IBS: When To Contact Your Doctor

Medically reviewed by Christelle Younes, MD
May 21st, 2020

Irritable bowel syndrome (IBS), in general, is common and often interferes with a person’s quality of life. However, symptoms of IBS suggesting serious causes are uncommon.

Goodpath is able to help most people with IBS. A person completes our IBS assessment. They answer questions about their IBS symptoms, health history, and lifestyle. From the answers, our medical team creates a personalized plan. 

There are times when a person’s IBS assessment answers suggest something else. Certain responses mean: the person should contact their doctor and make an appointment; at times they should get an urgent appointment; and, rarely, they should get emergency medical care.  

When assessment answers suggest a person should get medical care other than ours, that is exactly what Goodpath’s medical team recommends.

When IBS Symptoms May Be Serious

Medical experts recommend a person should contact their doctor when they have IBS symptoms along with certain signs and symptoms, and/or the presence of certain factors, and/or a history of specific medical problems. The doctor can: 

  • Complete a health history and physical exam

  • Order diagnostic tests, like colonoscopy or stool tests and lab work

  • Prescribe medicines

  • Make a referral to a specialist

Causes, Conditions, & Factors

The following information describes causes, conditions, and other factors that have symptoms similar to IBS, that mean a serious problem may be possible.

In each instance, we provide important information about the cause/condition/factor, such as symptoms and tests or treatments that might be done. 

This helps each individual to make an informed decision about seeking medical care. Again, Goodpath’s IBS assessment is designed so that those who have serious indicators, get medical care. 

1. Sudden, Extreme Change in IBS Symptoms

Goodpath’s Recommendation

Symptoms of IBS often change over time. However, people with IBS become familiar with their usual symptoms - the type (diarrhea or constipation, both diarrhea and constipation) and frequency of bowel movements, the type or level of pain, and whether or not they have other symptoms.

A person who has a sudden, extreme change in their IBS symptoms should contact a doctor. Depending on the symptom, they should contact their doctor’s office for an appointment, request an urgent appointment, or get immediate medical care.

Symptoms

An extreme change means symptoms of IBS suddenly change or become much worse. This may be due to the IBS or it may be from a new and unrelated problem. 

As you likely know, the symptoms of IBS include: belly (abdominal) discomfort or pain; diarrhea; constipation; diarrhea and constipation; bloating; gas; incomplete bowel movements; and mucus in the stool. 

If abdominal pain symptoms suddenly become much worse, then a person should get immediate medical care.

If an extreme change of any of the other symptoms occurs, a person should contact their doctor. 

Likely Course

The doctor will ask about the symptoms and examine the person, including feeling the abdomen. They may order imaging and lab tests. Depending on the results of testing, the doctor may prescribe medicine, suggest lifestyle changes, or refer the person to a gastrointestinal specialist (gastroenterologist). A referral to a surgeon might also be necessary.

2. IBS Diagnosis & Treatment, Without Improvement

Goodpath’s Recommendation

A person should see their doctor again, if they have been following a prescribed treatment plan (for example, medicines, diet changes) for 3 months without any improvement. If a follow-up appointment is not already scheduled, they should call their doctor’s office.

Symptoms

Continued or worsening IBS symptoms of: diarrhea; constipation; diarrhea and constipation; belly (abdominal) discomfort or pain; bloating; gas; incomplete bowel movements; or mucus in the stool. 

Likely Course

The doctor will ask questions about the IBS symptoms and compare them to notes from previous visits. They will also examine the person, checking their abdomen.

If the person has not had previous testing, when first seeing their doctor, tests may be ordered. They may have repeat or another type of testing if they have different or worsening symptoms.  

The doctor may recommend that they continue with previously prescribed treatment. Or, they may change the current treatment, or add something else to it. They may also refer the person to a specialist for further evaluation and treatment. A follow-up visit will be scheduled.

3. Acute (Sudden), Severe Abdominal Pain

Goodpath’s Recommendation

Anyone with severe abdominal pain should get medical care right away. A person may need to go to a nearby emergency department or call 911 for help.

The pain may have many causes. It may be from a problem with one of the organs of the gastrointestinal (GI) system - for example, the intestines, appendix, gallbladder, or pancreas. Or it may be from a problem with organs in other body systems - for example, the fallopian tubes or uterus, the kidneys, or the aorta.

Symptoms

This type of pain is acute which means it starts suddenly - over minutes or hours. It is the type of pain that makes it difficult to talk, move, and breathe. And, it doesn’t lessen or stop.

Other symptoms may include: changes in bowel movements; prolonged vomiting; fever; jaundice (yellowed skin); lightheadedness; fainting or passing out; and signs or symptoms of blood loss (for example, bloody or very dark stool; low red blood cell [RBC] count).

Likely Course

A doctor will ask questions about the pain, including the location and type, and perform an exam. They will also ask about the person’s medical history to help figure out the cause. With pain this severe, a person may be given short-term pain medicine. The person will have imaging and laboratory tests. 

The doctor may refer the person to a specialist, depending on the likely cause of the pain. For instance, a GI specialist or gastroenterologist or a surgeon.

Treatment depends on the diagnosis. It may include additional pain or other medicines, changes in diet, procedures, and hospitalization. Surgery is also a possibility. About 1 out of 10 people who go to an emergency department for severe abdominal pain require surgery.

4. Acute (Sudden), Severe Diarrhea

Goodpath’s Recommendation

Diarrhea means a person has: loose or watery bowel movements, increased frequency of bowel movements (at least 3 or more times in 24 hours), or both.

With IBS

As you know, diarrhea is a common symptom of IBS. A person with IBS knows their usual symptoms, including how much and how often they have diarrhea. 

If diarrhea suddenly becomes worse, especially with other new or worsening symptoms, it may mean something else, such as an infection or medicine side effects. 

