IBS flare-up symptoms: What are the early signs of an IBS flare-up?

Overview: What does an IBS flare-up feel like?

Irritable bowel syndrome (IBS) involves recurrent episodes of abdominal pain accompanied by bowel movement abnormalities, constipation, diarrhea, or both. There are many possible causes of IBS, and more than one may be at work in any individual. To get a diagnosis from a doctor or gastroenterologist, people with IBS must experience at least three IBS attacks every month for three months. The defining symptoms of IBS are abdominal pain and bowel movement changes. The abdominal pain can range from mild discomfort to cramping to severe pain. Diarrhea and constipation can also vary in intensity. There may be other intestinal symptoms like bloating or excessive gas, but these aren’t defining symptoms. Some people may have symptoms far from their intestines, like a lump in their throat, acid reflux, menstrual pain, and having to pee a lot. 

What are the early signs of an IBS flare-up?

The early signs of an IBS flare-up are:

• Abdominal discomfort or pain

• Abnormal bowel movements such as:

  • More frequent bowel movements

  • Less frequent bowel movements

  • Changes in stool appearance

  • Constipation

  • Diarrhea

  • Constipation alternating with diarrhea

Other IBS flare-up symptoms

The two defining symptoms of an IBS flare-up are abdominal pain and changes in bowel movements.

Abdominal pain can vary:

• Most people report abdominal cramping

• Some report mild abdominal discomfort

• Some report severe pain

• About half report that the pain improves after emptying their bowels

Bowel movement symptom changes include:

• Looser stools (46%)

• More frequent pooping (52%)

• A sensation following a bowel movement indicating that there is still some stool remaining (69%)

• Changes in the stool’s appearance

• Constipation

• Diarrhea

• Mucus in stools or coming out of the rectum (40%)

Some people have other gastrointestinal symptoms of IBS, such as:

• Bloating (32%)

• Gas

Other digestive tract symptoms are not common but can include:

• Feeling a lump in the throat

• Acid reflux

• Belching

• Getting full faster

• Trouble swallowing

• Stomach upset

• Chest pain unrelated to heart problems

Some people may have other symptoms that have nothing to do with the digestive system:

• Painful periods

• Pain during sex

• A feeling that one needs to urinate

• Frequent urination

• Symptoms of fibromyalgia

RELATED: Fibromyalgia symptoms: what are the early signs of fibromyalgia?

IBS flare-up vs. IBD symptoms

Because IBS and inflammatory bowel disease (IBD) involve the large intestines, they can have many of the same symptoms. However, IBS has many causes, but none are serious enough to cause long-term complications. Conversely, IBD is a serious autoimmune condition that damages the colon, affects other parts of the body, and has several progressive and health-threatening complications. As an autoimmune condition, it also typically causes fatigue during flare-ups. For healthcare providers, the red flags that may indicate IBD rather than IBS are rectal bleeding, blood in the stools, and involuntary weight loss.

RELATED: IBS vs. IBD: compare causes, symptoms, treatments, & more

Types of IBS flare-ups: How can I tell which one I have?

IBS has two major categories of symptoms: abdominal pain and bowel movement changes. Abdominal pain is a required symptom for most IBS attacks, but not every flare-up will involve abdominal pain. Bowel movement changes either involve more frequent episodes of loose stools (diarrhea), less frequent bowel movements (constipation), harder stools (constipation), or a feeling of incomplete evacuation after a bowel movement (constipation). It’s apparent from this list that IBS flare-ups involve either constipation, diarrhea, or an alternation of the two. 

For this reason, healthcare professionals diagnose people based on which bowel movement problem predominates:

• Irritable bowel syndrome with diarrhea (IBS-D)

• Irritable bowel syndrome with constipation (IBS-C)

• Irritable bowel syndrome with both diarrhea and constipation (mixed IBS or IBS-M)

• Unspecified irritable bowel syndrome (IBS-U) when it’s unclear whether diarrhea or constipation is the predominant complication

When to see a doctor for IBS flare-up symptoms

See a healthcare professional if IBS symptoms and flare-ups are interfering with or reducing the quality of daily life. IBS is treatable, so there’s no reason to suffer from the symptoms.

