Understanding Irritable Bowel Syndrome and How To Manage It Day To Day

Speaking of Women's Health Podcast Host Dr. Holly Thacker dives into irritable bowel syndrome with a clear, compassionate guide to understanding symptoms, pinpointing triggers, and building a plan that actually sticks. From the brain–gut connection and hormone-driven flares to the role of the microbiome, you’ll hear how stress, sleep, and daily choices shape everything from cramping and bloat to bathroom urgency.

Dr. Thacker shares how to manage IBS symptoms, including the low FODMAP diet, adding fiber to your diet, drinking plenty of water, and daily exercise. She discusses probiotics and fermented foods, how to support a resilient microbiome, and why managing anxiety with CBT, mindfulness, and yoga can soften the gut’s overreaction to stress.

Transcript

Symptoms And Daily Impact

How Common IBS Is In Women

Brain–Gut Link And Triggers

Risk Factors And Overlapping Conditions

Diagnosing IBS And Rule Outs

Treatments And Lifestyle Foundations

Probiotics, Prebiotics, And Diet

Fiber, Dairy, Gas, And Food Journals

Low FODMAP, Hydration, And Exercise

IBS Versus IBD Warning Signs

Other GI Issues: Gallbladder And Appendicitis

Personal Appendicitis Story And Lessons

Heartburn, Cardiac Signs, And When To Seek Care

Modern IBD Care And IBS Empowerment

Closing And Listener Support

SPEAKER_00 0:07

Welcome to the Speaking of Women's Health podcast. I'm your host, Dr. Holly Thacker, the Executive Director of Speaking of Women's Health. And I am back in the Sunflower House for a new edition of our Speaking of Women's Health podcast. I also direct our Center for Specialized Women's Health at the Cleveland Clinic. And today I'm going to discuss irritable bowel syndrome, also known as IBS. So irritable bowel syndrome is a very common disorder that affects the large intestine. It's characterized by symptoms like abdominal pain, cramping, bloating, and changes in bowel habits that can alternate between diarrhea, constipation, or both. Now, some of the key aspects of IBS is that it's a condition that affects your gut. And your gut is a very large organ. And it can be a chronic lifelong condition. But the good news is it can be managed with lifestyle changes, diet, and sometimes medication. And symptoms can range from mild to severe, and they can vary quite a bit from person to person. And there's no specific cure, but there is management. And it's important to understand how your lifestyle and various treatments help you manage your symptoms to improve the quality of your life. And the impact that IBS can have on a person's life, it can affect work, school, social activities. Because if you're having abdominal pain or bloating or needing to run to the bathroom, that obviously affects your day. So you might ask, how common is IBS? Well, it's very common. In fact, research shows about 10 to 15% of adults in the United States have IBS. And guess what percent of those are women? You guessed it, 70 to 80 percent. And it's the most common condition that gastroenerologists, who are internal medicine physicians who go on and specialize in gastroenterology, diagnose. So the symptoms of IBS can occur frequently or maybe during flare-ups. You might not always experience symptoms. The most common symptoms are abdominal pain and cramping. And pain is often relieved after a bowel movement. You might notice change in your bowel habits like diarrhea, constipation, or the alternation between the two. You may feel like you never totally empty the bowel. And this can be a frustrating symptom for uh women and men experiencing IBS-related constipation. And constipation is more common in women. If you didn't hear my first podcast in season one, that wasn't uh the chapters of my book, The Cleveland Clinic Guide to Menopause, I talked about iron and constipation. Now, having a lot of mucus in the stool, that can be another symptom that can be associated with IBS. So even though we don't know what the exact cause is of IBS, it is thought to be related to a combination of factors. There's a really strong brain-gut connection. Um, you've heard the phrase, trust your gut, um, what's your gut feeling on something? And so it's a huge interaction. And if you have imbalances in your gut bacteria, that can contribute to bowel symptoms. If you have a gastrointestinal infection, um, food poisoning, a virus, uh, that can trigger the onset of IBS. We also think that childhood trauma and stress can be a risk factor for developing IBS in later life. In fact, a large percentage of women with chronic IBS have reported a history of sexual abuse. And so that's always an important part of your history to share with your clinician. Now, certainly food tolerances and sensitivities or allergies may contribute to IBS. If you didn't hear my podcast in the fall of 2024 on