Without IBS

If acute, severe diarrhea occurs in a person who does not have IBS, it may also mean an infection, medicine side effects, or another condition (including a new diagnosis of IBS).

There are risk factors for acute, severe diarrhea such as: taking antibiotic medicine; recent travel or hospitalization; or eating/drinking unclean food/water.

There are other risk factors that can make acute diarrhea more severe. For example, a suppressed immune system (which may be from medicines to treat cancer or an autoimmune condition, or etc.).

A person should contact their doctor for an urgent appointment if they have acute, severe diarrhea.

Symptoms

The symptoms of severe diarrhea in a person with IBS include: 

  • IBS with diarrhea - severe diarrhea

  • IBS with diarrhea and constipation - severe diarrhea

  • IBS with constipation - new severe diarrhea

Other Serious Symptoms

Again, other symptoms may occur with acute, severe diarrhea. They mean something other than IBS. The symptoms include: fever, worsening or new mucus with bowel movements, bloody bowel movements, dark urine, and lightheadedness when changing positions (for example, sitting to standing). 

Likely Course

The doctor will ask questions about the person’s medical history and current symptoms. They may refer the person to a gastroenterologist, a gastrointestinal (GI) specialist. They will usually order lab tests to check the stool.

Treatment usually includes fluids to replace lost fluids. Medicines to lessen diarrhea or treat an infection may be prescribed.

5. Malabsorption Syndrome: Celiac Disease

Goodpath’s Recommendation

Malabsorption is a problem with a person’s intestines that result in trouble digesting or absorbing nutrients (fats, carbohydrates, proteins, vitamins, minerals, and trace elements). 

Malabsorption syndrome is a group of symptoms that occur together, one of which is malabsorption. One Two of these syndromes is celiac disease. Celiac disease is an autoimmune disease, meaning a person’s immune system causes it.  It is a  problem with gluten, a protein found in foods with wheat, barley, and rye. Celiac disease may damage the small intestine.

A risk factor for malabsorption syndrome is having a family history of malabsorption. Celiac disease is also more common in those with IBS, diarrhea type or mixed type compared to IBS, constipation type.

A person with symptoms of malabsorption should contact their doctor for an appointment.

Symptoms

The symptoms of malabsorption include: long-term (chronic) diarrhea; gas; bloating; belly (abdominal) pain; weight loss; and stool changes (pale color and bad odor).

Symptoms affecting other body systems and organs may occur in celiac disease or some of the other malabsorption syndromes - for example, anemia, tiredness, skin problems, or weakened bones.

Likely Course

The doctor will ask the person questions about gastrointestinal (GI) symptoms and diet. They may order diagnostic tests or refer the person to a GI specialist (gastroenterologist). Avoiding foods that cause symptoms is the main part of treatment.

6. Inflammatory Bowel Disease (IBD)

Goodpath’s Recommendation

Inflammatory bowel disease (IBD) is a serious, long-term (chronic) condition affecting the gastrointestinal (GI) tract. The two common types of IBD are Crohn’s disease and ulcerative colitis. Both conditions involve inflammation (the body’s reaction to disease or injury). They may get worse over time and often have periods where symptoms increase or decrease.

  • Crohn’s disease affects the lining and deeper layers of the small intestine or both the small and large intestine.

  • Ulcerative colitis affects the lining of the large intestine and rectum.

Having a close family member with IBD increases the risk of developing it.

Both conditions have symptoms that are similar to IBS, but both have additional unique symptoms. A person who has symptoms of IBD should contact their doctor for an appointment.

Symptoms

The symptoms of inflammatory bowel disease that are like IBS include: diarrhea; abdominal discomfort and pain; bloating; gas; incomplete bowel movements; and mucous in the stool. A person with IBD may have symptoms that interfere with sleep.

Other symptoms of IBD that are not common in IBS are: rectal bleeding; fever; weight loss (more than 5.0% of body weight); and feeling tired. There may also be symptoms affecting other body organs and systems such as the eyes, joints, skin, mouth, and blood.

Likely Course

A person with symptoms of IBD is usually referred to a GI specialist (gastroenterologist). The doctor will ask about medical history, current symptoms and complete an exam. The person will have tests, including diagnostic sigmoidoscopy or colonoscopy, upper GI testing, other imaging, and blood and stool tests.

If test results show IBD, medicines are prescribed to control symptoms. Changes in diet or  surgery are other possible treatments. Based on the advice of their doctor, a person with IBD should have more frequent colorectal cancer screening colonoscopies than those at average risk.

7. Colorectal Cancer

Goodpath’s Recommendation

In general, a person has a small risk of developing colorectal cancer. Individuals with colorectal cancer may not have symptoms or may have minor symptoms. Thus, colorectal cancer screening is recommended for those at average risk, beginning at age 50. Some individuals are at increased risk for colorectal cancer. For example, those with a history of inflammatory bowel disease, other rare inherited syndromes, small growths (polyps) in the colon, or a family history of colorectal cancer. 

A person who may have an increased risk for colorectal cancer should talk with their doctor about their specific risk, as well as recommendations for frequency and type of testing.

Symptoms

The symptoms of colorectal cancer include: a change in bowel habits; bloody or very dark stool; belly (abdominal) pain; weight loss; or low iron in the blood.

Likely Course

The doctor will ask about family history, medical history, and current symptoms. They will order blood and imaging tests and make an immediate referral to a GI specialist (gastroenterologist) for further testing. 

After initial testing, a person may have more advanced testing, like a tissue sampling (biopsy). There are several different approaches to treatment for colorectal cancer, depending on many factors.

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IBS symptoms are usually not something serious, although it is possible. If you have concerns about your IBS symptoms, please follow our guidance and contact your doctor or get immediate medical care.