Have you ever been explaining your child’s IBD diagnosis to a friend or family member only to receive the reply, “I totally understand what you guys are going through. I have IBS!” You may be frustrated by this response because you know that there are major differences between IBD and IBS. In fact, you can start rattling off a whole laundry list of differences! Or, perhaps you understand that IBS and IBD are two different disorders, but you are not quite sure what the differences are. After your child’s diagnosis, you may feel confident in your understanding of IBD, but what really is IBS? Are there any commonalities between the two disorders? What does IBS even stand for anyways? However you may be feeling in this situation, whether you are angry, annoyed, hurt, or confused, your response to this type of comment matters. You can choose to view moments like these as unique opportunities to spread IBD awareness by politely imparting your knowledge. Remember, common misconceptions are shattered one individual at a time! It is possible to respectfully share knowledge and build a strong connection without belittling or demeaning the individual or their disorder. This page is intended to arm you with some basic knowledge about IBS and IBD, taking care to highlight the similarities and differences between the two disorders.
 
Before we dive into the content, please note that this page is not intended to be a substitute for a professional medical opinion. For more detailed information regarding IBD or if you have questions pertaining to your child’s individual treatment plan, please seek out the professional medical advice of your child’s doctor. Additionally, please note that this page provides a brief overview of IBS and IBD and does not discuss these disorders in great detail. If you have any specific questions pertaining to either of these disorders you can always speak with your child’s doctor or another healthcare professional. Now let’s begin!
 
IBS
 
What is IBS?
Irritable bowel syndrome, or IBS, is a functional gastrointestinal disorder characterized by chronic abdominal pain or discomfort and alteration of bowel patterns.[i] Diarrhea or constipation may predominate or alternate. The symptoms of IBS can range from mildly annoying to chronically debilitating, impacting overall quality of life, social life, and an individual’s ability to work or travel. Individuals with IBS may feel less able to take part of normal, daily activities. IBS is fairly common, as it is estimated that around 12% of the United States population has been diagnosed with IBS.[ii] In the past, medical professionals have referred to IBS as IBS colitis, colitis, mucous colitis, spastic colon, spastic bowel, and nervous colon. The antiquated terms “IBS colitis” and “colitis” should not be confused with ulcerative colitis, one type of IBD. The older terminology certainly can contribute to the confusion between IBS and IBD! Unlike IBD, IBS does not cause any digestive system damage, as it is largely a disorder of gut/brain interaction.[iii]
 
What are the Symptoms of IBS?
Common symptoms of IBS include:

• Chronic/persistent abdominal pain
• Mucus in the stool
• Gassiness/flatulence
• Abdominal bloating or abdominal distention
• Sensation of feeling full
• Change in stool frequency
• Change in stool appearance
• Nausea
• Urgency
• Sensation of incomplete evacuation
• Non GI symptoms: fatigue, headache, sleep disturbances

 
What Causes IBS?
Just like with IBD, the exact cause of IBS is unknown. Psychological stressors, such as depression, anxiety, physical/sexual abuse, and PTSD, are associated with the development and exacerbation of IBS symptoms. However, there is a significant amount of researching pointing to the fact that IBS is a disorder caused by a disturbance between the brain and the gut, [iv] meaning that there are poorly coordinated signals between the brain and the intestines. This can cause the body of an individual with IBS to “overreact” to the typical digestive process, leading to many of the common IBS symptoms. Additionally, individuals with IBS typically have overactive muscle contractions in the intestines. The walls of the intestines are lined with layers of muscle, and the contractions of these muscles help to move food through the digestive tract. In an individual with IBS, the contractions can last longer and be stronger, which can lead to several different IBS symptoms. There is some research looking into mental health/stress, severe GI infections, food allergies, and changes in gut microbes as potential causes or contributors to the development of IBS. More research is needed in this area.
 
How is IBS Diagnosed?
IBS is diagnosed based on the symptoms of the patient and the elimination of other disorders/causes. IBS cannot be confirmed by imaging or other diagnostic tools, as is the case with IBD, however these tools can be used to eliminate other disorders as the root cause of symptoms. Thus, blood tests, stool tests, x-ray, and/or endoscopy/colonoscopy may be ordered to rule out other disorders (e.g. colorectal cancer, IBD, endometriosis, lactose intolerance, celiac disease, etc.). Once these disorders are ruled out, IBS is diagnosed using the Rome IV criteria. This requires that the patient have recurrent abdominal pain on average at least 1 day per week during a 3 month period that is associated with two or more of the following:

• Related to defecation
• Change in stool frequency
• Change in stool form/appearance[v]

 
How is IBS Treated?
No single therapy is effective for all IBS patients. Treatment is different for everyone but may include psychological therapy/changes, dietary and lifestyle changes, and/or medication therapy.

