Irritable Bowel vs. Gallstones

Abdominal discomfort is one of the most common reasons people seek medical care. Irritable bowel syndrome and gallbladder disease are frequently diagnosed in patients who have abdominal pain. According to a 2005 "American Family Physician" review, IBS affects 10 to 15 percent of the U.S. population 1.

A 2012 report in "Gut and Liver" indicates that up to 15 percent of American adults eventually develop gallstones. Although the symptoms of IBS and gallstones may overlap, these conditions can usually be differentiated.

Symptoms

Gallstone pain typically begins an hour or so after a meal, rapidly increases in intensity, plateaus and lasts for roughly 1 to 6 hours before subsiding. Gallstones frequently awaken patients at night. Nausea and vomiting are common during an "attack."

Gallstone pain is severe and is usually located in the right upper part of your abdomen. However, it can radiate to your back or right shoulder blade area. A change in bowel habits is not a prominent symptom of gallstones.

Abdominal pain due to IBS is typically not located in any particular region of your abdomen, although it can be.

The discomfort caused by IBS tends to be crampy and less severe than gallstone pain, and people with IBS usually aren’t awakened by it. IBS may be triggered by foods, stress or anxiety. One of the hallmarks of IBS is a change in bowel habits -- constipation, diarrhea or both. Bloating, belching and intolerance to fatty foods are more common in IBS than in people with gallstones, but these symptoms can occur with both conditions.

Diagnosis

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Gallstones are readily diagnosed using imaging procedures that visualize your gallbladder. Abdominal ultrasound is most commonly used for detecting gallstones. However, people without gallstones can develop gallbladder inflammation and pain, too. In such cases an ultrasound will not reveal gallstones, although your symptoms may suggest that you have them.

People with IBS often go through an array of diagnostic tests to identify the cause of their symptoms.

In fact, IBS is a "diagnosis of exclusion," meaning all other mechanical, biochemical and inflammatory causes of your symptoms must be ruled out before a diagnosis of IBS can be made. Abdominal ultrasound, upper endoscopy, colonoscopy, stool analysis and blood tests could be part of the workup for people with IBS.

Treatment

Approximately 80 percent of people with gallstones never have symptoms and, therefore, do not require treatment.

Once your gallstones start causing pain, however, your symptoms may escalate until medical intervention -- usually surgery -- is required to bring relief. Once gallstones become symptomatic, delaying treatment could lead to serious complications, such as pancreatitis, an inflammation of the pancreas.

IBS usually responds to medications that relieve bowel spasms, diarrhea or constipation. Dietary modifications, probiotics and antidepressants may also be useful.

People whose symptoms are triggered by anxiety or stress sometimes benefit from psychotherapy. Your doctor will tailor your treatment to address your predominant symptoms.

Long-Term Course

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Many people with gallstones are unaware of their presence until they undergo an abdominal ultrasound, CT or x-ray for other reasons.

Their long-term health may not be substantially affected by their gallstones. However, a study published in the February 2011 issue of "Gastroenterology" suggests that people with gallstones are at increased risk for heart disease, cancer and early death, possibly due to factors that increase their risk for all of these conditions, such as obesity and diabetes 4. Removing the gallstones does not alter this risk.

IBS symptoms tend to wax and wane, and your condition may cause persistent or intermittent discomfort for years. IBS is not a life-threatening condition but it may adversely affect your quality of life.