What Causes an IBS Flare-Up?

We all experience occasional digestive upset. After a day of unhealthy eating, you might experience stomach cramps, gas, or bloating. These symptoms are usually temporary but, for some, they happen all too often. Irritable bowel syndrome (IBS), the most common functional gastrointestinal disorder in the world, affects somewhere between 10% to 15% of the global population.

Irritable bowel syndrome is a chronic condition for which there is no cure. That being the case, diagnosing underlying conditions and identifying your triggers can help you learn to manage the condition. Even with hard work and careful meal planning, however, people with IBS can experience flare-ups throughout the course of their lives.

An IBS flare-up is a sudden increase in symptoms, also known as an “IBS attack”. Here’s what you need to know about IBS and IBS flare-ups, as well as some useful tips for managing them.

Overview of IBS

Irritable bowel syndrome is a digestive disorder that affects the large intestine. While the precise cause of the condition is unknown, certain factors have been identified which play a role.

Some factors that may be involved in causing IBS include:

• Abnormal Muscle Contractions – The intestinal walls are lined with muscles that contract to move food through the digestive tract. When these contractions are stronger or last longer than usual, you can experience IBS symptoms like gas, bloating, and diarrhea. If the contractions are weaker than usual, food passage can slow down which leads to dry, hard stools.
• Nervous System Abnormalities – When the nerves that control digestion aren’t working properly, you may experience pain or discomfort when the abdomen stretches from stool or gas. The body may overreact to poorly coordinated signals between the brain and GI tract.
• Digestive Infections – Severe bouts of gastroenteritis caused by bacteria or viruses can precede the development of IBS. This condition may also be associated with a surplus of bacteria in the digestive tract, known as bacterial overgrowth.
• Stress – Not only can stress be a major trigger for IBS attacks, but people who experience higher levels of stress (especially during childhood) seem to be more prone to IBS.
• Changes in Gut Microbiome – The composition of the microbiome in the gut plays a key role in digestive health. Changes in that composition can increase the risk for conditions like IBS.

Not only are there certain factors which can increase your risk for developing IBS but, once you have it, certain things can trigger a worsening of symptoms. These are called triggers. For many people, IBS triggers are certain foods, beverages, or stress.

How is IBS Typically Diagnosed?

If you’re experiencing symptoms of IBS, it’s important to talk toy our doctor. Your doctor will take a medical and family history and perform a physical exam to help rule out other conditions. They may also evaluate you for IBS risk factors.

Common risk factors for IBS include the following:

• Age – IBS is more common in people under the age of 50.
• Sex – Particularly in the U.S., IBS is more common in women than men.
• Genetics – Having a family history of IBS, as well as other shared factors in a family environment, can contribute to IBS risk.
• Mental Health – A history of mental health issues as well as sexual, physical, or emotional abuse can be a risk factor.

Because the symptoms of many digestive disorders overlap, it’s important to have a good understanding of your unique symptoms before talking to your doctor. It may be helpful to keep a food journal, so you have some idea what foods seem to trigger symptoms.

Some of the most common symptoms of IBS include:

• Abdominal pain or cramping
• Bloating or abdominal distention
• Changes in bowel movement appearance
• Changes in bowel movement frequency
• Increased mucus in the stool
• Increased gas or flatulence

Unfortunately, there’s no definitive test to diagnose IBS. In most cases, your doctor will first want to rule out other digestive disorders. Signs and symptoms that might indicate some other condition may include things like weight loss, fever, rectal bleeding, nausea, or iron-deficiency anemia.

If your doctor isn’t able to diagnose your IBS by ruling out other conditions, additional tests may be required. A colonoscopy or endoscopy may be performed to examine the digestive tract and to take tissue biopsies. Other tests may include X-rays or CT scans, lactose intolerance tests, breath test for bacterial overgrowth, and stool tests.

What Does a Flare-Up Feel Like?

With the help of your doctor and a strong dietary plan, you can minimize IBS symptoms and may even go into remission for weeks or months at a time. IBS affects every individually differently, however, so it may take time to figure out the right combination of steps to avoid your triggers.

Even if you’re good about avoiding IBS triggers, accidents happen, and periods of increased stress can lead to a flare-up.

Common symptoms of an IBS attack include:

• Stomach pain
• Gas
• Bloating
• Constipation
• Diarrhea
• Mucus in stool

Some people also experience things like nausea, indigestion, regurgitation, and intestinal spasms. Women with IBS may find that their symptoms worsen during the menstrual cycle.

The length of an IBS flare-up varies from one person to another. In many cases, symptoms will last for 2 to 4 days. After that period, the symptoms may lessen or even disappear completely. For others, however, IBS flare-ups occur in waves. You might find that your symptoms come and go over the course of several days or several weeks.

What Causes It?

