Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine. The main symptoms are abdominal pain, bloating, and changes in bowel habits such as diarrhea and constipation. IBS is considered a chronic condition, but the symptoms tend to come and go in episodes or “attacks.”
What is a severe IBS attack?
There is no standard definition for what constitutes a “severe” IBS attack. In general, a severe attack causes intense abdominal pain, extreme bloating, and diarrhea or constipation that is very disruptive to daily life. An IBS attack may be considered severe if:
- The abdominal pain is extremely intense, persistent, and debilitating
- There is severe bloating that causes significant distension of the abdomen
- Diarrhea or constipation is extreme, with very frequent or infrequent bowel movements
- Symptoms disrupt sleep, work, school, or normal activities
- Symptoms do not improve with typical home remedies
The symptoms of a severe IBS attack are usually much worse than typical IBS symptoms. The pain and bowel changes are so intense that the person may be unable to function normally.
How long can a severe IBS attack last?
There is no definitive answer, as the duration can vary greatly from person to person. Some general guidelines on the potential duration include:
- Hours to days: Most IBS attacks, even severe ones, may last a few hours to several days. The average is estimated to be around 12-24 hours.
- Weeks: It is not uncommon for a severe IBS flare-up to last several weeks, especially if treatment is delayed.
- Months: In rare cases, a severe bout of IBS can persist for months at a time. This is considered an extended or prolonged IBS attack.
According to clinical guidelines, an IBS attack is only considered a true “flare-up” if the symptoms persist for at least a few weeks. Attacks lasting less than 4 weeks are usually considered normal IBS symptom variability rather than a flare.
What factors affect the attack duration?
Some factors that can influence the length of a severe IBS attack include:
- Triggers: Identifiable triggers like food poisoning, intestinal infection, antibiotics, stress, or dietary triggers can prolong IBS attacks.
- IBS subtype: Diarrhea-predominant IBS attacks may be shorter than constipation-predominant ones.
- Treatment: How quickly effective treatment is started can impact attack duration.
- History: Those whose IBS follows a pattern of long flare-ups may experience them more frequently.
- Age: Duration may be longer in older adults compared to younger patients.
When to see a doctor
It is important to follow up with a doctor if you experience any of the following:
- A severe IBS attack lasts longer than 24-48 hours
- You have a high fever, bloody stools, or signs of dehydration
- The attack is not improving with home treatment
- You are unable to keep down fluids or food
- You have severe, persistent pain or diarrhea
- Attacks seem to be getting longer or worsening over time
Prolonged, severe episodes of diarrhea or constipation can sometimes signal an obstruction, infection, or other condition besides IBS. It is important to rule out other possible gastrointestinal disorders.
Treatments to stop an IBS attack
Working closely with your doctor to find effective treatments is key to shortening IBS attacks when they occur. Some medical treatments that may stop or reduce the length of attacks include:
- Antispasmodics: Medications that relax the intestinal muscles, such as dicyclomine or hyoscyamine.
- Tricyclic antidepressants: Amaroxetine or nortriptyline to reduce intestinal pain.
- Loperamide: An anti-diarrheal that slows gut motility.
- Cholestyramine: A bile acid binder that helps treat diarrhea.
- Lubiprostone: Helps with constipation by increasing fluid secretion.
- Rifaximin: An antibiotic that can reduce bloating by treating small intestine bacterial overgrowth.
- Peppermint oil: May help relax intestinal muscles during cramping or spasms.
- Addressing anxiety: Anti-anxiety medication, counseling, or hypnosis for IBS triggered by stress.
There are also many home remedies that people find provide relief during IBS flare-ups:
- Following a low FODMAP diet to identify problematic foods
- Exercising regularly to reduce GI symptoms
- Trying probiotics to improve gut health
- Applying a heating pad to ease abdominal pain
- Avoiding caffeine, alcohol, and other GI triggers
- Drinking plenty of fluids to stay hydrated
- Taking over-the-counter medications like peppermint oil or anti-diarrheals
- Practicing stress management and relaxation techniques
Lifestyle changes to prevent severe attacks
Making certain lifestyle changes can help reduce the frequency and severity of IBS attacks:
- Avoid trigger foods: Keep a food diary to identify problem foods.