• Psychological: Cognitive behavioral therapy and stress management techniques may help a patient to cope with any psychological factors that may be exacerbating IBS symptoms.
• Lifestyle changes: Regularly exercising may help to reduce bloating and constipation, as well as improve psychological factors that may be contributing to IBS symptoms. Many individuals with IBS find that following a special diet, such as a low FODMAP diet, can be very effective at reducing and managing symptoms. For those with constipation, an adequate fiber intake is necessary. Some individuals find that reducing dairy in their diet shows improvement in their IBS symptoms.
• Mediations: In severe cases of IBS, medications can help to reduce symptoms. Medication therapy is highly individualized for patients with IBS. There is no one medication that is most effective or works well for every single IBS patient.

 
IBD
 
Chances are that if you are reading this page, you are intimately familiar with what inflammatory bowel disease, or IBD, is. For this reason, we will only briefly discuss IBD in this post. For more detailed information on IBD, including the difference between Crohn’s disease and ulcerative colitis, please feel free to refer to my “What is IBD?” blog post. The link is at the bottom of this page. For the purposes of this post, the following information on IBD will be brief and will not dive into too much detail.
 
What is IBD?
Inflammatory bowel disease (IBD) is defined as a chronic inflammation of the GI tract.[vi] In an individual diagnosed with IBD, the body is triggered to produce an exaggerated, inappropriate immune response that results in GI tract inflammation. IBD is therefore considered to be an autoimmune disease. The resulting prolonged inflammation can cause tissue destruction and damage to the GI tract. IBD is characterized by periods of remission and periods of exacerbation.[vii]
 
What are the Symptoms of IBD?
Some of the common symptoms of IBD include:

• Persistent diarrhea
• Weight loss
• Fatigue
• Abdominal pain
• Bloody stools

 
Please note that this is not a comprehensive list of all IBD symptoms. Additionally, there are some differences in symptoms between the two types of IBD. For example, weight loss is more common in those diagnosed with Crohn’s disease, whereas bloody stools are more prevalent in those diagnosed with ulcerative colitis.[viii]
 
Unlike IBS, IBD patients can experience many different complications related to their disease.
 
Local complications can include:

• Hemorrhage
• Strictures
• Perforation
• Abscesses
• Fistulas
• C. difficile infection
• Toxic megacolon

 
Systemic complications can include:

• Skin, eye, and joint inflammation
• Mouth ulcers (in those with Crohn’s disease)
• Gallstones
• Kidney stones
• Liver disease
• Osteoporosis
• Blood clots
• Dehydration
• Malnutrition

 
What Causes IBD?
Unfortunately, the exact cause of IBD is unknown. However, we do know that the disease is a result of a weakened immune system.[ix] In a patient with IBD, the individual’s immune system develops an overactive, inappropriate immune response to the body’s own GI tract.[x] The most widely believed theory is that IBD is the result of an environmental trigger that causes an inappropriate, uncontrolled immune response in a genetically prone individual.[xi]
 
How is IBD Diagnosed?
In order to diagnose IBD, a full history of symptoms and a physical examination will need to be completed by the doctor. After all other conditions are ruled out, IBD is usually diagnosed based on certain tests, such as endoscopy, enteroscopy, sigmoidoscopy, and/or colonoscopy. Imaging studies (X-ray/CT/MRI) are sometimes necessary and can also be useful in diagnosing IBD.
 
How is IBD Treated?
There is no cure for IBD, but there are several different methods of IBD treatment, all with the goal of achieving and maintaining remission. These methods of treatment are:

• Medications
  • Anti-inflammatory drugs
    • Aminosalicylates
    • Corticosteroids
  • Immune system suppressors 
  • Biologics
  • Antibiotics
  • Anti-diarrheal medications
• Surgical therapy
• Nutritional therapy
• Rest
• Counseling and/or support group if desired

 
To summarize what was discussed on this page, please feel free to refer to the Venn Diagram included in this post. This diagram is not an exhaustive list of all the similarities and differences between IBS and IBD, but does highlight some of the key points discussed in this post. As mentioned above, if you have any questions or want to discuss this matter further, please contact your child’s doctor or other healthcare professional. It is my hope that this page provided you with a basic overview of the commonalities and vast differences between IBS and IBD. The next time that someone tries to compare IBD to IBS, remember that you have the opportunity to start shattering the misconception that these disorders are the same thing. You have the ability to kindly impart your knowledge in a gentle and loving way, without making light of anyone’s disorder or pain. As always, stay strong IBD Warrior parents!

