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Irritable bowel syndrome (IBS) affects people in different ways. But everyone with IBS gets pain and discomfort. You may also have diarrhea, constipation or bouts of both. You may sometimes feel bloated.

Some people with IBS only have mild symptoms for short periods. Others have unpleasant symptoms that last a long time. Many people have occasional flare-ups of their symptoms, often during times of stress.

You get symptoms because your bowel isn't working properly. Keep in mind that although IBS can be unpleasant, there is nothing seriously wrong with your bowels. IBS doesn't lead to more serious illnesses, like cancer.

Although symptoms vary a lot from person to person, there are four key symptoms.^{1 2}

• Pain. You may feel pain or discomfort in parts of your abdomen. The pain may be very bad. It may move around, and you may not be able to say exactly where it is. The pain may come and go. If you are a woman, it may get worse when you have your period. The pain may go away when you go to the bathroom or pass gas.
• Bloating. You may be bloated or have a feeling of fullness in your abdomen. You may pass more gas than usual.
• Diarrhea. Your stools may become loose and watery. You may need to go to the bathroom more often, or feel you need to go urgently.
• Constipation. Your stools may become small and hard. Going to the bathroom may be difficult or uncomfortable.

You get these symptoms because the muscles which form the wall of your bowels aren't working as they should.

• Your muscle might be contracting too quickly, so the food in your bowels gets pushed along too fast. There isn't time for water from the food to be absorbed into your bloodstream, so your stools become watery and you get diarrhea.
• Or the muscles may work very slowly or even stop working for a while. This means the food stays in your bowel for a long time. A lot of water gets absorbed into your bloodstream from the food. Your stools become hard and difficult to pass, making you constipated.
• The muscles in your colon may also go into spasm and cause cramping pain. Spasms are sudden, strong muscle movements that come and go. If you have spasms, gas or waste from food can get trapped in your colon. This can make you feel bloated.

Some people with IBS get diarrhea. Others have constipation, and some people have bouts of both. Lots of people with IBS have a feeling of not fully emptying their bowels when they go to the bathroom. You may also pass mucus when you go to the bathroom.

You may get symptoms that affect your stomach, such as burping or feeling nauseated.¹ And you could get symptoms that don't seem connected with your bowels. You may:^{3 4}

• Feel the need to pass urine frequently
• Get painful periods
• Get back pain
• Feel tired often
• Have trouble sleeping
• Get headaches
• Get pain in the jaw and face
• Get pain and stiffness in some of your muscles (fibromyalgia).

Doctors don't really know why people with IBS have these problems. It may be that people with IBS worry more about their health, so are more likely to go to their doctor with these kinds of problems. Or it may be that the things that cause IBS also cause other problems. For example, if you are under stress, this could affect other parts of your body, too.

Symptoms similar to IBS may occasionally be a sign of something more serious. You should see your doctor if you:¹

• Pass blood in your stools. But keep in mind most people with blood in their stools only have piles (hemorrhoids)
• Lose weight for no reason
• Feel very tired all the time. You could be anemic. Anemia is when you don't have enough oxygen-carrying red blood cells. This can happen if you've been bleeding because of another condition in your bowels, such as small growths (polyps) or cancer
• Feel a lump in your abdomen
• Have a fever
• Get symptoms for the first time after the age of 50.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.