Many patients walk into clinics saying:

• “All my reports are normal.”
• “Still I have gas, pain, loose motions or constipation.”
• “Doctors say it’s stress.”
• “Is this really in my head?”

Let’s clarify something clearly:

IBS is real.
The pain is real.
The discomfort is real.

But the connection between the brain and the gut plays a major role in how severe it becomes.

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What Is IBS?

Irritable Bowel Syndrome is a functional gastrointestinal condition.

This means:

• There is no structural damage.
• Scans and blood tests are often normal.
• But bowel function is dysregulated.

The intestine becomes over-sensitive and reactive.

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Different Types of IBS

IBS is not one single pattern. There are different types.

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1. IBS with Diarrhea (IBS-D)

Symptoms:

• Frequent loose motions
• Urgency (sudden need to rush to toilet)
• Abdominal cramps
• Fear of leaving home

Example:
A 28-year-old professional avoids travel because he fears he won’t find a washroom in time.

Stress worsens symptoms before meetings.

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2. IBS with Constipation (IBS-C)

Symptoms:

• Hard stools
• Incomplete evacuation feeling
• Bloating
• Straining

Example:
A student feels heavy and bloated for days before exams. Constipation increases when anxious.

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3. Mixed Type (IBS-M)

Symptoms:

• Alternating diarrhea and constipation
• Unpredictable bowel patterns

Example:
During stressful weeks → diarrhea
During sedentary periods → constipation

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4. Post-Infectious IBS

Begins after:

• Food poisoning
• Severe gastroenteritis

Even after infection clears, gut sensitivity remains high.

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The Mind–Gut Connection (In Detail)

This is crucial.

The gut and brain communicate constantly through:

• The vagus nerve
• Stress hormones
• Gut microbiota
• Immune signaling

This system is called the Gut–Brain Axis.

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How Stress Affects the Gut

When stressed:

1. Brain activates fight-or-flight response
2. Cortisol increases
3. Gut motility changes
4. Sensitivity of intestine increases

Normal gas becomes painful.
Normal bowel movement feels urgent.

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Why Anxiety Makes IBS Worse

Anxiety causes:

• Hyper-awareness of body sensations
• Catastrophic interpretation (“What if I lose control?”)
• Muscle tension in abdomen

This increases pain and bowel irregularity.

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Example of Mind–Gut Loop

Trigger: Office presentation
Thought: “What if I get loose motions?”
Anxiety rises
Gut contracts faster
Loose motion happens
Brain says: “See? It’s dangerous.”

Cycle strengthens.

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Do I Need Treatment or Should I Wait and Watch?

Mild IBS:

• Occasional symptoms
• Not affecting work or social life

Lifestyle + diet changes may be enough.

Moderate to Severe IBS:

• Frequent flare-ups
• Avoiding travel or social events
• Anxiety around food
• Impact on career or studies

Then waiting usually prolongs suffering.

IBS rarely disappears permanently by ignoring it.
But it improves significantly with proper management.

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How a Psychiatrist Can Help IBS

Many patients are surprised by this.

Psychiatric support does not mean “it’s imaginary.”

It means treating the brain–gut interaction.

A psychiatrist can:

1. Reduce underlying anxiety
2. Treat co-existing depression
3. Improve sleep
4. Lower gut sensitivity through medication
5. Provide CBT for IBS
6. Reduce health anxiety

Certain medications:

• Regulate gut motility
• Reduce pain perception
• Calm overactive stress response

Not everyone needs medication.
But some patients improve dramatically when anxiety is treated.

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Common Co-Morbid Disorders with IBS

IBS frequently coexists with:

• Generalized Anxiety Disorder
• Panic Disorder
• Depression
• Health Anxiety
• Somatic symptom patterns
• Stress-related disorders

Studies suggest:
Up to 50–60% of IBS patients have significant anxiety or depression symptoms.

Treating both gives better outcome.

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Indian Diet for IBS – What to Eat & Avoid

Diet is highly individual, but general guidance helps.

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Foods to Eat (Generally Safer Options)

Grains:

• Rice (plain, steamed)
• Poha (lightly prepared)
• Idli
• Dosa (less oil)
• Oats
• Roti (in moderation if tolerated)

Vegetables (Low Gas Forming):

• Bottle gourd (Lauki)
• Ridge gourd (Turai)
• Pumpkin (Kaddu)
• Carrot
• Spinach (in moderation)
• Cucumber

Fruits:

• Banana (ripe)
• Papaya
• Pomegranate
• Musk melon

Proteins:

• Curd (if tolerated)
• Buttermilk
• Moong dal
• Boiled eggs
• Grilled chicken (if tolerated)

Others:

• Jeera water
• Ginger tea
• Isabgol (for constipation type)

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Foods to Avoid (Common Triggers)

• Excessive spicy food
• Fried items
• Street food
• Excess tea/coffee
• Carbonated drinks
• Onion & garlic (in sensitive individuals)
• Rajma, chole (gas forming)
• Cabbage, cauliflower
• Excess dairy (if lactose intolerant)

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IBS-D Specific Advice

• Avoid heavy oils
• Limit milk
• Eat small frequent meals
• Avoid artificial sweeteners

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IBS-C Specific Advice

• Increase fiber gradually
• Drink 2–3 liters water daily
• Add soaked raisins
• Use flax seeds

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Lifestyle Modifications

• Fixed meal timings
• 30 minutes walking daily
• Reduce screen-time at night
• Practice slow breathing
• Avoid skipping meals

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Prognosis

IBS is chronic but manageable.

With:

• Diet control
• Stress management
• Psychological treatment when needed

Most patients:

• Improve significantly
• Live normal lives
• Reduce flare frequency

Untreated anxiety often worsens IBS.

Treated anxiety improves IBS outcomes.

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Final Thought

IBS is not “just in the stomach.”
It is not “just in the mind.”

It is a communication problem between the two.

Waiting is reasonable if symptoms are mild.

But if IBS is affecting your confidence, work, relationships, or travel —
professional help can change the course dramatically.

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This blog is for educational purposes and does not replace medical consultation.