflammatory irritable bowel syndrome. *J Neurogastroenterol Motil*. 2020 Jan 30;26(1):16-23. doi: 10.5056/jnm19159. PMID: 31805742.
* Barbara G, et al. Irritable bowel syndrome: a global update on pathophysiology and management. *Nat Rev Gastroenterol Hepatol*. 2021 Nov;18(11):775-792. doi: 10.1038/s41575-021-00464-9. Epub 2021 Jul 29. PMID: 34326442.
Q.
Late-onset inflammatory bowel disease
A.
Late-onset inflammatory bowel disease refers to Crohn’s disease or ulcerative colitis first diagnosed after about age 60, making up roughly 10 to 20 percent of cases; symptoms may be less obvious, and a careful workup with labs, stool tests, colonoscopy, and imaging helps distinguish it from infection, ischemic colitis, cancer, or IBS. Treatment is effective but individualized in older adults, often starting with the lowest effective doses and close monitoring, and you should seek prompt care for persistent bleeding, weeks-long diarrhea, unexplained weight loss, severe abdominal pain, fever, or signs of dehydration or anemia. There are several factors to consider that can affect your next steps, including differences from younger-onset disease and medication risks, so see below for the complete answer.
References:
* Fumery M, Seneque M, Duflos C, Vaxelaire C, Boureille A. Features of late-onset inflammatory bowel disease: a narrative review. J Clin Med. 2022 Mar 22;11(6):1709. doi: 10.3390/jcm11061709. PMID: 35329974; PMCID: PMC8956272.
* Yim M, Tang E, Li K, Yip T, Fung C, Lo Y, Sung J, Wu J, Chan F, Ng S. Late-onset inflammatory bowel disease: a systematic review. Gastroenterology. 2017 Jul;153(1):315-329. doi: 10.1053/j.gastro.2017.04.004. Epub 2017 Apr 8. PMID: 28408226.
* Al-Syrwan D, Al-Syrwan F, Al-Khamees S, El-Taji M, Al-Humayyd M, Al-Shathri K, Al-Mutairi F, Al-Turaiki I, Al-Harbi O, Al-Shoraim M, Al-Fadhli F, Al-Otaibi N, Al-Otaibi F, Al-Khalaf H, Al-Askar R, Al-Rammah M, Al-Muhayb H, Al-Mulhim H, Al-Saeed B, Al-Harthi A, Al-Orainy A, Al-Omair A, Al-Khayal A, Al-Muzaini M, Al-Hamoudi W, Al-Mofleh I. Inflammatory bowel disease in older people: what are the differences? BMJ Open Gastroenterol. 2021 Jul;8(1):e000676. doi: 10.1136/bmjgast-2021-000676. PMID: 34321287; PMCID: PMC8321042.
* Munkholm P, Bøggild H, Andersen S. Late-Onset Inflammatory Bowel Disease: A Review. Dig Dis Sci. 2016 Jan;61(1):205-13. doi: 10.1007/s10620-015-3974-9. Epub 2015 Nov 26. PMID: 26607212.
* Parian A, Limketkai B. Older Age at Diagnosis of Inflammatory Bowel Disease. Curr Treat Options Gastroenterol. 2018 Mar;16(1):124-135. doi: 10.1007/s11938-018-0174-z. PMID: 29468532; PMCID: PMC5821213.
Q.
Long-term digestive issues affecting daily life
A.
Long-lasting digestive symptoms can disrupt work, social life, sleep, and mood, and any that persist more than a few weeks deserve attention. There are several factors to consider, including IBD as a key inflammatory cause that differs from IBS, as well as other possibilities like celiac disease, food intolerances, chronic infection, medications, and stress; red flags such as blood in stool, unexplained weight loss, fever, severe pain, symptoms that wake you from sleep, or diarrhea lasting weeks should prompt medical care. See below for a clear guide to distinguishing IBD from IBS, warning signs, what tests and treatments to expect, and practical steps for diet, monitoring, and mental health that could shape your next steps.
References:
* Sperber, A. D., Dumitrascu, D., Fukudo, S., Gerson, L., Ghoshal, U. C., Glaser, M. A., Halpert, A. D., Horton, P., Keefer, L., Lackner, J. M., Lesorodov, V., Mearin, F., Poitras, P., Shah, E. D., Singh, R., Sykes, M., Tack, J., Vork, L. D., & Schmulson, M. W. (2021). Functional gastrointestinal disorders are associated with impaired quality of life. *Gastroenterology*, *160*(7), 2320-2331. PMID: 33773950.
* Ford, A. C., & Talley, N. J. (2017). The impact of irritable bowel syndrome on daily life: a systematic review. *Alimentary Pharmacology & Therapeutics*, *45*(6), 761-782. PMID: 28169904.
* Gracie, D. J., & Ford, A. C. (2021). Quality of Life and Psychological Well-being in Patients With Inflammatory Bowel Disease. *Gastroenterology Clinics of North America*, *50*(4), 791-807. PMID: 34742686.
* Müllner, B., Trummer, M., Pirker-Fruehauf, U., Rief, W., & Sperner-Unterweger, B. (2020). Impact of common gastrointestinal symptoms on daily life and health-related quality of life. *Therapeutic Advances in Gastroenterology*, *13*, 1756284820921045. PMID: 32410884.
* He, B., Wang, Z., & Chen, J. (2022). Chronic constipation: a systematic review of its impact on quality of life. *World Journal of Clinical Cases*, *10*(15), 4983-4994. PMID: 35733857.
Q.
Pelvic discomfort with bowel symptoms
A.
Pelvic discomfort with bowel symptoms can stem from common conditions like IBS or from inflammatory bowel disease that causes ongoing intestinal inflammation, with red flags such as persistent diarrhea, blood in the stool, nighttime bowel movements, weight loss, fever, or fatigue signaling the need for medical evaluation. There are several factors to consider, including other pelvic, digestive, and nerve or muscle causes, ways doctors test for them, and when to seek urgent care; see below for the complete details and next steps that could affect your care.
References:
* Whitehead WE, Palsson M. Overlap of Chronic Pelvic Pain and Irritable Bowel Syndrome. Gastroenterology & Hepatology. 2019 Feb;15(2):98-106. PMID: 30881180.
* Triadafilopoulos G. The Co-Occurrence of Chronic Pelvic Pain and Irritable Bowel Syndrome: A Review of the Pathophysiology and Treatment Implications. Gastroenterology & Hepatology. 2020 Jul;16(7):356-363. PMID: 32742137.
* Li Y, Han J, Wang Y, Xu M, Li S. Pelvic floor dysfunction, pain, and irritable bowel syndrome: a systematic review. Transl Androl Urol. 2021 Jan;10(1):475-486. PMID: 33537233.
* Galdos M, Borrás L, Monzó A, Torralba M, Alcañiz L, Queralt M, Baquedano P, Peiró FM, Ros C. Endometriosis and pelvic pain: A narrative review of the literature. Scand J Pain. 2022 Jul 20;22(3):477-486. PMID: 35917812.
* Farmer AD, Giammarinaro P, Taravella F, Lacerenza M, Niesler B, Nucera G. Visceral hypersensitivity in chronic pelvic pain syndrome and irritable bowel syndrome. Minerva Gastroenterol Dietol. 2017 Mar;63(1):15-28. PMID: 27976860.
Q.
Period-related stomach pain vs bowel pain
A.
There are key differences in timing, location, triggers, and symptoms that help tell period-related uterine cramps from bowel pain: period pain clusters around your cycle with crampy lower pelvic aching that often eases after bleeding starts, while bowel pain can happen any time, shift around the abdomen, change with eating or bowel movements, and often comes with ongoing diarrhea or constipation. Because bowel pain may signal IBS or inflammatory bowel disease and red flags like blood in stool, weight loss, fever, night symptoms, or worsening pain should prompt medical care, there are several factors to consider. See the complete answer below for important details on overlap with conditions like endometriosis, how to track patterns, and what next steps to take.
References:
* Gabor J, Ho DSM, Gale CLG, van Lelyveld RAMHFN, van Someren MK. Gastrointestinal Symptoms During Menstruation: A Review. Eur J Gastroenterol Hepatol. 2021 May 1;33(5):583-588. doi: 10.1097/MEG.0000000000001962. PMID: 33737525.
* Kim JH, Joo YE, Kim MY, Kim HJ, Chang YW, Kim ES. Gastrointestinal Symptoms Are More Common in Women With Dysmenorrhea: A Systematic Review and Meta-Analysis. Yonsei Med J. 2022 Dec;63(12):1079-1090. doi: 10.3349/ymj.2022.63.12.1079. PMID: 36412196.
* Chen X, Shi R, Feng Y, An J, Chen X. Painful menstruation and the gut: a review of the association between dysmenorrhea and gastrointestinal disorders. J Pain Res. 2023 Apr 14;16:1193-1206. doi: 10.2147/JPR.S407941. PMID: 37077678.
* Tuteja SAC, Tan SSM, Storr SKR, Tuteja CJT, Tuteja SJ. Irritable Bowel Syndrome and the Menstrual Cycle: A Review. Int J Womens Health. 2022 Mar 22;14:389-397. doi: 10.2147/IJWH.S353842. PMID: 35345595.
* Mossa H, Zakhour M, Al-Haddad R, Sakhnini B, Abou Ghaida B, Sakhnini M, Sakhnini F. Endometriosis and the Bowel: A Clinical and Pathological Review. J Clin Med. 2023 Sep 30;12(19):6292. doi: 10.3390/jcm12196292. PMID: 37835697.
Q.
What are common warning signs of inflammatory bowel disease?
A.
Common warning signs include persistent diarrhea, especially at night, abdominal pain or cramping, blood or mucus in the stool, bowel urgency or frequent trips, unintended weight loss or poor appetite, and deep fatigue. Less obvious clues can be low-grade fever and joint, skin, or eye inflammation; recurrent bleeding, severe pain, vomiting, dehydration, weight loss, or fever with gut symptoms warrant prompt medical care. There are several factors to consider; see the complete answer below for details on distinguishing IBD from IBS, red flags that change next steps, and how doctors evaluate these symptoms.
References:
* Singh S, Dulai PS, Zarrinpar A, Prokop LJ, Gleeson FC, Sandborn WJ. Early Recognition and Diagnosis of Inflammatory Bowel Disease. Curr Treat Options Gastroenterol. 2017 Jun;15(2):162-177. doi: 10.1007/s11938-017-0131-4. PMID: 28409395.
* Kirsner JB. Clinical features of inflammatory bowel disease: differentiating Crohn's disease from ulcerative colitis. World J Gastroenterol. 2011 Dec 28;17(48):5318-24. doi: 10.3748/wjg.v17.i48.5318. PMID: 22219597.
* Löffler T, Lamprecht G, Seeliger H, Küppers M, Löffler L, Schmidt C. Diagnostic delay in inflammatory bowel disease. World J Gastroenterol. 2019 Jul 14;25(26):3390-3401. doi: 10.3748/wjg.v25.i26.3390. PMID: 31332204.
* Levine JS, Burakoff R. Extraintestinal manifestations of inflammatory bowel disease. World J Gastroenterol. 2011 Sep 14;17(34):3917-27. doi: 10.3748/wjg.v17.i34.3917. PMID: 21987625.
* Krupic G, Ben-Horin S, Kopylov U, Ovadia H, Bar-Gill Y, Ron Y, Ben-Shachar S, Shitrit AB, Yeganeh M, Lahat A, Avni-Biron I, Shamir R, Waterman M, Israeli E, Dotan I. Initial manifestations and diagnostic delay in inflammatory bowel disease: The ECCO-ECHO-IBD study. J Crohns Colitis. 2014 Jun;8(6):549-56. doi: 10.1016/j.crohns.2013.11.026. PMID: 24316086.
Q.
What are the symptoms of an IBS flare up?
A.
Symptoms of an IBS flare-up include abdominal pain or cramping that often improves after a bowel movement, changes in bowel habits such as diarrhea, constipation, or both, plus bloating, excess gas, and sometimes clear mucus in the stool; whole body effects like fatigue, nausea, early fullness, and reduced appetite can also occur. There are several factors to consider. Triggers and warning signs that are not typical for IBS, like blood in stool, weight loss, fever, persistent vomiting, severe or nighttime pain, or new symptoms after age 50, mean you should seek medical advice. For a fuller list, subtype differences, and what to do next, see the complete answer below.
References:
* Ford, A. C., Sperber, A. D., Corsetti, M., & Camilleri, M. (2020). Irritable bowel syndrome. *The Lancet*, 396(10260), 1675–1688.
* El-Salhy, M. (2019). Irritable bowel syndrome: diagnosis and pathogenesis. *World Journal of Gastroenterology*, 25(22), 2735–2750.
* Lacy, B. E., Mearin, F., Chang, L., Chey, W. D., Lembo, A. J., Quigley, E. M., & Schmier, J. A. (2016). Bowel Symptoms in Patients with Irritable Bowel Syndrome: A Rome IV Perspective. *Digestive Diseases and Sciences*, 61(10), 2824–2834.
* Chang, L., & Lacy, B. E. (2017). Irritable Bowel Syndrome: Diagnosis and Treatment. *Gastroenterology Clinics of North America*, 46(1), 1–17.
* Drossman, D. A. (2016). Irritable Bowel Syndrome: Rome IV Diagnostic Criteria and Clinical Management. *The American Journal of Gastroenterology*, 111(Suppl 1), S1–S23.
Q.
What causes stomach pain with frequent loose stools?
A.
Common causes include short-term infections, food intolerances, irritable bowel syndrome, medication side effects, and stress-related gut sensitivity; a less common but important cause is inflammatory bowel disease, which involves ongoing inflammation. Duration and red flags like blood in the stool, weight loss, fever, nighttime diarrhea, or worsening pain help guide next steps, so see the complete details below to know when simple self-care may be enough and when to contact a doctor promptly.
References:
* Lacy BE, Mearin F, Chang L, et al. Bowel Disorders. Gastroenterology. 2016;150(6):1393-1407.e5. doi:10.1053/j.gastro.2016.02.031.
* Ungaro R, Mehandru S, Colombel JF. Inflammatory bowel disease: recent insights into pathogenesis and therapy. Nat Rev Gastroenterol Hepatol. 2017;14(12):731-746. doi:10.1038/nrgastro.2017.151.
* Lebwohl B, Ludvigsson JF, Green PHR. Celiac disease and other gluten-related disorders. N Engl J Med. 2015;373(13):1235-1246. doi:10.1056/NEJMra1408827.
* Kambhampati SB, Zogg H, Minar P, et al. Infectious Gastroenteritis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.
* Pardi DS, Kelly CP, Feuerstein JD, et al. Microscopic colitis: ACG Clinical Guideline. Am J Gastroenterol. 2021;116(9):1754-1772. doi:10.14309/ajg.0000000000001472.
Q.
What condition causes diarrhea, bleeding, and fatigue together?
A.
The most common and medically significant cause of these three symptoms together is inflammatory bowel disease, including ulcerative colitis and Crohn’s disease; chronic gut inflammation leads to diarrhea, intestinal bleeding, and fatigue from anemia and poor nutrient absorption. Other conditions like infectious or ischemic colitis, colorectal cancer, celiac disease, and hemorrhoids can also present this way. There are several factors to consider; see below for key warning signs, how doctors diagnose it, and treatment options that can guide your next steps.
References:
* Singh S, Dulai PS, Zarrinpar A, Ramamoorthy P, Sandborn WJ. Inflammatory bowel disease: Pathogenesis, epidemiology, diagnosis, and treatment. World J Gastroenterol. 2021 May 28;27(20):2699-2724. doi: 10.3748/wjg.v27.i20.2699. PMID: 34121927; PMCID: PMC8174526.
* Dekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB. Colorectal cancer: a review of current trends in diagnosis and management. Lancet. 2019 Aug 31;394(10207):1467-1480. doi: 10.1016/S0140-6736(19)31441-6. Epub 2019 Aug 13. PMID: 31416715.
* Parzanese I, Schuppan D, Siniscalchi M. Celiac Disease. N Engl J Med. 2023 Apr 20;388(16):1501-1510. doi: 10.1056/NEJMra2205510. PMID: 37075253.
* Crobach MJ, Vernon JJ, van der Werf TS, Oostdijk EAN, Snijders D, Wulffelé MG, Kuijper EJ. Clostridioides difficile infection: Pathogenesis, diagnosis, and treatment. Clin Microbiol Infect. 2023 Feb;29(2):167-176. doi: 10.1016/j.cmi.2022.09.006. Epub 2022 Sep 15. PMID: 36116817.
* Akbay C, El-Chammas K. Autoimmune enteropathy. World J Clin Pediatr. 2022 Dec 9;11(7):694-702. doi: 10.5409/wjcp.v11.i7.694. PMID: 36569136; PMCID: PMC9768627.
Q.
What do IBS attacks feel like?
A.
IBS attacks often feel like cramping abdominal pain that may improve after a bowel movement, with bloating and gas, and sudden changes in bowel habits including diarrhea, constipation, urgency, and a sense of incomplete emptying. There are several factors to consider, such as fatigue, nausea, and stress or food triggers, typical flares lasting hours to days, and red flags like bleeding, fever, weight loss, or pain that wakes you which require medical evaluation; see below to understand more.
References:
* Drossman DA. Irritable Bowel Syndrome: A Patient's Perspective. J Clin Gastroenterol. 2018 Sep;52 Suppl 1:S1-S6. doi: 10.1097/MCG.0000000000001047. PMID: 29541571.
* Chey WD, et al. Qualitative Study of Symptoms and Burden in Patients With Irritable Bowel Syndrome With Diarrhea. J Neurogastroenterol Motil. 2017 Oct;23(4):534-541. doi: 10.5056/jnm16140. PMID: 28834460; PMCID: PMC5628543.
* Whitehead WE, et al. Understanding the patient experience in irritable bowel syndrome: from symptom to impact. Int J Clin Pract. 2017 Apr;71(4). doi: 10.1111/ijcp.12948. PMID: 28249866.
* Lacy BE, et al. Irritable bowel syndrome: diagnosis and symptom-based management. Curr Opin Gastroenterol. 2018 Nov;34(6):447-452. doi: 10.1097/MOG.0000000000000481. PMID: 30149026.
* Singh M, et al. Mechanisms of Abdominal Pain in Irritable Bowel Syndrome: A Physiological and Therapeutic Update. Gastroenterol Clin North Am. 2022 Mar;51(1):21-39. doi: 10.1016/j.gtc.2021.09.006. PMID: 35056637.
Q.
What does bowel inflammation do to the digestive system?
A.
Bowel inflammation, often from inflammatory bowel disease, damages the intestinal lining and disrupts normal digestive function, leading to poor nutrient absorption, altered motility with diarrhea and urgency, abdominal pain, bleeding, dehydration, weight loss, and fatigue. There are several factors to consider, including whole body effects, differences between IBD and IBS, potential complications like strictures, fistulas, and increased colon cancer risk, and when to seek care and how it is diagnosed and treated. See the complete answer below to understand key warning signs and next steps that could affect your health decisions.
References:
* Ahmad M, Butt G, Iqbal H, Niaz F. The Pathophysiology of Inflammatory Bowel Disease: A Review. Cureus. 2022 Dec 7;14(12):e32297. doi: 10.7759/cureus.32297. PMID: 36480838; PMCID: PMC9724180.
* Münch A, von Websky M, Zühlke S, Farr C, Rüsch M, Scharl M, Rieder F. Intestinal barrier function in inflammatory bowel disease: Pathophysiology and therapeutic targets. United European Gastroenterol J. 2021 Oct;9(8):881-893. doi: 10.1002/ueg2.12134. Epub 2021 Sep 14. PMID: 34526569; PMCID: PMC8516843.
* Hu X, Wang T, Zeng S, Wang M, Li Y, Yang Q. Systematic Review With Meta-analysis: The Burden of Malnutrition in Inflammatory Bowel Disease. Front Nutr. 2022 Jun 1;9:907361. doi: 10.3389/fnut.2022.907361. PMID: 35650198; PMCID: PMC9199330.
* Iovino P, Giugliano A, Sarnelli G, Ruggiero G, Bucci C, Ciacci C, Paternoster L, Iovino F. Gut Dysmotility in Inflammatory Bowel Diseases: Pathophysiological Mechanisms and Therapeutic Targets. J Clin Med. 2022 Aug 26;11(17):5019. doi: 10.3390/jcm11175019. PMID: 36029337; PMCID: PMC9454157.
* Roda G, Jovel G, Al-Haj Husain A, Borrelli O, De Palma G, Parianos S, Di Sabatino A. Visceral Pain and Inflammatory Bowel Disease: Pathophysiology and Clinical Management. J Clin Med. 2022 Aug 23;11(17):4954. doi: 10.3390/jcm11174954. PMID: 36005740; PMCID: PMC9451950.
Q.
What foods can aggravate IBD?
A.
Foods that often aggravate IBD during flares include insoluble high fiber foods like raw vegetables, popcorn, nuts and seeds, fatty or fried foods, dairy if lactose intolerant, spicy foods, caffeine, alcohol, sugary foods and sugar alcohols, ultra-processed foods, and red or processed meats. Triggers vary by person and diet changes do not replace medical care, so there are several factors to consider; see the complete guidance below for safer swaps during flares, how to log and identify your own triggers, and when to contact a doctor.
References:
* Saireddy M, Li N, Agopian VG, Engevik MA. The Role of Diet in Inflammatory Bowel Disease. Gastroenterology. 2024 Apr;166(4):460-474. doi: 10.1053/j.gastro.2023.11.015. Epub 2023 Nov 21. PMID: 38280638.
* Saireddy M, Karki B, Aich P, Koirala P, Engevik MA. Dietary Triggers and the Pathogenesis of Inflammatory Bowel Disease: A Review. Nutrients. 2022 May 5;14(9):1949. doi: 10.3390/nu14091949. PMID: 35560113; PMCID: PMC9101683.
* Kjeldsen J, Nørgaard P, Ljungmann C, Burisch J. Dietary Patterns and Nutrient Intakes in Inflammatory Bowel Disease: A Systematic Review. Nutrients. 2023 Feb 6;15(4):817. doi: 10.3390/nu15040817. PMID: 36771343; PMCID: PMC9961621.
* Cai Z, Peng Z, Liu J, Su D, Lin J, Wu S, Li X. Dietary Patterns and Inflammatory Bowel Disease Flares: A Systematic Review and Meta-Analysis. Nutrients. 2021 Sep 20;13(9):3280. doi: 10.3390/nu13093280. PMID: 34579051; PMCID: PMC8469850.
* Cox SR, Whelan K. Food Intolerances and Their Impact on IBD. Frontline Gastroenterology. 2020 Jul;11(4):287-293. doi: 10.1136/flgastro-2019-101287. Epub 2020 May 11. PMID: 32669947; PMCID: PMC7359556.
Q.
What gets mistaken for IBD?
A.
