After sharing Part 1 about the differences between IBD and IBS, my friend Steph sent me a text:
“Your blogs are very informative. If you have IBS, do you automatically have IBD? I heard they are often interchanged, but that’s not accurate either, right?”
And immediately I thought:
Yep.
We need a Part 2.
Because Part 1 answered why IBD and IBS aren’t interchangeable.
Steph’s question brought us to the next layer:
If they’re two separate conditions, does having one mean you have the other?
And perhaps the more surprising question:
Can the same person have both?
The answers are:
No.
And…
Yes.
I know.
Apparently IBD and IBS weren’t confusing enough already. 😂
So let’s keep talking about intestines.
🔤 First, A Very Quick Refresher
IBD stands for Inflammatory Bowel Disease.
IBD includes Crohn’s Disease and Ulcerative Colitis and involves chronic inflammation of the gastrointestinal tract.
IBS stands for Irritable Bowel Syndrome.
IBS is a disorder of gut-brain interaction that can cause significant digestive symptoms without the characteristic chronic inflammatory damage associated with IBD.
As we established in Part 1:
IBD isn’t severe IBS, and IBS isn’t mild IBD.
One doesn’t automatically turn into the other.
There is no gastrointestinal promotion ceremony.
No certificate.
No cap and gown.
Thank goodness, because I’m pretty sure the dress code would require easy bathroom access.
🤔 So…Can You Have Both?
Yes.
Someone who has Crohn’s Disease or Ulcerative Colitis can also have IBS or experience IBS-like symptoms, including during periods when their IBD inflammation appears to be controlled.
And that’s where this gets interesting.
Symptoms don’t always tell us whether inflammation is active.
Abdominal pain, diarrhea, urgency, bloating, and changes in bowel habits can occur with both conditions.
So imagine already living with Crohn’s Disease or Ulcerative Colitis and suddenly experiencing those symptoms.
The natural thought might be:
“My IBD is flaring.”
And maybe it is.
But symptoms alone don’t necessarily answer that question.
Someone with IBD can continue to experience gastrointestinal symptoms even when testing suggests their inflammatory disease is controlled. Depending on the individual circumstances, those symptoms may be related to IBS or another cause.
Which means the digestive system can apparently send the same memo for completely different reasons.
Helpful.
Very helpful.
Having symptoms doesn’t always tell you what’s causing them.
🔥 Symptoms Don’t Always Equal Active Inflammation
This is particularly important for people living with IBD.
Crohn’s Disease and Ulcerative Colitis can go through periods of active disease and remission.
But gastrointestinal symptoms don’t automatically prove that inflammation has returned.
At the same time, someone with established IBD shouldn’t automatically assume:
“It’s probably just IBS.”
New, persistent, or worsening digestive symptoms can have different causes. Active IBD is one possibility, but infections, medication effects, complications of IBD, IBS-like symptoms, and other gastrointestinal problems can sometimes produce overlapping symptoms.
That’s why determining what’s actually happening matters.
Depending on the situation, healthcare providers may use medical history, examination, blood or stool tests, imaging, endoscopy, colonoscopy, or other evaluation to look for evidence of active inflammation and other possible causes.
So:
New symptoms don’t automatically mean an IBD flare.
And:
No obvious inflammation doesn’t automatically mean nothing is wrong.
There can be more to the story.
Unfortunately, your digestive system isn’t going to leave a Post-it note saying:
“FYI, this one’s IBS.”
Wouldn’t THAT be convenient?
🧠 But Doesn’t IBS Involve the Immune System Too?
Here’s where things get a little more nuanced.
IBS is not classified as an autoimmune disease or an inflammatory bowel disease.
It’s classified as a disorder of gut-brain interaction.
However, that doesn’t necessarily mean the immune system has absolutely no involvement.
Researchers have investigated low-grade immune activation and changes in immune signaling as possible contributors to IBS in some people, along with factors involving the gut-brain connection, intestinal sensitivity, motility, the microbiome, and other biological processes.
That’s different from IBD.
In Crohn’s Disease and Ulcerative Colitis, dysregulated immune responses and chronic gastrointestinal inflammation are central features of the disease process and can result in tissue damage and complications.