food freedom and the foods that we have in our United States food supply that are banned in other countries because of medical concerns, that's a good one to go back to listen to. So you might ask, does food or activity trigger IBS? You may or may not notice that certain things trigger your symptoms. Common triggers in women include menstrual cycles. You might notice that your IBS symptoms worsen predictably according to your menstrual cycle. And that can be true with other medical conditions like asthma, for instance, or migraine headaches, certain foods. Now, the food triggers do vary from person to person. Some of the common culprits known to make you irritable can include dairy foods or foods that contain gluten, like wheat. And you don't necessarily have to have true celiac disease to actually have gluten intolerance. And of course, there are certain foods and drinks that can make anyone more likely to be gaseous. Now, certainly stress. Uh, research does suggest that IBS is your gut's response to stress. And relatedly, this is why sometimes IBS is sometimes called a nervous stomach or an anxious stomach. So, what are the risk factors for irritable bowel syndrome? Well, it usually occurs in people in their late teens to early 40s, and women are twice as likely to get diagnosed with IBS. And the risk factors can include a history of abuse, physical, sexual abuse, intolerance to certain foods, severe digestive tract infections, and people who have a diagnosis of either anxiety, depression, or post-traumatic stress disorder are more likely to have IBS. And also, people that have IBS, women in particular who have other chronic pain conditions, can be associated with IBS. And I call them the serotonin kind of neurotransmitter triad. So fibromyalgia, chronic fatigue syndrome, and chronic pelvic pain many times are linked with IBS. So how is IBS diagnosed? Well, there's no single simple test. So the diagnosis is based on a good history and physical exam, importantly, ruling out other symptoms. So the medical history and physical exam, your physician or APP should take a detailed medical history and perform a physical exam to assess the symptoms and identify potential triggers. Ruling out other conditions is important. You may need stool samples, blood tests, and depending on age and length of symptoms, perhaps a colonoscopy or a sigmoidoscopy. You might also need imaging procedures to rule out inflammation or abnormal growth in the gastrointestinal tract. And that might include a full colonoscopy, which can help your clinician determine if you have certain bowel disorders that might be causing your symptoms, including IBD, which is inflammatory bowel disease. That's a serious condition. Certainly cancerous growths, polyps, inflammation can mimic IBS. A flexible sigmoidoscopy is similar to a colonoscopy, but it's much shorter. The scope only goes to the lower left side of the colon. Now, an upper endoscopy can help your medical team diagnose celiac disease or other GI conditions. And if you haven't heard our podcast on celiac, that would be a good one to go back to listen to, especially if you suspect that wheat or gluten may be making your gut irritated. Now you have been listening to the Speaking of Women's Health podcast. I'm your host, Dr. Holly Thacker in the Sunflower House, talking about a very common vexing condition in women: irritable bowel syndrome. And we are talking about the diagnosis of it. And now we want to move into treatment and management. So lifestyle changes for many chronic conditions usually always rank number one. And we usually start with diet modifications that might include a low FODMAP, F O D M A P FODMAP Diet. Stress management techniques are always a good thing. And our speaking of women's health.com website is loaded with lots of stress management tips as well as information on exercise and lifestyle, which also can help manage not just IBS but many other stress-exacerbating conditions. Now, in terms of medications, your physician might prescribe a medicine to slow down diarrhea or to treat constipation or reduce abdominal pain. Some gastroenterologists recommend IBGARD, which is a dietary supplement that helps manage cramping, diarrhea, bloating, bowel urgency, constipation, and gas. And stress management and mental health support, because since stress can worsen IBS, techniques such as cognitive behavioral therapy, mindfulness, and medication may be helpful. Yoga can be a very health-promoting activity. And if you didn't hear a podcast from a yoga expert that our executive producer Lee Clecker interviewed, that's a really good one to go back to. Now, probiotics, boy, probiotics, prebiotics really seem uh to be the rage. And some people do find significant relief from their IBS symptoms with probiotic supplements. Now, I usually tend to recommend prebiotic and