Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by recurrent abdominal pain and altered bowel habits. There are several types of IBS, classified by the predominant bowel pattern – IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), mixed IBS (IBS-M), and unclassified IBS. While IBS is typically manageable with diet, lifestyle changes, and medication, severe flares can occur periodically, causing debilitating gastrointestinal symptoms. This article will provide an in-depth look at the wide range of symptoms that can present during a severe IBS flare-up.
Abdominal Pain and Cramping
The hallmark of IBS is abdominal pain and discomfort. During a flare-up, the intensity and duration of this pain is often severe. Pain typically occurs in the lower abdomen but can be felt anywhere between the chest and pelvis. It may come and go in waves, intensifying then subsiding again. The quality of pain can vary between individuals – it may be sharp and stabbing, dull and achy, or colicky and cramping. Many report the pain as being strong enough to interrupt daily activities or keep them confined to home.
Abdominal cramping often accompanies the pain in IBS. These cramps are contractions of the intestinal muscles. Spasms may be brief but very painful. Some individuals experience mild cramping constantly during a flare. Anti-spasmodic medications can help relieve cramping but have variable effectiveness between patients.
Other Gastrointestinal Symptoms
Alongside abdominal pain, several other gastrointestinal disturbances commonly occur during an IBS flare:
– Bloating – sensation of fullness, tightness or swelling in the abdomen
– Excessive gas and flatulence
– Gurgling or rumbling noises from the bowels
– Fecal urgency – sudden need to have a bowel movement
– Constipation – difficulty passing stools, infrequent bowel movements
– Diarrhea – loose, watery stools, frequent bowel movements
– Bowel incontinence – inability to control bowel function
These symptoms result from dysmotility and hypersensitivity present in the gastrointestinal tract of IBS patients. The precise manifestations depend on whether the individual has IBS-C, IBS-D or mixed IBS.
Effects on Quality of Life
Severe IBS flares can significantly impair quality of life. The unrelenting gastrointestinal symptoms often disrupt work, school, social activities, exercise, sleep and mental health. Due to pain, bowel urgency or fear of incontinence, individuals may avoid leaving home. Cancellation of plans is commonplace. Concentration, productivity and performance can suffer greatly. The unpredictability of IBS flares and time spent managing symptoms breeds anxiety and depression in many. Feelings of isolation and frustration are also very common. Overall, quality of life is often rated lower in IBS patients compared to other chronic diseases like diabetes, end-stage kidney disease and inflammatory bowel disease.
Triggers of a Severe Flare
IBS flares have a variety of potential triggers including:
Diet
– High FODMAP foods – fermentable carbohydrates found in foods like wheat, onions, beans, dairy, sweeteners
– Caffeine, alcohol, carbonation, artificial sweeteners
– High fat meals
– Eating large meals
Medications
– Antibiotics – disrupt gut microbiome
– NSAIDs – cause gut inflammation
– Certain supplements – iron, magnesium, etc.
Gut infection
– Viral gastroenteritis
– Bacterial overgrowth
– Parasitic infection
Stress and anxiety
– Work, family, social, finances
– Trauma or major life event
– Generalized anxiety disorder
Hormonal changes
– Menstruation
– Perimenopause
– After pregnancy
Disrupted sleep cycle
– Insomnia
– Jet lag
– Shift work
Identifying and managing potential triggers is key to preventing and mitigating IBS flares. Keeping a symptom journal can help identify personal flare triggers.
When to Seek Emergency Care
Most IBS flares can be managed at home with rest, hydration, medication and diet changes. However, severe or prolonged flares sometimes require emergency medical attention. Seek immediate care if you experience:
– Intense abdominal pain that does not improve after 24 hours
– Blood in vomit or stools
– Fever over 101°F
– Diarrhea lasting more than 24 hours
– Signs of dehydration – dizziness, rapid heart rate, confusion
– Inability to keep down fluids due to vomiting
– Suicidal thoughts
These red flag symptoms may indicate a serious medical condition requiring hospitalization, such as a bowel obstruction, perforation or severe electrolyte imbalance. Do not hesitate to go to an emergency room or call 911 if your flare seems life-threatening.