So when we say IBS doesn’t cause the characteristic inflammation associated with IBD, we’re not saying:
“The immune system has absolutely nothing to do with IBS.”
We’re saying the conditions involve immune activity and inflammation differently.
Apparently even the explanation of the difference needed a Part 2.
🩺 Why Does Knowing What’s Causing the Symptoms Matter?
Because treatment has to address what’s actually happening.
IBD treatment generally focuses on controlling inflammation, achieving and maintaining remission, preventing complications, and limiting further intestinal damage.
IBS management focuses on reducing symptoms and improving quality of life and may involve dietary approaches, lifestyle changes, medications directed at specific symptoms, and strategies addressing the gut-brain connection.
Those aren’t interchangeable treatment goals.
So if someone with IBD develops digestive symptoms, simply saying:
“Your Crohn’s must be flaring.”
may not tell the whole story.
But neither does saying:
“It’s probably just IBS.”
Similar symptoms can have different causes.
That’s why evaluation matters.
“My stomach hurts” may be the beginning of the conversation—not the diagnosis.
And Dr. Google probably shouldn’t be making this call.
⚖️ And No, One Diagnosis Doesn’t Automatically Come With the Other
Let’s go back to Steph’s original question because this is the easiest part to remember:
Having IBS does NOT mean you automatically have IBD.
Having IBD does NOT mean you automatically have IBS.
They’re separate conditions.
One doesn’t automatically progress into the other.
But because they are separate conditions, the same person can potentially have IBD and IBS—or someone with IBD may experience IBS-like symptoms.
So they shouldn’t be used interchangeably.
And neither one is simply another version of the other.
IBD = bad IBS?
Nope.
We retired that explanation in Part 1.
💜 What Steph’s Question Really Highlighted
I loved Steph’s question because it showed exactly why I started writing educational entries like these.
Most people aren’t walking around studying gastrointestinal disorders for fun.
I mean…
Apparently I am now. 😂
Most people hear IBD and IBS, notice they’re separated by one tiny letter, hear that both can involve similar digestive symptoms, and understandably wonder:
Aren’t those basically the same thing?
Then they learn they’re different and naturally wonder:
Okay…but are they connected?
That’s how learning works.
One answer creates another question.
And instead of getting frustrated when someone doesn’t know the difference, I’d rather have the conversation.
That’s what advocacy looks like to me.
Not expecting everyone to already know.
Not making someone feel embarrassed for asking.
But creating opportunities for people to learn.
Steph asked.
I answered.
And then, naturally, I turned her text into an entire diary entry.
You’re welcome, Steph. 😂💜
💭 Reflection Corner
The more we learn about chronic illness, the more we realize how rarely medicine fits into neat little boxes.
IBD and IBS can share symptoms.
They can be confused with one another.
One does not automatically mean you have the other.
And yes, someone can potentially deal with both.
But there’s another lesson in Steph’s question that has nothing to do with intestines.
Ask questions.
Be curious.
Listen.
Don’t be embarrassed because you don’t know something.
And don’t make someone else feel embarrassed because they asked.
Advocacy isn’t just about telling people what they should know. Sometimes it’s about creating a space where people feel comfortable enough to say, “Wait…I don’t understand. Can you explain that?”
Because questions create conversations.
Conversations create understanding.
And understanding is part of how we make chronic illness a little less invisible.
Or, if you’re friends with me…
questions apparently create a Part 2. 😂
💜 Until Next Time…
Thank you for joining me for another page of The Dual Diagnosis Diaries—where reader questions become educational opportunities, chronic illness gets discussed without whispering, and my digestive system continues providing enough material for an ongoing series I never actually auditioned for.
If this entry helped clear up some of the confusion surrounding IBD and IBS, please like, subscribe, and share. Someone else may have been wondering the exact same thing but hadn’t asked yet.
And now I have a question for you:
Before reading Parts 1 and 2, did you know that IBD and IBS were separate conditions—or that someone could potentially deal with both?
Keep asking questions.
Keep learning.
Keep advocating.
And please keep sending me questions, because apparently that’s how sequels happen around here. 💜
Founder • Author • Advocate • Future Wellness Coach
Kia Lorice
The Dual Diagnosis Diaries 💜
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