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How are Colitis and IBS Similar?

Published date: April 4, 2023 | Modified date:
by Dr Stephen Wangen

Here’s what we’re going to cover

  1. What is the difference between IBS and colitis?
  2. Are there different types of colitis?
  3. Diagnosing IBS vs Colitis
  4. Can you have both IBS and colitis?
  5. How do You Treat IBS and Colitis?

Colitis and IBS are very similar, and can have the exact same symptoms. In fact, historically the words colitis and IBS were sometimes used interchangeably, and I’ve seen lots of patients given the diagnosis of colitis for IBS, but technically there is one specific difference.

What is the difference between IBS and colitis?

While these two conditions can have exactly the same symptoms, there is one distinction. Colitis literally means inflammation of the colon. So if you are diagnosed with colitis, it’s likely that you went to a gastroenterologist, and that they diagnosed you after doing a colonoscopy and finding inflammation in your colon.

If you didn’t do this, then your doctor may be using the words IBS and colitis interchangeably, which used to happen a lot, but happens less these days.

IBS can also involve inflammation in the colon, and if you were diagnosed with IBS you either weren’t tested for inflammation, the doctor saw it but used the diagnosis of IBS instead of colitis, which is still accurate, or you have the symptoms of IBS but no inflammation was noted in the colon.

Are there different types of colitis?

It’s important to note that there are many different types of colitis. There is ulcerative colitis, which is distinct from IBS because it involves visible ulcerations in the colon, which are seen during a colonoscopy.  This is not found in IBS.

But there are also subtypes of colitis, and these are generally not visible during a colonoscopy.  These include microscopic colitis, lymphocytic colitis, eosinophilic colitis, collagenous colitis, pseudomembranous colitis, and others. These are types of inflammation seen only under a microscope when a biopsy is performed during a colonoscopy.

Over the years we’ve had many patients come to us with these diagnoses. And they want to know if they can be treated. (Yes, they can!)  These subtypes tell you more about the type of inflammation that is occurring, but they don’t tell you why the inflammation is occurring. These types of inflammation are associated with the same types of symptoms seen in IBS and have a tremendous amount in common with IBS.

Diagnosing IBS vs Colitis

IBS is diagnosed purely based on you reporting having the symptoms of IBS. So you have either abdominal pain, diarrhea, constipation, gas or bloating. Or some combination of these symptoms.

Colitis has these same types of symptoms. But colitis is usually diagnosed based on the finding of inflammation seen on a biopsy. The biopsy is a tissue sample that was taken during your colonoscopy. That tissue sample was sent to the lab where it was examined under a microscope.

Different types of inflammation can be seen under the microscope. That’s how you end up with a diagnosis such as lymphocytic colitis or collagenous colitis or eosinophilic colitis. Those are different types of inflammation, and the words “microscopic colitis” are a more general title that covers a variety of types of inflammation seen under microscopic examination.

If you didn’t have a biopsy, or if no damage could be seen during the colonoscopy, then you are likely to end up with a diagnosis of IBS, because IBS is a diagnosis of exclusion. It means that nothing else specific showed up, so your diagnosis is based on your symptoms alone.

Can you have both IBS and colitis?

The short answer is “yes.”  In fact, most people with colitis also have IBS.  IBS is really just a big umbrella term that covers having one or more of the symptoms of diarrhea, abdominal pain, constipation, gas or bloating.

Colitis patients also have one or more of these symptoms. And the inflammation found in colitis means that whatever is irritating the colon has irritated it long enough or in such a way as to cause inflammation. In either case, the question is “why?” And regardless of the type of inflammation present in colitis and the diagnosis that you’ve been given, in our experience when patients come to us with these various types of colitis there has been a tremendous amount of overlap in the causes of their IBS and the causes of their colitis.  And fortunately we’ve found that both have an excellent chance of being successfully treated.

How do You Treat IBS and Colitis?

Successfully treating IBS and colitis is a detective process that starts with the diagnosis.  Unfortunately, most people’s experience ends with the diagnosis, because their doctors are experts in diagnosing these conditions, not treating them.

Receiving the diagnosis means that you’ve ruled out a lot of other things. That is very helpful, but it doesn’t change your symptoms, which of course is what you really want. What you need is an IBS specialist to do a deep dive into the microbiome of your digestive system and figure out exactly what is in there, as well as thoroughly assess you for all types of food allergies, intolerances, and sensitivities. This is not the kind of thing that is done by your regular doctor or by a gastroenterologist.

However, these are the kinds of things that cause IBS and colitis.  Once we understand all of these variables and how they are affecting your body, then we can create a proper treatment plan that will have a much greater chance of successfully solving your problem than just giving you an anti-inflammatory treatment or a one size fits all medication, diet or supplement regimen.

It’s much more productive to sort out and treat the cause than it is to treat the symptoms, but it takes more time and a different specialization than that of your gastroenterologist.  That may sound strange, but their expertise is in doing colonoscopies. That’s a different expertise than treating most cases of IBS or colitis.

If you have colitis or IBS, have hope. There is a solution and you can get your life back. I don’t say that lightly, but from experience as the founder and medical director of the IBS Treatment Center. And having worked with over 10,000 patients with these conditions we’ve seen how demoralizing it can be, but we’ve also seen these patients get better. So don’t give up!

Do you have IBS or colitis?