What Causes IBS Flare-Ups?

Irritable bowel syndrome (IBS) is a painful disorder that can cause frequent diarrhea, constipation, or episodes of both. It can flare up, meaning symptoms become significantly worse than usual. IBS flare-ups are sometimes called IBS attacks.

With work, IBS and its flare-ups can be treated and managed. It often takes a combination of approaches, including dietary changes, medication, and stress reduction.

Studies suggest IBS is common, with estimates ranging from about 11% to possibly more than 20%. The condition can affect you every day, or you may have long periods without symptoms. Either way, flare-ups are possible.

This article looks at the differences between an IBS attack and a flare-up, what flare-ups feel like and what causes them, and how to manage symptom flares when they occur.

What Does an IBS Flare-Up Feel Like?

An IBS flare-up is a period during which symptoms are more pronounced than usual. It may mean symptoms you experience regularly get more intense, or if you’ve been symptom-free for a while, you start having symptoms again.

Common symptoms of IBS include:

• Abdominal pain that may be tied to bowel movements
• Frequent diarrhea
• Frequent constipation
• Alternating bouts of diarrhea and constipation
• Bloating
• Feeling like you still need to “go” when you’ve just had a bowel movement
• Mucus in the stool
• Symptoms that get worse during a menstrual period

The severity of symptoms—either day-to-day or during a flare-up—varies greatly from person to person and even from flare-up to flare-up.

What Causes IBS Flare-Ups?

Many things can trigger IBS flare-ups, from something you ate to stress to catching a stomach bug. 

You may not always be able to determine what caused a flare-up, but it pays to examine the patterns. Learning what triggers your increased symptoms can help you avoid them.

Eating Trigger Foods

You may find that certain foods aggravate your digestive symptoms and trigger your flare-ups. The specific food triggers aren’t the same for everyone and it can take a lot of trial and error to figure out yours.

Common trigger foods include:

• FODMAPS (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols): A group of carbohydrates that are difficult to digest
• Fried foods
• Fatty foods
• Gluten (a protein in wheat, rye, and barley)
• Processed foods
• Milk and other dairy products
• Excessive fiber, especially from the skin of fruits and vegetables
• Excessive protein
• Chocolate
• Carbonated beverages
• Caffeine
• Alcohol

Healthcare providers sometimes recommend an elimination approach to discover your food triggers. Just eliminate a category of food for a week to see if it changes your symptoms. You can use the list above for reference or choose a food type based on what you suspect is bothering you.

For some potential triggers—such as gluten or FODMAPS—you’ll need to educate yourself on what foods contain them to successfully eliminate them:

• Gluten-free diet
• Low-FODMAP diet

If you’re having trouble identifying food types or triggers, or you’re feeling overwhelmed and need help, talk to your healthcare provider about seeing a dietitian.

Stress and Psychological Conditions

Research suggests that stress is an important trigger of irritable bowel syndrome flare-ups. Mental health conditions such as anxiety and depression can make IBS worse, as well. This is due to something called the brain-gut connection.

These emotional states can increase the activity of certain neurotransmitters (chemical messengers) in your intestinal tract.

These neurotransmitters can activate pain signals in your digestive system. They also make your brain react more strongly to the pain signals it receives. This is called central sensitization.

Lowering your stress levels and managing anxiety and depression can improve IBS symptoms and flare-ups, according to research.

Travel

Traveling can trigger flare-ups of irritable bowel syndrome for several reasons, including:

• Disrupted schedules
• New foods
• Anxiety surrounding bathroom access
• Travel-related stress

Because this is a flare-up you can predict, you can take steps to help mitigate the increased symptoms. Mental preparation, careful planning, smart eating, and possibly added medications may help you get through your trip without triggering the worst of your IBS. 

When traveling outside of the United States, be sure you know how to avoid intestinal infections, which can also be a major flare-up trigger.

Gastrointestinal Infections

Gastrointestinal (GI) infections can strike at any time, not just when you’re away from home, so it’s important to try to avoid them. You should do the following:

• Avoid contact with people who are ill.
• Wash your hands often.
• Make sure your food is prepared and cooked properly.

Symptoms of a GI infection are similar to those of IBS, so what you need to watch for is changes in your symptoms or their severity. Especially watch for what experts call “alarm symptoms,” which include:

• New symptom onset when you’re over 50
• Bloody or black, tarry stools
• Fever, chills, or night sweats
• Waking up at night due to symptoms
• New, different, or severe abdominal pain

Antibiotics can throw off your digestive system, so be especially vigilant for alarm symptoms after taking them.