There are no tests for IBS. Instead, a healthcare professional will evaluate the symptoms, consider how often they occur, and perform a physical examination. For a diagnosis, people must experience at least three IBS attacks a month lasting at least one day, for the last three months. 

That’s enough for a diagnosis, but a clinician may order blood tests for people who primarily experience diarrhea or both diarrhea and constipation. That’s a sign they may have celiac disease, an immune reaction triggered by gluten. Other warning signs like rectal bleeding or weight loss may point to conditions like IBD or colon cancer. With these warning signs, a healthcare professional will perform more blood and stool tests.

IBS flare-ups typically don’t require emergency medical care. However, people should see a doctor for medical advice on their digestive health as soon as possible if they notice symptoms like blood in the stools, rectal bleeding, involuntary weight loss, symptoms of anemia, or nighttime diarrhea. Another concerning sign is if symptoms progressively get worse. If IBS flare-ups occur beyond the age of 55, or if those with a family history of colon cancer or IBD experience what seems to be an IBS flare-up, consult a doctor as soon as possible.

RELATED: Colon cancer symptoms: what are the early signs of colon cancer?

Complications of an IBS flare-up

Untreated IBS does not have serious or life-threatening complications. However, flare-ups can cause other problems, including:

• Dehydration if diarrhea is bad enough

• Hemorrhoids due to constipation

How to treat IBS flare-up symptoms

IBS is primarily a symptom-defined disease, so medical treatments focus on relieving or preventing symptoms. Some work very well, some may not. The most effective treatment options include:

• Psychotherapy, including cognitive behavior therapy, gut-directed hypnotherapy, and stress reduction are highly effective at improving IBS symptoms

• Stress management to prevent flare-ups and reduce their severity

• Dietary changes can prevent flare-ups and reduce the severity of flare-ups

  • Reduced food intake that includes decreasing intake of fatty foods, spicy foods, caffeine, carbonated beverages, and artificial sweeteners

  • FODMAP-restricted diet that reduces short-chain fermentable carbohydrates such as fructose (found in fruits) and polyols (found in fruits and vegetables)

  • Gluten-restricted diet

• Regular exercise and physical activity to prevent the worsening of flare-ups

• Prescription antidepressants (SSRIs or tricyclic antidepressants) to reduce the severity of flare-ups

• The antibiotic rifaximin to prevent worsening of flare-ups

• Antispasmodic medications to relieve abdominal pain

• Antidiarrheal medications to treat diarrhea—they do not help with abdominal pain

• Chloride channel activators for mild to moderate constipation

• Serotonin antagonists for severe constipation

• Probiotics may help relieve pain, bloating, and excessive gas

• Peppermint oil can also relieve symptoms

Other treatments commonly used for IBS that may be less effective include:

• Fiber intake or fiber supplements

• Over-the-counter laxatives

• Acupuncture

RELATED: Stomach pain relief, including eight natural remedies

Signs IBS flare-up is getting better

IBS flare-ups are highly variable. Some people have mild flare-ups, and others can experience severe pain, diarrhea, or constipation. Episodes can last from a few hours to a few days to a few weeks to a month or longer. Some people report constant pain. Most people consider pain severity, frequency, and duration to be the biggest problems with IBS. The pre-eminent sign that IBS is getting better is the pain going away. This usually corresponds to bowel movements returning to normal, as well.

What’s next? Additional resources for people with IBS flare-up symptoms

Test and diagnostics

• Diagnosis and management of IBS in adults, American Family Physician

• Irritable bowel syndrome, StatPearls

Treatments

• Diagnosis and management of IBS in adults, American Family Physician

• IBS treatments and medications, SingleCare

• Irritable bowel syndrome, StatPearls

• Irritable bowel syndrome: questions and answers for effective care, American Family Physician

• The gut-brain connection: how psychotherapy treats irritable bowel syndrome, Baylor College of Medicine

Scientific studies and clinical trials

• Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome, Cochrane Database of Systematic Reviews

• Characterizing abdominal pain in IBS: guidance for study inclusion criteria, outcome measurement and clinical practice, Alimentary Pharmacology & Therapeutics

• Psychological treatments for the management of irritable bowel syndrome, Cochrane Database of Systematic Reviews