It can be so frustrating to be stopped in your tracks by an IBS flare up. Perhaps your belly has swelled up so you look pregnant, or you’re rushing to the loo every 10 minutes so can’t leave the house. These are all things my clients struggle with.
Read on for my tips on how to support your body and mind during an attack of your irritable bowel.
What is an IBS flare up?
An IBS attack is an increase of your digestive issues. Irritable bowel syndrome can often come and go. A suddent rise in bloating, gas, diarrhoea or contsipation can be triggered by something you ate, anxiety or stress, medication, alcohol, or changing the way you eat.
How do you calm IBS?
The best thing to do during an IBS flare up is to look after yourself and take some time out to recover. Of course, rest might not be so easy to actually put into practice when you’re busy and have caring responsibilities.
The following ideas may help you next time your digestion kicks off:
- Heat packs or hot water bottles on your stomach can ease pains or feeling of sensitivity
- Try drinking some soothing teas for digestion – Read about the Best teas for IBS
- Wear comfortable clothes with a soft expanding waistline to accommodate any bloating
- Take a warm bath to help yourself relax and soothe your stomach
- Snuggle up in bed and allow yourself to rest whenever you can
- Try some gentle movement to help ease gas and stomach pains
- Eat low FODMAP foods for a few days to ease your way through the flare (see below for more on how to do this). Read more about the low FODMAP diet for IBS – What is the FODMAP diet?
There isn’t a ‘one pill cure’ for an IBS attack like some health conditions, so unfortunately you may need to try a combination of these activities to see what works for you.
IBS Flare up top tip – I’ve found that clients who combine some basic self care, some gentle movement and diet changes tend to get over the flare up more quickly.
What causes irritable bowel attacks?
The most frustrating thing is, that even when you are doing everything ‘right’ you may still get an attack of IBS.
The flare could be caused by eating something that didn’t agree with you, or something that happened to stress or upset you. Sometimes it’s not related to what you’ve been eating at all!
I find most of my clients start by blaming the last food that they ate. Of course, this seems to make sense that the most recent food could be the cause of your bloating or dash to the toilet.
But, did you know it could also be related to how you’re feeling?
We know that our mental state has a large part to play in digestion.
- Stress – When we’re stressed we will have less energy for digestion, which means foods aren’t broken down as well by the process of digestion, so they cause bloating and sensitivity. This could be coupled with pain, and either diarrhoea or constipation.
- Lack of sleep – when we’re tired we feel more pain so you may be more sensitive. We also tend to eat more sugary, carb heavy foods when tired which can affect gut health. Related post – Sleep and Gut Health
- Diet – Eating something that doesn’t agree with you can cause an IBS flare up – this will be different for everyone, but could be too much fibre, coffee, alcohol, sweeteners, dairy, high protein diet, very greasy foods, or processed foods.
- Menstrual cycle – women may find IBS symptoms worse just before or around their period. This is because the hormones that make the uterus contract to release the lining, also affect the intestines which are nearby. This can lead to more cramps and pains.
Your 7 day low FODMAP meal plan
A tasty 7 day meal plan with over 25 healthy meals for easing IBS flares
What to eat during an IBS flare
Some of my clients find that eating a low FODMAP diet can help. FODMAP is an acronym for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols. These are types of fibre and starch that can be fermented in the gut.
You might find foods lower in fermentable carbohydrates during a flare up of IBS can improve symptoms like bloating, gas and pain.
FODMAPs are in common healthy foods, but in some people with IBS they can cause bloating, gas, cramps or diarrhoea. Typical high FODMAP foods are onions, garlic, wheat, mushrooms, red pepper, beans and lentils, stone fruit such as peaches and cherries, and dried fruits.
What to eat during an IBS attack – Example low FODMAP foods you CAN eat includes chicken, tofu, oats, eggs, kiwi, melon, potato, rice, blueberries, broccoli and many more.
I find some of my clients struggle to put a selection of low FODMAP foods into a normal meal, so I created the 7 day low FODMAP Meal plan. Try it for a low FODMAP selection of healthy recipes.
It’s not a diet to be followed long term, but can help in the short term during an episode of IBS.
How long does an IBS flare last?
Everything with IBS is very individual but you should experience an upset stomach for around 1-4 days before things settle down again.
If you’re not getting better, and the flare seems to be lasting for longer than usual you may need to speak to a doctor to confirm there is nothing else going on.
What does an IBS flare up feel like?
Your IBS attack may include:
- bloating or swelling in your tummy
- excess gas (with or without odour)
- abdominal pains
- feeling sensitive around your digestion
- feeling like you haven’t been able to fully empty bowels
Some people might get an IBS attack once a week or more frequently. On the other hand some people might only get a flare up every few months.
Your 7 day low FODMAP meal plan
A tasty 7 day meal plan with over 25 healthy meals for easing IBS flares
What foods could trigger an IBS attack?
Some foods higher in fermentable fibres, sometimes referred to as FODMAPs, can trigger bloating, gas and diarrhoea. Common foods such as wheat, lentils, apples, mushrooms, dates, cashew nuts, onion, garlic, asparagus and avocado are all high FODMAP foods.