How Long Does an IBS Flare-Up Last?

The length of a flare-up depends on multiple factors. In general, a flare-up can last anywhere from a few days to a few months.

Because they can impact your life for a long time, it’s important to learn how to avoid flare-ups and how to manage them when they do occur. Many strategies can help with this, starting with what you eat.

What to Eat During an IBS Flare-Up

Your diet can have a big impact on your IBS symptoms, especially during a flare-up. What foods you should avoid can be different depending on what type of IBS you have.

If you have constipation and bloating, it may help to eat: 

• Fresh fruits, especially peaches, apricots, plums, berries, and rhubarb
• Whole grains, such as whole-wheat bread, oats, brown rice, quinoa, and barley
• Fresh vegetables
• Prunes, raisins, and other dried fruits
• Prune juice
• Nuts and seeds
• Soluble fiber in foods like oats, avocados, sweet potatoes, apples, and carrots
• Foods that calm the digestive system, such as ginger, peppermint, or chamomile tea
• Linseeds, whole or ground, up to 1 tablespoon per day

If you have diarrhea with your IBS flare-ups, you may get some relief from eating bland foods, such as:

• Bananas
• White rice
• White toast (avoid whole-grain breads)
• Mashed potatoes
• Winter squashes (butternut, acorn, pumpkin)
• Lean meat that’s steamed, baked, or broiled
• Chicken broth
• Oatmeal or Cream of Wheat
• Fresh vegetables
• Pretzels
• Sauerkraut, kimchi, or other fermented foods
• Sports drinks and other fluids to prevent dehydration and replace electrolytes

Regardless of IBS type, you should try to:

• Eat slowly
• Have several small meals a day instead of three large ones
• Take probiotics for a month to see if they ease symptoms

What to Avoid During an IBS Flare-Up

Avoiding potential trigger foods is just as important as eating the right things. For diarrhea-predominant IBS, try avoiding:

• Alcohol
• Caffeine
• Carbonated beverages
• Chocolate
• Creamy foods
• Dairy, especially if you’re lactose intolerant
• Dried fruits
• Excessive fiber, especially from the skin of fruits and vegetables, plus nuts, seeds, brown rice, whole-grain bread
• Fried or fatty foods
• Gravy
• Gluten-containing food 
• Sorbitol and other artificial sweeteners

For constipation-predominant IBS, try avoiding:

• Alcohol
• Bananas
• Caffeine
• Carbonated beverages
• Dairy, especially cheese, ice cream, sour cream, and whole milk
• Fried foods
• Excessive protein
• Processed foods (snack food, chips, cookies)
• Processed meats (bacon, sausage, hot dogs)
• Red meat
• Refined grains such as white flour
• White rice

Keeping a food diary can help you identify what foods are—or aren’t—triggers for you.

Other Effective Strategies to Calm an IBS Flare-Up

Your diet isn’t the only way to address irritable bowel syndrome flare-ups. You have many other options to explore for flare-ups or everyday treatment and management.

Gut-Directed Hypnotherapy

Gut-directed hypnotherapy has emerged as an important IBS treatment. It involves getting into a state of deepened relaxation along with highly focused attention.

Once you’re in that state, the practitioner teaches you how to gain control over what are typically automatic physical responses. They may use techniques including:

• Progressive muscle relaxation
• Guided imagery
• Suggestive images or metaphors

You’ll also learn about your digestive system and how to normalize its function. You remain aware and in control of yourself during these sessions and are an active participant.

While this is a newer treatment, evidence of its effectiveness has been growing for more than a decade. The American College of Gastroenterology’s 2021 guidelines for the management of IBS recommend gut-directed hypnotherapy for treating global IBS symptoms.

A serious shortcoming of this treatment is that relatively few practitioners know how to perform gut-directed hypnotherapy. To make up for the lack of provider-driven care, researchers have looked at the effectiveness of smartphone apps that offer self-guided treatment.

While people using the app are less likely to complete the program, those who do finish it have similar results to people who see a practitioner in person. What’s more, the improvements appear to last for a year or longer.

If you’re interested in gut-directed hypnotherapy, talk to your healthcare provider about it. They may be able to refer you to a local practitioner or an app.

Reduce Stress

Given the impact of stress on IBS symptoms, learning how to manage and reduce stress is an important part of managing the condition. Research suggests many types of stress reduction can be effective, including:

• Stress-reducing exercise: Yoga, swimming, or running
• Relaxation therapies: Acupuncture, acupressure, mindfulness meditation
• Psychotherapy: Focused on anxiety and depression

Mindfulness-based stress reduction, in studies, appears to be especially effective at managing IBS symptoms. Researchers credit this to the increased ability to stay focused on the present.

