April is IBS Awareness Month, and here at The Crohnโs and Colitis Dietitians, we work with many individuals who have both IBS (irritable bowel syndrome) and IBD (inflammatory bowel disease) โtwo digestive conditions with similar symptoms but very different root causes and outcomes.ย
Both acronyms are easy to confuse, especially when youโre dealing with gut issues like bloating, diarrhea, and abdominal pain. But despite those overlapping symptoms, IBS and IBD are distinct conditions with different diagnoses, treatment approaches, and long-term outcomes.
In todayโs blog, weโll walk you through:
- The differences between IBS and IBD
- Why some IBD symptoms persist even during remission
- Common lookalike conditions we see in our practice
- Case studies from clients
IBS vs. IBD
Did you know that up to half of those with IBD also have IBS?
There are also many things those with IBD deal with that look like IBS but aren’t.
Even when the disease is controlled and inflammation is low – there can still be lingering symptoms that need support. Check out our video where we dive into more on this topic.
IBS: Irritable Bowel Syndrome
IBS is considered a functional gut disorder, meaning there are no structural or biochemical changes to the gut. Instead, it involves a disruption in how the brain and gut communicateโoften referred to as the gut-brain axis.
Key Features of IBS:
- Recurring abdominal pain
- Bowel changes: diarrhea, constipation, or both
- No visible inflammation or damage to the intestines
- Diagnosed using Rome IV criteria (after ruling out other causes)
There are four main types of IBS:
- IBS-D: Diarrhea-predominant
- IBS-C: Constipation-predominant
- IBS-M: Mixed (diarrhea and constipation)
- IBS-U: Unclassified
Prefer to watch? Check out our Youtube here!
IBD: Inflammatory Bowel Disease
IBD is an umbrella term that includes:
- Crohnโs Disease (CD)
- Ulcerative Colitis (UC)
- Microscopic Colitis (MC)
Unlike IBS, IBD involves chronic inflammation and immune system dysfunction that can lead to:
- Diarrhea
- Cramping and abdominal pain
- Bleeding
- Ulcers
- Fatigue
- Malnutrition
- Strictures or fistulas
Diagnosis often includes endoscopy, imaging, biopsies, blood work, and stool testing. Treatment may involve:
- Medication: immunosuppressants, biologics, corticosteroids
- Surgery
- Nutrition therapy, including personalized dietary strategies
What If Youโre in RemissionโBut Still Have Symptoms?
Itโs common for people with IBD to feel confused or frustrated when gut symptoms continue even after inflammation has resolved. You might be thinking:
“Is this still my IBD? Or is something else going on?”
This is where a deeper dive is often needed. Many people with IBD also meet the criteria for IBS, or may have other conditions that mimic IBS symptomsโlike bile acid malabsorption, SIBO, food intolerances, or Celiac Disease.
Want to learn more about “when it isnโt IBS”? We discuss this further here!
What Dietitians Look For When You Still Have Symptoms in Remission:
We consider many possibilities when supporting someone with persistent GI symptoms, including:
- Do they meet the diagnostic criteria for IBS?
- Are their stools floating and greasy? Could this be bile acid malabsorption?
- Have they been tested for SIBO (Small Intestinal Bacterial Overgrowth)?
- Could it be fructose malabsorption or lactose intolerance?
- Have they ever been screened for Celiac Disease?
- Have they had surgeries before? Have they given birth? Could this be pelvic floor dysfunction?
While dietitians canโt diagnose, we act as detectivesโhelping you and your healthcare team get to the root of your symptoms and guiding personalized nutrition strategies.
Now letโs discuss a few case studies of when people with IBD have had GI symptoms that turned out to be something else.
Note: names and ages have been altered for confidentiality.
Case Study 1: The Urgency That Wouldnโt Quit
Sarah, age 32 โ Diagnosed with Microscopic Colitis (MC)
Sarah had been in clinical remission for over a yearโall labs were within normal limits and a recent colonoscopy with biopsy showed no inflammation. However, despite the lack of inflammation, she still dealt with daily urgency and loose stools.
At first, she assumed it was โjust her MC acting up.โ But further testing revealed bile acid malabsorption (BAM)โa condition where bile acids irritate the colon, causing diarrhea. After introducing a bile acid binder prescribed by her doctor, prioritizing soluble fibers, and adjusting fat intake, her symptoms significantly improved.
Takeaway: BAM affects up to 43% of people with Microscopic Colitis and may be misdiagnosed as IBS-D.
How we addressed it: We brought in things to help reduce bile acid malabsorption and soluble prebiotic fibers to help with urgency and loose stools. Her intake was also significantly low when we started working together which we think may have also contributed to symptoms so we made sure to help support her in bringing in foods in a more tolerated way.
Case Study 2: The Bloat That Took Over Her Life
Lena, age 29 โ Diagnosed with Crohnโs Disease (CD)
Lena had undergone a small bowel resection years ago and was doing well overallโbut now dealt with persistent bloating and fatigue soon after meals.
A hydrogen breath test revealed SIBO (Small Intestinal Bacterial Overgrowth), likely due to structural changes of the intestine from surgery. After a treatment of antibiotics recommended by her doctor and dietary modifications to help with fatigue, her symptoms improved drastically.
Takeaway: SIBO is more common in Crohnโs, especially post-surgery or when gut motility is impaired.
How we addressed it: We ran nutrient testing and found that Vitamin D and B12 were low so we worked on treating the deficiencies. We worked on strategies to support the microbiome overall and used selective prebiotics that targeted what the SIBO testing showed. Bloating reduced by 65% after working with us and energy also improved significantly.
Case Study 3: The Mystery Symptoms
Jared, age 40 โ Diagnosed with Ulcerative Colitis (UC)
Despite a history of UC and being, Jared developed diarrhea, extreme bloating, and brain fog. He was constantly fatigued and had low iron and B12 labs.
Lab work showed elevated inflammatory markers, but a deeper nutrition review revealed undiagnosed Celiac Disease. Once gluten-containing foods were removed, symptoms resolved within 4-6 weeks and he had more energy to do the things he enjoys.
Takeaway: Overlapping autoimmune conditions can explain lingering symptomsโand are sometimes missed in routine IBD follow-ups.
How we addressed it: We took out gluten and helped him spot hidden places people often don’t often notice gluten in.
Is it IBS or something else?
If youโre living with IBD and still dealing with gut symptoms in remission, let us help you dive deeper! Working with a dietitian specializing in IBD and gut health can help provide you with personalized support and strategies for your symptoms.
As gut health dietitians, this is what we do every dayโlook beyond the surface, and support you in finding clarity and relief. Schedule a call with the Crohnโs and Colitis Dietitians today to work towards your symptom relief.
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