Can You Have IBS Without Pain?

Did your healthcare provider tell you that you have irritable bowel syndrome, but you don't have the kind of crippling pain you hear others say they have with IBS? You may wonder if it's possible to have IBS and not have pain. The answer may lie with your healthcare provider using older criteria for IBS where discomfort was listed rather than pain.

Pain as a Criteria for IBS Diagnosis

Technically, to receive a diagnosis of irritable bowel syndrome (IBS), your symptoms must meet specific criteria established by the Rome Foundation. Under the older 2006 Rome III criteria, "persistent abdominal pain or discomfort" was necessary for an IBS diagnosis. This was revised in the 2016 Rome IV criteria which eliminated the word discomfort. Now the criteria only list pain. This was done because the discomfort was too vague, especially when translated into different languages.

The Rome IV criteria for IBS are "Recurrent abdominal pain on average of at least 1 day a week in the last 3 months associated with two or more of the following:

1. Related to defecation.
2. Associated with a change in a frequency of stool.
3. Associated with a change in form (consistency) of stool.

Symptoms must have started at least 6 months ago."

Another change made from Rome III to Rome IV was in now saying that pain is "related to defecation" rather than being relieved by defecation, as often that was not the experience. As a result of these changes to the definition, it's likely that fewer people meet the new criteria for IBS.

What You May Have If You Don't Have Pain

If you don't have pain, your chronic intestinal problem may still be a functional bowel disorder. Many healthcare providers will give a label of "IBS" to any chronic intestinal problem once other disorders have been ruled out. For some people, a more accurate diagnosis by the Rome IV criteria would be:

• Functional constipation
• Functional diarrhea

These other functional gastrointestinal disorders (FGDs) share the motility dysfunction seen in IBS but without any abdominal pain.

Your healthcare provider may just be using the term IBS because it is more familiar to people. If your healthcare provider is confident that your symptoms are due to IBS or one of the above FGDs, then you should probably view your lack of pain as a good thing, rather than something to be worried about.

The good news is also that the Rome IV criteria include educational materials, patient questionnaires, diagnostic tools, and a clinical decision toolkit that healthcare providers can use to better diagnose and treat patients with functional bowel disorders.

A Word From Verywell

You deserve to get information from your healthcare provider that explains your diagnosis and treatment in a way you can understand. Don't be afraid to ask questions to clarify what you heard from your healthcare provider. You will be more likely to benefit from treatment by being an informed patient and taking an active role in your health care.