Key Clinical Summary

• An internet survey of 54,127 participants across 26 countries identified 2,195 people with Rome IV–defined irritable bowel syndrome (IBS).
• Constipation-predominant IBS (IBS-C) was associated with longer, more severe, and more widespread pain; pain in diarrhea-predominant IBS (IBS-D) was linked to changes in stool frequency and consistency.
• Psychological distress was reported across subtypes. Mediation analyses identified partial indirect associations involving bowel-function concerns, embarrassment, and work or activity impairment.

Abdominal pain is central to IBS, but its features differ by subtype, according to an analysis of the Rome Foundation Global Epidemiology Study published in Internal and Emergency Medicine. The findings describe distinct pain and psychosocial profiles across all four Rome IV–defined IBS subtypes, offering clinicians a more detailed account of symptoms that may accompany a patient’s bowel pattern.

Study Findings

Investigators analyzed data from an internet survey of 54,127 participants in 26 countries. The analysis included 712 participants with IBS-C, 629 with IBS-D, 712 with mixed-type IBS (IBS-M), and 142 with unclassified IBS (IBS-U). Validated questionnaires assessed clinical, dietary, and psychological characteristics.

Participants with IBS-C reported longer-lasting, more severe, and more widespread abdominal pain. Their pain often radiated to the back and was associated with greater analgesic use. They also reported greater dissatisfaction with bowel function.

In IBS-D, abdominal pain was linked to changes in stool frequency and consistency. Participants with IBS-U frequently named abdominal pain and bloating or distention as their most bothersome symptom. The supplied abstract did not describe a similarly distinctive pain pattern for IBS-M.

Psychological distress was prevalent across subtypes, affecting 69% to 78% of participants, according to the abstract. The investigators also examined somatic symptoms and factors that might help account for the association between IBS and psychological distress.

In mediation analyses, concerns about bowel function, embarrassment, and work or activity impairment showed partial indirect associations. Food avoidance did not. These findings describe associations observed in survey data; the analysis does not establish that the identified factors cause psychological distress.

Clinical Implications

The findings suggest that a subtype label alone does not fully describe a patient’s abdominal pain. Within the study population, pain duration, severity, distribution, and associated symptoms varied, as did dissatisfaction with bowel function and the symptoms participants found most bothersome.

For clinicians assessing IBS, the reported differences support documenting pain features alongside bowel habits and asking how symptoms affect work and daily activities. The study also draws attention to patients’ concerns and embarrassment about bowel function, which were among the factors linked indirectly with psychological distress.

The investigators emphasized personalized, multimodal management strategies. The survey findings can inform clinical assessment, but they did not test a treatment strategy or determine whether addressing any of these factors improves pain or psychological outcomes.

Expert Commentary

Hod and colleagues concluded that IBS subtypes have distinct pain and psychosocial profiles and emphasized the importance of “personalized, multimodal management strategies.” The supplied source provides no separate expert comment or author affiliations, titles, or locations.

Further work is needed to determine whether care tailored to these observed profiles improves patient outcomes.

Reference: Hod K, Marasco G, Colecchia L, et al. Distinct pain profiles across irritable bowel syndrome subtypes: results from the Rome Foundation Global Epidemiology Study. Intern Emerg Med. 2026;21:2065-2075. doi:10.1007/s11739-026-04375-1