Diagnosis
There is no definitive diagnostic test for IBS. It is considered a diagnosis of exclusion, made after ruling out other disorders like inflammatory bowel disease, celiac disease and colon cancer. IBS is frequently diagnosed based on symptom history alone using the Rome IV diagnostic criteria:
– Recurrent abdominal pain on average at least 1 day a week in the last 3 months
– Two or more of the following criteria:
– Related to defecation
– Associated with a change in stool frequency
– Associated with a change in stool form
– Symptoms onset at least 6 months prior to diagnosis
However, severe flares may warrant additional testing to exclude other conditions:
Blood tests
Check for anemia, infections, celiac disease
Stool tests
Check for blood, infections, parasites, cancer cells
Breath tests
Check for small intestinal bacterial overgrowth
Colonoscopy
Visual inspection to exclude inflammatory bowel disease, microscopic colitis, colon cancer
CT scan
Detailed images of the intestines to check for obstruction, tumors, other structural issues
Treatment
Successful treatment of a severe IBS flare focuses on managing symptoms and preventing complications like dehydration. A combination of home care and medical therapies is often needed.
Home Care
– Rest as much as possible
– Apply heat to abdomen for pain relief
– Drink plenty of water, broth, electrolyte drinks
– Follow a low FODMAP, low fat, low fiber diet
– Avoid NSAIDs, caffeine, alcohol
– Try relaxation techniques to reduce stress
Medications
– Antispasmodics – dicyclomine, hyoscyamine
– Antidiarrheals – loperamide, diphenoxylate
– Tricyclic antidepressants – nortriptyline, desipramine
– SSRIs – citalopram, sertraline
– Antibiotics – rifaximin, neomycin
– Pain medication – acetaminophen, tramadol
Emergency Care
– IV fluids for dehydration
– Nasogastric tube for vomiting
– Imaging tests to identify serious complications
– Medications to stop diarrhea, vomiting, pain
– Electrolyte replacement
– Psychological support
Alternative Therapies
– Acupuncture
– Probiotics
– Peppermint oil
– Cognitive behavioral therapy
– Gut-directed hypnotherapy
Preventing Severe Flares
While periodic IBS flares are often unavoidable, the following strategies can help reduce flare frequency and severity:
– Follow a regular meal schedule
– Avoid food and medication triggers
– Manage stress through meditation, therapy, exercise
– Get enough sleep
– Take probiotics and anti-spasmodic supplements regularly
– Keep hydrated
– Maintain a healthy body weight
– Limit caffeine, alcohol and sugary foods
– Don’t smoke
– Take prescribed IBS medications consistently
Having an IBS treatment plan in place allows for early intervention when symptoms start flaring up, often curtailing progression to a severe flare. Keeping a symptom journal helps determine what treatments are most effective for an individual’s IBS pattern.
Prognosis
IBS is a chronic, lifelong condition. There is no cure, only management aimed at controlling and minimizing symptoms. With proper, proactive treatment, periods between flares can be extended and most patients achieve reasonable control over their IBS. Severe flares tend to become less frequent over time as triggers are identified and avoiding. However, acute episodes will continue to occur periodically. Support from family, friends and health professionals helps coping with the challenges of living with IBS long-term.
Conclusion
Severe IBS flares can be extremely debilitating, significantly reducing quality of life. A wide range of gastrointestinal symptoms may present including abdominal pain, cramping, constipation, diarrhea and bowel incontinence. Psychological effects like depression and anxiety frequently accompany the physical symptoms. Identifying potential triggers and following an IBS treatment plan can help reduce flare frequency and intensity. Severe, prolonged flares may require hospitalization for pain management, rehydration and ruling out serious complications. While IBS requires chronic management, periods between flares can be extended with proper care and support.