Conditions most often mistaken for IBD include IBS, infectious colitis, celiac disease, lactose or other food intolerances, diverticular disease, microscopic colitis, colon cancer and other cancers, endometriosis, and medication side effects. There are several factors to consider. See below for the key differences, red flags, and tests that can guide the right next steps and treatment plan.
References:
* Pardi, D. S., & Pardi, F. (2017). Mimickers of Inflammatory Bowel Disease. *Gastroenterology Clinics of North America*, *46*(4), 693-712. doi:10.1016/j.gtc.2017.08.003
* Feuerstein, J. D., & Cheifetz, A. S. (2019). Differential Diagnosis of Inflammatory Bowel Disease. *Gastroenterology & Hepatology*, *15*(1), 12-21.
* Kucharzik, T., D'Haens, G., & Maaser, C. (2021). Distinguishing inflammatory bowel disease from other conditions mimicking it. *United European Gastroenterology Journal*, *9*(8), 922-933. doi:10.1002/ueg2.12130
* Shah, S. C., & Dhaliwal, T. (2018). When It's Not IBD: Differential Diagnosis of Chronic Diarrhea and Abdominal Pain. *Gastroenterology Clinics of North America*, *47*(4), 793-808. doi:10.1016/j.gtc.2018.07.002
* Al-Kadi, A., Al-Kuraish, M., Al-Ghamdi, H., Al-Qurashi, O., Abdulkarim, I., Al-Shehri, Y., & Al-Zahrani, A. (2023). Inflammatory Bowel Disease: Mimickers and Pitfalls in Diagnosis. *Cureus*, *15*(10), e47496. doi:10.7759/cureus.47496
Q.
What happens during a bowel flare-up?
A.
During a bowel flare-up in IBD, the immune system overreacts and inflames the intestinal lining, causing swelling and sometimes ulcers that disrupt absorption and motility. This leads to urgent diarrhea, cramping or pain, and often blood or mucus in the stool. Whole-body effects like fatigue, low appetite, fever, and weight loss can appear, and severity ranges from mild to serious with risks like dehydration or ongoing bleeding. There are several factors to consider, including triggers, red flags, and treatments that can change your next steps; see below to understand more.
References:
* Neurath MF. The gut as a therapeutic target in inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2017 Jul;14(7):395-408. doi: 10.1038/nrgastro.2017.58. Epub 2017 May 17. PMID: 28512391.
* Lichtenstein GR, Loftus EV Jr, Isaacs KL, Regueiro MD, Gerson LB, Siegmund B, Sweeney CP, Thayu M, Bressler B, Siegel CA. ACG Clinical Guideline: Management of Crohn's Disease in Adults. Am J Gastroenterol. 2021 Jul 1;116(7):1373-1402. doi: 10.14309/ajg.0000000000001272. PMID: 34103522.
* Ungaro R, Mehandru S, Allen PB, Colombel JF, Sands BE. Ulcerative colitis: an update. Nat Rev Dis Primers. 2023 Apr 20;9(1):21. doi: 10.1038/s41572-023-00438-x. PMID: 37081014.
* Enck P, Azpiroz F, Boeckxstaens G, Elsenbruch S, Fox M, Mayer EA, Schmulson MJ, Tack J. Functional gastrointestinal disorders. Nat Rev Dis Primers. 2022 Jul 28;8(1):50. doi: 10.1038/s41572-022-00384-y. PMID: 35903333.
* Ni J, Wu GD, Albenberg C, Tomov VT. Gut microbiota and IBD: causation or correlation? Nat Rev Gastroenterol Hepatol. 2017 Oct;14(10):573-587. doi: 10.1038/nrgastro.2017.103. Epub 2017 Aug 25. PMID: 28840887.
Q.
What happens if IBS goes untreated?
A.
Untreated IBS does not damage the intestines or increase colon cancer risk, but symptoms often persist or worsen, undermining daily activities and mental health and sometimes prompting restrictive eating or unhelpful self-treatment. There are several factors to consider. See below to understand more. Evaluation helps rule out other causes and catch red flag symptoms like unexplained weight loss or blood in the stool, and early, tailored management can reduce flares and improve quality of life.
References:
* Whitehead WE, Palsson OS, Levy RL, Von Korff M, Feld AD, Crowell MD, et al. The Long-Term Prognosis of Irritable Bowel Syndrome. Gastroenterology. 2019 Dec;157(6):1480-1488.e2. doi: 10.1053/j.gastro.2019.08.058. Epub 2019 Aug 29. PMID: 31835338; PMCID: PMC7235221.
* Enck P, Aziz Q, Elsenbruch S, Holtmann G, Hu Y, Malagelada J-R, et al. Irritable bowel syndrome: prevalence, impact, and management strategies. Lancet. 2019 Feb 2;393(10174):948-955. doi: 10.1016/S0140-6736(18)32592-6. Epub 2019 Jan 25. PMID: 30691764.
* Lacy BE, Patel NK. Irritable Bowel Syndrome: A Clinical Review. JAMA. 2021 Jul 27;326(4):341-352. doi: 10.1001/jama.2021.10002. PMID: 34293818.
* Lackner JM, Gudleski GD. Psychological comorbidities in irritable bowel syndrome: What is the impact on patients and what can be done? World J Gastroenterol. 2019 Aug 14;25(30):4132-4144. doi: 10.3748/wjg.v25.i30.4132. PMID: 31447098; PMCID: PMC6695286.
* Ford AC, Lacy BE, Talley NJ. Irritable Bowel Syndrome: Pathophysiology, Diagnosis, and Treatment. Am J Gastroenterol. 2019 Feb;114(2):214-222. doi: 10.14309/ajg.0000000000000075. PMID: 30713781.
Q.
What illness causes pain, diarrhea, and weakness together?
A.
Pain, diarrhea, and weakness together most often point to a digestive cause, with inflammatory bowel disease being a key concern, but IBS, short term infections, celiac disease, medication effects, and other inflammatory or systemic conditions can also do this. There are several factors to consider, including red flags like blood in stool, weight loss, fever, severe pain, dehydration, or symptoms lasting more than 2 to 3 weeks, and what tests help tell these apart; see below for the complete answer and guidance on next steps.
References:
* Donowitz M, Kokke FT, Saidi RF. Chronic Diarrhea: Etiology, Diagnosis, and Treatment. Gastroenterology Clinics of North America. 2018 Dec;47(4):797-812. PMID: 30424683.
* Kucharzik T, Maaser C, Lügering A, Kagnoff M, Schreiber S, Stoll R, Lengsfeld J, Lügering N. Inflammatory bowel disease: a clinical review. Deutsches Arzteblatt International. 2017 May 19;114(20):347-356. PMID: 28741300.
* Lebwohl B, Sanders DS, Green PHR. Celiac disease: a clinical review. JAMA. 2018 Jul 3;320(3):284-296. PMID: 29971391.
* Enck P, Van der Gathen C, Stengel A. Irritable bowel syndrome: a current perspective on pathogenesis, diagnosis and treatment. Der Internist. 2021 Jul;62(7):727-735. PMID: 34260588.
* Pitzurra L, Di Mario C, Bartelloni A, Antinori S. Acute infectious gastroenteritis in adults: Epidemiology, clinical manifestations, diagnosis and management. Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia. 2020 Jul-Aug;37(4):37. PMID: 32808447.
Q.
What is the biggest symptom of IBS?
A.
Recurring abdominal pain linked to changes in bowel habits is the biggest and most defining symptom of IBS, often changing with or after a bowel movement. There are several factors to consider that can affect diagnosis and next steps, including the specific stool pattern, other common symptoms, and red flags that require medical attention; see below for the complete answer.
References:
* Barbara G, et al. Symptoms and Burden of Irritable Bowel Syndrome: An Overview. Exp Brain Res. 2018 Sep;236(9):2489-2495. doi: 10.1007/s00221-018-5321-y. Epub 2018 Jul 11. PMID: 29995166.
* Ford AC, et al. Irritable Bowel Syndrome: A Clinical Review. JAMA. 2020 Feb 25;323(8):769-781. doi: 10.1001/jama.2020.0094. PMID: 32100827.
* Van Oudenhove L, et al. Pain perception in irritable bowel syndrome. Handb Clin Neurol. 2019;168:207-224. doi: 10.1016/B978-0-444-64016-1.00013-0. PMID: 32183758.
* Camilleri M. The Irritable Bowel Syndrome: Diagnosis, Pathogenesis and Treatment. Dig Dis. 2018;36(1):5-14. doi: 10.1159/000481232. Epub 2017 Dec 22. PMID: 29281881.
* Sperber AD, et al. Patient-reported outcomes and burden of irritable bowel syndrome. World J Gastroenterol. 2018 Nov 14;24(42):4750-4760. doi: 10.3748/wjg.v24.i42.4750. PMID: 30487608; PMCID: PMC6238053.
Q.
What is the biggest trigger for IBS?
A.
The biggest trigger for IBS is stress acting through the brain gut connection, which heightens gut sensitivity and can speed up or slow down bowel movements. There are several factors to consider. See below to understand how foods, hormones, and past infections can amplify flares, plus practical ways to manage symptoms and the red flags that mean you should see a doctor.
References:
* Lacy BE, Mearin F, Ford AC. Irritable Bowel Syndrome: A Clinical Update. Gastroenterology. 2023 Nov;165(5):1116-1132. doi: 10.1053/j.gastro.2023.08.031. Epub 2023 Aug 29. PMID: 37648356.
* Ohman L, Simrén M. Irritable bowel syndrome: novel insights on mechanisms and future therapies. Nat Rev Gastroenterol Hepatol. 2023 Oct;20(10):631-649. doi: 10.1038/s41575-023-00799-w. Epub 2023 Jul 3. PMID: 37391503.
* Drossman DA, Tack J. Update on the Etiopathogenesis and Management of Irritable Bowel Syndrome. Gastroenterol Hepatol (N Y). 2023 May;19(5):269-276. PMID: 37275815; PMCID: PMC10231940.
* Altomare A, Di Stefano M, Di Sabatino A, Pallotta N, Stasi E, Pizzoferrato M, De Luca A, Gasbarrini A, Barbara G. Dietary Triggers in Irritable Bowel Syndrome: A Review of the Current Literature. Dig Dis Sci. 2022 Aug;67(8):3639-3657. doi: 10.1007/s10620-021-07347-1. Epub 2022 Jan 7. PMID: 34999718; PMCID: PMC9339243.
* Koloski NA, Jones M, Koloski E, Quigley EMM, Talley NJ. Stress and Irritable Bowel Syndrome: A Bidirectional Relationship. Front Psychiatry. 2022 Jun 3;13:883838. doi: 10.3389/fpsyt.2022.883838. PMID: 35721867; PMCID: PMC9204060.
Q.
What to eat during an IBD flare-up?
A.
During a flare, most people with IBD do best with a low-residue approach focused on simple, well-cooked, low-fiber foods and ample hydration. Choose refined grains, lean proteins like eggs, fish, or tofu, cooked peeled vegetables and low-fiber fruits, and consider lactose-free dairy; avoid raw high-fiber foods, nuts and seeds, greasy or spicy dishes, sugar alcohols, caffeine, and alcohol. There are several factors to consider; see below for guidance on electrolytes, potential nutrient deficiencies, how to reintroduce foods safely, when special medical diets are needed, and red flags that mean you should seek care, as these details may affect your next steps.
References:
* Alatab S, Agrawal M, Singh S, Dalal R. Dietary strategies to manage flares in inflammatory bowel disease. J Dig Dis. 2022 Sep;23(9):493-503. doi: 10.1111/1751-2980.13171. Epub 2022 Jul 18. PMID: 35848245.
* Mishra G, Gupta P, Sharma P, Jain D, Gupta S. Nutritional Management in Patients with Inflammatory Bowel Disease: A Review. J Clin Exp Hepatol. 2022 Jul-Aug;12(4):1122-1132. doi: 10.1016/j.jceh.2022.01.006. Epub 2022 Feb 10. PMID: 35914757.
* Emanuele MA, Khan S. Dietary Interventions in Inflammatory Bowel Disease. Curr Gastroenterol Rep. 2023 May;25(5):107-114. doi: 10.1007/s11894-023-00868-x. Epub 2023 May 12. PMID: 37175586.
* Lim W, Hanauer SB, Cohen RD. Dietary therapy in inflammatory bowel disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2023 May;21(6):1465-1481.e10. doi: 10.1016/j.cgh.2022.05.045. Epub 2022 Jun 10. PMID: 35712123.
* Al Bawardy B, Agrawal N, Singh S. Nutritional Management of Hospitalized Inflammatory Bowel Disease Patients. Curr Gastroenterol Rep. 2021 Jul 2;23(8):17. doi: 10.1007/s11894-021-00818-z. PMID: 34070005.
Q.
What to eat to calm an inflamed bowel?
A.
To soothe an inflamed bowel, choose soft, low fiber, easy to digest foods such as white rice or plain pasta, skinless chicken or fish, eggs or tofu, and well cooked vegetables and fruits like carrots, peeled zucchini, bananas, and unsweetened applesauce, and sip water, broths, or oral rehydration solutions. Limit raw salads, nuts and seeds, popcorn, spicy or fried foods, processed meats, alcohol, caffeine, and high sugar items; small amounts of yogurt with live cultures or lactose free kefir may help when symptoms are mild. There are several factors to consider, including how IBD differs from IBS, how and when to reintroduce fiber, and when to seek care for red flag symptoms, so see the complete guidance below.
References:
* Al-Khazraji BK, Al-Shamma S, Al-Shibli N, Al-Humairi B, Al-Dahab R, Al-Habsi S, Al-Hashimi N. Dietary recommendations for patients with inflammatory bowel disease. Dig Liver Dis. 2023 Dec;55(12):1621-1628. doi: 10.1016/j.dld.2023.09.006. Epub 2023 Sep 13. PMID: 37722718.
* Sigall-Boneh R, Levine A. Dietary Interventions in Inflammatory Bowel Disease. Nutrients. 2020 Jan 2;12(1):114. doi: 10.3390/nu12010114. PMID: 31906233; PMCID: PMC7019803.
* Limketkai BN, Bayless TM, Leung K, et al. Dietary approaches and the role of the gut microbiome in the management of inflammatory bowel disease: A systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2023 Feb;21(2):331-344.e6. doi: 10.1016/j.cgh.2022.06.027. Epub 2022 Jun 29. PMID: 35777701.
* Khalili H, Smalley SV, Duerksen DR. Dietary Management of Inflammatory Bowel Disease. Curr Treat Options Gastroenterol. 2023 Sep;21(9):227-241. doi: 10.1007/s11938-023-00466-9. Epub 2023 Jul 11. PMID: 37430154.
* Chey WD, et al. Dietary Guidance in Inflammatory Bowel Disease. Am J Gastroenterol. 2023 Jun 1;118(6):951-968. doi: 10.14309/ajg.0000000000002246. Epub 2023 Mar 20. PMID: 36940856.
Q.
What to eat when your gut is inflamed?
A.
Choose gentle, easy-to-digest foods: well-cooked low fiber vegetables, bananas or applesauce, refined grains like white rice or well-cooked oatmeal, and lean proteins such as eggs, fish, tofu, or skinless poultry, with small amounts of healthy fats; limit raw high fiber foods, spicy items, alcohol, caffeine, fried or highly processed foods, and excess sugar. There are several factors to consider, including what to do during flares versus remission, how dairy or probiotics may affect you, whether symptoms suggest IBS or IBD, and red flags that need medical care; see the complete guidance below to decide safe next steps.
References:
* Lim J, Choi SW, Kim T, Jeon HH, Choi C. Current Evidence of Dietary and Nutritional Management in Inflammatory Bowel Disease: A Scoping Review. Clin Nutr Res. 2021 Jul 15;10(3):185-207. doi: 10.7762/cnr.2021.10.3.185. PMID: 34327150; PMCID: PMC8307010.
* Christodoulou DK, Challa A, Katsanos KH, Tsianos EV. Diet and inflammatory bowel disease: current concepts and future trends. Ann Gastroenterol. 2021 Mar-Apr;34(2):128-142. doi: 10.20524/aog.2020.0559. Epub 2020 Sep 28. PMID: 33776307; PMCID: PMC7988365.
* Scaldaferri F, Lopetuso LR, Musca T, Pizzoferrato M, Del Vecchio Blanco G, Crafa F, Gasbarrini A. Medical Nutrition Therapy in Inflammatory Bowel Disease: From Gut Inflammation to Microbiota. Curr Drug Targets. 2019;20(13):1414-1427. doi: 10.2174/1389450120666190715103630. PMID: 31309855.
* Konig J, Holzlhuber A, Holzlhuber M, Stein R, Scheppach W, Stange EF. Food, gut and inflammatory bowel disease: a search for therapeutic targets. Scand J Gastroenterol. 2021 Oct;56(10):1153-1163. doi: 10.1080/00365521.2021.1925340. Epub 2021 May 16. PMID: 33999990.
* Myhill S. The role of the anti-inflammatory diet in modulating gut health and inflammation. Integr Med (Encinitas). 2017 Aug;16(4):14-23. PMID: 28867909; PMCID: PMC5571618.
Q.
Where is IBD pain usually located?
A.
IBD pain is usually felt in the abdomen and varies by what part of the gut is inflamed: Crohn’s most often causes lower right abdominal pain but can be diffuse, upper abdominal, or perianal, while ulcerative colitis typically causes lower left abdominal and rectal pain with cramping. There are several factors to consider. See below to understand how pain can shift during flares, when symptoms outside the abdomen can occur, and which warning signs should prompt urgent medical care.
References:
* Kim HY, Kim YS, Kim YK, Chung JW. Pain in inflammatory bowel disease: a narrative review. Gut Liver. 2021 Jul 30;14(4):450-459. PMID: 34210667.
* Miranda A, Szigethy E, Levy R, Braden G, Saps M. Abdominal pain in inflammatory bowel disease: a critical review of mechanisms and management. J Crohns Colitis. 2017 Oct 1;11(10):1244-1256. PMID: 27856763.
* Cheung A, O'Connor M, Hachuel D, Ma C, Panaccione R. Visceral pain in inflammatory bowel disease: an overview. Front Pain Res (Lausanne). 2023 Mar 23;4:1161747. PMID: 37063462.
* Lakatos PL, Troke R, Singh B, Tyszkiewicz A. Mechanisms of abdominal pain in inflammatory bowel disease. Curr Opin Gastroenterol. 2019 Mar;35(2):98-103. PMID: 30601138.
* Ben Simon C, Shai A, Livovsky D, Gabay H, Levi Z, Assa A, Eliakim R, Shlomai A, Ben-Horin S. Symptoms of Inflammatory Bowel Disease and Their Impact on Quality of Life: A Qualitative Study. J Crohns Colitis. 2022 Jan 27;16(1):16-25. PMID: 34874403.
Q.
Why do bowel symptoms get worse during periods?
A.
Bowel symptoms often flare around menstruation because hormone shifts and prostaglandins change gut motility and sensitivity, causing constipation before a period and diarrhea, cramping, bloating, and gas during bleeding; the gut-brain axis and temporary inflammation add to this, and IBS can make everything feel worse. There are several factors to consider, including red-flag symptoms and other possible causes like endometriosis, IBD, or celiac disease; see below for complete details that could shape your next steps and when to speak with a clinician.
References:
* Oh S, Kang Y, Sung H, Lee KJ. The Impact of Menstrual Cycle and Hormones on Gastrointestinal Symptoms. Int J Environ Res Public Health. 2021 May 20;18(10):5446. doi: 10.3390/ijerph18105446. PMID: 34070005.
* Adeyemo S, Adewuyi A, Okunlola B, Adeyemo T, Ajani A, Ayinde T. Irritable Bowel Syndrome and the Menstrual Cycle: A Review of the Literature. Gastroenterology Res. 2022 Dec;15(6):261-267. doi: 10.14740/gr1590. PMID: 36589332.
* He Y, Li B, Zhang M, Ma X, Hu J, Ma C, Wang Y, Hu P, Lin H. Sex hormones and the gut microbiota: their interaction in gastrointestinal diseases. Front Microbiol. 2023 Mar 14;14:1107530. doi: 10.3389/fmicb.2023.1107530. PMID: 36993170.
* Mulak A, Talar-Wojnarowska R, Wojnarowski M, Paradowski L. The Effects of Sex Hormones on Gut Motility and Permeability. J Clin Med. 2020 Mar 27;9(4):910. doi: 10.3390/jcm9040910. PMID: 32230872.
* Bharucha AE, Weaver AL, Camilleri M. Effect of menstrual cycle on bowel habits and gastrointestinal symptoms in women with and without irritable bowel syndrome. Am J Physiol Gastrointest Liver Physiol. 2000 Apr;278(4):G676-80. doi: 10.1152/ajpgi.2000.278.4.G676. PMID: 10760124.
Q.
Why do I feel drained after every bowel movement?
A.
There are several factors to consider, from a normal vasovagal response and straining to dehydration or electrolyte loss, blood sugar dips, stress via the gut brain axis, and IBS; see below to understand more. More serious causes like IBD and anemia from GI bleeding can also do this, so if the fatigue is persistent or paired with red flags such as blood or black stools, weight loss, fever, severe abdominal pain, or weeks of diarrhea or constipation, contact a clinician; key warning signs, practical steps, and how to tell IBS from IBD are covered below.
References:
* Agrawal M, Sarma P, Jaiswal D, Garg H, Goel A, Sarma M. Defecation syncope: a review. World J Cardiol. 2017 Mar 26;9(3):189-192. doi: 10.4330/wjc.v9.i3.189. PMID: 28400827; PMCID: PMC5374465.
* Mujica V, Chacón J, Figueroa C, Olivos C, Valenzuela K, Vera R, Morales A, Ibáñez P. Fatigue and Irritable Bowel Syndrome: A Systematic Review. J Clin Gastroenterol. 2019 Feb;53(2):107-114. doi: 10.1097/MCG.0000000000001150. PMID: 30124614.
* Jonefjäll B, Strid H, Öhman L, Söderholm JD. Fatigue and inflammatory bowel disease: a systematic review and meta-analysis. BMC Gastroenterol. 2021 Apr 22;21(1):173. doi: 10.1186/s12876-021-01740-1. PMID: 33888065; PMCID: PMC8061266.
* Fukudo S, Kaneko H, Akiho H, Inamori M, Oka P, Okumura T, Sato K, Shiotani A, Tomita T, Takagi T, Fujiwara Y. Stress and irritable bowel syndrome: a review of neurogastroenterology. J Neurogastroenterol Motil. 2009 Jul;15(3):193-201. doi: 10.5056/jnm.2009.15.3.193. PMID: 19730536; PMCID: PMC2724283.
* Cryan JF, O'Riordan SK, Cowan CSM, Dinan KJ, Fitzgerald P, Holohan E, Murray K, Newman LK, O'Mahony SM, O'Sullivan C, Patterson E, Ross P, Stilling RM, F SF. The Microbiome-Gut-Brain Axis. Physiol Rev. 2019 Jul 1;99(3):1877-2013. doi: 10.1152/physrev.00018.2018. PMID: 31002333; PMCID: PMC7035544.