- Manage stress: Use exercise, meditation, psychotherapy, or support groups.
- Take regular medications: Such as fiber, antispasmodics, or antidiarrheals.
- Get enough sleep: Sleep deprivation exacerbates gut issues.
- Stay active: Low-impact exercise helps motility and reduces stress.
- Stay hydrated: Dehydration worsens constipation.
- Consider psychotherapy: Addressing anxiety, depression, and trauma can improve IBS symptoms.
When to see a gastroenterologist
It is advisable to see a gastroenterologist (digestive specialist) if you experience any of the following:
- Frequent or prolonged IBS attacks that disrupt your quality of life
- Attacks that are not improving with standard treatments
- Symptoms that may indicate a more serious condition, like inflammatory bowel disease
- Ongoing bloating, diarrhea, constipation, or abdominal pain
A gastroenterologist can help diagnose the cause of your symptoms, provide specialized treatments, and monitor you for other possible gastrointestinal disorders. They may recommend tests like:
- Blood tests
- Stool tests
- Colonoscopy
- Endoscopy
- CT scan
- Biopsies
Seeing a dietician, acupuncturist, counselor, or pain specialist may also be helpful.
When to go to the emergency room
Urgent medical care is needed if an IBS attack is accompanied by:
- Extreme, persistent pain or cramping
- Bloody diarrhea
- Inability to keep down food or liquids
- Fever over 101°F (38°C)
- Confusion, dizziness, or fainting
- Signs of dehydration from prolonged diarrhea or vomiting
Prolonged nausea, vomiting, or diarrhea can cause dangerous electrolyte imbalances and dehydration. Seeking prompt medical treatment can help prevent complications.
When IBS attacks require hospitalization
Hospitalization for an IBS flare-up is uncommon, but may be needed if:
- Dehydration or electrolyte imbalance occurs
- You cannot keep down food, fluids or medications
- You have unrelenting abdominal pain
- You need intravenous pain medication
- Further testing like a colonoscopy is required
- There are signs of intestinal blockage
IV fluid replacement, medication adjustments, pain management, and digestive rest may be part of the hospital treatment plan. Rarely, surgery is required if there is an intestinal obstruction.
Preventing future severe IBS attacks
Although IBS flare-ups cannot always be prevented, the following tips can reduce their frequency and severity:
- Take IBS medications regularly, not just during attacks
- Avoid foods and beverages that trigger your symptoms
- Manage stress through yoga, meditation, counseling, or journaling
- Get regular exercise to improve GI functioning
- Get enough sleep and go to bed at the same time each day
- Stay hydrated by drinking 8-10 glasses of fluid daily
- Consider probiotic supplements to benefit your gut microbiome
- Consider cognitive behavioral therapy to improve coping skills
- Discuss long-term management options with your doctor
Keeping a symptom diary can also help identify triggers that worsen your IBS so that they can be avoided.
Outlook and prognosis
The long-term outlook for people with severe IBS depends on many factors. With proper management, many people find that over time their IBS attacks become shorter and less frequent. Others continue to experience periodic severe flare-ups. IBS is a chronic condition, so flare-ups may come and go over the course of many years. Staying in close contact with your healthcare providers is key to finding an effective treatment regimen that provides adequate relief.
Conclusion
In summary, the duration of a severe IBS attack can range from hours to days to weeks in some cases. Episodes lasting months are less common. Various factors like triggers, IBS subtype, and treatment response can influence the length. Seeing a doctor quickly at the onset of an attack, following an IBS-friendly diet, managing stress, staying hydrated, and taking medications as prescribed can all help shorten flare-up duration. With proper management, IBS symptoms can often be kept under better control.
