The increasing prevalence of IBS is causing billions of dollars to get flushed down the toilet

Shahreen starts and ends her workdays fighting an endless war with her bowels.

A product manager, age 23, she has irritable bowel syndrome, a gastrointestinal disorder that affects the large intestine. Shahreen, who works at a major tech company, pushes through her 9-to-5 with throbbing headaches, stomach pangs, facial pain, and even choking sensations, especially after she eats. These symptoms are accompanied by runs to the toilet — at least four times a day — and, when she’s in the office, trips to the wellness room, where she lies down when she’s feeling gassy.

“When I’m in the office it’s so painful,” said Shahreen, who asked us to use only her first name. “It’s so embarrassing to have to go to the bathroom back and forth a million times.” 

IBS affects as many as 45 million people in the US — up to 15% of the American population — and cases continue to rise. A recent nationwide survey of 89,000 people by Cedars-Sinai found that the prevalence of IBS was higher in 2020 than in previous years. The condition seems so normalized now that IBS is having a cultural moment, with the hashtag “Hot Girls With IBS” on TikTok raking in tens of millions of views.

But for those who have IBS, the daily grind is often met with a silent struggle, and productivity, job performance, and career growth are at risk of frequent disruption. To some, IBS makes getting through the workday difficult. To others it can cost them their career. 

“In my practice it’s quite common for IBS patients to report significant challenges in maintaining consistent job performance due to their symptoms,” Ritu Nahar, a gastroenterologist at New Jersey’s Independent Gastroenterology Group, said. 

The uptick in gastrointestinal issues has economic consequences. A survey of 1,776 employees at a large US bank found that workers with IBS were 15% less productive compared to the performance of workers without IBS. Employees suffered a 21% decrease in overall work productivity, equivalent to less than four days of work out of a five-day workweek. Treating IBS is also expensive. Patients with IBS related to constipation pay an average of $11,182 a year in healthcare costs, which include doctors’ visits, outpatient services, hospitalizations, prescriptions, and ER visits.

That’s good news for the pharmaceuticals industry. In July and August, Ardelyx saw sales for Ibsrela, an IBS medication for constipation, jump 82% percent, to $40.6 million, year over year, on track to generate up to $150 million for that drug alone by the end of this year. In that same time, Bausch Health’s revenues for Xifaxan, an IBS med for diarrhea, grew 7%, and Ironwood Pharmaceuticals’ demand for IBS drug Linzess rose 13%, to 54 million capsules. That growth falls in line with the growth in the global IBS-treatment market, which Ardelyx projects will generate over $6 billion in revenue by 2030. 

Nahar, the gastroenterologist, said the most common symptoms she sees IBS patients face include bouts of diarrhea, abdominal pain, cramping, and bloating. These symptoms can lead to frequent bathroom breaks, the need to leave meetings abruptly, and time off work, which can reflect poorly on employees if their employers don’t know their condition. 

For those with IBS dominated by constipation, discomfort from gas buildup and incomplete bowel movements can lower a patient’s concentration and energy levels. Anxiety around flare-ups could even sway workers to miss work-related events like networking sessions. 

Nobody would expect Shahreen’s gastrointestinal disorder to be so disruptive to her job. After all, she’s a high-performing employee. Little do her coworkers know the physical, mental, and emotional lengths she has to go to deal with her symptoms — all while staying on top of meetings, managerial responsibilities, and social obligations like work happy hours.

“I have to work, like, five times harder than another employee to get the same results,” she said. “I’m managing all these physical symptoms, like physically being in pain and communicating to the doctor and going to these doctor appointments, and then also not being able to go to work a lot of the time.”

The invisible toll of IBS 

IBS is also considered a psychosomatic disorder, meaning psychological factors like stress could exacerbate chronic gut discomfort. Nahar said it’s common for IBS symptoms to flare up during high-pressure work situations, which can make an already difficult workday hellish. 