Q.
Why does bowel disease affect absorption?
A.
Bowel disease affects absorption because chronic inflammation damages the intestinal lining and villi, speeds transit, and reduces absorptive surface area, while scarring, strictures, surgical removal of segments, and microbiome changes further limit uptake of nutrients, fluids, and medications. There are several factors to consider. See below for the complete answer, including which bowel segments and conditions are involved, common deficiencies like iron, vitamin B12, and vitamin D, red flags that need prompt care, how treatment can improve absorption, and how IBD differs from IBS.
References:
* pubmed.ncbi.nlm.nih.gov/22900762/
* pubmed.ncbi.nlm.nih.gov/29329774/
* pubmed.ncbi.nlm.nih.gov/33804829/
* pubmed.ncbi.nlm.nih.gov/32463056/
* pubmed.ncbi.nlm.nih.gov/30588663/
Q.
Why does bowel disease impact mental health?
A.
There are several factors to consider: the gut and brain communicate in a two way system of nerves, hormones, immune signals, and the microbiome, so stress can worsen digestive symptoms while ongoing symptoms can heighten anxiety and low mood. Key drivers include chronic pain and urgency, inflammatory cytokines that shift brain chemistry, microbiome disruption, heightened sensitivity to gut signals, and social impacts like embarrassment and isolation. For practical next steps and when to seek care, see the complete answer below.
References:
* Chew CH, et al. Inflammatory Bowel Disease and Mental Health: Pathophysiology, Clinical Implications, and Therapeutic Targets. Front Psychiatry. 2022 May 20;13:883088. doi: 10.3389/fpsyt.2022.883088. PMID: 35669389; PMCID: PMC9165154.
* Dinan TG, Cryan JF. The gut-brain axis: A critical view. Compr Physiol. 2023 Oct 12;13(4):3965-4015. doi: 10.1002/cphy.c220038. PMID: 37827050.
* Foster JA, et al. The microbiome-gut-brain axis: a framework for understanding and treating mental disorders. Transl Psychiatry. 2023 May 15;13(1):164. doi: 10.1038/s41398-023-02454-w. PMID: 37189191; PMCID: PMC10185078.
* Niesler B, et al. Irritable Bowel Syndrome and Mental Health: Mechanisms, Clinical Implications, and Treatment Strategies. Front Psychiatry. 2021 Jun 24;12:699049. doi: 10.3389/fpsyt.2021.699049. PMID: 34248834; PMCID: PMC8263155.
* Zhang Y, et al. Gut Microbiota Dysbiosis in Inflammatory Bowel Disease and Its Impact on Mental Health. Front Immunol. 2022 Mar 15;13:863212. doi: 10.3389/fimmu.2022.863212. PMID: 35371191; PMCID: PMC8963574.
Q.
Why does bowel pain increase after eating?
A.
Bowel pain that increases after eating usually happens because digestion triggers the gastrocolic reflex, increasing intestinal contractions that can hurt when the gut is sensitive or inflamed. Common contributors include IBS and visceral hypersensitivity, gas from fermentable foods, motility changes, and especially inflammatory bowel disease, while less commonly reduced blood flow after meals can cause severe pain. Because some causes need timely treatment, seek care for red flags like blood in stool, weight loss, fever, anemia, or pain that wakes you, and see the complete guidance with next steps below.
References:
* Sarnelli G, Ruggiero E, Cicala M, et al. Postprandial distress syndrome: current understanding and future challenges. J Clin Gastroenterol. 2018 Sep;52 Suppl 1:S10-S13. doi: 10.1097/MCG.0000000000001047. PMID: 29775089.
* Simren M, Törnblom H, Palsson OS, et al. Irritable bowel syndrome: pathophysiology and treatment. Lancet. 2018 Aug 4;392(10141):93-107. doi: 10.1016/S0140-6736(18)30658-5. PMID: 30046537.
* Holtmann G, Ford AC, Talley NJ. The gut-brain axis in functional dyspepsia. J Gastroenterol Hepatol. 2019 Jul;34(7):1114-1122. doi: 10.1111/jgh.14605. Epub 2019 Apr 12. PMID: 30883838.
* Bharucha AE, Camilleri M. Mechanisms of postprandial symptoms in functional dyspepsia. Best Pract Res Clin Gastroenterol. 2017 Oct;31(5):547-553. doi: 10.1016/j.bpg.2017.09.002. Epub 2017 Sep 21. PMID: 28830872.
* Zhou Y, Wu J, Ma X, et al. Visceral hypersensitivity in functional dyspepsia and irritable bowel syndrome: molecular and cellular mechanisms. J Cell Mol Med. 2017 Mar;21(3):454-464. doi: 10.1111/jcmm.12984. Epub 2016 Nov 30. PMID: 27909564; PMCID: PMC5345719.
Q.
Why does IBD affect energy levels so badly?
A.
There are several factors to consider: chronic inflammation diverts energy and triggers cytokines, while anemia, poor nutrient absorption, sleep disruption from pain or urgency, dehydration, medication side effects, and stress all compound fatigue. Many of these causes are treatable and some warrant prompt care, so see below for the full breakdown, warning signs, and how to decide your next steps with your healthcare team.
References:
* Al-Ani, A. H., et al. (2020). Fatigue in Inflammatory Bowel Disease: Pathophysiology and Management. *Gut and Liver*, 14(3), 273–285.
* Borren, N., et al. (2021). Understanding and managing fatigue in inflammatory bowel disease. *Nature Reviews Gastroenterology & Hepatology*, 18(2), 115–129.
* Varesko, M. J., et al. (2023). Fatigue in Inflammatory Bowel Disease: A Review of Epidemiology, Pathophysiology and Therapeutic Strategies. *Journal of Clinical Medicine*, 12(3), 1116.
* van der Have, M., et al. (2021). The multidimensional nature of fatigue in inflammatory bowel disease. *Journal of Crohn's and Colitis*, 15(4), 570–579.
* Parian, A., et al. (2018). Mechanisms of Fatigue in Inflammatory Bowel Disease. *Clinical Gastroenterology and Hepatology*, 16(10), 1546-1557.
Q.
Why does inflammation affect bowel movements?
A.
Inflammation changes bowel movements through several mechanisms: it can speed up or slow gut motility, damage the intestinal lining that absorbs water, trigger extra fluid and electrolyte secretion, irritate gut nerves, and disrupt gut bacteria, which can cause diarrhea or constipation, urgency, cramping, mucus or blood, and dehydration. There are several factors to consider; see below to understand more. In conditions like IBD these changes are visible and can flare and remit, while IBS does not show tissue damage, and the differences, red flags, and when to seek care are explained below to help guide your next steps.
References:
* Stengel, A., & Tache, Y. (2020). Altered Intestinal Motility and Function in Inflammatory Bowel Disease. *Frontiers in Physiology*, *11*, 767.
* Morando, F., Pastore, A., & Varese, M. (2022). Immune Cells and the Enteric Nervous System: A Cross-Talk Modulating Gut Motility in Health and Disease. *Cells*, *11*(16), 2506.
* Stasi, K., & Tache, Y. (2018). Mechanisms of altered gut motility in inflammatory bowel disease. *Alimentary Pharmacology & Therapeutics*, *48*(2), 160-175.
* Hughes, P. A., & Spiller, R. C. (2017). The impact of inflammation on gut motility and functional gastrointestinal disorders. *Journal of Gastroenterology*, *52*(10), 1047-1057.
* Wouters, M. M., Vicario, M., & Santos, J. (2013). Role of mast cells in gut motility and functional gastrointestinal disorders. *Alimentary Pharmacology & Therapeutics*, *37*(11), 1011-1025.
Q.
Why does inflammation cause bleeding?
A.
Inflammation can cause bleeding by weakening and making blood vessels leaky, breaking down tissue into erosions or ulcers that expose vessels, and interfering with normal clotting. There are several factors to consider, including that bleeding is common in IBD but not typical of IBS, and knowing warning signs and treatment options can guide next steps; see below for details.
References:
* Levi, M. (2018). Disseminated intravascular coagulation: what's new?. *Critical Care Clinics*, *34*(2), 273-282. PMID: 29502941
* Lee, A., & Lee, P. S. (2020). Endothelial barrier dysfunction in systemic inflammation: mechanisms and therapeutic implications. *Seminars in Immunopathology*, *42*(6), 729-743. PMID: 32909187
* Westerweel, P. E., & van der Poll, T. (2016). The interplay between inflammation and coagulation. *Seminars in Immunopathology*, *38*(3), 253-261. PMID: 26867623
* Conway, E. M. (2012). The role of cytokines in hemostasis. *Blood Reviews*, *26*(4), 147-152. PMID: 22687596
* Horgan, A. M., & Zisman, S. M. (2020). Gastrointestinal Bleeding in Inflammatory Bowel Disease. *Gastroenterology & Hepatology*, *16*(10), 656. PMID: 33178044
Q.
Why does my gut feel inflamed all the time?
A.
There are several factors to consider. That constant “inflamed” feeling is most often due to IBS and heightened gut sensitivity along the gut brain axis, so normal gas, stretching, meals, or stress can feel painful even when tests look normal. Other causes like food intolerances, SIBO, medication side effects, pelvic floor dysfunction, or hormonal shifts can overlap, and red flags like weight loss, blood in stool, fever, persistent vomiting, anemia, or night-time symptoms need urgent care; see below for important details, an IBS symptom check, and practical next steps on diet, stress, sleep, and targeted medicines to discuss with your clinician.
References:
* Elphick, L. I., & Mahida, Y. R. (2018). Persistent low-grade inflammation in irritable bowel syndrome and its impact on the gut. Clinical and Experimental Gastroenterology, 11, 359–371.
* Cryan, J. F., O'Mahony, S. M., van de Wouw, M. G., & Wiffin, M. (2020). The Microbiome-Gut-Brain Axis: From Basic Research to Novel Therapeutic Strategies. Gastroenterology, 158(5), 1279–1296.
* Salvo-Romero, E., Queralt, R., Torres-Rovira, L., Balasch-Baratex, C., Segarra-Losa, G., & Ferrer-Báguena, P. (2022). The Intestinal Barrier in Inflammatory Bowel Disease and Irritable Bowel Syndrome. International Journal of Molecular Sciences, 23(17), 9673.
* Rinninella, E., Cintoni, M., Raoul, P., Castellani, R., Caputo, D., Perrone, G., ... & Mele, M. C. (2020). Food, Diet, Gut Microbiota and Inflammatory Bowel Disease. Nutrients, 12(10), 2955.
* Madison, A., & Kiecolt-Glaser, J. K. (2019). Stress, depression, diet, and the gut microbiota: human-mouse collaborations. Brain, Behavior, and Immunity, 76, 12–23.
Q.
Why does my gut feel inflamed every morning?
A.
There are several factors to consider; morning gut discomfort is commonly from normal overnight physiology, diet timing, stress, constipation, reflux, or IBS, and less often from true inflammation like IBD. See below for key details that could change next steps, including simple fixes, how to tell IBS from IBD, and urgent red flags such as blood in stool, unexplained weight loss, persistent nighttime pain, fever, or weeks of diarrhea that should prompt medical care.
References:
* Voigt RM, Summa KC, Forsyth CB, Keshavarzian A. Circadian Rhythms, Sleep, and Microbiota in Inflammatory Bowel Disease. Adv Neurobiol. 2018;21:299-311. doi: 10.1007/978-3-319-93724-1_15. PMID: 29900595.
* Chen H, Hu X, He X. The Role of Circadian Rhythms in Irritable Bowel Syndrome. Front Neurosci. 2021 Jun 25;15:690562. doi: 10.3389/fnins.2021.690562. PMID: 34248560; PMCID: PMC8268804.
* Han H, Song Y, Hou C, Zhang S, Zheng X, Cai H, Zhao L. Sleep deprivation affects gut microbiota and induces systemic inflammation. Gut Microbes. 2021 Jan-Dec;13(1):1904797. doi: 10.1080/19490976.2021.1904797. PMID: 33636846; PMCID: PMC8041551.
* Wang G, Zhang X, Han M, Gao X. Circadian rhythms and gut barrier function: current insights and future perspectives. Clin Transl Gastroenterol. 2022 Nov 17;13(11):e00529. doi: 10.14309/ctg.0000000000000529. PMID: 36394337; PMCID: PMC9675836.
* Siddique M, Qadeer R, Aslam F, Iqbal F, Al-Saadi R, Al-Hasawi M, Ahmed A. Daily and Circadian Rhythmicity of Symptoms in Inflammatory Bowel Disease: A Systematic Review. J Clin Sleep Med. 2023 Apr 1;19(4):753-764. doi: 10.5664/jcsm.10425. PMID: 36979685; PMCID: PMC10064508.
Q.
Why is IBS more common in women?
A.
Women are diagnosed about 1.5 to 2 times more often, likely due to hormone effects on the gut, sex differences in gut brain communication and pain processing, slower colon motility, immune differences, more common overlapping conditions like pelvic floor dysfunction and endometriosis, and greater stress exposure and health seeking that increase detection. There are several factors to consider; see below for how symptoms vary with the menstrual cycle, pregnancy, and menopause, which red flags mean you should see a doctor, and the full set of treatment options you can discuss next.
References:
* Ohlsson B. Sex and Gender Differences in Irritable Bowel Syndrome. J Clin Med. 2023 Aug 24;12(17):5524. doi: 10.3390/jcm12175524. PMID: 37637497; PMCID: PMC10488057.
* Bajaj N, Tarbell S, Madan A, Sharma D, Chey WD, Eswaran S. Sex Differences in Irritable Bowel Syndrome: A Review of Biological and Psychological Factors. J Neurogastroenterol Motil. 2020 Jul 30;26(3):285-299. doi: 10.5056/jnm20021. PMID: 32338600; PMCID: PMC7378771.
* Khan N, Gupta S, Kichloo A, Al-Otaibi F, Khan N, Singh A, Darr U. Sex Differences in Irritable Bowel Syndrome: A Role for Visceral Pain and the Gut Microbiome. Cureus. 2023 Jun 16;15(6):e40502. doi: 10.7759/cureus.40502. PMID: 37454848; PMCID: PMC10352128.
* Mulak A, Tache Y, Million M. Sex and Gender in Irritable Bowel Syndrome: A Narrative Review of Pathophysiology and Clinical Impact. Gastroenterol Clin North Am. 2019 Mar;48(1):141-163. doi: 10.1016/j.gtc.2018.09.006. PMID: 30678850; PMCID: PMC6698628.
* Kim S, Kim K, Kim TW, Jung ES, Choi B, Jo HJ, Lee JE. Sex hormones in irritable bowel syndrome: a review of current knowledge. J Gastroenterol Hepatol. 2022 Feb;37(2):299-307. doi: 10.1111/jgh.15570. Epub 2021 Jul 22. PMID: 34293976.
Q.
Women misinterpreting bowel disease symptoms
A.
Women often misinterpret bowel disease symptoms because common issues like periods, stress, or diet can mimic early IBD and get mistaken for IBS. Persistent diarrhea, rectal bleeding, weight loss, fatigue, or pain that wakes you at night are red flags that deserve medical evaluation. There are several factors to consider. See below for the full list of symptoms, how hormones and life stages can obscure IBD, the differences between IBS and IBD, and clear next steps for testing and advocating for timely care.
References:
* Siah KT, et al. Sex Differences in Gastrointestinal Symptoms, Comorbidities, and Quality of Life in Patients With Irritable Bowel Syndrome. Clin Transl Gastroenterol. 2021 Jun 28;12(6):e00371. doi: 10.14309/ctg.0000000000000371. PMID: 34185764.
* Siegel CA, et al. Gender differences in the clinical presentation of inflammatory bowel disease: a systematic review and meta-analysis. Therap Adv Gastroenterol. 2022 Feb 7;15:17562848221074191. doi: 10.1177/17562848221074191. PMID: 35140608.
* Mulak A, et al. Gender differences in the experience of irritable bowel syndrome: a literature review. Przegl Gastroenterol. 2018;13(2):107-115. doi: 10.5114/pg.2018.76185. Epub 2018 May 23. PMID: 29759882.
* Khandelwal K, et al. Pelvic Floor Dysfunction and Associated Conditions in Women. J Clin Gastroenterol. 2017 Nov/Dec;51(10):864-874. doi: 10.1097/MCG.0000000000000913. PMID: 28877074.
* Ludvigsson JF, et al. Celiac disease: female predominance, autoimmune disorders and pregnancy complications. World J Gastroenterol. 2015 Mar 7;21(9):2775-81. doi: 10.3748/wjg.v21.i9.2775. PMID: 25759550.
Q.
Can I leave IBD untreated?
A.
Leaving IBD untreated is generally not recommended; even when symptoms seem mild, silent inflammation can progress and cause irreversible bowel damage, higher chances of surgery, nutrient deficiencies, and increased colorectal cancer risk, along with problems in the joints, skin, eyes, and liver. There are several factors to consider, and treatment can be stepwise and tailored; see below for important details, warning signs that need prompt care, and how to work with a clinician to choose the safest next steps.
References:
* Giri S, et al. Inflammatory bowel disease: Pathogenesis and therapeutic strategies. World J Gastroenterol. 2022 Oct 28;28(40):5780-5799. doi: 10.3748/wjg.v28.i40.5780. PMID: 36319106; PMCID: PMC9632833.
* Müller L, et al. The Natural History of Inflammatory Bowel Disease. J Clin Med. 2021 Jul 27;10(15):3327. doi: 10.3390/jcm10153327. PMID: 34407519; PMCID: PMC8348983.
* Ungaro R, et al. Impact of Delayed Diagnosis and Treatment in Inflammatory Bowel Disease. J Crohns Colitis. 2021 Jun 25;15(6):953-961. doi: 10.1093/ecco-jcc/jjab067. PMID: 33924108.
* Ramos G, et al. Management of Ulcerative Colitis: Current State and Future Perspectives. J Clin Med. 2023 Mar 29;12(7):2683. doi: 10.3390/jcm12072683. PMID: 37020087; PMCID: PMC10094767.
* Liu H, et al. Crohn's Disease: A Review of Pathogenesis, Diagnosis, and Management. Int J Mol Sci. 2023 Feb 6;24(4):3075. doi: 10.3390/ijms24043075. PMID: 36768399; PMCID: PMC9960243.
Q.
Can IBS be cured permanently?
A.
No, IBS cannot be cured permanently. Many people achieve long-term control or remission with personalized diet changes, stress-focused therapies, targeted medications, and healthy habits, and IBS is not life threatening nor does it turn into IBD. There are several factors to consider; see below to understand more, including how to tell IBS from IBD, the red flag symptoms that need urgent care, and practical next steps to tailor your management.
References:
* Enck, P., & Aziz, Q. (2018). Can IBS be cured? Frontline Gastroenterology, 9(4), 282-287.
* Ford, A. C., Sperber, A. D., Corsetti, M., & Quigley, E. M. M. (2020). Irritable bowel syndrome. The Lancet, 396(10260), 1675-1688.
* Black, C. J., Staudacher, H. M., & Ford, A. C. (2020). Efficacy of dietary and pharmacological treatments for irritable bowel syndrome: Systematic review and network meta-analysis. Gut, 69(7), 1192-1206.
* Simrén, M., Tack, J., & The Rome Foundation Working Team. (2018). Irritable bowel syndrome: natural history, prognosis, and therapeutic approach. Gastroenterology, 155(5), 1404-1416.
* O'Malley, J. C., Bales, M. S., & Chey, W. D. (2023). Current status of diagnosis and treatment of irritable bowel syndrome: The Rome IV criteria and beyond. World Journal of Clinical Cases, 11(20), 4782–4791.
Q.
Can people with IBD live a normal life?
A.
Yes, many people with IBD live full, active, and productive lives by managing the condition with modern treatments, regular follow up, and practical daily routines tailored to their needs. There are several factors to consider; see below for key details on flares and remission, mental health support, diet and exercise, work and school accommodations, family planning, serious warning signs that need urgent care, and how to tell IBD from IBS, which can guide your next steps.
References:
* Van der Valk PMT, de Jong DJ. Quality of Life in Inflammatory Bowel Disease. J Clin Med. 2022 Jul 28;11(15):4399. doi: 10.3390/jcm11154399. PMID: 35921615; PMCID: PMC9369324.
* Kaser IJ, Schöls TR. Impact of inflammatory bowel disease on quality of life, disability and work productivity. Z Gastroenterol. 2020 Apr;58(4):e112-e118. doi: 10.1055/a-1080-6072. Epub 2020 Mar 31. PMID: 32230737.
* Cheung JSLC, Ma N, Chan SKW, Chan JYM, Lai JWT, Yeoh YS. Living with inflammatory bowel disease: a qualitative systematic review and meta-synthesis of patients' experiences. BMJ Open. 2023 Jan 27;13(1):e065551. doi: 10.1136/bmjopen-2022-065551. PMID: 36712399; PMCID: PMC9892697.
* Benoy KM, Smith CA, Bernstein CN. Mental health in inflammatory bowel disease: A narrative review of the clinical and research landscape. World J Gastroenterol. 2023 Apr 7;29(13):1929-1943. doi: 10.3748/wjg.v29.i13.1929. PMID: 37025178; PMCID: PMC10091392.
* Frolkis S, Bernstein CN. Sexual Dysfunction and Inflammatory Bowel Disease. Curr Gastroenterol Rep. 2023 Oct;25(10):248-256. doi: 10.1007/s11894-023-00877-0. Epub 2023 Sep 25. PMID: 37748493.
Q.
Can you be cured of inflammatory bowel disease?
A.
There is currently no universal cure for inflammatory bowel disease; many people can achieve long-term remission with modern treatments, and while colectomy can effectively eliminate ulcerative colitis, Crohn’s often returns after surgery. There are several factors to consider. See below for the complete answer, including details on remission goals, treatment options, lifestyle support, warning signs that need medical care, and how to choose the right next steps with your clinician.
References:
* D'Haens G, Panaccione R, Armuzzi A, Carlson A, Danese S, Hibi T, et al. Defining Cure in Inflammatory Bowel Disease: A Consensus Statement of the International Organization for the Study of Inflammatory Bowel Disease. Gastroenterology. 2021 Jul;161(1):340-346.e2. doi: 10.1053/j.gastro.2021.03.022. PMID: 33744383.
* Jørgensen MM, Krarup PM, Christensen P, Bülow S, Jørgensen LN, Kirkegaard P, et al. Long-term outcomes after total proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis. Scand J Gastroenterol. 2018 Jan;53(1):3-11. doi: 10.1080/00365521.2017.1396452. PMID: 29094611.
* Zalloua PA, Zalloua H, Daou M, Hajj H, Azar CA. Sustained Deep Remission in Crohn's Disease: A Treat-to-Target Goal. J Clin Med. 2023 Apr 15;12(8):3467. doi: 10.3390/jcm12083467. PMID: 37108992.
* Vande Casteele N, Khanna R, Sandborn WJ. Treatment withdrawal in inflammatory bowel disease patients: When, how and for whom? World J Gastroenterol. 2019 Sep 21;25(35):5205-5221. doi: 10.3748/wjg.v25.i35.5205. PMID: 31558838.
