IBD vs. IBS: Key Differences, Symptoms, Causes, and Treatment Options

What Is Inflammatory Bowel Disease (IBD)?

IBD is not just a bad tummy - it’s a chronic inflammatory condition where your immune system goes rogue and attacks your gut. IBD causes structural damage to the intestines and other parts of the gut. The two most common types of IBD are,

Crohn’s Disease

• It can occur at any part of the gastrointestinal tract (GIT) from mouth to anus.
• It causes inflammation of deep layers of tissues, leading to pain, blockages, and sometimes, fistulas.
• Crohn’s is mainly like a roller coaster, with flare-ups and calm periods.

Ulcerative Colitis

• It affects the colon and the rectum (the large intestine).
• It causes inflammation and ulcers in the innermost layer of the intestine, leading to bloody diarrhoea.

Why Does IBD occur?

• Scientists are still piecing it together, but a recent study states that IBD is an inappropriate response to the healthy intestinal flora.
• It is a mix of genetics, abnormal immune responses, and environmental triggers.

Additional Forms of IBD

Microscopic Colitis

• It is a less common variant of IBD characterised by chronic, watery diarrhoea. It usually required the use of a microscope for diagnosis.

Indeterminate Colitis

• It is a type of IBD where both Crohn’s and ulcerative colitis are present, but a definitive differential diagnosis is not possible.

What Is Irritable Bowel Syndrome (IBS)?

IBS is a functional gastrointestinal disorder, meaning it affects the functions of the body, such as bowel movements and gut motility, rather than causing inflammation and damage.

A study has found that there is a relationship between the gut-brain axis and IBS. The hampered gut-brain axis leads to abnormal contractions of gut muscles and abnormal gut motility.

To learn more about the gut-brain connection, click here.

Depending upon the clinical presentation, IBS is classified into three main types. They are,

• IBS-D (Diarrhoea-predominant): It is the most common and frequent type of IBS that is associated with an increased frequency of loose stools.
• IBS-C (Constipation-predominant): It is a type of IBS characterised by difficulty in passing stools, often hard or infrequent.
• IBS-M (Mixed type): It is a type of IBD that alternates between diarrhoea and constipation.

A study states that Irritable bowel syndrome (IBS) is a chronic and debilitating functional gastrointestinal disorder that affects 9%-23% of the population across the world. 

Key Differences Between IBD and IBS

Type 

• IBD is an autoimmune inflammatory disorder of the digestive tract.
• IBS is a functional disorder of the large intestine.

Inflammation and Damage

• IBD causes inflammation, leading to bleeding, ulcers, fistulas, and permanent intestinal damage.
• In IBS, there is no inflammation or tissue damage to the gut. The digestive system is structurally normal in this condition, whereas there is an alteration in the functions of the large intestine, leading to discomfort.

Underlying Cause

• The exact causes of IBD and IBS are unclear. After detailed research, scientists claim the following to be the causes of IBS and IBS.

The most common causes of IBD are,

• Genetic Susceptibility: A family history increases the likelihood of developing IBD.
• Immune System Dysfunction: An abnormal immune response attacks the intestinal lining.
• Environmental Factors: Smoking, diet, and infections may contribute.
• Imbalance in Gut Microbiota: Disruptions in gut bacteria play a role in inflammation.

The factors contributing to IBS are,

• Abnormal Gut Motility: The intestines contract too fast or too slow, leading to diarrhoea or constipation.
• Gut-Brain Axis Miscommunication: Your gut and your brain are interconnected. IBS can be caused by a failure to communicate effectively between the gut and brain.
• Increases Pain Sensitivity: The intestines tend to react more intensely to normal digestive processes.
• Microbial Imbalance: Any changes in gut bacteria composition can trigger symptoms.
• Emotional Stress: Anxiety, depression, and stress are known to aggravate IBS symptoms.

Symptoms

Common symptoms of IBD are,

• Bloody stools (a sign of intestinal bleeding due to inflammation).
• Severe diarrhoea (due to increased gut motility).
• Loss of appetite and nutritional deficiencies.
• Unintended weight loss (the intestines fail to absorb good nutrition).
• Fatigue (due to loss of water and electrolytes from the body).
• Joint pain (often a result of inflammation).

Common symptoms of IBS are,

• Mucus in stools (most common symptoms of IBS).
• Recurrent abdominal discomfort (gets relieved after passing stools).
• Chronic bloating and excessive gas.
• Irregular bowel habits (often alternating between diarrhoea and constipation).
• Sudden urgency to pass stools in IBS-D.

