IBS Flare-Up: Symptoms, Causes, Duration & Treatment

What is an IBS flare-up?

During an irritable bowel syndrome (IBS) flare-up (sometimes referred to as an “IBS attack”) you may experience more gut symptoms, such as stomach cramps, bloating, diarrhea, and constipation. An IBS flare-up can last anywhere from a few hours to a few months.

So, what causes an IBS flare-up? An increase in symptoms can sometimes be triggered by eating certain foods or from anxiety or stress. However, even if you're doing all the 'right' things, an IBS flare-up can still happen with no obvious cause.

There's no cure for IBS but there are things you can do to help relieve symptoms and reduce the chance of future episodes.

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What is the difference between an IBS flare-up and an IBS attack?

IBS flare-ups and attacks are two terms used to describe the sudden onset or worsening of symptoms in people with IBS. While there is no official distinction between the two terms, a flare-up is generally used to describe a temporary increase in symptoms that can be triggered by certain foods, stress, or other factors, whereas an attack is a more severe and prolonged episode of symptoms that may require medical attention. IBS attacks may last for days or even weeks and may cause intense pain, discomfort, and disruption to daily activities, whereas flare-ups are typically more short-lived and less severe.‍

What is IBS?

IBS is a common gastrointestinal condition that affects around 1 in 7 people worldwide and is almost twice as common in women as it is in men. While IBS can occur at any age, most people start to notice their symptoms between 20 and 30 years old.

A healthcare professional can diagnose whether you have IBS based on your medical history and your symptoms. You might have IBS if you have had recurrent abdominal pain for at least one day per week in the past three months, and two or more of the following:

• Changes in stool frequency
• Changes in stool appearance 
• Pain or relief of pain associated with a bowel movement

What does an IBS flare-up or attack feel like?

Some people will experience IBS flare-ups on a daily basis, while others can go for long periods of time without symptoms. An IBS flare-up means that you are experiencing a sudden increase in IBS symptoms over a period of time. So what does an IBS flare-up feel like? Common symptoms of an IBS attack can include:

• Abdominal pain 
• Swelling or bloating of the abdomen 
• Passing excessive gas 
• A feeling that the bowels are not empty after passing stools
• Diarrhea or constipation

Some people also experience some less common symptoms, such as:

• Headache 
• Joint or muscle pain 
• Fatigue 
• Frequent urination 
• Feelings of anxiety or depression 

How long does an IBS flare-up last?

An IBS flare-up duration is different for everyone. Most people's IBS symptoms will flare up for 2-4 days, after which your symptoms may lower in severity or disappear completely. Many people experience IBS in waves, in which symptoms may come and go over several days or weeks.

IBS attacks can be managed to reduce symptoms or shorten duration using several management techniques (which we discuss below).

What causes an IBS flare-up or IBS attack?

It's unclear what causes episodes of IBS symptoms, but several studies have shown the following factors may play a part in IBS flare-ups or IBS attacks:

• Eating ‘trigger’ foods: high FODMAP foods (foods that are poorly digested by the gut) may cause IBS symptoms. 
• Stress: both short and long-term stress, for example, situations at work or in life in general, can increase gut problems. 
• Gastrointestinal infection: especially in severe cases, gut infections have been shown to trigger IBS symptoms.
• Psychological conditions: anxiety, depression and post-traumatic stress disorder can all bring on an IBS flare-up.

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What to eat during an IBS flare-up or IBS attack?

It's difficult to know what foods to eat with an IBS flare-up or attack, with foods that are high in ‘FODMAPS’ (small carbohydrate molecules that cause bacteria in the body, stomach, and gut to release gas) often triggering IBS symptoms. A diet low in FODMAPs can reduce symptoms of IBS in most people.

To calm an IBS flare-up, avoid high-FODMAP foods such as: 

• Fructans (a fructose molecule that stores carbohydrates): such as garlic, onion, wheat, rye, and broccoli 
• Oligosaccharides (a type of carbohydrate): such as chickpeas, lentils, tofu, and beans 
• Lactose and dairy: Such as cow’s milk, yogurt, and ice-cream 
• Fructose (fruit sugar): such as apples, mangoes, watermelon, and honey 
• Polyols (naturally occurring sugar alcohols): such as nectarines, peaches, plums, cauliflower, and mushrooms

So what foods should you eat during an IBS flare-up?

• Some grains: gluten-free oats and white, brown, and basmati rice 
• White meats: poultry and fish 
• Cooked vegetables: carrots, peas, potato, Swiss chard, eggplant, and kale 
• Nuts and seeds: flaxseed, pecans, pine nuts, almonds

A low FODMAP diet involves eliminating high FODMAP foods, then slowly reintroducing them, one at a time, and noting any changes in symptoms. This two-step approach should help identify foods that trigger a flare-up. 

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What are some effective strategies to calm an IBS flare-up?

1. Try gut-directed hypnotherapy

You might not have heard of hypnotherapy as a treatment for digestive health and conditions, but it’s been proven to help IBS symptoms and can even address other conditions such as chronic pain or smoking addiction. In hypnotherapy, you are gently brought into a relaxed and focused state, where you then use visualizations and suggestions to improve your gut-brain connection. It's one of the best natural remedies for IBS flare-ups and requires no drugs or diets to see results.

A recent study showed that gut-directed hypnotherapy is equally effective as the low-FODMAP diet in reducing IBS symptoms—which is good news for people wanting to improve their symptoms without overhauling their diet and lifestyle. Gut-directed hypnotherapy has been shown to significantly reduce symptoms of IBS in over 50% of people.  You can try gut-directed hypnotherapy by visiting a gut-directed hypnotherapist or using a gut health mobile app like Nerva (based on this recent study).