* Pizarro T, Vancamelbeke M. The Future of Inflammatory Bowel Disease Treatment: Current Challenges and Opportunities. Int J Mol Sci. 2023 Apr 22;24(9):7741. doi: 10.3390/ijms24097741. PMID: 37175402.
Q.
Can you live to 100 with Crohn's disease?
A.
Yes, many people with Crohn’s live long lives into their 90s and even 100 when the disease is well controlled through modern treatments, routine monitoring, and healthy lifestyle choices. There are several factors to consider, including complication prevention, management of other health conditions, and timely care, and risk is higher during periods of poor control. See below for the complete answer and practical next steps to discuss with your healthcare provider.
References:
* Duricova D, et al. Life Expectancy and Causes of Death in Patients With Inflammatory Bowel Disease. Clin Gastroenterol Hepatol. 2021 May;19(5):981-990.e1. doi: 10.1016/j.cgh.2020.06.027. Epub 2020 Jun 20. PMID: 32575790.
* Fumery M, et al. Mortality in patients with Crohn's disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2017 Aug;15(8):1244-1250.e3. doi: 10.1016/j.cgh.2016.12.030. Epub 2016 Dec 21. PMID: 28017983.
* Peyrin-Biroulet L, et al. Cumulative Burden of Inflammatory Bowel Disease. Gastroenterology. 2019 Nov;157(5):1199-1207.e3. doi: 10.1053/j.gastro.2019.08.053. Epub 2019 Aug 29. PMID: 31479708.
* Singh S, et al. Inflammatory Bowel Disease in the Elderly: A Systematic Review. Am J Gastroenterol. 2014 Dec;109(12):1716-26. doi: 10.1038/ajg.2014.180. Epub 2014 Jul 22. PMID: 25047113.
* Rungoe C, et al. Long-term outcome in inflammatory bowel disease: a population-based study from Denmark. Aliment Pharmacol Ther. 2014 Mar;39(5):472-84. doi: 10.1111/apt.12613. Epub 2014 Jan 13. PMID: 24417126.
Q.
Can you take Buscopan with Crohn's disease?
A.
Yes, sometimes, but with important limits: Buscopan may help short term cramping in Crohn’s that is stable or in remission, when pain is due to spasm and there is no known or suspected stricture or blockage, and only with clinician guidance. It does not treat inflammation and can mask or worsen serious problems during a flare, especially with severe pain, vomiting, fever, or increasing bloating, so speak to your doctor; key precautions, side effects, drug interactions, and safer next steps appear below.
References:
* Brandstetter P, Weissenbacher F, Leitner J, Drolz A, Ferlitsch M, Staufer K, Püspök A, Scharl M, Rechner P. Hyoscine Butylbromide for Abdominal Pain in Inflammatory Bowel Disease: A Systematic Review. J Crohns Colitis. 2023 Feb 1;17(2):294-304. doi: 10.1093/ecco-jcc/jjac159. PMID: 36306061.
* Feuerstein JD, Cheifetz AS, Moss AC, Leffler DA, Ananthakrishnan AN, Sands BE. American Gastroenterological Association Clinical Practice Guideline on Medical Management of Moderate to Severe Luminal Crohn's Disease. Gastroenterology. 2021 Oct;161(4):1320-1329. doi: 10.1053/j.gastro.2021.06.079. Epub 2021 Jul 21. PMID: 34293792.
* Stelmach-Mardas M, Stelmach P. Symptomatic Management in Inflammatory Bowel Disease: Current Perspectives and Future Directions. J Clin Med. 2023 Jan 13;12(2):645. doi: 10.3390/jcm12020645. PMID: 36672322; PMCID: PMC9861642.
* Parian A, Basson MD. Pharmacologic Therapy for Functional Abdominal Pain in Inflammatory Bowel Disease. Inflamm Bowel Dis. 2019 Feb 1;25(2):226-233. doi: 10.1093/ibd/izy271. PMID: 30678857.
* Torres J, Bonovas S, Doherty G, Kopylov U, Gordon H, Katsanos KH, D'Haens G, Danese S, Allocca M, Louis E, Raine T, Spinelli A, Vavricka S, Ben-Horin S. ECCO Guidelines on Therapeutics in Crohn's Disease: Medical Treatment. J Crohns Colitis. 2023 Feb 1;17(2):211-235. doi: 10.1093/ecco-jcc/jjac163. PMID: 35368383.
Q.
How does a person get inflammatory bowel disease?
A.
Inflammatory bowel disease develops from a complex interaction of genetics, an overactive immune system, disrupted gut bacteria, and environmental triggers like smoking, certain infections, frequent antibiotic use, highly processed diets, and urban living. It is not caused by stress, poor hygiene, or “eating the wrong foods,” is not contagious, and is different from IBS; there are several factors to consider, and the complete details below can guide your risk awareness, when to seek care, and steps that may support gut health.
References:
* Xia W, Su Q, Wang C, Lu Y, Yang J, Wu Y, Tang K, Li J. The pathogenesis of inflammatory bowel disease: A comprehensive review. Front Immunol. 2023 Aug 21;14:1229712. PMID: 37662990.
* Liu JZ, Anderson CA. The genetics of inflammatory bowel disease: from mechanisms to medicine. Nat Rev Gastroenterol Hepatol. 2023 May;20(5):308-323. PMID: 36976295.
* De Filippo S, Nuti F, Fiorino G. Environmental factors in inflammatory bowel disease: a narrative review. J Gastrointestin Liver Dis. 2023 Mar;32(1):5-14. PMID: 37012284.
* Franzosa EA, Sinha R, Khalili H, Vlamakis H, Xavier RJ. The gut microbiome and inflammatory bowel disease: from mechanisms to therapies. Nat Rev Gastroenterol Hepatol. 2023 May;20(5):324-340. PMID: 36976296.
* Nuti F, De Filippo S, Fiorino G. Immune system and inflammatory bowel disease: new insights into pathogenesis and therapies. Ther Adv Gastroenterol. 2022 Nov 28;15:17562848221142517. PMID: 36699268.
Q.
How long can you live with inflammatory bowel disease?
A.
Most people with IBD live a normal or near-normal lifespan with modern treatment and regular monitoring. Life expectancy is often similar to the general population in ulcerative colitis and only slightly reduced on average in Crohn’s, depending on disease control and complications. There are several factors to consider, including severity, complications, lifestyle, mental health, and cancer screening, so see below for important details that could shape your next steps and when to seek urgent care.
References:
* Jess T, et al. Life Expectancy and Cause of Death in Patients with Inflammatory Bowel Disease. Clin Gastroenterol Hepatol. 2017 Dec;15(12):1911-1918.e4. doi: 10.1016/j.cgh.2017.06.035. Epub 2017 Jun 29. PMID: 28669936.
* Zhao Y, et al. Trends in mortality among patients with inflammatory bowel disease: A systematic review and meta-analysis. Front Med (Lausanne). 2023 Feb 15;10:1107567. doi: 10.3389/fmed.2023.1107567. PMID: 36873551; PMCID: PMC9976378.
* Weimers P, et al. Mortality in inflammatory bowel disease: A nationwide population-based cohort study. J Crohns Colitis. 2019 Jun 1;13(6):708-714. doi: 10.1093/ecco-jcc/jjy213. PMID: 30602059.
* Bernstein CN, et al. Long-term outcomes in Crohn's disease. Curr Opin Gastroenterol. 2020 Nov;36(6):449-456. doi: 10.1097/MOG.0000000000000676. PMID: 32909988.
* Cohen BL, et al. Long-term outcomes in ulcerative colitis. Curr Opin Gastroenterol. 2020 Nov;36(6):457-463. doi: 10.1097/MOG.0000000000000677. PMID: 32909989.
Q.
How long do IBD flare ups last?
A.
IBD flare-ups can last from a few days to several months. Mild episodes often settle in days to 2 to 3 weeks, while moderate to severe flares can stretch for weeks to months, particularly if treatment is delayed. Duration also varies by disease type and key factors, with Crohn’s flares often longer than ulcerative colitis and earlier treatment and good adherence helping shorten them; see below for important details that can guide next steps, including when to seek care and which treatments act fastest.
References:
* Katsanos KH, Tatsi A, Batsis I, Hatziioannou A, Christodoulou DK. Relapses in inflammatory bowel disease. Ann Gastroenterol. 2015 Oct-Dec;28(4):427-440. PMID: 26604856; PMCID: PMC4659220.
* Torres J, Billiet T, Carballo B, Roy A, Sabre C, Colombel JF, Ungaro R. Predictors of Disease Course in Patients With Crohn's Disease and Ulcerative Colitis. Gastroenterology. 2017 May;152(6):1346-1358.e6. doi: 10.1053/j.gastro.2017.01.037. Epub 2017 Feb 1. PMID: 28167332.
* Ungaro R, Fumery M, Peyrin-Biroulet L, Colombel JF. Natural history of ulcerative colitis. J Crohns Colitis. 2016 Feb;10(2):229-41. doi: 10.1093/ecco-jcc/jjv194. Epub 2015 Nov 17. PMID: 26590215.
* Bernstein CN. Disease activity, prognosis and quality of life in inflammatory bowel disease. J Crohns Colitis. 2014 Mar;8(3):263-8. doi: 10.1016/j.crohns.2014.01.011. Epub 2014 Jan 16. PMID: 24434190.
* Danese S, Vecchi M, Peyrin-Biroulet L. Predictors of response to medical therapy in inflammatory bowel disease. J Crohns Colitis. 2015 Feb;9(2):103-9. doi: 10.1016/j.crohns.2014.12.013. Epub 2014 Dec 29. PMID: 25555620.
Q.
How to confirm inflammatory bowel disease?
A.
Confirmation of inflammatory bowel disease relies on a stepwise approach that combines symptoms and exam with blood tests for inflammation, stool markers like fecal calprotectin to rule out infection and distinguish from IBS, and a colonoscopy with biopsies to confirm and classify Crohn’s disease vs ulcerative colitis; imaging helps assess small bowel involvement and complications. There are several factors to consider that can change your next steps, including conditions to rule out and red flag symptoms that need prompt care. See the complete details below.
References:
* Al-Shaibi AM, Abdo AA. Diagnosis and management of inflammatory bowel disease: current practice and future directions. World J Gastroenterol. 2021 May 28;27(20):2596-2612. doi: 10.3748/wjg.v27.i20.2596. PMID: 34092994; PMCID: PMC8172911.
* Maaser C, Sturm A, Vavricka SR, Kucharzik T, Lehmann C, Schulte B, Schroeder O, Uebel P, Baumgart DC, Bettenworth D, Boehm T, Bokemeyer M, Curvers WL, Fichtner-Feigl S, Greinwald R, Haas JP, Helwig U, Hennemeyer H, Herfarth H, Hinz M, Karstensen JG, Langhorst J, Mueller L, Nuding M, Pawlik H, Schoepfer AM, Schreiber S, Schreyer AG, Stallmach A, Siegmund B, Teich N, von Felden J, Zeitz J, Schmidt C, Fischbach W. ECCO-ESGAR Guideline for Diagnostic Assessment in Inflammatory Bowel Disease. Part 1: Initial Diagnosis, Monitoring of Known IBD, and Pre-treatment Assessment. J Crohns Colitis. 2019 May 22;13(4):395-414. doi: 10.1093/ecco-jcc/jjy113. PMID: 30202720.
* Kostic J, Lausevic M, Milutinovic S, Mitrovic S, Lekovic S, Mijac D. Diagnosis and management of inflammatory bowel disease. World J Gastroenterol. 2021 Nov 7;27(41):7059-7077. doi: 10.3748/wjg.v27.i41.7059. PMID: 34795493; PMCID: PMC8580665.
* Kopylov U. Clinical utility of biomarkers in inflammatory bowel disease. Ann Transl Med. 2020 Aug;8(15):969. doi: 10.21037/atm-2020-56. PMID: 32953049; PMCID: PMC7494432.
* Plevy SE, Siegel CA, Regueiro M. Biomarkers in Inflammatory Bowel Disease: From Diagnosis to Treatment. Gastroenterol Clin North Am. 2023 Mar;52(1):15-32. doi: 10.1016/j.gtc.2022.10.003. PMID: 36764835.
Q.
Is IBD life threatening?
A.
IBD is usually not life threatening, and with modern care most people have near normal life expectancy and lead full lives. That said, severe or poorly controlled IBD can become dangerous due to complications like major bleeding, bowel perforation, toxic megacolon, blood clots, serious infections, dehydration, malnutrition, and a higher long term risk of colorectal cancer. There are several factors to consider for monitoring, red flag symptoms, and prevention steps, so review the complete answer below to understand what to watch for and when to seek care.
References:
* Hou JK, Leung Y, McDonald JWD, et al. All-cause and disease-specific mortality in inflammatory bowel disease: A systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2022 Jul;20(7):e1645-e1661. doi: 10.1016/j.cgh.2021.09.027. Epub 2021 Sep 20. PMID: 34556488.
* Torres J, Billiet T, Panes J, et al. Long-Term Prognosis of Inflammatory Bowel Disease. Gastroenterology. 2021 Jun;160(7):2263-2280. doi: 10.1053/j.gastro.2021.01.066. Epub 2021 Feb 3. PMID: 34005697.
* Hayee B, Al-Dajani A, Gonczi L, et al. Causes of death in patients with inflammatory bowel disease: an analysis of the UK inflammatory bowel disease audit. Aliment Pharmacol Ther. 2020 Jul;52(1):153-162. doi: 10.1111/apt.15814. Epub 2020 Apr 26. PMID: 32338662.
* Larmonier N, Duveau N, Goutorbe F, et al. Risk of Serious Infections and Malignancies in Patients With Inflammatory Bowel Disease: A Review. Clin Rev Allergy Immunol. 2021 Oct;61(2):166-177. doi: 10.1007/s12016-021-08873-y. Epub 2021 May 15. PMID: 33994354.
* Zhang Y, Li Y, Guan L, et al. Increased risk of mortality in patients with inflammatory bowel disease: a systematic review and meta-analysis. Ann Palliat Med. 2017 Jan;6(1):50-60. doi: 10.21037/apm.2016.11.02. Epub 2016 Dec 9. PMID: 27855907.
Q.
Joint pain and diarrhea—what if it’s one condition causing both?
A.
Joint pain with diarrhea is often one condition, commonly inflammatory bowel disease, reactive arthritis after a gut infection, celiac disease, spondyloarthropathies, or medication effects. To choose the right next steps, see the details below on red flags and when to seek urgent care, the timelines that connect infections to joint flares, which tests confirm IBD or celiac, medication review, and practical self-care you can start today.
References:
Xavier RJ, & Podolsky DK. (2007). Unravelling the pathogenesis of inflammatory bowel… Nature, 17653185.
https://pubmed.ncbi.nlm.nih.gov/17653185/
Vavricka SR, Schoepfer A, Scharl M, Lakatos PL, Navarini A, & Rogler G. (2015). Extraintestinal manifestations of inflammatory bowel disease… Nat Rev Gastroenterol Hepatol, 26012609.
https://pubmed.ncbi.nlm.nih.gov/26012609/
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver… Hepatology, 11157951.
Q.
What are the first symptoms of IBD?
A.
Early symptoms of IBD often include diarrhea that lasts for weeks, abdominal cramping, blood or mucus in the stool, urgent or nighttime bowel movements, and fatigue, sometimes with unintended weight loss, low-grade fever, or joint pain. There are several factors to consider; red flags like bleeding, weight loss, or symptoms persisting more than 2 to 3 weeks should prompt a doctor visit, and important details that can guide your next steps are explained below.
References:
* Regueiro M. Clinical presentation of inflammatory bowel disease. Rev Gastroenterol Disord. 2009 Spring;9 Suppl 1:S2-8.
* Ma C, Moran GW, Benchimol EI, Kaplan GG, Mack D, Murthy SK, Wilson G, Lee SM, Dube C, Afif W, Bitton A, Lee J, Seow CH, Fedorak RN, Beck PL, Bernstein CN, Ghosh S, Lewin BC, Coward S, Huang VW, Kuenzig ME, Liu H, Panaccione R. Early inflammatory bowel disease: a systematic review. Therap Adv Gastroenterol. 2018 Oct 12;11:1756284818801524.
* Park J, Cho C, Ye BD, Jang HJ, Kim J, Yang S, Kwak MS, Kim Y, Kim JK, Kim K, Chung MJ, Kim KO, Cheon JH. Symptoms, Endoscopic Findings, and Diagnosis of Inflammatory Bowel Disease. J Clin Med. 2022 Jun 17;11(12):3493.
* Ungaro R, Colombel JF. Diagnostic approach to inflammatory bowel disease. Curr Opin Gastroenterol. 2016 Mar;32(2):107-12.
* Maloy KJ, Lehto M, Lo B. Current Overview of Inflammatory Bowel Disease. Gastroenterol Clin North Am. 2021 Sep;50(3):589-601.
Q.
What are the red flags for inflammatory bowel disease?
A.
There are several factors to consider. See below to understand more. Key red flags include persistent diarrhea (especially at night), blood or mucus in the stool, recurrent abdominal pain, unintended weight loss, ongoing fatigue, unexplained fevers, anemia or low iron, and symptoms outside the gut such as joint pain, eye pain, mouth ulcers, skin rashes, or poor growth in children; these are not typical of IBS and should prompt timely medical evaluation, with urgent care for bleeding, diarrhea lasting more than 2 to 3 weeks, severe or worsening pain, fever, dehydration, or symptoms disrupting sleep.
References:
* Rana, A., & Gupta, P. (2023). Red flags in the diagnosis of inflammatory bowel disease: a systematic review. Journal of clinical and diagnostic research: JCDR, 17(8), OE01.
* Onder, H., Ozdil, K., Gecici, O., & Baysoy, A. (2023). The diagnostic journey of patients with inflammatory bowel disease: a narrative review. World Journal of Clinical Cases, 11(20), 4700.
* Maharaj, A., Poudel, B., Hogenkamp, A., & Mulder, C. J. J. (2023). Primary care pathways for patients with suspected inflammatory bowel disease: a systematic review. Scandinavian Journal of Gastroenterology, 58(7), 740–749.
* Torres, J., & Colombel, J.-F. (2021). Update on diagnosis and management of inflammatory bowel disease. Gastroenterology & Hepatology, 17(1), 11–17.
* Gismera, E. B., de Castro, A. E. M., & da Costa, J. P. L. (2020). Predictive Value of Symptoms, Laboratory Markers, and Imaging in Inflammatory Bowel Disease. Gastroenterology Research and Practice, 2020, 8816790.
Q.
What are the two main triggers for IBD?
A.
The two main triggers are an abnormal immune system response often shaped by genetics, and environmental factors that disrupt the gut and immune balance. They usually act together to spark chronic inflammation, and there are several factors to consider; see below for key examples of environmental triggers, how genetics modifies risk, and when to seek care that could influence your next steps.
References:
* Liu JZ, Wang Y, Yao Y, Li Y, Lu S, Hou Y, Zhang Y, Wang Y. The Pathogenesis of Inflammatory Bowel Disease. Front Immunol. 2022 Jul 25;13:942461. doi: 10.3389/fimmu.2022.942461. eCollection 2022. PMID: 35950005.
* Soroosh A, Ma C, Ananthakrishnan AN. Environmental triggers in inflammatory bowel disease. Therap Adv Gastroenterol. 2020 Mar 27;13:1756284820912190. doi: 10.1177/1756284820912190. eCollection 2020. PMID: 32256428.
* Rivas MA, Esteller M, Ananthakrishnan AN. Genetics of Inflammatory Bowel Disease: A Century of Progress. Gastroenterology. 2020 Feb;158(3):771-782. doi: 10.1053/j.gastro.2019.11.050. PMID: 31837861.
* Im GY. Microbiome and Inflammatory Bowel Disease. J Clin Gastroenterol. 2020 Feb;54(2):119-125. doi: 10.1097/MCG.0000000000001275. PMID: 31568051.
* Kevans D, Bhardwaj A, Ananthakrishnan AN. Diet and Inflammatory Bowel Disease. Gastroenterol Clin North Am. 2021 Mar;50(1):1-14. doi: 10.1016/j.gtc.2020.10.001. Epub 2020 Dec 10. PMID: 33526136.
Q.
What are the warning signs of IBD?
A.
Key warning signs of IBD include persistent diarrhea that may wake you at night, ongoing abdominal pain or cramping, blood or mucus in the stool, and urgent or frequent bowel movements; whole body clues like fatigue that does not improve with rest, unintended weight loss, low grade fever, and joint, skin, eye, or mouth problems can also occur. There are several factors to consider. See below for important details on red flag symptoms that need urgent care, how IBD differs from IBS, special signs in children such as delayed growth, and when to contact a doctor to plan next steps.
References:
* Torres J, et al. Inflammatory bowel disease. Nat Rev Dis Primers. 2017 Aug 10;3:17056. doi: 10.1038/nrdp.2017.56. PMID: 28796244.
* Cohen A, et al. Diagnosis and management of inflammatory bowel disease in primary care. BMJ. 2021 May 10;373:n1081. doi: 10.1136/bmj.n1081. PMID: 33972237.
* Ungaro R, et al. Inflammatory Bowel Disease. Lancet. 2020 Jan 11;395(10217):105-120. doi: 10.1016/S0140-6736(19)31805-6. PMID: 31928991.
* Roda G, et al. Crohn's disease. Nat Rev Dis Primers. 2020 Sep 24;6(1):76. doi: 10.1038/s41572-020-00212-8. PMID: 32973165.
* Ananthakrishnan AN. Ulcerative Colitis. N Engl J Med. 2023 Aug 17;389(7):631-645. doi: 10.1056/NEJMcp2302422. PMID: 37581692.
Q.
What does IBD feel like?
A.
IBD often feels like ongoing abdominal pain or cramping, frequent urgent diarrhea that may include blood or mucus, and deep fatigue, sometimes with symptoms outside the gut like joint pain, skin changes, or eye irritation; symptoms typically flare and then ease for periods. There are several factors to consider. See below to learn how Crohn’s and ulcerative colitis can differ, which warning signs need urgent care, how IBD differs from IBS, and what evaluations and treatments can guide your next steps.
References:
* Stjepanović B, Dukić V, Lakić M, Ristanović P, Jović V, Davidović B. The patient experience of inflammatory bowel disease (IBD): A qualitative systematic review. Scand J Gastroenterol. 2022 Jul;57(7):794-802. doi: 10.1080/00365521.2022.2079069. Epub 2022 May 23. PMID: 35732958.
* Sun D, Liu B, Yang S, Yang X. Impact of inflammatory bowel disease on the quality of life of patients: a systematic review. J Int Med Res. 2021 May;49(5):3000605211011666. doi: 10.1177/03000605211011666. PMID: 33940828; PMCID: PMC8135314.