Try Peppermint Oil

Research shows peppermint oil has properties that calm IBS flare-up symptoms by preventing spasms in the digestive tract. (IBS used to be called “spastic colon.”) It’s also an:

• Anti-inflammatory
• Antimicrobial
• Antioxidant
• Immunomodulator
• Pain reliever

In a major review of available studies, researchers concluded that peppermint oil is both safe and effective for relieving abdominal pain and other IBS symptoms.

Reduce Caffeine

Caffeine from coffee, tea, some soda, chocolate, and energy drinks can stimulate the bowel, which may lead to cramping and diarrhea or loose stools. For this reason, many experts recommend avoiding caffeine to help curb IBS symptoms.

Heat Therapy

A simple way to relieve or prevent IBS flare-up symptoms is an electric heating pad or microwavable rice bag. It can relax cramping muscles and ease abdominal pain.

You may also find that a hot bath or shower helps. Another option is sipping a warm cup of non-caffeinated, mild herbal tea, such as chamomile.

Exercise

Exercise has more to offer than just stress reduction. Research suggests it can help alleviate overall IBS symptoms, as well. While it may help ease symptoms during and immediately after exercise, researchers say it appears to have long-term positive effects on symptoms.

Exercise may help with constipation more than with other IBS symptoms.

However, these findings should be considered preliminary. A 2022 review of evidence reports “low confidence” in the research that’s been done and calls for high-quality studies to gauge the effectiveness of exercise on IBS.

Common Medical Treatments for IBS

Common medical treatments for IBS may prevent or lower your risk of a flare-up as well as help you manage flare-ups when they occur. You and your healthcare provider should talk about what medications may be right for you.

IBS Medications

For IBS with constipation, common medications include:

• Laxatives
• Amitiza (lubiprostone)
• Linzess (linaclotide)
• Trulance (plecanatide)

For IBS with diarrhea, common prescription antidiarrheal medications are:

• Loperamide
• Xifaxan (rifaximin)
• Viberzi (eluxadoline)
• Lotronex (alosetron)

Antispasmodics

Antispasmodics are commonly used for IBS because they calm the muscles of the digestive tract and keep them from spasming. These include:

• Bentyl (dicyclomine)
• Buscopan (hyoscine butylbromide)
• Levsin (hyoscyamine)
• Cimetropium
• Mebeverine
• Otilonium
• Pinaverium bromide
• Trimebutine

Over-the-Counter (OTC) Antidiarrheals

Antidiarrheal medications firm up loose stools. Nonprescription antidiarrheals include:

• Imodium (loperamide)
• Pepto-Bismol, Kaopectate (bismuth subsalicylate)

If OTC antidiarrheals aren’t effective for you, your healthcare provider may prescribe one of the prescription medications listed above for IBS with diarrhea.

Antidepressant Medications

Because irritable bowel syndrome involves some of the same neurotransmitters as depression, antidepressant medications can be beneficial. Common ones are:

• Celexa (citalopram)
• Elavil (amitriptyline)
• Norpramin (desipramine)
• Pamelor (nortriptyline)
• Paxil (paroxetine)
• Prozac (fluoxetine)
• Tofranil (imipramine)
• Zoloft (sertraline)

If you have depression or anxiety along with IBS, these drugs may be especially useful.

When to Contact a Healthcare Provider

If you have symptoms suggestive of IBS, you should get an appointment with a healthcare provider. They may want to refer you to a specialist for diagnosis and treatment.

You should also contact your provider if your IBS symptoms have gotten noticeably worse or have changed significantly.

Whether or not you’re diagnosed with IBS, you should get immediate medical attention if you develop any alarm symptoms, such as: 

• New symptom onset when you’re over 50
• Bloody or black, tarry stools
• Fever, chills, or night sweats
• Waking up at night due to symptoms
• New, different, or severe abdominal pain

A proper diagnosis can get you on the path to treatment, which can help restore your quality of life.

Summary

IBS can have flare-ups, which are times when symptoms are markedly worse than usual. Flare-ups can last for a few days or a few months. Flare-ups may be caused by eating trigger foods, stress, mental health conditions, travel, and GI infections. Dietary changes may help ease flare-ups.

Other helpful treatments include gut-directed hypnotherapy, stress reduction, peppermint oil, reducing caffeine, heat therapy, and exercise. Common medications for IBS include antispasmodics, antidiarrheals, and antidepressants.