What to know about IBS flare-ups

An IBS flare-up is a sudden and intense worsening of symptoms associated with IBS, a chronic gastrointestinal disorder.

During a flare-up, you may experience uncomfortable digestive symptoms — such as abdominal pain, bloating, diarrhea, or constipation — which can significantly impact your quality of life. 

Symptoms

Symptoms of an IBS flare-up may include:

• Abdominal pain: Intense and cramp-like pain in your abdomen is a hallmark symptom of an IBS flare-up. The pain may range from mild to severe and can occur in different areas of your abdomen.
• Bloating and distension: You may experience bloating and a feeling of abdominal distension during IBS flare-ups. This can cause discomfort and a sensation of fullness.
• Changes in bowel habits: IBS flare-ups can lead to alterations in bowel movements, such as diarrhea, constipation, or a combination of both. 
• Gas and flatulence: Increased gas production is common during an IBS flare-up, leading to excessive flatulence and a gurgling or rumbling sensation in your abdomen.
• Fatigue: Flare-ups can be physically and emotionally draining, often resulting in fatigue and a general sense of low energy.
• Nausea and vomiting: You may experience bouts of nausea and occasional vomiting during an IBS flare-up, although this symptom is less common.

Causes

The exact causes of IBS flare-ups are unknown, but several factors may increase your risk, including:

• Gut sensitivity: Some people may have an oversensitive or hyperreactive gut, leading to exaggerated responses to normal stimuli such as food or stress, which can cause IBS flare-ups.
• Changes in gut motility: Altered patterns of muscle contractions in your digestive system can affect food movement through the intestines, leading to symptoms like diarrhea or constipation.
• Intestinal inflammation: Low-grade inflammation in the intestines may contribute to IBS symptoms. 
• Gut microbiota imbalance: Disruptions in the balance of bacteria in your gut, known as gut dysbiosis, have been associated with IBS. Changes in the types of bacteria present in your gut can affect how your digestive system works and lead to IBS symptoms.
• Psychological factors: Some studies have linked stress to IBS flare-ups. Stress and negative emotions can trigger increased gut motility, sensitivity, and immune function changes, exacerbating symptoms.
• Dietary factors: Certain foods and drinks can trigger IBS flare-ups. These may include caffeine, alcohol, or spicy foods.

Learn how you can manage IBS around Thanksgiving

Treatment

Treatment for IBS aims to alleviate symptoms and improve your quality of life. While IBS has no cure, various treatment options, including medications, can help manage it. Common medications for IBS may include:

• Antispasmodics: Medications such as hyoscyamine (Levsin) and dicyclomine (Bentyl) can help relax the smooth muscles of your intestines, reducing abdominal pain and cramping. These medications block certain nerve signals that cause muscle contractions in the gut.
• Antidiarrheal medications: For people experiencing diarrhea, antidiarrheal medications such as loperamide (Imodium) and diphenoxylate/atropine (Lomotil) can be helpful in reducing bowel frequency and improving stool consistency.
• Low dose antidepressants: A doctor may prescribe tricyclic antidepressants (TCAs) such as amitriptyline (Elavil) and selective serotonin reuptake inhibitors (SSRIs) in low doses to help manage IBS symptoms. They work by modifying pain perception, improving mood, and regulating bowel function. 
• Probiotics: Certain strains of probiotics, such as Bifidobacterium infantis and Lactobacillus plantarum, have shown potential in managing IBS symptoms, particularly bloating and gas. Probiotics help restore the balance of beneficial bacteria in your gut, potentially improving gut function.

Additionally, a doctor may recommend non-pharmacological approaches — such as dietary modifications, stress management techniques, and counseling — as part of an integrated treatment plan.

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Prevention

Preventing IBS flare-ups involves adopting certain diet and lifestyle measures to help manage symptoms and reduce the frequency and severity of episodes. These may include:

1. Dietary modifications

• Identify trigger foods: Keep a food diary to track your diet and symptoms. This can help identify specific trigger foods or drinks that worsen your symptoms. 
• Follow a low FODMAP diet: Consider working with a registered dietitian to follow a low FODMAP diet. This involves temporarily avoiding certain poorly absorbed carbohydrates that can trigger IBS symptoms. Gradual reintroduction can identify specific foods that trigger your IBS symptoms.
• Eat regular, balanced meals: Stick to regular meal times and aim for balanced meals that include fiber-rich foods, such as fruits, vegetables, and whole grains. Making sure you are hydrated is also important.

2. Stress management

• Relaxation techniques: Practice stress reduction techniques like deep breathing exercises, meditation, yoga, or mindfulness to manage stress levels, as stress can exacerbate IBS symptoms.
• Regular exercise: Engage in regular physical activity, such as walking, jogging, or yoga, to help reduce stress, improve overall well-being, and promote healthy digestion.

3. Gut-healthy habits

• Adequate hydration: Drink plenty of water throughout the day to maintain optimal hydration and support your digestive health.
• Regular sleep: Prioritize sufficient and restful sleep, as poor sleep quality can worsen IBS symptoms.
• Avoid smoking: If you smoke, consider quitting or reducing smoking, as smoking has been associated with increased IBS severity.

4. Seek support

• Counseling or therapy: If stress, anxiety, or other psychological factors significantly impact your IBS symptoms, you may want to consider seeking counseling or therapy to develop coping mechanisms and stress management strategies.

When should you speak with a doctor?

Consider speaking with a doctor if you experience any of the following:

• unexplained weight loss
• severe abdominal pain or cramping
• persistent diarrhea or constipation
• persistent or worsening fatigue, weakness, or shortness of breath
• changes in your stool color

Summary 

IBS is a chronic gastrointestinal disorder that involves recurring abdominal pain, discomfort, and changes in bowel habits. IBS flare-ups are sudden surges of intensified IBS symptoms.

IBS can flare up at any time, but monitoring how your body reacts to certain dietary changes and stressful situations can help you manage it.

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