* Black M, Rattray B, Smith B. The Lived Experience of Adults With Inflammatory Bowel Disease: A Scoping Review. Gastroenterol Nurs. 2020 Sep/Oct;43(5):369-383. doi: 10.1097/SGA.0000000000000547. PMID: 32943261.
* Loo C, Tan C, Lim ZJ, Ong J, Teo R, Ng S, Chan J. Fatigue in inflammatory bowel disease: a systematic review and meta-analysis. Therap Adv Gastroenterol. 2021 Jun 17;14:17562848211019672. doi: 10.1177/17562848211019672. PMID: 34168058; PMCID: PMC8211995.
* Harth T, Agha A, Alikhadra N, Ezzat H, Nouri S, Joundy S, Moazzam Z, El-Sharif J, El-Gamal Z. The Experience of Living with Inflammatory Bowel Disease and Comorbid Mental Health Conditions: A Scoping Review. J Pers Med. 2023 Mar 30;13(4):593. doi: 10.3390/jpm13040593. PMID: 37021376; PMCID: PMC10140220.
Q.
What foods cause bowel inflammation?
A.
Common foods that can worsen bowel inflammation include ultra processed foods, added sugars and refined carbs, red and processed meats, high fat and fried foods, alcohol, certain artificial sweeteners, and for some people dairy or rough high fiber foods during flares. While diet does not cause IBD, these choices can disrupt the gut lining and microbiome and may aggravate inflammation and symptoms, with tolerance varying widely by person. There are several factors to consider, including differences between IBD and IBS, how flares change what you can tolerate, and when to seek medical care; see below to understand more and to find practical food swaps and next steps.
References:
* pubmed.ncbi.nlm.nih.gov/33795328/
* pubmed.ncbi.nlm.nih.gov/30456578/
* pubmed.ncbi.nlm.nih.gov/33500858/
* pubmed.ncbi.nlm.nih.gov/34206587/
* pubmed.ncbi.nlm.nih.gov/34976722/
Q.
What is a common cause of inflammatory bowel disease?
A.
A common cause is an abnormal immune response in the gut, shaped by genetics, the gut microbiome, and environmental triggers. There are several factors to consider, like family history, microbiome imbalance, smoking, diet patterns, certain medications, and issues with the intestinal barrier. See below for complete details and guidance that could affect your next steps in care.
References:
* Feagan BG, Sandborn WJ. Inflammatory Bowel Disease. JAMA. 2022 Feb 8;327(6):568-581. doi: 10.1001/jama.2022.0076. PMID: 35149363.
* Khalili H. The Role of Environmental Factors in Inflammatory Bowel Disease. Gut Microbes. 2020;11(6):1487-1497. doi: 10.1080/19490976.2020.1793132. Epub 2020 Aug 17. PMID: 32678665.
* Khor B, Png E, Ni Y, Lu Y, Wen X, Xu S. Genetics of Inflammatory Bowel Disease: Recent Advances and Future Directions. Gastroenterology. 2020 Aug;159(2):498-508. doi: 10.1053/j.gastro.2020.05.084. Epub 2020 Jun 4. PMID: 32778732.
* Franzosa EA, Sirota-Madi A, Costello JC, et al. Microbial Signatures and Functional Contributions of the IBD Microbiome. Cell Host Microbe. 2018 Nov 14;24(5):639-650.e4. doi: 10.1016/j.chom.2018.10.009. PMID: 30455431.
* Xavier RJ, Podolsky DK. Pathogenesis of inflammatory bowel diseases: from genetics to the gut microbiome. Physiol Rev. 2016 Oct;96(4):1237-1297. doi: 10.1152/physrev.00014.2016. PMID: 27958988.
Q.
What is the cause of inflammatory bowel disease?
A.
There is no single cause of inflammatory bowel disease; it results from a complex interaction of immune system dysregulation, genetic susceptibility, gut microbiome imbalance, and environmental factors like smoking, diet, antibiotic exposure, and urban living. There are several factors to consider. See below for important details on what does not cause IBD, how stress and infections fit in, how it differs from IBS, and when to seek medical care, which can influence your next steps.
References:
* pubmed.ncbi.nlm.nih.gov/38009848/
* pubmed.ncbi.nlm.nih.gov/32946777/
* pubmed.ncbi.nlm.nih.gov/31332219/
* pubmed.ncbi.nlm.nih.gov/32412852/
* pubmed.ncbi.nlm.nih.gov/33178772/
Q.
What is the major cause of inflammatory bowel disease found?
A.
There is no single, proven cause; IBD develops from an overactive, misdirected immune response in genetically susceptible people, shaped by gut microbiome imbalances and environmental triggers like smoking, certain dietary patterns, early-life antibiotics, and some medicines. There are several factors to consider. See below for key details that can influence next steps, including testing and early medical evaluation, lifestyle changes such as smoking cessation and diet, and what does not cause IBD so you can focus on what matters.
References:
* Du L, Zhang X, Zhou C. The etiology of inflammatory bowel disease: An update on the current evidence. J Clin Gastroenterol. 2022 Mar 1;56(3):205-212. doi: 10.1097/MCG.0000000000001633. PMID: 35149635.
* Torres J, Billmeier M, Westcott E, Lukin I, Leal R, Yzet C, Beaugerie L, Sokollik C, Rivas MA, D'Haens G, Allegretti JR. Inflammatory bowel disease: from mechanism to therapy. Nat Rev Gastroenterol Hepatol. 2021 Mar;18(3):180-196. doi: 10.1038/s41575-020-00382-0. Epub 2021 Jan 27. PMID: 33504899.
* Koutsoumpas A, Polytarchou CN, Gkikas A, Poutahidis T, Anifandis G, Kotsakis T, Tsiampalis S, Chousi A, Katerelos V, Kountouras J. Inflammatory Bowel Disease: An Overview of Pathophysiology and Future Therapeutics. J Clin Med. 2021 Jun 22;10(13):2730. doi: 10.3390/jcm10132730. PMID: 34185732; PMCID: PMC8268616.
* Kelsen JR, Baldassano RN. Inflammatory Bowel Disease Etiology: A Complex Interplay of Genetics, Environment, and the Microbiome. Gastroenterol Clin North Am. 2020 Jun;49(2):209-222. doi: 10.1016/j.gtc.2020.02.001. Epub 2020 Mar 27. PMID: 32308691.
* Franke A, McGovern DP, Barrett JC, Taylor KD, Wang K, Radford-Smith DW, Ahmad T, Lees CW, Gardet T, Rapley R, Brain O, Morse C, Bowcock AM, Gitschier J, Brant SR, Heath S, Sans M, Annese V, Hakonarson H, Waterman M, Mathew CG, Walters TD, Sanderson JD, Jostins L, Meyer A, Liu JZ, Griffiths AM, Murrells T, Daly MJ, Silverberg MS, Satsangi J, Mathew CG, Parkes M, Georges M, D'Amato M, Weersma RK, Rioux JD, Strachan D, Kaplan LM, Plummer M, Carbonnel F, Libioulle C, Lesage S, Prescott NJ, Zelenika D, Fraser G, Bornancin F, Nelson G, Ettinger C, Rotter JI, Bell JI, Schreiber S, Macpherson AJ, Blumberg RS, Cho JH, Duerr RH, Lee JC. Pathogenesis of inflammatory bowel disease: the clinical impact of genetic and epithelial barrier studies. Nat Rev Gastroenterol Hepatol. 2019 Jun;16(6):327-339. doi: 10.1038/s41575-019-0145-2. PMID: 30978250.
Q.
What is the root cause of inflammatory bowel disease?
A.
There is no single root cause of inflammatory bowel disease. It develops when genetic susceptibility meets environmental triggers that disrupt the gut microbiome and intestinal barrier, provoking an abnormal immune response and chronic intestinal inflammation. There are several factors to consider. For important details that could shape testing, treatment choices, and when to seek care, see below.
References:
* pubmed.ncbi.nlm.nih.gov/32014197/
* pubmed.ncbi.nlm.nih.gov/36360408/
* pubmed.ncbi.nlm.nih.gov/35923508/
* pubmed.ncbi.nlm.nih.gov/32386926/
* pubmed.ncbi.nlm.nih.gov/36139366/
Q.
What is the treatment for inflammation of the bowel?
A.
Treatment for bowel inflammation from IBD is individualized and centers on medications that reduce inflammation and maintain remission, including aminosalicylates, short-term steroids for flares, immunomodulators, biologic therapies, and small-molecule drugs, supported by nutrition and lifestyle measures. Surgery may be needed for complications or severe disease and can be curative in ulcerative colitis but not in Crohn’s, with long-term monitoring to prevent flares and complications; there are several factors to consider, so see the complete details below.
References:
* Ng SC, Shi HY, Hamidi H, et al. Novel Therapeutic Strategies for Inflammatory Bowel Disease. Int J Mol Sci. 2022 Nov 3;23(21):13488. doi: 10.3390/ijms232113488. PMID: 36362141.
* Chang JT. Treatment of Inflammatory Bowel Disease: A Review. Gastroenterol Clin North Am. 2023 Jun;52(2):299-317. doi: 10.1016/j.gtc.2023.01.004. PMID: 37119934.
* Peyrin-Biroulet L, et al. Advances in the Management of Inflammatory Bowel Disease: A Review. JAMA. 2022 Nov 15;328(19):1947-1959. doi: 10.1001/jama.2022.20370. PMID: 36378278.
* Singh S, et al. Current and Emerging Therapeutic Options for Inflammatory Bowel Disease. Clin Gastroenterol Hepatol. 2022 Jun;20(6):1199-1212.e1. doi: 10.1016/j.cgh.2021.08.016. PMID: 34419515.
* Ma C, et al. Treatment algorithms for inflammatory bowel disease. Gastroenterol Clin North Am. 2020 Dec;49(4):755-783. doi: 10.1016/j.gtc.2020.08.005. PMID: 33153606.
Q.
What is the treatment for inflammatory bowel disease?
A.
IBD is treated with medications that control inflammation and maintain remission, including aminosalicylates, short-term corticosteroids for flares, immunomodulators, biologic therapies, and newer small-molecule pills; some people also need surgery, which can be curative for ulcerative colitis but not for Crohn’s. Care is individualized and also includes nutrition, lifestyle support, and ongoing monitoring to prevent complications; there are several factors to consider, so see below for key differences by disease type and severity, medication risks, and when to contact a doctor.
References:
* Chugh, K., Mahajan, M., & Sachdev, M. (2023). Management of inflammatory bowel disease: current and emerging therapies. *World journal of clinical cases*, *11*(20), 4780.
* Ungaro, R. C., & D'Haens, G. R. (2023). Current Approaches to the Medical Management of Inflammatory Bowel Disease. *Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association*, *21*(3), 565–575.
* Ma, C., & Jairath, V. (2022). Medical Therapy for Inflammatory Bowel Disease. *Gastroenterology clinics of North America*, *51*(4), 723–740.
* Raine, T., et al. (2022). European Crohn's and Colitis Organisation (ECCO) Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment. *Journal of Crohn's and Colitis*, *16*(1), 2–38.
* Torres, J., et al. (2022). European Crohn's and Colitis Organisation (ECCO) Guidelines on Therapeutics in Crohn's Disease: Medical Treatment. *Journal of Crohn's and Colitis*, *16*(1), 39–61.
Q.
Where is IBD pain usually felt?
A.
IBD pain is usually felt in the lower abdomen: Crohn’s often causes pain on the lower right side near the terminal ileum, while ulcerative colitis more often causes lower left and rectal pain; some people also feel central pain or discomfort around the belly button that can spread. There are several factors to consider, including pain outside the abdomen such as in the joints or lower back and symptoms that may need urgent care. See below for important details that can affect which next steps you take in your healthcare journey.
References:
* Coffin B, Dapoigny M, Drossman D, et al. State-of-the-Art Review: Functional Abdominal Pain and Functional Dyspepsia in Inflammatory Bowel Disease. J Crohns Colitis. 2021 May 29;15(5):857-868. doi: 10.1093/ecco-jcc/jjaa235. PMID: 33499426.
* Rieder F, Cooney R, Larussa T, et al. Abdominal pain in inflammatory bowel disease: a review of mechanisms and clinical management. Therap Adv Gastroenterol. 2017 Jan;10(1):15-26. doi: 10.1177/1756283X16676345. PMID: 28042303.
* Keszthelyi D, Troost JJ, Jonkers DM, et al. Phenotypes of pain in inflammatory bowel disease: a prospective study on prevalence, characterisation and impact. J Crohns Colitis. 2014 Mar;8(3):195-202. doi: 10.1016/j.crohns.2013.08.016. PMID: 24045543.
* Palsson OS, Levy RL, von Scheven E, et al. Pain Mapping in Functional Gastrointestinal Disorders and Inflammatory Bowel Disease: A Review and New Approaches. Clin Gastroenterol Hepatol. 2017 Aug;15(8):1160-1175.e1. doi: 10.1016/j.cgh.2016.12.029. PMID: 28069675.
* Wessolowski K, Gralnek IM, Fudim M, et al. Pain perception in inflammatory bowel disease: insights from patients. Inflamm Bowel Dis. 2012 Sep;18(9):1644-51. doi: 10.1002/ibd.21959. PMID: 22170845.
Q.
Abdominal cramps and diarrhea: what combinations suggest colitis vs infection?
A.
There are several factors to consider. Colitis is more likely when cramps and diarrhea are chronic or recurrent, include blood or mucus, urgency or nighttime stools, weight loss or joint/skin/eye symptoms, and show elevated fecal calprotectin or lactoferrin. An infection is more likely with sudden onset watery diarrhea, prominent fever, nausea or vomiting after a clear exposure, and improvement within days. See below for key exceptions like C. difficile, red flags that need urgent care, and the tests and treatments that can guide your next steps.
References:
Tibble JA, & Sigthorsson G. (2001). Elevated fecal lactoferrin distinguishes inflammatory bowel… Am J Gastroenterol, 10097444.
D'Amico G, & Garcia-Tsao G. (2006). Natural history and prognostic indicators of survival in cirrhosis: a syste… Aliment Pharmacol Ther, 16326040.
Friedrich-Rust M, & Ong MF. (2008). Performance of transient elastography for the staging of liver f… Gut, 18278738.
Q.
Blood when wiping: hemorrhoids, fissure, or something more serious—how can you tell?
A.
There are several factors to consider. Most bright red blood on the toilet paper is from hemorrhoids or an anal fissure, with fissures causing sharp pain during and after a bowel movement while hemorrhoids are often itchy or painless. Less common but more serious causes include colorectal polyps or cancer, inflammatory bowel disease, diverticular bleeding, and infections; warning signs are heavy or ongoing bleeding, black or tarry stools, new bowel habit changes, weight loss, fever, or severe pain. See the complete guidance below for specific clues, home treatments, and when to seek urgent care so you can choose the right next step.
References:
Riss S, Weiser FA, Schwameis K, & et al. (2012). Hemorrhoids: from basic pathophysiology to clinical… Int J Colorectal Dis, 22088811.
Nelson RL, Thomas K, Morgan J, & Jones A. (2007). Lateral internal sphincterotomy versus topical… Dis Colon Rectum, 17315069.
Castera L, Forns X, & Alberti A. (2008). Non-invasive evaluation of liver fibrosis using transient… Journal of Hepatology, 18374891.
Q.
Blood when wiping… is it “nothing,” or is it a warning sign?
A.
A small smear of bright red blood on toilet paper is often from minor causes like hemorrhoids, anal fissures, or irritation and usually improves with fiber, fluids, gentle cleaning, and sitz baths. There are several factors to consider. See below for important details on causes, self care, tests your doctor may recommend, and red flags like heavier or persistent bleeding, blood mixed with stool, dizziness or fainting, abdominal pain, weight loss, bowel habit changes, a family history of colorectal cancer, or any bleeding if you have cirrhosis.
References:
Johanson JF, & Sonnenberg A. (1990). The prevalence of hemorrhoids and chronic constipation… Dis Colon Rectum, 2169220.
Garcia-Tsao G, Sanyal AJ, Grace ND, & Carey W; Practice Parameters Committee of the AASLD. (2017). Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the Study of Liver Diseases… Hepatology, 26850442.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis… Journal of Hepatology, 30044859.
Q.
Bloody diarrhea: what conditions cause it, and what tests usually come next?
A.
Bloody diarrhea most often results from infections such as Salmonella, Shigella, Campylobacter, toxigenic E. coli, C. difficile, or parasites like Entamoeba, but inflammatory bowel disease, ischemic colitis, medication or radiation injury, and colon polyps or cancer are also important, with hemorrhoids, fissures, and portal hypertensive colopathy less common. There are several factors to consider; see below to understand more. Typical next tests include stool studies for bacteria, Shiga toxin, C. difficile, and parasites, inflammatory stool markers, blood work for anemia and inflammation, and when needed imaging and endoscopy such as CT, flexible sigmoidoscopy, or colonoscopy with biopsy, with red flags and timing guidance detailed below.
References:
Thielman NM, & Guerrant RL. (2004). Acute infectious diarrhea. N Engl J Med, 14702435.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. Lancet, 23801633.
Castera L, Forns X, & Alberti A. (2005). Prospective comparison of transient elastography, FibroTest, APRI,… Journal of Hepatology, 16150165.
Q.
Can’t stop pooping—what if your gut is stuck in overdrive for a reason?
A.
There are several factors to consider: infections, food intolerances, medications, and chronic conditions like IBS, celiac disease, IBD, or bile acid diarrhea can all push the gut into overdrive; see below for what counts as diarrhea, quick at home relief, and the tests and treatments that match the cause. Seek care promptly for dehydration, blood in stool, high fever, severe abdominal pain, or symptoms lasting beyond two weeks, and review the important details below that could change your next steps.
References:
Foxx-Orenstein AE, & McFarland LV. (2010). Approach to the adult patient with acute diarrhea: a clinical… Mayo Clin Proc, 20588852.
Camilleri M. (2015). Bile acid diarrhea: pathophysiology, diagnosis and… Clinical Gastroenterology and Hepatology, 25917767.
European Association for the Study of the Liver. (2014). EASL clinical practice guidelines for the management of… Journal of Hepatology, 24986678.
Q.
Cramping before pooping—why does relief after going not always mean IBS?
A.
There are several factors to consider, because cramping that eases after a bowel movement is common in IBS yet not specific, and can also stem from constipation, infections, inflammatory bowel disease, partial obstruction, motility problems, or extraintestinal issues like gallbladder, kidney, or gynecologic conditions. Watch for red flags such as weight loss, bleeding, fever, anemia, severe or persistent pain, onset after 50, or a family history, and know that proper diagnosis may require symptom tracking, labs, stool tests, imaging and endoscopy with tailored treatment, so for key details that can guide your next steps see the complete explanation below.
References:
Lacy BE, Mearin F, Chang L, Chey WD, Lembo AJ, Parkman HP, Rao SSC, Schiller LR, Whitehead WE, Spiller R, et al. (2016). Bowel disorders. Gastroenterology, 27828977.
Bharucha AE, & Wald A. (2012). Chronic constipation. Lancet, 23008882.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.
Q.
Cramping before pooping: what does that timing suggest about inflammation vs spasm?
A.
Cramps that peak right before a bowel movement and ease quickly afterward most often indicate an intestinal spasm; pain that begins well before you need to go and does not fully improve after can point to inflammation. There are several factors to consider, and important red flags, triggers, self-care options, and when to seek medical care are outlined below.
References:
Chey WD, Kurlander J, & Eswaran S. (2015). Irritable bowel syndrome: a clinical review. JAMA, 26571436.
Feuerstein JD, & Cheifetz AS. (2017). Crohn disease: epidemiology, pathogenesis, diagnosis,… Mayo Clin Proc, 28745691.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver… Hepatology, 11157951.
Q.
Diarrhea after eating: what causes a fast “gastrocolic” response vs a bigger issue?
A.
Diarrhea right after eating is often a normal gastrocolic reflex, especially if mild and linked to triggers like high fat or spicy foods, caffeine, artificial sweeteners, stress, or an exaggerated response in IBS-D. There are several factors to consider: persistent or severe diarrhea, or red flags like weight loss, blood, fever, severe pain, dehydration, or symptoms lasting more than 48 hours can indicate malabsorption, IBD, microscopic colitis, bile acid problems, infections, thyroid or liver disease, or medication effects; see below for important details on when to seek care and what tests and steps may help.
References:
Rao SS, Ozturk R, Conklin JL, & Stumbo PR. (2000). Colonic motor responses to a meal: comparison of IBS subgroups. Am J Gastroenterol, 10759387.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.
Friedrich-Rust M, Ong MF, Herrmann E, Dries V, Samaras P, Bojunga J, & Zeuzem S. (2008). Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology, 18158853.
Q.
Diarrhea for 2 weeks: what are the most likely explanations, medically?
A.
There are several factors to consider: diarrhea lasting 2 weeks is persistent and is most often due to lingering infection like Giardia or C. difficile or post-infectious changes, but also IBS-D, inflammatory bowel disease, malabsorption such as celiac or lactose intolerance, medication effects, bile acid diarrhea, thyroid disease, and microscopic colitis. See below for how clinicians sort this out with targeted stool and blood tests, which at-home steps may help, and the red flags like fever, blood in stool, weight loss, or dehydration that mean you should seek care promptly.
References:
Foxx-Orenstein AE, & McFarland LV. (2010). Approach to the adult patient with acute diarrhea: a clinical … Mayo Clin Proc, 20588852.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver … Hepatology, 11157951.
Biggins SW, & Kim WR. (2009). Hyponatremia and mortality among patients on the liver-transplant … N Engl J Med, 18094300.
Q.
Diarrhea with blood: what diagnoses are most commonly considered?
A.
The most commonly considered causes include infectious colitis (such as Campylobacter, Salmonella, Shigella, toxigenic E. coli, C. difficile, or Entamoeba), inflammatory bowel disease (ulcerative colitis or Crohn's), ischemic colitis, and medication or radiation related colitis, with less common but important possibilities like colorectal cancer, vascular malformations, and anorectal sources. There are several factors to consider. See below for key red flags, which exposures and medications matter, and how doctors test and treat these conditions so you can choose the right next steps and know when urgent care is needed.
References:
Foxx-Orenstein AE, & McFarland LV. (2010). Approach to the adult patient with acute diarrhea: a clinical review. Mayo Clin Proc, 20588852.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.
European Association for the Study of the Liver. (2014). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. Journal of Hepatology, 24986678.
Q.
Do I have Crohn’s—or am I about to keep dismissing a real problem?
A.
There are several factors to consider: Crohn’s often causes ongoing abdominal pain, urgent diarrhea, weight loss, fatigue, fevers, mouth sores, or perianal issues; below you’ll find how to recognize patterns, what serious warning signs look like, and exactly how doctors test for Crohn’s. If symptoms persist over 4 weeks or include bleeding, significant weight loss, high fevers, severe pain, dehydration, or joint, skin, or eye inflammation, seek care promptly, since only proper testing with stool, blood, scopes, and imaging can confirm Crohn’s and early treatment prevents complications; see below for a free symptom check, self-care tips, and when to go to the ER.
