Thought it was IBS? It could be IBD – Here's how to tell

What is IBD (inflammatory bowel disease)?

Inflammatory bowel disease is a chronic condition in which the immune system turns against the digestive tract, triggering persistent inflammation and causing real, physical damage to the gut lining over time. It is not something you caused, and it is not something that will simply go away on its own.

Morgan Binder, PA-C, RD, a gastroenterology clinician specializing in nutrition care, describes IBD as “a chronic immune-mediated disease of the GI tract” marked by inflammation, ulceration, tissue damage, and periods of relapse and remission.

IBD is an umbrella term for two main conditions:

Crohn's Disease – inflammation that can occur anywhere in the digestive tract, from mouth to anus, often affecting deeper layers of the gut wall.

Ulcerative Colitis (UC) – inflammation confined to the inner lining of the large intestine and rectum.

Both conditions cause real, measurable changes in the body – which is why diagnosis involves tests, scans, and often a colonoscopy.

Because IBD causes real inflammation and tissue damage, diagnosis usually requires medical testing such as blood work, stool tests, imaging, and often a colonoscopy to directly examine the digestive tract.

Gastroenterology clinician Morgan Binder, PA-C, RD, notes that many people with IBD also face nutritional challenges over time, particularly when symptoms such as diarrhea, abdominal pain, reduced appetite, or malabsorption begin to interfere with eating and nutrient absorption. This is one reason why IBD care often involves both medical treatment and nutritional support.

What causes IBD?

The exact cause of IBD isn't fully known, but research points to a combination of genetics (IBD often runs in families), immune dysfunction where the body attacks its own gut tissue, environmental triggers including diet and antibiotics, and gut microbiome imbalance.

IBD is not caused by

• stress

• diet choices

• anything you did wrong.

It’s a complex medical condition – and it deserves to be treated as one.

How common is IBD?

IBD affects more than 7 million people worldwide, with prevalence rising across all age groups and regions.¹ It can develop at any age, though it is most commonly diagnosed between the ages of 15 and 35.

It affects men and women in roughly equal numbers and occurs across all ethnicities, making it one of the most widespread chronic gastrointestinal conditions globally.

What does IBD look like? Common symptoms you might be experiencing

IBD tends to follow a pattern of flares (active symptoms) and remission (periods of calm). This unpredictability is one of the hardest parts of living with the condition – and it's completely valid to find it exhausting, frightening, or isolating.

The most common IBD symptoms

Persistent diarrhea – sometimes with blood or mucus

Abdominal pain and cramping – often recurring and unpredictable

Fatigue that doesn't improve with rest – exhaustion is a real symptom

Unintended weight loss – often a sign the gut is struggling to absorb nutrients

Reduced appetite – eating can start to feel like a trigger

Fever during flare-ups – a sign the immune system is actively responding

IBD can also affect areas outside the gut, including joints, skin, and eyes – known as extra-intestinal manifestations.

What is the difference between IBS and IBD?

This is one of the most searched questions in gut health – and for good reason. The two conditions share overlapping symptoms but have fundamentally different causes, diagnoses, and treatments.

The key difference: IBS is a functional condition – the gut looks normal but behaves abnormally. IBD is a structural condition – the gut shows visible inflammation and damage.

Many people arrive at an IBD diagnosis after first being told they have IBS. If your symptoms have been dismissed or you're still searching for answers, you may require further investigations.

Is IBD a gut-brain disorder like IBS?

You may have heard the term 'gut-brain disorder’ or Disorder of Gut-Brain Interaction (DGBI) – which is used to describe conditions like IBS, functional dyspepsia, or rumination syndrome where the communication between the brain and the gut plays a central role in symptoms.

IBD is not a gut-brain disorder – instead, it’s an immune-mediated condition with a clear physical cause – inflammation – that requires medical treatment.

That said, IBD and gut-brain disorders are closely connected in important ways: many people with IBD also develop IBS-like symptoms even during remission, suggesting gut-brain dysregulation can co-exist.

Stress and anxiety don’t cause IBD, but they can trigger flares and worsen symptoms.

The gut microbiome – a key player in gut-brain communication – is often disrupted in people with IBD. And psychological support, mindfulness, and gut-directed therapies can meaningfully improve quality of life for people with IBD, even if they don't treat the inflammation itself.

So while IBD lives in a different category from IBS and other gut-brain conditions, the two worlds overlap more than most people realize.

How is IBD diagnosed?