FODMAPs are fibres or sugar alcohols which don’t get broken down in the small intestine as normal.
This poor digestion leads to water being drawn into the small intestine which can feel like bloating, or diarrhoea. Alternatively the molecules of partially digested foods can travel to the large intestine, where they are fermented by gut bacteria. The fermentation causes excessive gas, or you may also experience the movement of more water into the colon, causing diarrhoea.
If you eat a large amount of these foods in one meal they may contribute to your IBS episode.
Other common foods triggers for an IBS attack can be high amounts of caffeine, or alcohol, or a high fat meal.
- Caffeine speeds up gut transit time which can cause diarrhoea or cramps. Caffeine in tea, coffee, energy drinks or even chocolate, and can also increase feelings of anxiety which may contribute to digestive issues. Limit your intake to 1-2 cups a day, or even try cutting it right out of your diet.
- Alcohol is known to cause to irritation to the gut lining, and it’s not only during drinking that you can experience gas, loose stools or cramps. It can sometimes upset your digestion for a few days, so think about how much you’re drinking, and how often.
- High fat meals – when we eat meals with lots of saturated fats it can affect IBS in two ways. Firstly, if you don’t digest fats properly you might find you get diarrhoea. Signs of fat malabsorption include frothy stools, particularly light coloured orangey poo. Alternatively, you may find high fat meals slow down your digestion which can create more fermentation and gas.
Over the counter help for IBS flare ups
Your pharmacist may be able to provide help for dealing with bloating, constipation, gas and diarrhoea.
Some products you might find helpful include:
- To encourage a bowel movement, some work within 5 hours, some take a few days.
- You can try diffierent types of laxatives to find a solution that works for you. Some laxatives provide more fibre which adds bulk to the stool, and hopefully stimualtes the need to go. Other laxatives draw water in the large intestine to soften the stool, or cause the intestines to contract. It’s ok to use a combination of products for a short while, but check with your doctor or pharmacist if you have questions.
- Useful to control loose stools.
- Short term use is fine.
Peppermint Capsules (e.g. Buscomint, Colpermine)
- Useful for cramps and gas
- Look out for ‘enterically coated’ or ‘sustained release’ to avoid burning sensation and / or reflux. Enterically coated means the capsules will only open in the alkaline environment of your small intestine, rather than the stomach.
Products to disperse the wind (e.g Simeticone) –
- These contain an anti-foaming agent by changing the surface area of gas bubbles causing them to come together to move through the gut. The medicine isn’t absorbed
Antispasmodic (e.g. Buscopan)
- Useful for cramping and pain, and should work within around 2 hours.
- Not to be taken with constipation (because they slow down motility of the gut (the opposite of what you want!)
If you’re ready to identify what triggers your IBS flares then please get in touch. I can help you, as I’ve helped many other people already find a diet that works. Send me a message to get started on your IBS Gut Reset.
Check out a few Frequently Asked Questions on IBS flares:
How do you get SIBO?
There are multiple causes of small intestine bacterial overgrowth but significant risk factors include:
- slow gut transit caused by poor diet
- Previous stomach bug which could damage the migrating motor complex
- adhesions or strictures slowing down the passage of food through your gut
- frequent antibiotic usage
- low stomach acid which can allow more microbes into the digestive system.
You can read more about risk factors for SIBO here.
Other conditions associated with SIBO include
- low functioning thyroid / hypothyroidism
- EDS / hypermobility
- Mast activation syndrome (MCAS)
- histamine sensitivity
- Parkinson’s disease
How to test for SIBO
Testing for SIBO is possible through a breath test that checks for hydrogen and methane gases. These gasses are made by the overgrowth of bacteria in your small intestine, and wouldn’t otherwise be there. The gasses are absorbed through the gut walls into the blood stream and exhaled in your breath.
A stool test may be helpful in some cases to show which bacteria are in the large intestine although it’s not diagnostic for SIBO, because that’s the small intestine.
I can arrange for a SIBO breath test, or a stool test to be carried out for you as part of the Gut Reset. I often wait until after our initial consultation to consider testing, because sometimes tests aren’t necessary. If you can make improvements to diet and lifestyle that improves your symptoms I don’t want you to pay for tests you don’t need.
The symptoms of SIBO are similar to those of other gastrointestinal disorders such as irritable bowel syndrome (IBS), Inflammatory Bowel Disease and coeliac disease. This means it’s important to get your doctor to rule out other conditions.
Treatment for SIBO
There are many options for improving the symptoms of SIBO, but the main element is understanding how you got the overgrowth of bacteria in the first place.
Treatments to consider:
- Antibiotics are used to kill off the bacteria that has grown in the small intestine. The most common antibiotic that is used for SIBO is called rifaximin. Your gastroenterologist or GP may be able to help you get the right medication (as a nutritional therapist I can’t prescribe antibiotics).