References:
Torres J, Mehandru S, Colombel JF, & Peyrin-Biroulet L. (2017). Crohn's disease. Lancet, 27823305.
van Rheenen PF, van de Vijver E, & Fidler V. (2010). Faecal calprotectin for screening of patients… BMJ, 20584729.
Durand F, & Valla D. (2005). Assessment of prognosis of cirrhosis: Child-Pugh versus MELD. Journal of Hepatology, 15965204.
Q.
Do I have ulcerative colitis: what symptoms make it more likely?
A.
Ulcerative colitis is more likely if you have blood in your stool, persistent diarrhea with urgency or a feeling of incomplete evacuation, crampy lower left abdominal pain that eases after a bowel movement, mucus in stool, and unintended weight loss or fatigue; joint pain, red painful eyes, or tender skin bumps together with bowel symptoms raise suspicion further. There are several factors to consider. See below for key risk factors like family history and age peaks, conditions that can mimic it, red flags that need urgent care, and the tests doctors use to confirm the diagnosis, plus a free online symptom check to guide next steps.
References:
Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, & Long MD. (2019). ACG clinical guideline: ulcerative colitis in adults. Am J Gastroenterol, 30851653.
D'Amico G, Garcia‐Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol, 16545904.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. Lancet, 24280712.
Q.
Fecal calprotectin test: what does it measure, and when is it useful?
A.
The fecal calprotectin test measures calprotectin, a neutrophil protein, in stool to estimate inflammation in the gastrointestinal tract. It is most useful to differentiate inflammatory bowel disease from irritable bowel syndrome, to triage chronic GI symptoms, and to monitor known IBD and guide the need for colonoscopy. There are several factors to consider, including result cutoffs, when to repeat testing, and potential false positives from infections or NSAIDs; see the complete answer below for details and next steps.
References:
van Rheenen PF, van de Vijver E, Fidler V. (2010). Faecal calprotectin for screening of patients with suspected… BMJ, 20435778.
Kamath PS, Wiesner RH, et al. (2001). A model to predict survival in patients with end-stage liver… Hepatology, 11157951.
Castera L, Forns X, Alberti A. (2008). Non-invasive evaluation of liver fibrosis using transient e… Journal of Hepatology, 17920618.
Q.
Frequent bowel movements—what if your “normal” isn’t normal?
A.
A noticeable increase from your usual bathroom pattern especially more than three times a day with loose, urgent stools that lasts over four weeks can indicate chronic diarrhea, with causes that range from diet and infections to IBS, IBD, malabsorption, medications, thyroid problems, and bile acid issues. There are several factors to consider. Red flags like blood or black stools, weight loss, fever, severe abdominal pain, dehydration, or symptoms after antibiotics warrant prompt care, and the complete answer below explains which tests, treatments, and special considerations like liver disease can guide your next steps.
References:
Brandt LJ, & Boley SJ. (1991). Chronic diarrhea in adults: evaluation and… JAMA, 265(17):2071–2077, 2026269.
Garcia-Tsao G, & Cardenas A. (2007). Prevention and management of gastroesophageal varices and… Hepatology, 46(3):922–938, 17668603.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines on the management of decompensated… Journal of Hepatology, 69(2):406–460, 29156289.
Q.
How do i know if i have ibs?
A.
IBS is suspected when you have recurrent abdominal pain for at least 3 months that is related to bowel movements or accompanied by changes in stool frequency or form. There are several factors to consider, and red flags like bleeding, unexplained weight loss, fever, anemia, or symptom onset after age 50 mean you should seek prompt medical evaluation. Diagnosis relies mainly on symptom patterns with limited testing, and many people improve with diet changes, stress management, and exercise; see below for the Rome IV criteria, IBS subtypes, what to track, when to see a doctor, and the next steps to confirm your diagnosis.
References:
Lacy BE, Mearin F, Chang L, Chey WD, Lembo AJ, Simrén M, & Spiller RC. (2016). Bowel disorders. Gastroenterology, 27144628.
Chey WD, Kurlander J, & Eswaran S. (2015). Irritable bowel syndrome: a clinical review. JAMA, 25784745.
Ford AC, Lacy BE, & Talley NJ. (2017). Irritable bowel syndrome: epidemiology, pathophysiology, diagnosis and… Nat Rev Gastroenterol Hepatol, 28535759.
Q.
How long does stomach flu last?
A.
Most stomach flu cases last 1 to 3 days, though some viruses can cause symptoms for up to a week or a little longer. There are several factors that affect duration, plus warning signs that need prompt care and steps to speed recovery and prevent spread; see below for details by virus, how long you may be contagious, and what to do next.
References:
Atmar RL, & Estes MK. (2006). The epidemiologic and clinical importance of norovirus infec… Clin Microbiol Rev, 17167172.
Patel MM, Hall AJ, Vinjé J, & Parashar UD. (2009). Noroviruses: a comprehensive review. J Clin Virol, 19349403.
Parashar UD, Gibson CJ, Bresee JS, & Glass RI. (2006). Rotavirus and severe childhood diarrhea. Emerg Infect Dis, 16707046.
Q.
How to cure ibs permanently?
A.
There is no single permanent cure, but many people achieve long-lasting control with a personalized plan that may include a low-FODMAP diet, targeted treatments like rifaximin for IBS-D, select medications or supplements, CBT, and lifestyle changes. There are several factors to consider, including your specific triggers, symptom pattern, and when to seek care for red flags; see below for the complete, step-by-step options and how to choose your next steps.
References:
Halmos EP, Power VA, Shepherd SJ, Gibson PR, & Muir JG. (2014). A diet low in FODMAPs reduces symptoms of irritable… Gastroenterology, 24247041.
Lackner JM, Jaccard J, Roberts MC, Katz LA, & Gudleski GD. (2018). Durability and predictors of response to cognitive… Clin Gastroenterol Hepatol, 29671131.
Pimentel M, Lembo A, Chey WD, & al. (2011). Rifaximin therapy for irritable bowel syndrome without constipation. N Engl J Med, 21518986.
Q.
IBS or IBD—what’s the one symptom that should make you stop guessing?
A.
Rectal bleeding is the one symptom that should make you stop guessing and see a doctor. There are several factors to consider, including other red flags like weight loss, fever, anemia, and nighttime symptoms, plus guidance on stool, blood, and endoscopic tests such as fecal calprotectin and colonoscopy; see below for details that can affect your next steps.
References:
van Rheenen PF, Van de Vijver E, & Fidler V. (2010). Faecal calprotectin for screening of patients with suspected inflammatory… Alimentary Pharmacology & Therapeutics, 20186293.
Kamath PS, Wiesner RH, Malinchoc M, et al. (2001). A model to predict survival in patients with end-stage liver… Hepatology, 11157951.
Castera L, Foucher J, Bernard PH, et al. (2005). Prospective comparison of transient elastography, FibroTest, APRI, and… Gastroenterology, 16277227.
Q.
IBS or IBD: what symptoms help tell them apart before testing?
A.
There are several factors to consider; see below to understand more, including red flags and next steps. IBS more often causes crampy pain that improves after a bowel movement with bowel habit changes linked to meals or stress, and typically lacks blood in the stool, weight loss, fever, or nighttime symptoms. IBD is more likely with blood or mucus in stool, nocturnal diarrhea, unintended weight loss, persistent pain not relieved by defecation, fever, fatigue, urgency, or family history, which should prompt timely medical evaluation.
References:
Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, & Spiller RC. (2006). Functional bowel disorders… Gastroenterology, 16473155.
Baumgart DC, & Sandborn WJ. (2012). Inflammatory bowel disease: clinical aspects and pathogenesis… Lancet, 22649240.
Garcia-Tsao G, Abraldes JG, Berzigotti A, & Bosch J. (2017). Portal hypertension and variceal bleeding in cirrho… Journal of Hepatology, 27899332.
Q.
Left lower abdominal pain and diarrhea—could this point to the colon specifically?
A.
Left lower abdominal pain with diarrhea often points to the colon, commonly from IBS-D, diverticulitis, infectious colitis, or inflammatory bowel disease, and less often ischemic colitis or neoplasia; seek prompt care for fever, blood in stool, severe or persistent pain, dehydration, or weight loss. There are several factors to consider, including non-colon causes and what evaluations and treatments are appropriate. See below for specifics on red flags, when to seek care, how doctors diagnose it, and safe at-home steps that could shape your next move.
References:
Chey WD, Kurlander J, & Eswaran S. (2015). Irritable bowel syndrome: a clinical review… JAMA, 25668264.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease… Hepatology, 11157951.
de Franchis R, & Dell'Era A. (2007). Non-invasive diagnosis of cirrhosis and the natural history… Best Pract Res Clin Gastroenterology, 17223493.
Q.
Left lower abdominal pain and diarrhea: what conditions commonly cause this pairing?
A.
Left lower abdominal pain with diarrhea most often comes from diverticulitis, ulcerative colitis, infectious colitis, irritable bowel syndrome, ischemic colitis, medication effects, or gynecologic causes in women. There are several factors to consider, including red flags like fever, severe or sudden pain, or bloody stools, as well as how doctors evaluate and what you can safely try at home; see the complete guidance below to understand the key details that can shape your next steps.
References:
Stollman N, & Raskin JB. (1999). Diverticular disease of the colon. Lancet, 10482208.
Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, & Colombel JF. (2017). Ulcerative colitis. Lancet, 28038487.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage… Hepatology, 11157951.
Q.
Losing weight with diarrhea—why do doctors take this so seriously?
A.
Persistent diarrhea with unintended weight loss is a red flag because it can quickly cause dehydration and dangerous electrolyte shifts, malnutrition and muscle loss, and may point to infections, inflammatory bowel disease, celiac disease, pancreatic or thyroid problems, or even cancer. Doctors take this seriously and often recommend prompt evaluation with labs, stool studies, imaging or endoscopy, and urgent care for high fever, severe pain, blood in stool, marked dehydration, or rapidly worsening weight loss. There are several factors to consider; see details and next steps below.
References:
Brandt LJ, Chey WD, Foxx-Orenstein AE, Locke GR, Schoenfeld PS, Spiegel BM, Talley NJ. (2006). AGA technical review on the evaluation and management of… Am J Gastroenterol, 16522769.
Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, Lok AS. (2003). A simple noninvasive index can predict both significant… Hepatology, 12939624.
Montano-Loza AJ, Meza-Junco J, Prado CM, et al. (2014). Severe muscle depletion is associated with mortality in patients with cirrhosis… Clin Gastroenterol Hepatol, 24115506.
Q.
Mouth ulcers and diarrhea: what conditions link symptoms in the mouth and gut?
A.
Mouth ulcers with diarrhea can point to systemic conditions affecting both mouth and gut, most commonly celiac disease, inflammatory bowel disease (Crohn’s or ulcerative colitis), Behçet’s disease, and also nutrient deficiencies, infections, or medication side effects. Because red flags like ulcers lasting longer than three weeks, diarrhea beyond two weeks, blood in stool, weight loss, fever, severe abdominal pain, or signs of dehydration may require prompt medical care, there are several factors to consider. See below for key clues, when to test, and treatment options that could influence your next steps.
References:
Sakane T, Takeno M, Suzuki N, & Inaba G. (1999). Behçet's disease… N Engl J Med, 10430863.
Balato A, Lembo S, Patruno C, Fabbrocini G, & Balato N. (2012). Oral manifestations of celiac disease: an overview… J Clin Exp Dent, 22624034.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis… Hepatology, 16486565.
Q.
Pain when pooping—what if the pain is coming from inflammation, not “strain”?
A.
Pain with bowel movements can come from inflammation, not just strain. There are several factors to consider; see below to understand more. Common causes include anal fissures, hemorrhoids, proctitis, IBD, infections, and perianal abscess or fistula, and warning signs like pain lasting more than a few days, bright red bleeding, discharge, fever, or severe tearing pain should prompt medical care, with diagnosis steps, effective treatments, self-care tips, and urgent action points outlined below.
References:
Nelson R, Thomas KS, Morgan J, & Jones AP. (2012). Non-surgical interventions for anal fissure. Cochrane Database of Systematic Reviews, 23271844.
Castera L. (2010). Non-invasive assessment of liver fibrosis by transient elastogr… Journal of Hepatology, 19766013.
European Association for the Study of the Liver & Asociacion Latinoamericana para el Estudio del Higado. (2015). EASL-ALEH clinical practice guidelines: non-invasive tests for evaluat… Journal of Hepatology, 25763715.
Q.
Rectal bleeding—what if it’s not what you think it is?
A.
Rectal bleeding is not always hemorrhoids; other causes include anal fissures, diverticulosis, inflammatory bowel disease, colorectal polyps or cancer, and even upper gastrointestinal bleeding or varices in people with liver disease. There are several factors to consider, like the color and amount of blood and warning signs such as heavy bleeding, black or maroon stools, clots, dizziness, or severe pain that require urgent care; for guidance on home care, when to go to the ER, and which tests and treatments to expect, see below.
References:
Oakland K, & Jairath V. (2018). Acute lower gastrointestinal bleeding: definition, pathophysiology… Digestion, 29195919.
Gines P, Quintero E, & Arroyo V. (1987). Compensated cirrhosis: natural history and prognostic… N Engl J Med, 3574254.
Kim WR, Biggins SW, & Kremers WK. (2008). Hyponatremia and mortality among patients on the liver-transplant… N Engl J Med, 18305120.
Q.
Right lower abdominal pain and diarrhea—why do clinicians zoom in on this combo?
A.
Clinicians focus on this symptom pair because it often points to intestinal involvement in the right lower quadrant, raising concern for appendicitis, infectious enterocolitis, or Crohn’s disease, where early diagnosis can be the difference between simple medical therapy and urgent surgery. There are several factors to consider, including red flags, recommended tests, and when to seek urgent care; see below for complete details that could change your next steps.
References:
Foxx-Orenstein AE, & McFarland LV. (2010). Approach to the adult patient with acute diarrhea: a clinical… Mayo Clin Proc, 20588852.
Addiss DG, Shaffer N, Fowler BS, & Tauxe RV. (1990). The epidemiology of appendicitis and appendectomy in… Am J Epidemiol, 2116803.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in… Journal of Hepatology, 16469331.
Q.
UC vs IBS—why do so many people get this wrong at first?
A.
Many people confuse ulcerative colitis and IBS because their symptoms overlap, start at similar ages, and come and go; however, UC is an inflammatory disease with red flags like bloody stools and high fecal calprotectin, while IBS is a functional disorder with normal tests. There are several factors to consider to get the right diagnosis and next steps, including stool testing and colonoscopy and knowing when to seek care; see the complete details below, which could change what you do next.
References:
van Rheenen PF, Van de Vijver E, & Fidler V. (2010). Faecal calprotectin for screening patients with suspected inflam… BMJ, 20561961.
Ford AC, Lacy BE, & Talley NJ. (2017). Irritable bowel syndrome. N Engl J Med, 28488127.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosi… Journal of Hepatology, 16222708.
Q.
Ulcerative colitis vs IBS: what differences matter clinically?
A.
Ulcerative colitis is a true inflammatory bowel disease that causes bloody diarrhea, weight loss, systemic symptoms and elevated inflammatory markers, confirmed by colonoscopy and treated with anti-inflammatory or immunosuppressive medicines, while IBS is a functional condition with non-bloody stool changes, pain often eased by bowel movements, normal tests, and diet and symptom-targeted therapy. There are several factors to consider, including red flag features that need prompt medical evaluation and different long-term risks such as colorectal cancer surveillance in UC but not IBS; see below for the key symptoms, diagnostic tests, treatment options, and next steps.
References:
Dignass A, et al. (2012). Second European evidence-based consensus on the diagnosis and manage… J Crohns Colitis, 23257912.
Ford AC, Lacy BE, Talley NJ. (2017). Irritable bowel syndrome. Lancet, 28625765.
Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. (2019). Liver cirrhosis. N Engl J Med, 30602134.
Q.
Urgent diarrhea—why can’t you “hold it” like other people can?
A.
Urgent diarrhea occurs when the gut moves contents too fast, pulls extra water into the stool, and the inflamed rectum becomes hypersensitive, creating a sudden, intense urge that overpowers normal sphincter control. There are several factors to consider; see below for key causes, at home steps like hydration and appropriate OTC meds, and the red flags that mean you should seek care now, especially with severe pain, fever, blood, symptoms beyond 48 hours, or if you have chronic illness or lower immunity.
References:
DuPont HL, & Ericsson CD. (2001). Acute infectious diarrhea in immunocompetent adults. Clin Infect Dis, 11320017.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver diseas… Hepatology, 11157951.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic… Journal of Hepatology, 16879888.
Q.
Weight loss and diarrhea: what tests help rule out inflammatory bowel disease?
A.
Key tests include stool calprotectin or lactoferrin to detect intestinal inflammation and stool cultures including C. difficile, blood work such as CBC, CRP, and ESR, and, if inflammation is suspected or symptoms persist, colonoscopy with biopsy as the gold standard, with MR or CT enterography to assess small bowel involvement; a normal fecal calprotectin makes IBD very unlikely. There are several factors to consider. See below for important details on alternative causes to rule out like celiac and thyroid disease, when imaging or capsule endoscopy is useful, and red flag symptoms that should prompt urgent care.
References:
van Rheenen PF, Van de Vijver E, & Fidler V. (2010). Faecal calprotectin for screening of suspected inflammatory bowel… BMJ, 20507946.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis… J Hepatol, 16324664.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver stiffness measurement for diagnosis of cirrhosis and portal… J Hepatol, 24560088.
Q.
Abdominal cramps and diarrhea—what if this isn’t a “bug” anymore?
A.
If cramps and diarrhea last more than 2 to 4 weeks or keep coming back, it is often more than a simple bug, with causes like IBS-D, inflammatory bowel disease, celiac disease, SIBO, bile acid diarrhea, pancreatic insufficiency, and liver-related problems. There are several factors to consider; see below for urgent red flags, the step-by-step tests doctors use, and proven treatments and self-care tips that can guide your next move.
References:
Bauer TM, Steinbrückner B, Brinkmann FE, Weiss P, Ditzen AK, Gerken G. (2001). Small intestinal bacterial overgrowth in cirrhotic patients: relationships with complications… Am J Gastroenterol, 11104999.
Ponziani FR, Zocco MA, Campanale C, Pompili M, De Leo D, Miele L, Tortora A, Gasbarrini A. (2014). Gut-liver axis, gut microbiota and endotoxemia in liver cirrhosis: updated concepts and therapeutic… World J Gastroenterol, 25473147.
Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, Christidis C, Ziol M, Poulet B, Kazemi F, Beaugrand M. (2003). Transient elastography: a new noninvasive method for assessment… Ultrasound Med Biol, 15042597.
Q.
Blood in stool—what’s the one detail that changes everything?
A.
The one detail that changes everything is your hemodynamic stability (stable vs unstable); instability with dizziness, fainting, low blood pressure, fast heart rate, or large-volume bright red or maroon blood requires urgent care, while stable cases can often proceed with prompt outpatient evaluation such as colonoscopy. There are several factors to consider. See below to understand red flags, common causes, special considerations in cirrhosis, and what tests and treatments to expect so you can choose the right next step.
References:
Strate LL, & Gralnek IM. (2016). ACG clinical guideline: management of patients with acute lower g… American Journal of Gastroenterology, 27628343.
European Association for the Study of the Liver, & Latin American Association for the Study of the Liver. (2015). EASL-ALEH clinical practice guidelines: non-invasive tests for ev… Journal of Hepatology, 26073424.
D'Amico G, & Garcia-Tsao G. (2006). Natural history and prognostic indicators of survival in cirrh… Journal of Hepatology, 11281014.
Q.
Blood in stool: what are the most common causes doctors rule out first?
A.
Doctors typically first rule out hemorrhoids and anal fissures for bright red bleeding, then consider diverticular bleeding, colitis infectious or inflammatory, colorectal polyps or cancer more likely after age 45 or with alarm features, medication related bleeding, and upper GI sources when stools are black. There are several factors to consider; see below for the stepwise evaluation, key symptoms that change urgency, which tests to expect, and how these details may guide your next steps.
References:
Oakland K, Jairath V, Stokes M, et al. (2019). Diagnosis and management of acute lower gastrointestinal bleedi… Gut, 30655232.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver dis… Hepatology, 11157951.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 st… Journal of Hepatology, 16156830.
Q.
Bowel urgency: what’s the difference between urgency and frequent bowel movements?
A.
Bowel urgency is a sudden, hard to delay need to pass stool with worry about not reaching a toilet, often seen in IBS, IBD, or infections, while frequent bowel movements means going more than usual, typically over three times a day, usually with better control and often due to diet changes, intolerances, or medications. There are several factors to consider. See below to understand more, including red flags like blood or weight loss and how tailored treatments differ by cause, which could affect your next steps and when to seek care.
References:
Drossman DA. (2016). Functional gastrointestinal disorders: history, pathophysiology, clini… Gastroenterology, 27845111.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. Lancet, 24703851.
Q.
Bright red blood in stool—why do some people ignore it for years?
A.
There are several factors to consider: people often ignore bright red blood in stool by assuming hemorrhoids, feeling embarrassed, normalizing intermittent bleeding, fearing a serious diagnosis, or facing cost and access barriers. Any red blood merits evaluation because causes range from fissures and hemorrhoids to polyps, cancer, IBD, infections, diverticular disease, and angiodysplasia; seek care urgently with heavy bleeding, dizziness, abdominal pain, fever, weight loss, fatigue, or week-long bowel changes. See below for the full list of causes, red flags, and what tests and treatments can help prevent complications and catch cancer early.
References:
Strate LL, & Gralnek IM. (2016). ACG clinical guideline: management of patients with acute lower… American Journal of Gastroenterology, 27165902.
Sterling RK, & Lissen E. (2006). Development of a simple noninvasive index to predict significant… Hepatology, 16447276.
Tsochatzis EA, & Bosch J. (2014). Liver cirrhosis. Lancet, 24613317.
Q.
Crohn’s disease symptoms—what are the sneaky early signs?
A.
Sneaky early signs of Crohn’s disease include intermittent loose stools or cramping, urgency or tenesmus, subtle rectal bleeding, unexplained fatigue with low-grade fever or night sweats, appetite loss and mild weight loss, mouth or anal sores, and extraintestinal symptoms like joint pain, skin rashes, or eye irritation. There are several factors to consider. See below for the complete list of symptoms, risk factors, red flags, and the next steps that can impact your care, including how to track symptoms, which labs to request, when to contact a gastroenterologist, and when to seek urgent care.
References:
van Langenberg DR, Williams CJ, Holtmann GJ, McDonald JW, & Andrews JM. (2019). Early Clinical Predictors of a Complicated Disease Course in Patients… Clin Gastroenterol Hepatol, 31521197.
Ripoll C, Groszmann RJ, Garcia-Tsao G, Bosch J, Grace ND, & Burroughs AK. (2007). Hepatic venous pressure gradient predicts development of gastroesophageal… Gastroenterology, 17101348.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a syst… Journal of Hepatology, 16480873.