How hypnotherapy exactly works is still unclear to researchers, but it is thought to work by helping you:

• Reduce sensitivity to pain in regions of the brain 
• Restore signals of the gut-brain connection to normal
• Reduce levels of anxiety and depression, which may worsen pain ‍

2. Reduce stress 

Stress can worsen symptoms of a flare-up because of the gut-brain connection (literally a chemical connection between your gut and brain). This is why relaxation techniques that work for the mind can also help calm the gut. Two common ways to reduce stress and episodes of IBS are:

Mindfulness meditation: meditation can calm the mind and the gut. In several studies, meditation was shown to lower gut symptoms of pain and bloating. Researchers believe this is due to reducing pain signals that can cause a flare-up of IBS symptoms.

Yoga: yoga is a mind and body practice that combines breathing with movement. In adolescents, it has been shown to reduce symptoms of IBS and anxiety.

3. Try peppermint oil 

Peppermint oil is a herbal supplement that has been used as a natural remedy for centuries. It has been approved by the Food and Drug Administration (FDA) for the treatment of IBS and is well supported by evidence from clinical studies. Peppermint oil is an excellent natural remedy for an IBS flare-up.

The active ingredient in peppermint oil is menthol, which has a cooling effect. Menthol dulls pain receptors and relaxes the muscles of the colon. Peppermint oil can help reduce pain, bloating, and constipation and has even been shown to be more effective than antispasmodics in relieving the overall symptoms of IBS.

Peppermint oil is available over the counter in capsule form and is well tolerated by most people. However, in rare cases, peppermint oil may cause side effects such as gastric reflux. If you don’t feel comfortable taking peppermint oil, you can always try sipping peppermint tea. 

4. Reduce caffeine intake 

Coffee and other sources of caffeine may worsen symptoms of IBS during a flare-up. Even without IBS, caffeine is known to have a laxative effect on the body with diarrhea being a common side-effect of overconsumption. One study showed coffee drinkers were 50% more likely to develop IBS than those who did not drink coffee.

It’s best to avoid caffeine during a flare-up. Try cutting out all forms of caffeine—this means teas, soft drinks, coffee, and chocolate—and watch for any changes in your symptoms.

5. Heat therapy 

Heat therapy is a traditional home remedy for pain and offers a gentler approach than taking medications when your stomach is already upset. 

Heat therapy works by reducing blood flow to relax the muscles of the abdomen. It has been shown to relieve certain kinds of back pain more effectively than ibuprofen and is a good choice for treating pain in IBS.

Try applying something warm, like a heat-pack or hot water bottle, to your belly. Make sure you place a towel between your skin and the heat source to avoid being burned.

6. Exercise 

Increasing your levels of exercise may provide relief from an IBS episode. Exercise helps relieve your symptoms as it can stimulate normal contractions of the intestines while also reducing stress.

In one study, participants who took part in 20 to 30 minutes of moderate-intensity exercise noted significant improvements in abdominal pain and quality of life compared to the control group. Although this study was conducted over a longer time frame, even a single session may be beneficial in fighting a flare-up. 

Common medical treatments for IBS

Since the exact cause of IBS is not known, the goal of treatment is to reduce symptoms. If diet and lifestyle changes don’t improve your symptoms, your healthcare provider may recommend IBS medications. Some common medications include:

• IBS medications: Some medications can help with IBS by either slowing the movement of material through the bowel to reduce diarrhea or by increasing fluid production in the small intestine to reduce constipation. Alosetron (Lotronex) or Lubiprostone (Amitiza) are two common IBS medications.
• Antispasmodics: These are designed to relax the smooth muscles of the colon to ease cramping and spasms. Two such medications are hyoscine (Levsin) and dicyclomine (Bentyl). They may cause side effects that include dry mouth, palpitations, and difficulty urinating.
• Antidiarrheals: These medications can be useful in treating severe diarrhea. But they should be taken with caution— antidiarrheals may have side effects such as nausea and vomiting and should be taken under close supervision. Loperamide (Imodium) is an example of an Antidiarrheal medication.
• Antidepressant medications: Certain antidepressants can help relieve diarrhea and constipation and may treat pain in IBS. They are often prescribed in lower doses for IBS than for depression.  Antidepressants for IBS should be taken under supervision as side effects can include insomnia, nausea, and weight gain or loss. Some tricyclic antidepressants used for IBS include imipramine (Tofranil) and selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa).

When to see a doctor

If you’ve tried at-home remedies and haven’t seen a change in your symptoms, it might be time to talk to a healthcare provider. Sometimes, you may experience symptoms similar to those of IBS that are actually caused by a different condition. These include: 

• Dizziness 
• Progressive worsening pain
• Symptoms that occur at night and cause you to wake up repeatedly 
• Lack of appetite 
• Blood in stools 
• Vomiting

If you experience any of these symptoms, you should visit a doctor as soon as possible. In addition to assessing your symptoms, several tests can be performed to find out if you have a different medical condition.

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The Wrap Up

An IBS flare-up can be frustrating and may cause a range of digestive symptoms. If you’re experiencing a flare, there are several at-home remedies you can try, such as gut-directed hypnotherapy, removing high-FODMAP foods from your diet, heat therapy, avoiding caffeine, exercising, and reducing stress. You may also wish to talk to your healthcare provider about medications to treat IBS symptoms and check that another condition isn’t causing your digestive symptoms. 

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