probiotic foods that help your gut colonize the healthy gut bacteria, the bifidous bacteria. And so foods like yogurt that have active cultures of lactobacillus, kefir, fermented foods, kamici, um, pickles, those can be very important for your gut. And of course, avoiding things that are not good for your gut microbiome, like antibiotics. Um, and so if you need antibiotics for a bacterial infection, then you need to complete the course. But sometimes people visit urgent care when they have a viral infection and want antibiotics, and you have to think about how that's going to affect your gut. Now, what should you eat to avoid IBS symptoms or flare-ups? Well, generally speaking, having a good amount of fiber in your diet and eating fiber-rich foods like fruits and veggies and grains, prunes and nuts and seeds can help quite a bit if you're struggling with constipation, as well as keeping your fluid intake up. Introduce fiber slowly because you need to give some time for your gut to adjust. You might need to add supplemental fiber to your diet. And there's a lot of over-the-counter fiber supplements like metamucil and citrical. Some people find that if they limit dairy products like cheese and milk, lactose intolerance is more common in people with IBS. But if you cut back on dairy, you have to make sure you're getting non-dairy calcium-rich foods like broccoli, spinach, salmon, almonds, sesame seed, calcium-fortified orange juice, tofu. So there's a lot of non-dairy calcium-rich foods. Interestingly, you know, there's a lot of controversy, and state laws vary about raw milk, but there is a group of people that uh feel that their GI symptoms are much better if they ingest raw milk. But there's always the chance of potential infection if milk is not pasteurized. So it's really important to uh work with your physician, a local trusted dairy farmer, as well as to understand what the rules and regulations and laws in your particular locale. Now, limiting foods that can make you gassy is kind of a good idea for most people, even though a lot of the foods that can make people gassy are healthy foods like beans. In fact, beans are a big part of the mind diet, which is the Mediterranean diet, plus beans to help reduce cognitive decline. Other foods that can make you gassy, which are really good for your, you know, uh pre- and probiotic status of your gut, are foods like Brussels sprouts and cabbage, but they can be notorious in some people for causing gas. Now, so can carbonated sodas, and there's no reason why anyone has to ingest carbonated sodas or any carbonated drinks. And even chewing gum can make some people gassier. So you might want to reduce these foods and go easier on your gut. I do think that it's helpful to keep a food journal and an activity journal. Whenever you have a chronic symptom, that some days are so much better than others, and it can be kind of vexing to figure out what your triggers are, whether it's headaches or chronic pain or irritable bowel syndrome. Um if you keep a journal, that many times can help you and your healthcare team figure out what might be your triggers. Now, avoiding gluten. People with IBS, even those without celiac, do seem to be a lot more sensitive to gluten. And if you opt for a gluten-free diet, you've got to work with a team and perhaps a nutritionist to make sure you're getting enough of the key vitamins and minerals like fiber and iron and calcium. Now, some people find that it all depends on how uh the wheat-containing foods are processed. Um, like I frequently hear patients say, I can't eat bread, I can't have pizza in the United States, but when I'm in Italy, no problem. Uh, so it may be somewhat in the processing of these foods. Now, in general, your healthcare team, and this is not medical advice, this is just empowering health information to empower you to be strong and be healthy and be in charge and come prepared, you know, to your medical visits. So, your healthcare team might recommend that you try the so-called low FODMAP diet. So, this food plan reduces the amount of hard-to-digest carbohydrates that you might eat. And it recommends alternatives that allow you to get the nutrients you need while going much easier on your GI tract. And as I've often said on this Speaking of Women's Health podcast, there is no essential carbohydrate. There are essential proteins, amino acids that are the building blocks of protein, and essential fats. So you can safely eliminate carbohydrates generally from your diet under medical supervision. Now, minerals, some vitamins, things do have to be balanced and under supervision. It is important to drink plenty of water, at least eight-ounce glasses of water, which is about two liters. Water keeps your gastrointestinal tract kind of lubricated and many times can treat or help prevent constipation because your