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What is irritable bowel syndrome (IBS)?
Irritable bowel syndrome (IBS) is a disorder of how the gut and brain communicate: the bowel is not damaged, but it is oversensitive and poorly coordinated, producing abdominal pain tied to bowel movements, bloating, and diarrhea, constipation or both. Dr. Ihab Herraka, an IBS specialist in Fort Smith, diagnoses and treats it at our Main Clinic. IBS is common, and it does not turn into cancer or inflammatory bowel disease. Doctors group IBS by the pattern that dominates, diarrhea (IBS-D), constipation (IBS-C) or a mix (IBS-M), because the pattern decides which treatments come first.
Symptoms
IBS symptoms come and go over years, and often flare around meals or stressful stretches.
- Abdominal pain or cramping, usually low in the belly, tied to bowel movements and often easier after you go
- Bloating or a visibly swollen belly, often worse later in the day
- Diarrhea, constipation, or an alternating pattern of both
- Urgency, mucus in the stool, or a feeling that you have not finished See a doctor promptly if you have any of the following; they point away from IBS and toward something that needs testing:
- Blood in the stool, or black, tarry stools
- Unexplained weight loss
- Anemia on bloodwork
- Pain or diarrhea that wakes you from sleep
- Fever with bowel symptoms
- Symptoms that began after age 45
- A family history of colorectal cancer or inflammatory bowel disease
How IBS is diagnosed
No single test proves IBS. It is diagnosed from your history and exam, and by ruling out the conditions that look like it. At the Main Clinic, that usually means:
- A detailed history and exam. IBS is diagnosed using the Rome IV criteria: abdominal pain that has recurred for at least three months, tied to bowel movements or to a change in stool frequency or form. IBS is a positive diagnosis made from a recognizable symptom pattern, not just a label used once other tests come back normal. The exam covers your abdomen and, when appropriate, a rectal exam.
- Targeted bloodwork. A blood count for anemia, an inflammation marker, and blood tests for celiac disease, which mimics IBS closely.
- Stool testing when diarrhea dominates. Fecal calprotectin measures bowel inflammation and helps separate IBS from inflammatory bowel disease; stool studies for infection are added when the story suggests one.
- Colonoscopy when it is warranted. With red-flag features, signs of inflammation, or at 45 and older when colon cancer screening is due, a colonoscopy in our on-site endoscopy center lets Dr. Herraka examine the lining directly and take biopsies. Celiac disease, microscopic colitis and the inflammatory bowel diseases covered on our IBD specialist Fort Smith page are the look-alikes we exclude. If one symptom dominates, see chronic diarrhea doctor or chronic constipation. A visit with an IBS specialist goes further than most primary care visits have time for: a full symptom-pattern history against the Rome IV criteria, targeted lab and stool testing to rule out the conditions that mimic IBS, and a treatment plan matched to your subtype rather than a single trial-and-error prescription. Most insurance plans do not require a referral to be seen.
Treatment
IBS treatment in Fort Smith starts with your main symptom, pain, diarrhea or constipation, and builds from the simplest measures up. In the order a specialist typically tries them:
- The basics. Regular meals, consistent sleep, daily physical activity, and less alcohol, caffeine and heavy, fatty meals.
- Soluble fiber. A daily supplement such as psyllium helps both diarrhea and constipation. Insoluble fiber like wheat bran often worsens bloating, so the type matters.
- A low-FODMAP trial. FODMAPs are fermentable carbohydrates in some fruits, vegetables, dairy, wheat, beans and sweeteners. Cutting them for a few weeks, then adding them back one group at a time, finds your triggers. It is a short test, not a permanent diet.
- Stress management and brain–gut therapies. Cognitive behavioral therapy, gut-directed hypnotherapy and relaxation training reduce symptoms for many patients, according to clinical guidance from the American College of Gastroenterology. This is not "in your head"; it treats the pathway that carries the pain.
IBS-C: constipation-predominant
Fiber and a low-FODMAP trial come first. If symptoms persist, prescription options that draw fluid into the bowel and speed transit include linaclotide, lubiprostone and plecanatide. These are chosen and dosed based on how you respond, not tried all at once.
IBS-D: diarrhea-predominant
Soluble fiber and dietary triggers are addressed first, along with anti-diarrheal medicine for flares. When symptoms persist, options include rifaximin, a gut-targeted antibiotic used in a short course, and eluxadoline, a prescription medicine that slows transit and reduces urgency.