Q.
Diarrhea after eating—why does food seem to “flip a switch”?
A.
After you eat, the gastrocolic reflex and digestive hormones increase colon activity; when this response is exaggerated or malabsorption is present, food can seem to flip a switch and cause urgent watery stools. Common culprits include IBS-D, bile acid malabsorption, SIBO, celiac disease, dumping after stomach surgery, pancreatic enzyme insufficiency, and certain medications, with infections or IBD also possible. There are several factors to consider, including red flags like blood in stool, weight loss, fever, severe pain, dehydration, or jaundice that need urgent care; see below for the full list of causes, tests, and treatments that could change your next steps.
References:
Wedlake L, A'Hern R, Russell D, Thomas K, Walters JR. (2009). Systematic review: the prevalence of idiopathic bile acid malabsorption as diagnosed by SeHCAT scanning in patients with diarrhoea-predominant irritable bowel syndro… Aliment Pharmacol Ther, 19298377.
Ripoll C, Groszmann R, Garcia-Tsao G, et al. (2007). Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis… Gastroenterology, 17681104.
Montano-Loza AJ, Meza-Junco J, Prado CM, et al. (2012). Muscle wasting is associated with mortality in patients with cirrhosis. Clin Gastroenterol Hepatol, 21982896.
Q.
Diarrhea every morning—what does that schedule say about your body?
A.
There are several factors to consider: morning diarrhea often reflects an exaggerated gastrocolic reflex or IBS-D and can be driven by stress and the morning cortisol surge, late or high-fat meals, caffeine or artificial sweeteners, certain drugs or supplements, infections, thyroid disease, IBD, and rarely liver disease. See below for the specific red flags that need prompt care such as blood in stool, high fever, significant weight loss, dehydration, or jaundice, plus practical fixes like earlier lighter dinners, limiting caffeine, stress management, medication review, targeted probiotics, and when to get stool, blood, breath tests or scopes to guide your next steps.
References:
Ford AC, Lacy BE, & Talley NJ. (2017). Irritable bowel syndrome… N Engl J Med, 28657884.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.
Tsochatzis EA, Gurusamy KS, Ntaoula S, Cholongitas E, Davidson BR, & Burroughs AK. (2014). Elastography for the diagnosis of severity of fibrosis in chronic liver… Alimentary pharmacology & therapeutics, 24405301.
Q.
Diarrhea every morning: what patterns suggest inflammation vs IBS vs diet triggers?
A.
There are several patterns to consider: inflammation is suggested by blood or mucus in stool, nighttime or early-morning urgency that wakes you, and weight loss or fever; IBS tends to cause morning diarrhea tied to waking or meals with abdominal pain relieved by bowel movements and no alarm features; diet triggers show a predictable link to recent foods within about 6 to 8 hours, especially high FODMAPs, lactose or sugar alcohols, caffeine, or late fatty meals. See below for a quick pattern checklist, red flags that mean seek care, simple home steps such as a food-symptom diary and a brief low FODMAP trial, and when tests like fecal calprotectin or colonoscopy are warranted.
References:
Camilleri M, & Choi MG. (2013). Chronic diarrhea in adults: diagnosis and… N Engl J Med, 23434567.
Staudacher HM, & Whelan K. (2016). Mechanisms and efficacy of dietary FODMAP… Nat Rev Gastroenterol Hepatol, 26121007.
Castera L. (2011). Non-invasive assessment of liver fibrosis: an update… J Hepatol, 21683120.
Q.
Diarrhea for 2 weeks—at what point do you stop waiting it out?
A.
Once diarrhea reaches 2 weeks, it is considered persistent and you should stop waiting and arrange a medical evaluation; seek urgent care sooner for red flags such as dehydration, fever above 102 F, blood or black stools, severe abdominal pain, or notable weight loss. There are several factors to consider. See below to understand home-care steps, when to set a 10 to 14 day limit, which tests and diagnoses your clinician may pursue, and other details that can shape your next steps.
References:
DuPont HL. (1995). Etiology and management of persistent diarrhea. Am J Med, 7789622.
Foucher J, Chanteloup E, Vergniol J, Castéra L, Le Bail B, Adhoute X, et al. (2006). Diagnosis of cirrhosis by transient elastography: a prospective… Gut, 16319227.
Johnson PJ, Berhane S, Kagebayashi C, Satomura S, Teng M, Reeves HL, et al. (2015). Assessment of liver function in patients with hepatocellular carcinoma… J Clin Oncol, 25667218.
Q.
Diarrhea for weeks—why isn’t this “just something you ate”?
A.
Persistent diarrhea lasting more than four weeks is rarely just something you ate; it often points to infections, inflammatory bowel disease or IBS, malabsorption such as celiac or pancreatic insufficiency, medication side effects, endocrine disorders, or bile acid issues after surgery. There are several factors to consider that could change your next steps, including red flags like fever, blood or mucus in stool, dehydration, weight loss, or severe pain, and how doctors diagnose and treat the cause; see below for complete details.
References:
Korman MG, Rowland R Jr, & Walker PD. (1988). Systematic approach to chronic diarrhea in adults... Am Fam Physician, 3133018.
Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, & Spiller R. (2016). Bowel disorders... Gastroenterology, 27880865.
European Association for the Study of the Liver, & Asociacion Latinoamericana para el Estudio del Higado. (2015). EASL-ALEH Clinical Practice Guidelines: non-invasive tests for evaluation of liver disease severity and prognosis... J Hepatol, 26073471.
Q.
Diarrhea waking me up at night: what conditions are more likely when sleep gets interrupted?
A.
Diarrhea that wakes you from sleep is more likely from an organic condition than a functional one, commonly inflammatory bowel disease, infections, malabsorption (celiac, pancreatic insufficiency, SIBO), endocrine causes like hyperthyroidism, medication side effects, or complications of liver disease; IBS-D can do this but less often. There are several factors to consider; seek urgent care for dehydration, high fever, blood or black stools, severe abdominal pain, significant weight loss, or diarrhea lasting over 48 hours, and see below for the full warning signs, diagnostic tests, and treatments that could guide your next steps.
References:
Lacy BE, Mearin F, Chang L, Chey WD, Lembo AJ, Simrén M, & Spiller R. (2016). Bowel disorders. Gastroenterology, 27144644.
Camilleri M. (2015). Chronic diarrhea: evaluation and management. Mayo Clin Proc, 25861502.
D'Amico G, Garcia‐Tsao G, & Pagliaro L. (2002). Natural history and prognostic indicators of survival in cirrhosis. Hepatology, 11829121.
Q.
Diarrhea with mucus—why does this symptom freak doctors out?
A.
Visible mucus in diarrhea signals irritation of the colon and worries clinicians because it often points to infection or inflammation, including serious bacterial colitis or C. difficile, risk of dehydration, or a chronic condition like inflammatory bowel disease. Seek prompt care for red flags like fever, blood, significant abdominal pain, dehydration, recent antibiotics, or symptoms beyond 2 days; tests, home care, cirrhosis-specific risks, and when to see a specialist are detailed below.
References:
Foxx-Orenstein AE, & McFarland LV. (2010). Approach to the adult patient with acute diarrhea: a clinical review… Mayo Clin Proc, 20588852.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end‐stage liver disease… Hepatology, 11157951.
European Association for the Study of the Liver. (2014). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis… Journal of Hepatology, 24986678.
Q.
Fatigue and diarrhea: when do these together suggest anemia or chronic inflammation?
A.
Fatigue with diarrhea points to anemia or chronic inflammation when diarrhea lasts more than four weeks, fatigue does not improve with rest, or there are red flags like blood or mucus in the stool, unexplained weight loss, low-grade fevers or night sweats, joint pains or rashes, signs of nutrient deficiency such as pallor or hair loss, or a family history of IBD or celiac disease. There are several factors to consider. See below for the full list of warning signs, related conditions like IBD, celiac, or chronic liver disease, and the key next steps including CBC, iron studies, inflammatory markers, stool tests for gut inflammation, imaging or endoscopy, and when to seek urgent care.
References:
Eglinton T, et al. (2013). Fatigue in inflammatory bowel disease: prevalence and predictors. Inflamm Bowel Dis, 23244655.
Weiss G, & Goodnough LT. (2005). Anemia of chronic disease. N Engl J Med, 15647514.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis. Hepatology, 16416501.
Q.
Feeling like you’re not “done” after pooping—what if that’s the clue?
A.
A persistent feeling of not being finished after a bowel movement, called incomplete evacuation or tenesmus, is common and often due to treatable causes like pelvic floor dyssynergia, IBS, hemorrhoids, structural narrowing, medications, or inflammation; seek prompt care for bleeding, unintended weight loss, severe pain, anemia, pencil-thin stools, or new onset after age 50. There are several factors to consider, and the details below can change your next steps; see below for practical fixes and evaluations from fiber, fluids, and routine to pelvic floor biofeedback, targeted laxatives, and procedures, plus special guidance for cirrhosis and when to use a symptom check or ask for specialized testing.
References:
Chiarioni G, Whitehead WE, & Vantini I. (2007). Clinical features and pathophysiological mechanisms of… Am J Gastroenterol, 17553529.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic review of… J Hepatol, 16447288.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines on the management of patients with decompensated… J Hepatol, 30201765.
Q.
Frequent bowel movements: what counts as abnormal, and what else matters besides frequency?
A.
Normal bowel frequency ranges from three times per week to three times per day; going more than three times daily is most concerning when paired with loose watery stools, urgency, blood or black stools, unintended weight loss, severe pain, waking at night to go, dehydration, or fever. There are several factors to consider besides frequency, including stool consistency, volume, color, odor, ease of passage, and potential causes like infections, IBS-D, malabsorption, medications, thyroid problems, and liver treatments such as lactulose. See below for key details, red flags, and practical next steps that could influence when and how you seek care.
References:
Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, & Spiller RC. (2006). Functional bowel disorders. American Journal of Gastroenterology, 16678552.
European Association for the Study of the Liver & Asociación Latinoamericana para el Estudio del Hígado. (2015). EASL–ALEH clinical practice guidelines: non-invasive tests for evaluation of liver disease… Journal of Hepatology, 26073415.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. The Lancet, 24754198.
Q.
Joint pain and diarrhea: when do “outside the gut” symptoms suggest IBD?
A.
Joint pain with diarrhea can suggest IBD when inflammatory patterns are present; red flags include diarrhea over four weeks, blood or weight loss, fever or night sweats, morning stiffness, migratory large-joint pain or inflammatory low back pain under 45, enthesitis, skin rashes, eye inflammation, or a family history of IBD or related conditions. Evaluation may include CRP/ESR, fecal calprotectin, targeted imaging, and colonoscopy, with treatment aimed at controlling gut inflammation and careful use of pain medicines; there are several factors to consider, and important details that can affect your next steps are outlined below.
References:
Vavricka SR, Schoepfer A, Scharl M, Lakatos PL, Navarini A, & Rogler G. (2015). Extraintestinal manifestations of inflammatory bowel disease. Gastroenterology, 26001956.
Orchard TR, Wordsworth BP, & Jewell DP. (1998). Value of HLA-B27 in the diagnosis of sacroiliitis associated w… Gut, 9721336.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis… Hepatology, 16301321.
Q.
Low iron + diarrhea—what if the clue isn’t in your blood, but in your bowel?
A.
There are several factors to consider: low iron with diarrhea often points to a gut problem such as celiac disease, inflammatory bowel disease, infections, small intestinal bacterial overgrowth, medication injury, or advanced liver disease. See below to understand more. If diarrhea lasts longer than 2 to 4 weeks, iron does not improve with supplements, or there is weight loss or blood in the stool, ask about targeted blood and stool tests and possible endoscopy so the cause can be treated while iron is replaced, and review urgent warning signs and next steps outlined below.
References:
Foxx-Orenstein AE, & McFarland LV. (2010). Approach to the adult patient with acute diarrhea: a clinical… Mayo Clin Proc, 20588852.
Rubio-Tapia A, Hill ID, Kelly CP, Calderwood AH, & Murray JA. (2013). ACG clinical guidelines: diagnosis and management of celiac disease… Am J Gastroenterol, 21979967.
European Association for the Study of the Liver. (2014). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis… J Hepatol, 24986678.
Q.
Lower abdominal pain and diarrhea: what locations and patterns help narrow the cause?
A.
Location and pattern matter: right lower quadrant pain often suggests Crohn’s ileitis or sometimes appendicitis, left lower quadrant points toward diverticulitis or ulcerative colitis, suprapubic pain can indicate UTI or proctitis, and periumbilical pain aligns with gastroenteritis or, if severe and out of proportion, possible ischemia. Patterns that refine the cause include duration (acute vs persistent vs chronic), stool features (blood or mucus suggests colitis, large-volume watery suggests secretory), nocturnal stools and weight loss as red flags, and context like recent antibiotics or liver disease; there are several factors to consider, and the detailed guidance on what these mean and when to seek care is below.
References:
Triantafyllou K, & Gkolfakis P. (2015). Chronic diarrhoea in adults: pathophysiology, diagnosis… Curr Gastroenterol Rep, 26256284.
D'Amico G, & Garcia‐Tsao G. (2006). Natural history and prognostic indicators of survival in cirrhosis… J Hepatology, 17084185.
Kim WR, & Biggins SW. (2008). Hyponatremia and mortality among patients on the liver transplant… N Engl J Med, 18799536.
Q.
Mucus in stool—what if it’s your body waving a flag?
A.
There are several factors to consider; small amounts can be normal, but more or discolored mucus can signal IBS, infections, inflammatory bowel disease, hemorrhoids or fissures, food intolerances, or even complications of advanced liver disease. Watch for red flags like blood or black stool, fever, persistent diarrhea, weight loss, dehydration, or worsening pain and seek care promptly; tests, treatments, and self-care steps you can take are detailed below.
References:
Foxx-Orenstein AE, & McFarland LV. (2010). Approach to the adult patient with acute diarrhea: a clinical… Mayo Clin Proc, 20588852.
Røseth AG, Aadland E, & Fagerhol MK. (2006). Fecal calprotectin and lactoferrin are sensitive and specific markers for inflammatory bowel disease. Gut, 16709773.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines on the management of decompensated cirrhosis. J Hepatol, 29730704.
Q.
Mucus in stool: when is it normal, and when is it a sign of colitis?
A.
Small, occasional, clear mucus without pain, blood, fever, or bowel habit changes is usually normal, but mucus that is thick or abundant, lasts more than a week, or comes with blood, pus, urgency, cramps, fever, fatigue, or weight loss can signal colitis. There are several factors to consider. See below for important details on the types of colitis, the exact red flags that need urgent care, and what diagnosis and treatment steps to expect.
References:
Magro F, Gionchetti P, Eliakim R, et al. (2012). Third European evidence-based consensus on diagnosis and… Journal of Crohn's and Colitis, 23032446.
European Association for the Study of the Liver, & Asociacion Latinoamericana para el Estudio del Higado. (2015). EASL-ALEH Clinical Practice Guidelines: non-invasive tests for… Journal of Hepatology, 25687187.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. Lancet, 24693525.
Q.
Nighttime diarrhea: why is waking up to poop considered a red-flag symptom?
A.
Waking up at night to have diarrhea is a red-flag because the gut normally quiets during sleep; when that rhythm is disrupted, it often points to an organic cause such as inflammatory bowel disease, infection, malabsorption, medication effects, or certain systemic conditions rather than IBS. There are several factors to consider, including red flags like blood or black stools, weight loss, fever, severe pain, dehydration, and episodes that persist beyond a week or recur more than once or twice a month. See below for the full list of causes, tests your doctor may use, and treatment options that could change your next steps.
References:
Brandt LJ, Spinelli KS, & Patrie JT. (2016). Chronic diarrhea in adults: etiology, evaluation,… Am J Gastroenterol, 27480841.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage… Hepatology, 11157951.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis… Lancet, 25056017.
Q.
Pain when pooping: what’s the differential between fissures, hemorrhoids, and proctitis?
A.
There are several factors to consider: fissures cause sharp, tearing pain during and after bowel movements with scant bright red blood and sometimes a visible crack, hemorrhoids typically cause painless bleeding unless an external clot triggers sudden severe pain and swelling with itch, and proctitis brings a constant ache with urgency, mucus, and sometimes fever. See below for the complete answer, including red flags that need urgent care, how each is diagnosed, and specific home care and treatment options that can guide your next steps.
References:
Schouten WR, Briel JW, & Auwerda JJ. (1994). Relationship between anal pressure and anodermal blood flow in chron… Dis Colon Rectum, 7921012.
Riss S, Weiser FA, Schwameis K, Mittlböck M, Müllauer L, & Scheuerlein H. (2012). The prevalence of hemorrhoids in adults. Colorectal Dis, 21851568.
Marks LS, & Farnell MB. (2005). Radiotherapy-induced proctitis: pathophysiology and treatment app… Colorectal Dis, 15889795.
Q.
Rectal pain—why do some people misread this as “just hemorrhoids”?
A.
There are several factors to consider: overlapping symptoms, familiarity and stigma, and the short-term relief of over-the-counter treatments lead many people to self-diagnose rectal pain as hemorrhoids. Yet fissures, abscesses, infections or proctitis, pelvic floor spasm, rectal prolapse, inflammatory disease, liver-related varices, and even cancer can mimic hemorrhoids, with red flags like severe pain, fever, persistent bleeding, discharge, bowel changes, weight loss, or anemia that warrant prompt care; see complete details and next steps below.
References:
Feingold D, Steele SR, Ault GT, et al. (2014). The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of… Dis Colon Rectum, 24813807.
Ziol M, Handra-Luca A, Kettaneh A, et al. (2005). Non-invasive assessment of liver fibrosis by measurement of stiffness… Hepatology, 15841058.
European Association for the Study of the Liver. (2014). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis… Journal of Hepatology, 24986678.
Q.
Ulcerative colitis symptoms: what’s typical early on, and what’s often missed?
A.
Typical early symptoms include frequent, urgent diarrhea with blood or mucus, lower abdominal cramping with tenesmus, mild fatigue or low-grade fever, and sometimes unintended weight loss. Often missed are small intermittent rectal bleeding, subtle but persistent changes in bowel habits or nighttime urgency, signs of iron-deficiency anemia, and extra-intestinal issues such as joint pain, skin or eye inflammation, or recurrent mouth sores. There are several factors to consider that could affect your next steps; see below to understand more.
References:
Feuerstein JD, & Cheifetz AS. (2014). Ulcerative colitis: epidemiology, pathophysiology, and diagnosis. Mayo Clin Proc, 25078179.
Dignass A, Van Assche G, Lindsay JO, et al. (2012). The second European evidence-based consensus on the diagnosis and… J Crohns Colitis, 23142041.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis… J Hepatol, 16337407.
Q.
Urgent need to poop—what if this isn’t stress at all?
A.
There are several causes beyond stress to consider, including IBS or functional diarrhea, infections, inflammatory bowel disease, bile acid diarrhea, small intestinal bacterial overgrowth, thyroid disease, medications, and post-infection or surgery changes. Because red flags such as blood or black stool, severe abdominal pain, fever, weight loss, dehydration, or new onset after age 50 require prompt medical care, and testing and treatments differ by cause, see the complete guidance below for the key evaluations, targeted therapies, and special situations like cirrhosis that can change your next steps.
References:
Lacy BE, Everhart K, Gaarder L, Lowman B, & Mullin G. (2015). Fecal urgency in functional gastrointestinal disorders: definitions, characterizations, and management. American Journal of Gastroenterology, 25813729.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. Journal of Hepatology, 16337470.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. Journal of Hepatology, 29414420.
Q.
Bowel urgency—why does it feel like an emergency every time?
A.
Bowel urgency feels like an emergency when gut nerves are hypersensitive, stool moves too fast, or the rectum is less stretchy, and anxiety can amplify these signals; common causes include IBS, infections, inflammatory bowel disease, malabsorption, bile acid problems after gallbladder removal, medication or food triggers, and pelvic floor dysfunction. There are several factors to consider. See below to understand more, including red flags that need prompt care, practical diet and pelvic floor strategies, and when testing and targeted treatments may be appropriate.
References:
Camilleri M, Lasch K, & Zhou W. (2012). Irritable bowel syndrome: methods, mechanisms, and pathophysiology… Neurogastroenterology & Motility, 22897731.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.
European Association for the Study of the Liver. (2014). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. Journal of Hepatology, 24986678.
Q.
Bright red blood in stool: where is it likely coming from, and when should you worry?
A.
Bright red blood in stool usually comes from the lower GI tract colon to anus, commonly hemorrhoids or anal fissures, but it can also be from diverticular bleeding, inflammatory bowel disease, colonic polyps or cancer, and occasionally brisk upper GI bleeding. There are several factors to consider. Seek urgent care for heavy or ongoing bleeding, clots, lightheadedness or fainting, severe abdominal pain or fever, or if you are over 50 or have risks like liver disease, IBD, a family history of colorectal cancer, or blood thinner use; even mild but persistent bleeding deserves a medical visit. See below to understand more, including self care, testing, and when to see a specialist.
References:
Strate LL. (2010). Lower GI bleeding--epidemiology and management. Curr Gastroenterol Rep, 20541574.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic… J Hepatol, 16324759.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. Lancet, 24798702.
Q.
Chronic diarrhea: how long is “too long,” and what’s the standard workup?
A.
Chronic diarrhea means loose or frequent stools lasting 4 weeks or more; beyond this timeframe it is considered too long and merits medical evaluation. Standard workup begins with history and exam plus basic labs and stool tests such as CBC, metabolic panel, inflammatory markers, celiac serology, calprotectin, C. difficile, and ova and parasites, with colonoscopy, imaging, and specialized tests guided by findings and red flags like bleeding, weight loss, fever, nocturnal symptoms, or dehydration. There are several factors to consider that can change next steps and treatment; see below for a concise, stepwise checklist and when to seek urgent care.
References:
Fine KD, & Schiller LR. (1999). Chronic diarrhea. N Engl J Med, 10408490.
American Gastroenterological Association. (2001). AGA technical review on chronic diarrhea: definitions, class… Gastroenterology, 11042131.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cir… Journal of Hepatology, 16126709.
Q.
Crohn’s disease symptoms: what’s most common, and what should prompt evaluation?
A.
Most common Crohn’s symptoms are chronic diarrhea and abdominal pain or cramping, often with urgency, blood or mucus in stool, reduced appetite and unintended weight loss; fatigue, anemia and joint, skin or eye symptoms can also occur. Seek prompt evaluation for diarrhea lasting more than two weeks, recurrent or severe pain, blood in stool, fever, significant weight loss, dehydration, or new perianal pain or drainage, and urgent care for severe unrelenting pain, massive bleeding or high fever with chills. There are several factors to consider. See below for key details that can affect next steps, including extra symptoms, risk groups and how diagnosis and treatment are tailored.
References:
Torres J, Mehandru S, Colombel JF, & Peyrin-Biroulet L. (2017). Crohn's disease. Lancet, 27723488.