colon's purpose is to extract water from the GI effluent. And if you're dehydrated, it's going to extract all the water it can, which makes for very hard stools. As I mentioned, keeping a food diary to note how you might respond to foods. Other lifestyle changes that you can make are to aim for regular exercise. And this is just general good health habits, aiming for about 150 minutes of moderate exercise weekly. So that's about 30 minutes a day, five days a week. And moderate means you know you're a little tiny bit short of breath and you're raising your heart rate. Relaxation techniques like daily yoga or meditation or other de stressing techniques can really help calm down an overtaxed nervous system and a nervous gut. Sometimes you may need to actually see a behavioral therapist. You might want to check out and see if if you're in the workplace, if there's any employee stress help that's available. Now getting enough sleep is definitely important for any chronic condition and for just good general health. And we've had several podcasts on sleep. So if sleep is one of your Achilles heels, please go back and listen to those. You can go on the website, speaking of women's health.com, look at podcasts, and in the podcast section, which will list all our seasons, put in the topic you're interested in and hit enter. And then you can get the exact dates of the podcast that you're interested in listening to that I've referenced. And then you can go back to whatever podcast app you listen to on Spotify or tune in and find that specific one. In general, most adults need seven to nine hours of quality sleep each night. And going to bed at the same time each night and waking up the same time, regardless of what the day of the week is, is an important health hygiene. And getting a good night's rest is really one of our uh most powerful de stressors available. And if you're having trouble falling asleep, staying asleep, or getting up too soon, it's time to make an appointment with your healthcare clinician. So you may ask, uh, what's the difference between IBD and IBS? And so unlike IBD, IBS isn't a full-blown disease because it doesn't intrinsically damage the bowel. But inflammatory bowel disease does uh damage the bowel and may actually increase risk for other conditions and even cancer. But even though IBS isn't reflective of a damaged bowel, just a malfunctioning one, it still can cause great discomfort as well as embarrassment and inconvenience. Twice as many women than men have inflammatory bowel disease, which mainly consists of Crohn's disease and ulcerative colitis. And with Crohn's and ulcerative colitis, actually intestinal damage can occur. And abdominal pain, cramping, and diarrhea are symptoms, but also there may be blood in the stool. And blood in the stool is a red flag symptom. Now, if you've eaten a lot of red beets, your stool may look red but not have blood in it. But it's pretty easy for your physician to do a test on the stool and see if there's blood. And if there is blood mixed in with the stool, then clearly you know that that's blood as opposed to just red stool from eating too much, too many beets or drinking a lot of beet juice. If you are having any kind of symptoms of either IBD or IBS, uh you really have to consult with your physician or even a specialist like a gastroenterologist for proper diagnosis and management because the conditions of ulcerative colitis after several years can increase dysplasia and cancer. So more frequent GI screenings are needed. Women that are thinking about pregnancy who have GI conditions really want to get them optimized before pregnancy. In fact, untreated celiac disease can reduce fertility, lead to osteoporosis, uh, the inflammatory bowel disease conditions, if they're associated with blood loss, can lead to anemia, low blood, low iron, fatigue. Sometimes there can be fistulas or communications between the bowel and other parts of the body like the bladder, the vagina. There can be extra GI manifestations of inflammatory bowel disease that can affect the skin, the joints. Um IBD is very serious, uh, and you need to have these conditions evaluated and get a good treatment plan and get periodic evaluation. Well, I would like to talk about some other relatively common gastrointestinal problems that people might mistake initially for IBS, irritable bowel syndrome. And one of those is gallbladder problems. And women are a lot more likely to have gallbladder problems. In fact, if you're female, fair skinned, and over 40, um, and especially if your cholesterol's up and/or you have a family history of gallstones, if you notice that after eating foods, especially like fatty foods, uh, you get pain in your right upper quadrant. That can mean that you've got gallbladder problems. And certainly women can have, or men as well, IBS as well as