In the same way IBS has no singular defined cause, IBS flare-ups can be related to a number of different factors. Research suggests that four primary things can trigger an IBS attack.

The most common triggers for IBS flare-ups include:

• Eating Trigger Foods – Eating foods that are poorly digested by the gut have a high risk of triggering an IBS flare-up. FODMAPs, certain fermentable short-chain carbohydrates, are a key contributor as are carbonated and alcoholic beverages.
• Stress – Both short-term and long-term stress has been shown to have a negative impact on the digestive system and can increase your risk for IBS attack.
• Gastrointestinal Infection – Infections of the digestive tract, especially in severe cases, can change the composition of gut bacteria and trigger IBS symptoms.
• Psychological Conditions – A number of psychological conditions including anxiety, depression, and post-traumatic stress disorder have been shown to trigger IBS flare-ups.

Again, there’s no cure for IBS but it is a condition that can be managed. There are a variety of strategies that may help you manage a flare-up and avoid future recurrences.

How to Treat IBS Flare-Ups

When you’re experiencing an IBS flare-up, it’s important to identify the trigger and avoid it. If you already know what your triggers are, you should be able to identify it fairly quickly and take steps to correct the problem. If you’re still learning, however, there are certain things you should start implementing into your routine to avoid future flare-ups.

Here are a few suggestions to help manage IBS and treat flare-ups:

1. Switch to a low FODMAP diet

Avoiding FODMAPs works very well for many people with IBS. Again, FODMAPS are certain short-chain carbohydrates that the gut has a hard time breaking down. Because they’re difficult to digest, these foods tend to ferment in the digestive tract which creates gas and other digestive issues. FODMAPs can be found in certain vegetables, high-sugar fruits, beans and legumes, dairy, and certain sweeteners.

Some of the best low FODMAP foods to eat during an IBS flare-up include:

• Gluten-free grains like rice and oats
• White meats like fish and poultry
• Cooked veggies like carrots, potato, and eggplant
• Nuts and seeds like pecans and almonds

If you want to get serious about following a low FODMAP diet, you’ll have to start by eliminating high FODMAP foods. You’ll follow the elimination diet until symptoms of your IBS disappear. From there, you can introduce high FODMAP foods back into your diet one at a time, noting which ones trigger symptoms. Then you’ll have the option to avoid only the foods that trigger your IBS.

2. Learn to manage your stress

After food triggers, stress is the most common factor that contributes to IBS flare-ups. It has to do with the gut-brain connection, a literal chemical connection between the gut and the brain. If you can relax your mind, you may also be able to relax your gut.

Two of the best stress relief techniques for IBS are mindfulness meditation and yoga. Meditation has been shown to reduce gut symptoms like pain and bloating, possibly because it helps reduce the pain signals that contribute to IBS flare-ups. Yoga is a mind and body practice that combines elements of movement with measured breathing. It has been shown to reduce both anxiety and IBS symptoms.

3. Try herbal supplements

Though you should always talk to your doctor before taking any new medication or supplements, some herbal supplements have been shown to help reduce IBS symptoms. Peppermint oil has been used as a natural remedy for digestive problems for centuries. It has even been approved by the U.S. Food and Drug Administration (FDA) for the treatment of IBS.

Peppermint oil contains an active ingredient called menthol which has a cooling effect. Menthol relaxes the muscles in the colon and can dull pain receptors. It may also reduce bloating, pain, and constipation in IBS sufferers. You can take it in an over-the-counter capsule form which is well-tolerated by most people, though some individuals experience mild gastric reflux.

4. Reduce your caffeine intake

Coffee and other caffeinated foods and beverages have been shown to worsen IBS symptoms, especially during a flare-up. Generally speaking, coffee has been known to have a laxative effect in some individuals so you may want to avoid it in general. In one study, people who drank coffee were 50% more likely to experience IBS symptoms than non-coffee-drinkers.

During an IBS flare-up, try to avoid all forms of caffeine. This includes coffee as well as tea, soft drinks, and even chocolate.

5. Exercise regularly

Whether you have IBS or not, regular exercise is important for your overall health and wellness. Exercise has also been shown to support digestive health, so getting 20 to 30 minutes of exercise a day may help you avoid IBS symptoms. Exercise helps stimulate normal contractions in the intestines and it can also be a method of stress relief.

In a 2011 study published in the American Journal of Gastroenterology, participants who engaged in 20 to 30 minutes of moderate-intensity exercise per day experienced significant improvements in abdominal pain. They also experienced an improved quality of life over the control group.

Experiencing an IBS flare-up can be frustrating, especially if you feel like you’ve been following your diet plan well. Fortunately, there are several at-home remedies you can try to relieve symptoms and the more you try, the more you’ll learn. You can always talk to your doctor about additional management strategies and other potential treatment options.