IBS-M: mixed pattern
Mixed IBS is treated symptom by symptom as it shifts, often starting with soluble fiber and antispasmodics for cramping, then adding a subtype-specific medication when one pattern (constipation or diarrhea) is dominating on a given week.
Medication for pain
Antispasmodics or enteric-coated peppermint oil ease cramping across all subtypes. Low-dose tricyclic antidepressants are also used, prescribed here for gut pain rather than mood, at doses well below those used for depression. Probiotics have mixed evidence; if you try one, give it a few weeks and stop if nothing changes. When a low-FODMAP trial is the right next step, we can refer you to a registered dietitian to run it safely, since cutting out whole food groups without guidance can create new nutrition gaps.
What to expect at your visit
Your first appointment is mostly conversation: your pain, bowel pattern, diet, medications, stress, and what you have already tried. Bring your medication and supplement list. An exam follows, and blood or stool tests can be arranged the same day. You leave with a working diagnosis, a plan built around your main symptom, and a follow-up several weeks out. For most plans, no referral is needed.
Cost & insurance
Office visits and the tests used to evaluate IBS are covered by most plans when medically necessary. We accept most major plans, including Medicare and both Arkansas and Oklahoma Medicaid, and the full list is on our insurance page. Our staff verifies your benefits before your appointment and tells you if prior authorization is required.
Frequently asked questions
What is the difference between IBS and inflammatory bowel disease?
IBS is a problem with how the bowel works and how sensitive it is. Nothing is damaged, and it does not lead to cancer. Crohn's disease and ulcerative colitis are inflammatory diseases that damage the bowel lining and can cause complications. They can feel similar, which is why testing is what tells them apart.
Can IBS turn into colon cancer?
No. IBS does not damage the lining of the colon and does not raise your risk of colorectal cancer. Colon cancer screening still begins at age 45 for average-risk adults, and new bleeding or weight loss should be checked rather than blamed on IBS.
Can a colonoscopy detect IBS?
Not directly. A colonoscopy cannot see IBS itself, because there is no visible damage for it to find; it is used to rule out the conditions that mimic IBS. If you are under 45 with typical symptoms and normal blood and stool tests, IBS can usually be diagnosed without one. A colonoscopy is recommended if you have red flags such as bleeding, anemia, weight loss or nighttime symptoms, if testing suggests inflammation, or if you are 45 or older and due for screening.
What brings on an IBS flare-up?
Common triggers include large or fatty meals, certain foods (especially high-FODMAP ones), stress, poor sleep, hormonal changes, and some infections that leave the gut sensitive afterward. Triggers vary from person to person, which is why tracking symptoms against meals and stress for a few weeks can help identify yours.
Is irritable bowel syndrome curable?
There is no single cure, but IBS is very manageable. Most patients get meaningful, lasting symptom control once their subtype is identified and treatment is matched to it. Symptoms can flare during stressful periods even after they have settled, so treatment is often ongoing rather than a one-time fix.
When should I seek treatment for irritable bowel syndrome?
Any time symptoms are affecting your daily life, diet or plans is reason enough. See a doctor sooner if symptoms are new, worsening, or paired with any of the red-flag features listed above.
Is IBS caused by stress?
Stress does not cause IBS, but it makes it worse, because the nerves connecting the gut and brain carry signals in both directions. Many patients first notice symptoms after a stomach infection or a stressful stretch. Treating the stress side, through sleep, exercise or brain–gut therapies, is real IBS treatment, not a consolation prize.
Should I be tested for celiac disease if I think I have IBS?
Yes, in most cases. Celiac disease causes pain, bloating and diarrhea that look like IBS, and it is treated very differently. A blood test screens for it, and a small-bowel biopsy during an upper endoscopy confirms it. Keep eating gluten until testing is done, because a gluten-free diet can make the tests falsely normal.
See an IBS doctor near you in Fort Smith
Call the Digestive & Liver Center of Arkansas Main Clinic at (479) 242-2888 or request an appointment online to see Dr. Ihab Herraka at 3416 Old Greenwood Rd, Fort Smith, AR 72903, Monday through Friday, 8:00 to 5:00. We care for patients from Fort Smith, Van Buren, Greenwood, Alma, Barling, Charleston and Ozark, and from Poteau, Sallisaw and eastern Oklahoma, where Oklahoma Medicaid is accepted.