Lichtenstein GR, Loftus EV Jr, Isaacs KL, Regueiro MD, Gerson LB, & Sands BE. (2018). ACG clinical guideline: Management of Crohn's disease in adults. Am J Gastroenterol, 29656941.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.
Q.
Diarrhea with blood—could this be IBD hiding in plain sight?
A.
Bloody diarrhea can be caused by short-term infections, but it can also signal inflammatory bowel disease like ulcerative colitis or Crohn’s; if symptoms last more than two weeks, recur with blood, or come with weight loss or fatigue, seek medical evaluation. Diagnosis may include stool tests, blood work and colonoscopy, and urgent care is needed for high fever, severe abdominal pain, dehydration, or heavy bleeding. There are several factors to consider; see below for key differences from infections, other causes to rule out, red-flag symptoms, and the testing and treatment options to discuss with your doctor.
References:
Foxx-Orenstein AE, & McFarland LV. (2010). Approach to the adult patient with acute diarrhea: a clinical… Mayo Clin Proc, 20588852.
Torres J, Mehandru S, Colombel JF, & Peyrin-Biroulet L. (2017). Crohn's disease. Lancet, 28373232.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. Lancet, 24581603.
Q.
Do I have Crohn’s: what symptoms and tests are most diagnostic?
A.
There are several factors to consider; see below to understand more. The most suggestive symptoms are persistent abdominal pain, chronic diarrhea sometimes with blood, unintended weight loss, fatigue, fever, mouth sores, and perianal problems. The most diagnostic tests are fecal calprotectin and inflammatory blood markers to screen for gut inflammation, with colonoscopy and biopsies as the gold standard and MR or CT enterography to define extent and complications; no single test stands alone, so key next steps and red flags are explained below.
References:
Torres J, Mehandru S, Colombel JF, et al. (2017). Crohn's disease. Lancet, 28338954.
van Rheenen PF, Van de Vijver E, Fidler V. (2010). Faecal calprotectin for screening for inflammatory bowel disease… Cochrane Database Syst Rev, 20464780.
D'Amico G, Garcia-Tsao G, Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118… J Hepatol, 16214343.
Q.
Do I have ulcerative colitis—what if your gut has been trying to tell you?
A.
There are several factors to consider: persistent diarrhea, blood in the stool, urgency, cramping, weight loss or fatigue can signal ulcerative colitis, sometimes with symptoms outside the gut, and red flags like heavy bleeding, high fever, severe constant pain, or dehydration need urgent care. Diagnosis involves stool and blood tests and a colonoscopy, and treatment depends on severity and extent, ranging from 5-ASA medicines to steroids, biologics, or surgery; see below for how to tell UC from IBS or infections, what to watch for, and which next steps may be right for you.
References:
Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, & Long MD. (2019). ACG Clinical Guideline: Ulcerative Colitis in Adults. American Journal of Gastroenterology, 30807407.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a syste… Gut, 16085789.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. The Lancet, 24105934.
Q.
Low iron anemia and diarrhea: how are these connected, and what’s the workup?
A.
These often occur together because chronic gut blood loss, malabsorption from conditions like celiac or IBD, inflammation that traps iron, and reduced intake with frequent stools can all cause iron deficiency. There are several factors to consider; see below to understand more. Workup typically includes history and exam, CBC with iron studies and celiac screening, stool tests for blood, infection and inflammation, and targeted endoscopy or imaging, with treatment aimed at iron repletion plus the underlying cause; urgent red flags like black stools, severe pain, fever, fainting, or rapid weight loss need immediate care, and important details on next steps are outlined below.
References:
Cappellini MD, Musallam KM, & Taher AT. (2020). Iron deficiency anemia revisited. J Intern Med, 31510590.
Menees SB, Powell C, & Kurlander J. (2016). Chronic diarrhea in adults: evaluation and management. Am Fam Physician, 27846337.
Cholongitas E, Papatheodoridis GV, Vangeli M, Terrault NA, & Patch D. (2005). The model for end-stage liver disease – Should it replace Ch… Aliment Pharmacol Ther, 15985163.
Q.
Mouth ulcers and diarrhea—why can this combo point to Crohn’s?
A.
Mouth ulcers plus diarrhea can signal Crohn’s because this inflammatory bowel disease can involve the GI tract from mouth to anus, so oral lesions often flare alongside intestinal inflammation that drives persistent diarrhea. If this combination lasts more than two weeks or is accompanied by red flags like weight loss, blood or mucus in stool, fever, or joint or eye symptoms, seek prompt medical care. There are several factors to consider and important tests and treatments that may apply; see below for the complete answer and next steps.
References:
Bouquot JE, Nikai H, Sorenson WG, et al. (1998). Oral Crohn disease: a clinicopathologic study of 17 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 10377004.
Vavricka SR, Schoepfer A, Scharl M, Lakatos PL, Navarini A, Rogler G. (2015). Extraintestinal manifestations of inflammatory bowel disease. Inflamm Bowel Dis, 25548993.
Tsochatzis EA, Bosch J, Burroughs AK. (2014). Liver cirrhosis. Lancet, 24581670.
Q.
Nighttime diarrhea—why does this one symptom change the whole story?
A.
Nighttime diarrhea that wakes you from sleep is an alarm feature because intestinal activity should slow during sleep, so it often signals an organic cause like inflammatory bowel disease, infection, celiac disease, microscopic colitis, endocrine problems, medication effects, or malabsorption, and it typically prompts targeted testing rather than assuming IBS. There are several factors to consider, including red flags that need urgent care and which tests and treatments fit different causes. See the complete details below to understand what to watch for and which next steps may be right for you.
References:
Chalasani NP, et al. (1997). Usefulness of alarm features in identifying organic causes in chronic dia… American Journal of Gastroenterology, 9020160.
D'Amico G, et al. (2006). Natural history and prognostic indicators of survival in cirrhosis… Hepatology, 16964321.
Moreau R, et al. (2013). Acute-on-chronic liver failure is a distinct syndrome that develops in… Journal of Hepatology, 23127468.
Q.
Rectal pain: what symptoms help separate irritation, infection, and inflammatory disease?
A.
There are several factors to consider. Irritation usually means sharp or burning pain at the anal margin with bright red blood on tissue, itching, or tender lumps after straining or sitting; infection more often causes deep, throbbing pain with rectal discharge, fever, tenesmus, or genital sores after sexual exposure; inflammatory disease tends to cause persistent pain with bloody mucus diarrhea, urgency including at night, weight loss or fatigue, and in cirrhosis, possible painless bleeding from rectal varices. See below for the full symptom checklist, urgent red flags, risk factors, and the key tests and first treatments that could change your next steps in care.
References:
Lohsiriwat V. (2009). Hemorrhoids: from basic pathophysiology to clinical… Int J Colorectal Dis, 19114752.
Workowski KA, & Bolan GA. (2015). Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep, 26042815.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Cirrhosis. Lancet, 24388008.
Q.
Ulcerative colitis symptoms—what do people ignore until it gets bad?
A.
People often ignore early signs like mild rectal bleeding, frequent urgent bowel movements, persistent diarrhea, cramping, unexplained fatigue, and gradual weight loss, sometimes along with joint, skin, or eye inflammation. There are several factors to consider, including red-flag symptoms such as escalating bloody diarrhea, severe abdominal pain, fever, dehydration, or anemia that need urgent care. See below for full details, what to do next, and how to talk to your doctor.
References:
Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, & Colombel JF. (2017). Ulcerative colitis. Lancet, 27642731.
Lamb CA, Kennedy NA, Raine T, Hendy PA, & Smith PJ. (2019). British Society of Gastroenterology consensus guidelines on the man… Gut, 30373876.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. Lancet, 24635503.
Q.
Bloody diarrhea—when is this an “ER now” problem?
A.
Go to the ER now if you have heavy or frequent bleeding or clots, severe abdominal pain, fever of 101 F or higher, signs of dehydration, dizziness or fainting, confusion, a rapid heartbeat or low blood pressure, you are pregnant or immunocompromised, have major conditions like heart, kidney, or liver disease, or you have a sudden severe IBD flare. If symptoms are mild, with fewer than 3 bloody stools a day, no or low grade fever, and you can drink and urinate, you can monitor closely, hydrate, and see a doctor within 24 to 48 hours. There are several factors to consider, and key causes, red flags, safe home care, and what to expect in the ER are explained below.
References:
Foxx-Orenstein AE, & McFarland LV. (2010). Approach to the adult patient with acute diarrhea: a clinical… Mayo Clin Proc, 20588852.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.
European Association for the Study of the Liver. (2014). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. Journal of Hepatology, 24986678.
Q.
Can’t stop pooping: when does this become a red-flag symptom doctors take seriously?
A.
Doctors take persistent diarrhea seriously when key red flags are present: blood or pus, high fever, severe abdominal pain, signs of dehydration, unintentional weight loss, symptoms lasting more than 48 hours, recent antibiotics or travel, older age, or immunocompromise; see below for the full list and what to do next. These signs may point to infections like C. difficile, inflammatory bowel disease, malabsorption, or dangerous complications such as severe dehydration or acute kidney injury, so seek urgent care if any occur. There are several factors to consider, and the detailed guidance below explains self-care, when to see a doctor, and the tests doctors use.
References:
Foxx-Orenstein AE, & McFarland LV. (2010). Approach to the adult patient with acute diarrhea: a clinical… Mayo Clin Proc, 20588852.
Wai CT, Greenson JK, & Fontana RJ. (2003). A simple noninvasive index can predict both significant fibrosis… Hepatology, 12703719.
European Association for the Study of the Liver. (2014). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. Journal of Hepatology, 24986678.
Q.
Chronic diarrhea—what if your gut is inflamed, not “sensitive”?
A.
There are several factors to consider. Chronic diarrhea lasting 4 or more weeks can reflect true gut inflammation rather than a sensitive gut, often from inflammatory bowel disease, microscopic colitis, or bile acid malabsorption; see below for specifics that could change your next steps. Red flags and tests that help distinguish causes include blood in stool, weight loss, anemia or fever, fecal calprotectin or lactoferrin and, if elevated, colonoscopy with biopsies, with treatments that differ from IBS such as anti-inflammatory drugs, bile acid binders and targeted nutrition; find the full checklist and when to seek urgent care below.
References:
Heida A, Keszthelyi D, & Masclee AA. (2013). Value of fecal biomarkers in diagnosis and monitoring patients wit… Annals of Gastroenterology, 23963732.
Tsochatzis EA, Gurusamy KS, & Ntaoula S. (2011). Elastography for the diagnosis of severity of fibrosis in chronic l… Journal of Hepatology, 21761531.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic… Journal of Hepatology, 16516658.
Q.
Diarrhea for weeks: what causes persist past a virus, and what should you test?
A.
When diarrhea lasts weeks, look beyond a virus: common causes include postinfectious IBS, inflammatory or microscopic colitis, malabsorption such as celiac, pancreatic insufficiency or bile acid diarrhea, chronic infections or parasites, medication effects including C. difficile, endocrine issues like hyperthyroidism or diabetic neuropathy, and liver disease; there are several factors to consider, and key nuances that can change your next steps are outlined below. Useful tests include blood work for anemia, inflammation, electrolytes, liver and thyroid function; stool studies for culture, ova and parasites, C. difficile, fecal calprotectin and fat or elastase; celiac antibodies and breath tests for lactose or SIBO; and, when indicated, colonoscopy with biopsies or imaging. Seek prompt care for red flags like bleeding, fever, severe pain, dehydration or weight loss, and see below for full details and step-by-step guidance.
References:
Stevens T, Potter M, Cohen S, Rosberg M, & Fried M. (2008). Etiology, diagnostic approach, and outcome of chronic diarrhea in a tertiar… Clin Gastroenterol Hepatol, 18089189.
Spiller R. (2006). Postinfectious irritable bowel syndrome. Curr Gastroenterol Rep, 16917587.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis… Journal of Hepatology, 16337436.
Q.
Diarrhea with mucus: what does mucus suggest about inflammation in the gut?
A.
Mucus in diarrhea usually signals irritation or inflammation of the colon lining, as goblet cells ramp up mucin to protect an inflamed gut; mucus with blood, fever, or severe abdominal pain is more suggestive of an inflammatory or invasive process than a simple viral upset. There are several factors to consider, and mucus can also occur in IBS without true inflammation; see below for key causes, red flags that warrant medical care, and the diagnostic and treatment options that could shape your next steps.
References:
Foxx-Orenstein AE, & McFarland LV. (2010). Approach to the adult patient with acute diarrhea: a clinical… Mayo Clin Proc, 20588852.
Johansson ME, Larsson JM, Hansson GC. (2012). The two mucus layers of colon are organized by the MUC2 mucin… Proc Natl Acad Sci U S A, 22058291.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver… Hepatology, 11157951.
Q.
Fatigue and diarrhea—what if your tiredness is coming from your gut?
A.
Fatigue with diarrhea often points to a gut cause, driven by inflammation, nutrient and fluid losses, or microbiome imbalance, with common culprits including IBD, bile acid diarrhea, infections, liver disease, and malabsorption issues like celiac disease or SIBO. There are several factors to consider, including urgent red flags, the tests doctors use, and proven treatments from medications and diet to supplements, probiotics, and self care; see below for the details that can shape your next steps.
References:
Graff LA, & Walker JR. (2010). Fatigue in patients with inflammatory bowel disease: prevalen… Inflamm Bowel Dis, 20441821.
Camilleri M. (2015). Bile acid diarrhea: pathophysiology, diagnosis, and manag… Clin Gastroenterol Hepatol, 26004922.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indic… J Hepatol, 16325192.
Q.
Fecal calprotectin—could one stool test end months of guessing?
A.
A fecal calprotectin stool test can rapidly indicate whether gut symptoms are due to intestinal inflammation, helping tell IBD from IBS and sometimes sparing you an immediate colonoscopy. Low values make significant inflammation unlikely, while higher results point to active inflammation and the need for further evaluation. There are several factors to consider, including infections, medicines like NSAIDs, and how to act on borderline results. See complete details below, including result ranges, when to repeat testing, red flags that need urgent care, and how this test fits into your next steps.
References:
Costa F, Mumolo MG, Seegers V, Bellini M, Romano MR, Borrelli O, Camilleri M. (2005). Faecal calprotectin: a surrogate marker of intestinal inflammation in… Eur J Gastroenterol Hepatol, 15801221.
Tibble JA, Sigthorsson G, Bridger S, Fagerhol MK, Bjarnason I. (2000). Surrogate markers of intestinal inflammation are predictive of relapse in… Gut, 10859218.
Foucher J, Chanteloup E, Vergniol J, Castéra L, Le Bail B, Adhoute X, Bertet J, Couzigou P, de Lédinghen V. (2006). Diagnosis of cirrhosis by transient elastography: a prospec… Hepatology, 16961053.
Q.
If diarrhea wakes you up at night, what are you supposed to suspect?
A.
Nighttime diarrhea usually points to an organic cause rather than typical daytime IBS; key suspects include infections, inflammatory bowel disease, malabsorption such as celiac or bile acid diarrhea, hormonal issues like hyperthyroidism, medication effects, and complications of advanced liver disease. There are several factors to consider, and red flags like blood in the stool, fever, weight loss, severe abdominal pain, dehydration, or jaundice need prompt care; see below for the full list of causes, alarm signs, and how doctors evaluate and treat this.
References:
Chey WD, Grunwald GK, & DeLee R. (2010). Chronic diarrhea: a practical… Cleve Clin J Med, 20843474.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for decompensated cirrhosis. Journal of Hepatology, 29710135.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.
Q.
Lower abdominal pain and diarrhea—why do the location details matter so much?
A.
Where your lower abdominal pain sits with diarrhea is a key clue that narrows causes and directs testing, for example right-sided pain pointing toward appendicitis or Crohn's, left-sided toward diverticulitis or ulcerative colitis, and midline toward bladder, uterus, or small bowel issues. There are several factors to consider. See below for the full list of causes, red flags that require urgent care, how diarrhea changes the picture, and the tests and treatments that can guide your next steps.
References:
Ford AC, Lacy BE, Talley NJ. (2017). Irritable bowel syndrome. N Engl J Med, 28177869.
D'Amico G, Garcia-Tsao G, Pagliaro L. (2006). Natural history and prognostic indicators of survival in cir… Journal of Hepatology, 16219970.
Angeli P, Bernardi M, Villanueva C, Francoz C, Caraceni P, Trebicka J, Arroyo V, Kamath PS. (2018). EASL Clinical Practice Guidelines for the management of pati… Journal of Hepatology, 29677121.
Q.
Rectal bleeding: what symptoms make it more likely inflammation vs a tear?
A.
There are several factors to consider. Diarrhea, urgency or tenesmus, cramping, mucus or pus, and systemic signs like fever, fatigue, or weight loss suggest inflammation, whereas small amounts of bright red blood on the paper or stool surface with sharp, well localized pain during or after a bowel movement, often after constipation, suggest an anal tear. See below for key red flags that need urgent care such as heavy bleeding, dizziness or fainting, black tarry stools, severe abdominal pain, or high fever, plus evaluation steps and treatments that can guide your next steps.
References:
Pardi DS, Tremaine WJ, Sandborn WJ, & Zinsmeister AR. (2001). Predicting inflammatory bowel disease among patients with rectal b… Am J Gastroenterol, 11467946.
Strate LL, & Gralnek IM. (2016). ACG clinical guideline: management of patients with acute lower g… Am J Gastroenterol, 26757492.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrh… Hepatology, 16899897.
Q.
Right lower abdominal pain and diarrhea: what diagnoses are usually considered first?
A.
First-line diagnoses include acute appendicitis, infectious ileocolitis (Yersinia, Salmonella, Campylobacter, C. difficile, parasites), and Crohn’s disease of the terminal ileum. Depending on age and risk factors, clinicians also consider mesenteric adenitis, IBS, NSAID enteropathy, and less commonly Meckel’s diverticulitis, ileocecal tuberculosis, ischemia, or tumors; important red flags and next tests are outlined below.
References:
Rieder F, & Fiocchi C. (2014). Differential diagnosis of ileitis: when it is not Crohn's disease… Gastroenterology Clinics of North America, 25499990.
Bottone EJ. (1997). Yersinia enterocolitica: a brief review of the role of pigs as a reservoir… Clinical Infectious Diseases, 9233542.
Kim WR, & Kamath PS. (2021). Model for end‐stage liver disease (MELD) 3.0: updated calibration and validation in patients with cirrhosis… Hepatology, 34103975.
Q.
Sensation of incomplete evacuation: what does this symptom mean clinically?
A.
Clinically, the sensation of incomplete evacuation is the feeling that stool remains after a bowel movement even when the rectum is empty, most often tied to functional anorectal disorders like dyssynergic defecation or IBS-C, though structural issues such as rectocele or rectal prolapse can also play a role. There are several factors to consider, and appropriate next steps often include a focused history and exam, possible anorectal testing, and first-line care with fiber, hydration, pelvic floor physical therapy, and cautious use of laxatives, with urgent evaluation for red flags like bleeding, weight loss, or severe pain. See below to understand more.
References:
Bharucha AE, Wald A, & Enck P. (2016). Functional anorectal disorders… Gastroenterology, 27261812.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis… Journal of Hepatology, 16879838.
Castera L, Forns X, & Alberti A. (2008). Non-invasive evaluation of liver fibrosis using transient elastography… Journal of Hepatology, 18295713.
Q.
Urgent diarrhea: what does urgency suggest about the colon and rectum?
A.
Urgent diarrhea usually points to involvement of the distal colon and rectum, where inflammation or irritation reduces storage capacity, speeds transit, and makes the rectum hypersensitive with poor compliance. This leads to rapid, loose stools, tenesmus, and a strong need to pass small amounts of stool or mucus. There are several factors to consider, including infectious colitis, inflammatory bowel disease, IBS-D, radiation or ischemic injury, and medication effects, along with red flags that may require urgent care; see below to understand more.
References:
Riddle MS, Connor BA, Rao M, Sanders JW, Porter CK. (2016). ACG Clinical Guideline: diagnosis, treatment, and prevention of acute… Am J Gastroenterol, 27301435.
Tsochatzis EA, Bosch J, Burroughs AK. (2014). Liver cirrhosis. Lancet, 24613338.
Foucher J, Chanteloup E, Vergniol J, et al. (2006). Diagnosis of cirrhosis by transient elastography (FibroScan): a prospec… Gastroenterology, 16697759.
Q.
Urgent need to poop: what symptoms point to inflammatory bowel disease?
A.
Persistent urgent diarrhea, especially at night, with blood or mucus, abdominal cramping, tenesmus, unexplained weight loss, and fatigue suggests inflammatory bowel disease rather than IBS; extra clues outside the gut include joint pain or swelling, skin rashes, and eye inflammation. There are several factors to consider; see below for the key differences from IBS and the specific tests and red flags that guide next steps, including fecal calprotectin, blood work for inflammation and anemia, colonoscopy with biopsy, and imaging.
References:
Maaser C, Sturm A, Vavricka SR, et al. (2019). ECCO-ESGAR Guideline for Diagnostic Assessment in IBD: initial… Journal of Crohn's and Colitis, 31104639.
Halpin SJ, & Ford AC. (2012). Prevalence of IBS-type symptoms in inflammatory bowel… American Journal of Gastroenterology, 22745188.
Merli M, Giannelli V, De Santis A, et al. (2011). Thrombocytopenia is associated with increased mortality in… Clinical Gastroenterology and Hepatology, 21473902.
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Borghini R, Donato G, Alvaro D, Picarelli A. New insights in IBS-like disorders: Pandora's box has been opened; a review. Gastroenterol Hepatol Bed Bench. 2017 Spring;10(2):79-89. PMID: 28702130; PMCID: PMC5495893.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5495893/Fond G, Loundou A, Hamdani N, Boukouaci W, Dargel A, Oliveira J, Roger M, Tamouza R, Leboyer M, Boyer L. Anxiety and depression comorbidities in irritable bowel syndrome (IBS): a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci. 2014 Dec;264(8):651-60. doi: 10.1007/s00406-014-0502-z. Epub 2014 Apr 6. PMID: 24705634.
https://link.springer.com/article/10.1007/s00406-014-0502-zAltomare A, Di Rosa C, Imperia E, Emerenziani S, Cicala M, Guarino MPL. Diarrhea Predominant-Irritable Bowel Syndrome (IBS-D): Effects of Different Nutritional Patterns on Intestinal Dysbiosis and Symptoms. Nutrients. 2021 Apr 29;13(5):1506. doi: 10.3390/nu13051506. PMID: 33946961; PMCID: PMC8146452.
https://www.mdpi.com/2072-6643/13/5/1506Nee J, Lembo A. Review Article: Current and future treatment approaches for IBS with diarrhoea (IBS-D) and IBS mixed pattern (IBS-M). Aliment Pharmacol Ther. 2021 Dec;54 Suppl 1:S63-S74. doi: 10.1111/apt.16625. PMID: 34927757.
https://onlinelibrary.wiley.com/doi/10.1111/apt.16625