Alatab, Sudabeh, Sadaf G Sepanlou, Kevin Ikuta, Homayoon Vahedi, Catherine Bisignano, Saeid Safiri, Anahita Sadeghi, et al. “The Global, Regional, and National Burden of Inflammatory Bowel Disease in 195 Countries and Territories, 1990–2017: A Systematic Analysis for the Global Burden of Disease Study 2017.” The Lancet Gastroenterology & Hepatology 5, no. 1 (2020): 17–30. https://doi.org/10.1016/s2468-1253(19)30333-4.

Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. Journal of the
American Medical Association. 2015;313(9):949–958.

“Definition & Facts for Irritable Bowel Syndrome - NIDDK.” National Institute of Diabetes and Digestive and Kidney Diseases. U.S. Department of Health and Human Services. Accessed April 6, 2023. https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/definition-facts.

Lewis, Sharon Mantik, Linda Bucher, Margaret McLean Heitkemper, and Mariann M. Harding. Medical-Surgical Nursing: Assessment and Management of Clinical Problems. St. Louis (Miss.): Elsevier, 2017.

​“What Is Inflammatory Bowel Disease (IBD)?” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, April 13, 2022. https://www.cdc.gov/ibd/what-is-ibd.htm.  

​You hear it all the time. The importance of a healthy diet. Aphorisms like “An apple a day keeps the doctor away,” “You are what you eat,” and “Food is fuel” circulate like wildfire within popular culture. You know that a healthy diet is important, and you know the basics of what constitutes a healthy diet. You’ve seen MyPlate images online depicting healthy portions of proteins, grains, dairy, fruits, and vegetables. You know that you should try to incorporate these food groups into each meal you serve your child. You know that in a general sense, it is better to serve more single ingredient/unprocessed foods than processed foods. If your child is diagnosed with IBD, however, you may be wondering if any of this translates to how you should be feeding and nourishing your child. Do the basic principles of a healthy diet still apply to your diagnosed child’s diet? How will preparing your child’s meals differ post diagnosis? Should it? Is there one right way to feed your child? What does feeding your child with IBD look like practically? By feeding your child a certain way, did you cause your child’s IBD diagnosis? This page will attempt to answer some of these questions, or at the very least, bring to light some information about the functional relationship between inflammatory bowel disease and diet.
 
Before we dive into the content, please note that this page is not intended to be a substitute for a professional medical opinion. For more detailed information regarding IBD or if you have questions pertaining to your child’s individual treatment plan, please seek out the professional medical advice of your child’s doctor. Additionally, while I am a registered nurse, I am not a registered dietician. This page is intended to be used to communicate generalized information regarding the role of diet in the life of a diagnosed IBD patient. I do not know your child’s individualized diet needs. For more specific questions related to your child’s unique diet and treatment plan, please refer to your child’s doctor, as well as a registered dietician if/when appropriate. Now let’s begin!
 
Does Diet Cause IBD?
A common misconception is that diet is the direct cause of IBD development. Please understand that your child was not diagnosed with IBD because you fed him or her a certain food or meal. Unfortunately, the exact cause of IBD is unknown. We do know, however, that the disease is a result of immune system dysregulation. In a patient with IBD, the individual’s immune system develops an overactive, inappropriate immune response to the body’s own GI tract.[1] The most widely believed theory is that IBD develops after continued exposure to environmental triggers. These exposures spark the inappropriate, uncontrolled immune response in a genetically prone individual.[2] Some of the different environmental triggers that have been explored are infection, exposure to smoke, medication use, pollution, climate change, hygiene, and diet. While diet is not the direct cause of IBD, there are some studies that seem to suggest that diets containing a high amount of fiber, particularly from fruits, may lower the risk of developing Crohn’s disease, but not ulcerative colitis.[3] There is definitely a need for more research on the relationship between diet and IBD, but it is important to remember that although there may be a small association between diet and IBD, diet is not the cause of diagnosis. There are several factors that lead to the diagnosis of IBD.
 