Complications

• IBD can lead to fistula, stricture, or increase the risk of cancer.
• IBS does not have such complications, but it can lead to daily life struggles.

Duration and Pattern

• IBD symptoms can last for a prolonged duration, which results in periods of flare-ups followed by periods of remission. The inflammation in IBD can lead to permanent damage to the intestines if not properly treated.
• IBS symptoms are chronic, but they do not affect the structural integrity of the digestive tract. The common trigger factors are stress, diet, and hormonal changes.

Diagnosing IBD and IBS

There are various tools to diagnose IBD and IBS. 

Diagnosing IBD,

• Blood Tests: They are done to detect inflammatory markers, active infections, and anaemia due to blood loss.
• Stool Analysis: This is done to look for blood in stools and check for inflammatory markers or the presence of infection-causing organisms.
• Colonoscopy/Sigmoidoscopy: It is a test where a small camera is inserted into the anus to examine the intestines and collect samples for biopsy.
• Imaging tests (CT/MRI scans): They are done to determine the extent of damage to the intestine and to assess which part of the intestine is involved.

Diagnosing IBS,

• Rome III Criteria: It is used to assess IBS on the basis of symptoms.
• Stool tests: To ensure there is no involvement of infection or inflammation.
• Blood tests: Blood tests are done to check for involvement of other intestinal diseases.
• Colonoscopy: To rule out serious conditions.

Treatment Options for IBD and IBS

There are various treatment options available that help manage and combat the symptoms of IBD and IBS.

Treatment options for IBD are,

The main focus in treating IBD is to reduce the inflammation.

• Anti-inflammatory Medications: Since IBD is an inflammatory disease, the main focus would be to reduce the inflammation, which helps manage the symptoms.
• Immunosuppressive drugs: They reduce the activity of the immune system and prevent it from attacking the body’s healthy cells.
• Biologic therapies: These therapies help stimulate and restore the body’s normal immune response.
• Surgical intervention: Not all cases require surgical intervention. In cases of severe damage to the intestinal tissue or due to complications such as fistulas or strictures, surgery might be an option.
• Dietary adjustments: It is often helpful if a low-residue or anti-inflammatory diet is followed.

Treatment options for IBS,

In IBS, the main focus is to correct digestion and improve bowel movement.

• Nutritional changes: Indulge in a low FODMAP diet (fermentable carbohydrates) to gain symptomatic relief. Reduce caffeine, alcohol, processed foods, or foods that alter digestion. If you are suffering from IBS-D, befriend a fibre-rich diet. 
• Medications: Laxatives can help relieve constipation if you are suffering from IBS-C. In IBS-D, antidiarrheals are a better option. Antispasmodics are used to reduce abdominal pain and cramps.
• Probiotics: Probiotics are an excellent option to restore the gut microbiota.

Click here to learn more about vegan probiotics.

• Psychological therapies: Relaxation techniques or cognitive behavioural therapies (CBT) should be used to manage stress and emotions.

How Can Ayurveda Help

The experts of Ayurveda have coined a unique term called Grahani Roga for both IBD and IBS. Grahani” refers to the digestive tract, and it is the primary seat of “agni”, the digestive fire. Ayurvedic treatments for Inflammatory Bowel Disease focus on improving digestion and reducing inflammation in the digestive tract.

To understand how Ayurveda can help in IBD, click here.

When to Seek Medical Attention

When should YOU see my doctor? It is the one thing we always question ourselves. 

The earlier, the better! Do not ignore the early symptoms that your body is trying to communicate. Listen to your body.

For IBD,

• If you have chronic diarrhoea with blood or mucus.
• Unexplained weight loss and severe fatigue.
• Continuous abdominal pain and fever.

For IBS,

• If the symptoms are interfering with your daily activities.
• A constant change in your bowel habits.
• Unexplained weight loss or excessive mucus in stools, or the presence of blood in the stool (could indicate another condition like carcinoma of the rectum).

Wrapping Up

At times, we tend to ignore our gut health. We tend to cave into our cravings, which leads to gut disturbances.

IBD is an inflammatory disorder that requires immune-modulating treatment, whereas IBS is a functional disorder that is best managed through dietary and lifestyle changes. IBD can cause serious complications leading to permanent intestinal damage, while IBS does not cause permanent intestinal damage but significantly impacts the quality of life.

Early diagnosis is crucial to managing symptoms and preventing complications in both IBD and IBS.