- Another treatment option is herbal supplements such as antimicrobial herbs, prebiotics or Saccharomyces boulardii. There are various supplements for SIBO which can help to improve gut health and decrease bacterial overgrowth.
- Improving gut motility – through meal timing, food choices and supplements you can help your body with the internal housekeeper for the small intestine, the migrating motor complex. Read more about the migrating motor complex in my blog post.
SIBO is a complex condition, which often requires more than one round of treatment. Also, it’s very important in SIBO treatment to use prokinetics to help keep the migrating motor complex moving.
What are the symptoms of SIBO?
The symptoms of SIBO can vary from person to person and depend on where the infection is located in your intestines, how many microbes are there, and which kind of microbes. So it’s a very individual kind of condition, but common symptoms include:
- Abdominal pain
When you read that you might think these sound a lot like IBS, and you’d be right! There is a large overlap with people who have been told they have IBS, but actually may have SIBO. This is why it’s good to work with a nutritionist who understands SIBO.
SIBO & IBS
SIBO has a big overlap with the symptoms of IBS, it’s thought between 4% and 78% of patients with IBS have SIBO.
There are different classifications of SIBO according to the different types of gasses produced by the microbes.
Through their fermentation process microbes either create:
- Methane or
- Hydrogen Sulphide
Microbes which create methane and hydrogen sulphide rely on high levels of hydrogen to create their gasses.
Symptoms are varied and can include excessive gas, bloating, distended tummy, reflux, constipation, diarrhoea, as well as non digestive symptoms like fatigue, skin rashes, or mood changes like anxiety or depression.
Symptoms can also depend on the type of microbes and the gas they produce:
- Symptoms of hydrogen predominant SIBO include diarrhoea (which may alternate with constipation), abdominal cramping, fibromyalgia.
- Methane dominant SIBO presents with constipation, burping, nausea. An overgrowth of methane in the large intestine is called Intestinal Methanogen Overgrowth and is also linked to cooked cabbage smelling flatulence. I’ve written more detail on Intestinal methanogen overgrowth and constipation.
- If you have hydrogen sulphide producing bacteria you’re more likely to experience foul smelling stools or gas, joint pain, bladder sensitivity and diarrhoea.
There can also be issues with poor nutrient absorption leading to anaemia or loss of bone density. (I’ve written in more detail on how the bacterial overgrowth can reduce iron absorption.)
SIBO seems to be more common in women, people over 50 and those with digestive issues.
Can you get rid of SIBO naturally?
Herbal supplements can be used to treat SIBO, and in some cases they have shown promising results in comparison to antibiotics. Typical herbs to address the overgrowth of bacteria include oregano, neem, thyme, grapefruit seed extract, and berberine.
When people ask about ‘natural treatments’ I like to clarify it depends what you mean by ‘naturally’! (Normally people mean without a doctor’s prescription.) Antibiotics such as Rifaximin definitely have their place in SIBO treatment and shouldn’t be automatically discounted.
But I like to be very clear that the antimicrobial herbs you can use can also have a large impact on your gut microbes, and shouldn’t be taken long term or without supervision.
Even with a combination of antibiotics and herbal treatments SIBO might require several rounds of treatment to reduce symptoms. SIBO can be very difficult to reduce.
Depending on your levels of overgrowth, the type of bacteria you have, and your current diet and lifestyle, the alternative approach to ‘killing off’ bacteria is to encourage healthy beneficial bacteria to grow instead. This can be done through healthy lifestyle habits such as a good diet, changing your eating patterns, managing stress, improving sleep and focusing on encouraging diversity in your gut bacteria.
How to get an IBS diagnosis
There isn’t a clear medical test for IBS, and so it can take a while to get a diagnosis from a doctor. If you suspect you might have IBS it’s important you visit a doctor so they can confirm this.
There are lots of more serious conditions, such as colon cancer, inflammatory bowel disease or coeliac disease that have similar symptoms to IBS, so you don’t want to miss your doctor ruling these out first. IBS is sometimes called a diagnosis of exclusion, because we have to rule out other conditions before it’s confirmed you’ve got irritable bowel syndrome.
Typical tests your doctor might run depend on your symptoms, they could include:
- Blood test – looking for inflammation markers such as CRP, or ESR
- Stool test – looking for a bacterial or parasite infection, or traces of blood in the stool which could indicate a more serious condition
- Endoscopy – looking at the health of your upper digestive system with a small camera
- Colonoscopy – looking at the health of your colon with a small camera
- Feeling your stomach – physical examination can check for lumps, adhesions and your pain
- Scans – CT or MRI scans to look inside your body and check for adhesions, tumours or blockages.
Once you have an IBS diagnosis, there is no automatic treatment path as with some medical diagnoses, but there is lots of help in terms of diet and lifestyle, as well as some medication to ease symptoms.
Hi I'm Anna Mapson, registered Nutritional Therapist.
I can help you to:
- understand your digestion better, so you recognise your triggers
- eat a well balanced diet, with tasty meals that are simple to prepare
- develop better digestion and more energy
Find more about my 3 month 1:1 Gut Reset programme
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