Why is Diet So Important for an IBD Patient?
As mentioned earlier, a healthy diet is important for everyone, but it is particularly crucial for children with IBD. Research has shown that a well-balanced diet can contribute to achieving and maintaining remission, reducing IBD symptoms, and improving overall nutritional status. Additionally, diet can play a role in improving immune function and nutrient absorption to better support growth and development.
 
What Should My Child Eat After Diagnosis?
The best piece of advice I can give you is to work closely with your child’s doctor and/or an IBD-focused registered dietician to assist you in developing a personalized diet plan for your child. This plan would be individualized to your child’s specific nutritional needs, factoring in diagnosis (i.e. Crohn’s disease versus ulcerative colitis), status of disease (active or in remission), location and extent of disease, and any current symptoms your child is experiencing. Please note that there is not one single eating plan that works well for every individual diagnosed with IBD. There is not a magic formula or a magic diet for IBD. Every IBD patient has unique nutritional needs, and it is recommended that you work closely with your child’s healthcare professionals to ensure that your child is receiving individualized nutritional care.
 
That being said, here is a bulleted list of general tips for feeding your child with IBD. These tips are meant to give you a birds-eye view of the role of diet in regards to IBD. They are applicable to a general audience, but you should always follow the advice of your child’s doctor or registered dietician for a more specific nutritional plan pertaining to your child. This is especially true if you child is placed on a specialized diet (e.g. low FODMAP diet, Crohn’s disease exclusive diet, anti-inflammatory diet, etc.).
 

• Minimize trigger foods:
  • Trigger foods are simply foods that cause your child to experience discomfort. Trigger foods do not necessarily cause inflammation in your child’s GI tract, but they can cause some pretty unpleasant symptoms. Every IBD patient will have different trigger foods.
  • Common trigger foods include:
    • Foods high in insoluble fiber (bran, nuts, sunflower seeds, apple skins, etc.)
    • Foods high in fiber (cabbage, broccoli, beans, cauliflower, etc.)
    • Foods high in lactose (cow’s milk, ice cream, etc.)
    • Foods high in sugar (cookies, pastries, maple syrup, etc.)
    • Fried foods/high fat foods (butter, fried chicken, etc.)
    • Spicy foods
    • Caffeinated beverages
• Minimize foods that can increase inflammation:
  • Certain foods, such as red meats, have been linked to increasing overall inflammation when consumed frequently over a long period of time. Moderation is key!
• Increase foods linked to decreased inflammation:
  • Focus on increasing foods that are linked to decreasing inflammation, including fruits and vegetables, foods high in omega 3 fatty acids (fatty fish, chia seeds, flaxseed, etc.)
• When your child is in flare:
  • If your child is in flare, focus on increasing fluids and increasing protein (lean meats, beans, yogurt, chia seeds, etc.). If your child’s appetite has decreased while in flare, focus on nutrient-dense snacks offered frequently throughout the day, rather than big meals.
  • For example, you may be able to offer your child a smoothie packed with fruits, veggies, and chia seeds. Another snack option could be a banana with a spoonful of peanut butter. Over time, you will find what works best for you and your child.
• When your child is in remission:
  • When your child is in remission, focus on offering a wide variety of foods to ensure that your child is receiving a well-balanced diet. You should still be mindful of trigger foods, as well as foods that tend to cause inflammation over a longer period of time.

 
Practical Tips
You may be wondering how the above information translates into real-life scenarios. How can you apply what you just read in a practical way to meet the nutritional needs of your child? Here are some tips to help you deconstruct the above information and integrate it into your child’s day-to-day life.

• Keep a food log/diary. Keeping a tangible record of what your child eats throughout the day, as well as any symptoms your child is experiencing, is a very effective strategy to identity trigger foods and track the nutritional status of your child. In keeping a food journal, you may notice that your child actually consumes a fraction of the amount of recommended vegetables throughout the day. Or you may identity that honey, a very sugary food, is one of your child’s main trigger foods. A food log is an especially helpful tool to your child’s doctor or registered dietician. He or she can review the log and identity and discuss any nutritional gaps that may be missing from your child’s diet. A registered dietician can also use the information recorded in a food log to help curate your child’s unique diet plan.
• Prepare meals in advance. It may be helpful to prepare meals in advance. You may even consider freezing some meals. Planning/preparing meals in advance provides you with a greater chance of sticking to your child’s diet plan and recording foods/symptoms in your child’s food diary.
• Keep your kitchen well stocked. Try to keep your kitchen well stocked with snacks and ingredients for meals you know will not be triggering for your child/lead to inflammation.
• Plan for those nights. You know those nights. I’m talking about the nights when you are too tired to cook dinner or you run out of freezer/prepared meals. Have a few meal ideas in your head that you can fall back on in a pinch. Ideally, these meals are quick, easy, and adhere to your child’s diet restrictions. Keep the ingredients for these meals well stocked in your home for these types of nights.
• Plan for meals outside of the home. Look up menus to restaurants ahead of time if possible! If you are gathering at someone else’s home, you can always bring your own meal for your child, or discuss the meal ingredients with the host of the gathering if you are comfortable.