Jeffrey Roberts, a freelance web developer with IBS who’s worked in IT for more than 30 years, recalled 9/11 as a “turning point” when his IBS flared up for the first time. Back then, Roberts worked as an IT manager at a financial-services company in Toronto. After the Twin Towers collapsed, he worked more than six hours straight trying to keep his organization afloat as the stock market plummeted.

Roberts came into the office with a bad gut, and the combination of horrific news and work stress exacerbated his IBS. He made frequent trips to the bathroom and took antispasmodic medications to alleviate his abdominal pain and slow his bowel movements, which made him sleepy and groggy. 

“That day I probably had literally 20 bowel movements,” Roberts, now 63, said. “By the end of it, there was nothing. I was just going through the motions.” 

In extreme cases, IBS could cost professionals their careers. Trevor, who has IBS and asked us not to use his real name, worked as a business strategist in creative industries for 14 years free of symptoms before losing his ability to find work. After he got laid off in 2022, Trevor was actively job searching, networking, and landing interviews with no health problems. A few months later, he was hit with unexpected abdominal pain. Absent of diarrhea, the pain became so excruciating that he couldn't stand up, and his job search came to a halt. Unable to focus, he couldn’t apply to jobs and struggled to make it through interviews and networking calls without needing to lie down. Even if he did get an offer, he said, he knew it would be impossible to perform the job’s responsibilities.

“I’m not going to take a job that I’m not able to deliver,” Trevor said. “That would be unfair for them and that would be unfair to me.”  

He now takes on freelance assignments and the occasional dog-walking gig on Rover, income that’s supplemented by disability benefits he receives from his private insurer.

Workers with IBS can qualify for long-term disability from their employers if their symptoms hinder their ability to do their jobs. Some lawyers, though, say it can be tough for workers to get disability approved for their IBS. 

Leah Small, a managing attorney at CCK Law Firm that specializes in disability litigation, said applicants must have evidence their symptoms infringe on their ability to work, whether that’s a track record of missing deadlines, poor performance, or frequent time off. That could be hard to prove if applicants aren’t documenting their day-to-day symptoms. If symptoms aren’t perceived as severe, insurance companies could reject their claims and advise employees to just sit near a bathroom or to seek mental-health treatment to mitigate stress. Different state disability laws could make qualifying even harder. 

“It’s easy for insurance companies to try and say it’s not really as bad as you’re saying it is,” Small said about IBS. “There are a lot of people who have gastrointestinal issues, and so they may look at it as, ‘All these other people are working with these issues — why can’t you?’” 

How workers manage their IBS 

Employees with IBS take precautionary measures to help manage their symptoms at work. 

Jocelyn, a newspaper reporter who suspects she has IBS, said she carries 30 different supplements, like antacids and ginger capsules, whenever she’s doing field reporting, in case her symptoms flare up.

Dietary changes have also been crucial. Jocelyn, who used to be vegan, reintroduced lean meats and eggs into her diet, which she said has helped alleviate her symptoms. She also takes enzymes before and after she eats, and drinks lots of ginger tea. Shahreen, the product manager, said she eats a low-FODMAP diet, a plan that restricts hard-to-digest carbohydrates like apples, yogurt, and beans, and prepares lunch and dinner with “health foods” like sauerkraut to prevent cramps, gas, and diarrhea.

IBS patients who spoke with Sherwood News also take prescribed medications and seek mental-health treatment to manage stress. Some have even informed their supervisors about their condition so that they have context for erratic behavior. 

Nahar recommends relaxation techniques like mindfulness, deep breathing, and regular breaks to manage stress. Incorporating daily movements like short walks and standing stretches into their days could also help desk workers regulate their bowels. 

That said, there’s only so much self-soothing that employees with IBS can do to find relief. Employers, too, have a responsibility to be more proactive in creating workplaces that are inclusive of everyone’s medical needs, Nahar said. 

“Employers should understand that it’s not just about stress management,” she added. “It’s about creating a supportive environment that includes flexible work options, and understanding that bathroom breaks and occasional absenteeism may be necessary.”

Aaron Mok is a freelance journalist who covers technology and the future of work.