gallbladder problems, as well as potentially other gastrointestinal problems. In general, if you have a fever, if you're throwing up, uh, that would be reflective of some other kind of acute gastroenteritis or an acute abdominal problem, and you would not want to just brush that off as, oh, I have a nervous stomach or a sensitive gut, um, because generally those are not symptoms that are associated. Another relatively common condition, which can be life-threatening, um, I recently experienced it. I was in Alabama visiting my uh brother and nephew and my new grandnephew, Sammy. I was so excited to see them. And uh I was in Alabama visiting, and after a really nice dinner, I just kind of noticed that my stomach didn't feel right. I had some epigastric kind of perimbilical discomfort. And that progressed, and I kept ignoring it, and I just thought, oh, you know, maybe it's travel-related GI symptoms. And then it persisted, and um, I was golfing with my family, and I couldn't finish even after the fourth hole. I had to stop, and that is just not like me. And then I developed the fever, and then my non-medical husband was looking up signs of appendicitis, and I didn't think I had appendicitis because I still could eat a little. And in medical school, they teach you well, people with appendicitis have no appetite, they cannot jump up and down because they have peritoneal signs. Um, and I didn't want to go into an emergency room, especially in another state, that you know, I just had GI upset, or maybe I thought I had some travel bug or wasn't used to the drinking water. But when my uh husband did the sign to check to see if there was any kind of inflammation near the ileosois uh muscle, and I screamed, he was like, okay, it's time to go to the hospital. And sure enough, I had actually had a perforated appendix and was really very thankful for getting such excellent care on the road. Um, and got antibiotics and was rushed in to emergency surgery, and luckily was able to go home with a drain and fully recovered. And appendicitis is very common actually. Over 7% of women will experience uh appendicitis in their lifetime, and over 8% of men. So even if you don't have a fever, even if you think you can eat, even if you think, oh, is this constipation or is this just a GI bug or is this just my IBS flaring up, rupturing your bowel, where the bowel contents are released into the peritoneum, which is an area that's supposed to be sterile, um almost, not entirely, but almost uniformly can result in death if it's not treated. So uh that was really kind of a personal lesson. Um, you know, when in doubt, it's better to seek medical attention. Uh it's just like it's Experiencing what you think might be heartburn. That's another very common GI condition. In fact, um, if you haven't listened to the podcast we did on gastroesophageal reflux, that's a good one to listen to. But you know, you feel like, oh, I have this elephant sitting on my chest, or I have this burping, or this irritation, or I can't take quite a deep breath, or I just don't feel good. A lot of times, especially women many times will think, oh, it can't be heart problems. I don't have any heart problems. And it can be. Uh, and that might be your first sign or symptom of cardiac disease. And people can die from a myocardial infarction, a heart attack. So when in doubt, when you've got new symptoms, disturbing symptoms, symptoms that really just don't quite add up, that aren't part of maybe a regular pattern that you've experienced in the past of abdominal cramping or bloating or GI distress with diarrhea or ultra-rating constipation, which are more likely if they're part of a chronic intermittent pattern, part of your um IBD or IBS. IBD is inflammatory bowel disease. And if you're having a bad flare of your inflammatory bowel disease, that is also a warning that it's time to maybe get reassessed with your gastroenterologist, see your primary care doctor, see if there's, you know, there's a lot of new biologic agents, um, there's various dietary therapies, and in conjunction with immunologic and medications, uh, that have really improved the quality of life uh for those suffering with inflammatory bowel disease. And for irritable bowel syndrome, well, which we've spent most of the podcast talking about, uh, you can be empowered that there are some strategies that can help you manage this condition and live a full life. So I want to thank our listeners for joining me in the Sunflower House for another edition of Speaking of Women's Health. If you enjoyed this podcast, please give us a five-star rating. Uh share it with friends or family or someone you know who might be suffering with IBD or IBS. And if you don't already subscribe, hit follow collect, which is free on all the podcast apps. Thanks again. Remember, be strong, be healthy, and be in charge.