 
Other General Tips:

• Make sure your child is well hydrated. Offer plenty of fluids! Your child’s urine should be pale yellow and clear, not dark yellow/amber.
• Ask your child’s doctor about consulting with a registered dietician.
• Consult your child’s doctor for vitamin/supplement recommendations.
• Give yourself some grace. Preparing IBD-friendly meals is no easy feat. Remember, it is more important to focus on your child’s overall diet/eating patterns, rather than one specific snack, meal, or day.
• As your child ages, be mindful of their behaviors towards food and be on the lookout for disordered eating or restrictive eating. Please seek help from a professional if necessary.

 
Malnutrition
Both Crohn’s disease and ulcerative colitis impact your body’s ability to properly absorb nutrients from ingested food, which means there is a greater risk of malnourishment. Be mindful of signs and symptoms of malnutrition in your child. Should you observe any signs of malnutrition, you should contact your child’s doctor immediately to prevent long-term complications, such as delayed growth, stricture, and decreased bone density. You can discuss any potential nutritional gaps with your child’s doctor or a registered dietician. Some of the more noticeable signs of malnutrition include:

• Fatigue and/or low energy
• Decreased muscle mass
• Weight loss and/or lack of growth in a child
• Weakness

 
Final Thoughts
Maintaining a healthy diet is important for children with IBD, as it can help reduce IBD symptoms, improve nutrient absorption and immune function, achieve and maintain remission, and support overall health and development. I hope the information on this page was useful to you as you navigate your child’s IBD journey in relation to their diet. Please note that this page does not address nutritional support therapy (e.g. enteral or parenteral nutrition) or specific diet plans for IBD, such as an anti-inflammatory diet, an autoimmune protocol diet, or a low FODMAP diet. There are several different types of diet plans that can be implemented for IBD patients, and a registered dietician may suggest a specific one based on your child’s disease process, location, and symptoms. If you would like more help or have any questions pertaining to diet, you can feel free to reach out to me using my email address linked below. Please know that there are options for support available as well. Being a parent of a child with IBD can be challenging! IBD Connect offers a virtual caregiver support group that meets one time monthly. We also have an in-person family support group, a virtual family support group, and a virtual young adult support group as available options for support. If you would like more information about these groups, click the link at the bottom of this page. Stay strong IBD Warrior parents!


[1] Lewis, Sharon et al., Medical-Surgical Nursing: Assessment and Management of Clinical Problems (St. Louis, Missouri: Elsevier, 2017), 944.

[2] Sudabeh Alatab et al., The Global, Regional, and National Burden of Inflammatory Bowel Disease in 195 Countries and Territories, 1990–2017: A Systematic Analysis for the Global Burden of Disease Study 2017

[3] Ananthakrishnan AN, Khalili H, Konijeti GG, et al. A prospective study of long-term intake of dietary fiber and risk of Crohn’s disease and ulcerative colitis.
 

Alatab, Sudabeh, Sadaf G Sepanlou, Kevin Ikuta, Homayoon Vahedi, Catherine Bisignano, Saeid Safiri, Anahita Sadeghi, et al. “The Global, Regional, and National Burden of Inflammatory Bowel Disease in 195 Countries and Territories, 1990–2017: A Systematic Analysis for the Global Burden of Disease Study 2017.” The Lancet Gastroenterology & Hepatology 5, no. 1 (2020): 17–30. https://doi.org/10.1016/s2468-1253(19)30333-4.

Ananthakrishnan AN, Khalili H, Konijeti GG, et al. A prospective study of long-term intake of
dietary fiber and risk of Crohn’s disease and ulcerative colitis. Gastroenterology. 2013;145(5):970-7.

​Lewis, Sharon Mantik, Linda Bucher, Margaret McLean Heitkemper, and Mariann M. Harding. Medical-Surgical Nursing: Assessment and Management of Clinical Problems. St. Louis (Miss.): Elsevier, 2017.