If your healthcare provider suspects IBD, you'll likely have blood tests to check for inflammation and anemia, stool tests measuring inflammation markers like calprotectin, a colonoscopy to view the gut directly and take biopsies, and an MRI or CT scan to assess the extent of inflammation.

Reaching a definitive diagnosis can take time – in some cases, distinguishing between Chrons and UC (the 2 types of IBD) requires multiple investigations and even then the picture isn't always clear.²

If you're pre-diagnosis and waiting for these tests, it's okay to feel anxious. Write down your symptoms, note when they happen, and bring that information to your appointment – you are your own best advocate.

How do I treat IBD?

There is currently no cure for IBD, but effective treatments exist that can bring and maintain remission. The approach is highly individual – what works for one person may not work for another – and finding the right combination often takes time and close collaboration with your gastroenterologist.

Treatment typically involves some combination of medications including anti-inflammatories, immunosuppressants, and biologics, dietary support from a specialist dietitian, and mental health care to address the psychological weight of living with a chronic condition. For some people, surgery is necessary – and for those with Ulcerative Colitis, removing the colon and rectum eliminates the disease at its source.³

Dietary strategies can also play an important role in symptom management. As Binder explains, the Mediterranean diet is often the most practical starting point because it is less restrictive and appropriate in many IBD scenarios, while more restrictive diets may be considered in select cases.

Research also highlights that many IBD symptoms are not driven by active inflammation alone – making psychological support and stress management a meaningful part of comprehensive care, not just an afterthought.⁴ This is where the gut-brain connection becomes particularly relevant for people with IBD, even though IBD itself is not a gut-brain disorder.

Can I live a normal life with IBD?

IBD is a lifelong condition, but for most people it is manageable.

With an accurate diagnosis, the right treatment plan, and a care team that understands the condition, many people with IBD achieve long periods of remission and maintain a good quality of life.

The earlier it is identified and treated, the better the outcomes tend to be.

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Frequently asked questions

Can IBD be silent with no symptoms?

Yes. Active inflammation can be present without obvious symptoms – sometimes called subclinical IBD. This is why regular monitoring matters even when you feel well, as damage can continue silently between flares.

Is IBD hereditary?

IBD is not directly inherited, but genetics play a role. Having a first-degree relative with IBD increases your risk. Most people with associated genetic variants never develop the condition, suggesting environment and the gut microbiome are also significant factors.

Can children get IBD?

Yes – IBD can develop at any age. It is increasingly diagnosed in children and teenagers, and is sometimes missed because symptoms overlap with other conditions. In children, IBD can also affect growth and development, making early diagnosis especially important.

What is an IBD flare?

A flare is a period of active inflammation when symptoms such as pain, diarrhea, and fatigue return or worsen. Between flares, many people experience remission – when symptoms ease significantly or disappear. The goal of treatment is to reduce the frequency and severity of flares.

Does IBD cause cancer?

IBD does not directly cause cancer, but long-standing IBD – particularly extensive Ulcerative Colitis – is associated with a moderately increased risk of colorectal cancer.⁵ The good news is that regular colonoscopies and keeping the disease well managed can meaningfully lower that risk.⁶

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References

1. Solitano V, Bernstein CN, Dotan I, et al. Shaping the future of inflammatory bowel disease: a global research agenda for better management and public health response. Nat Rev Gastroenterol Hepatol. 2025;22:438–452. doi:10.1038/s41575-025-01063-x

2. Tontini GE, Vecchi M, Pastorelli L, Neurath MF, Neumann H. Differential diagnosis in inflammatory bowel disease colitis: state of the art and future perspectives. World J Gastroenterol. 2015;21(1):21–46. doi:10.3748/wjg.v21.i1.21

3. Holubar SD, Lightner AL, Poylin V, et al. American Society of Colon and Rectal Surgeons clinical practice guidelines for the surgical management of ulcerative colitis. Dis Colon Rectum. 2021;64(7):783–804. doi:10.1097/DCR.0000000000002037

4. Bernstein CN. Treatment of IBD: where we are and where we are going. Am J Gastroenterol. 2015;110(1):114–126. doi:10.1038/ajg.2014.357

5. Olén O, Erichsen R, Sachs MC, et al. Colorectal cancer in ulcerative colitis: a Scandinavian population-based cohort study. Lancet. 2020;395(10218):123-131.

6. Lutgens MWMD, van Oijen MGH, van der Heijden GJMG, Vleggaar FP, Siersema PD, Oldenburg B. Declining risk of colorectal cancer in inflammatory bowel disease. Gastroenterology. 2013;144(7):1484-1492.

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