Today I will try to answer some of the most common questions I always receive about the relation of IBS and Ibuprofen, paracetamol, and other painkillers.

Do Ibuprofen help IBS pain? Does taking Ibuprofen can make my IBS worse? What can I do to take anti-inflammatory medications safely without affecting my IBS?

These questions and more will be thoroughly answered in this article. Stay tuned.

IBS and Ibuprofen:

Ibuprofen (Advil) is a Non-Steroidal Anti-inflammatory Drug. It is Now available as Over a counter (OTC) pain killer (200 Mg dosage is the only available OTC in the USA, other doses are prescription). 

It is used for a variety of painful conditions like headaches, arthritis, and other inflammatory conditions.

I usually receive lots of questions about IBS and Ibuprofen:

1- Can ibuprofen be used for IBS pain relief?

No.

Ibuprofen doesn?t help IBS pain. Rome IV criteria for diagnosis and management of IBS didn’t include any recommendation for Use of Ibuprofen in the treatment of IBS.

This is because IBS colics is NOT inflammatory pain. IBS pain occurs due to the spasm of the smooth muscles in the wall of your colon.

The colics or spasms don’t respond to painkillers like ibuprofen. It responds to antispasmodics like anticholinergic drugs, peppermint oil, or mebeverine.

However, Some patients report IBS relief by ibuprofen. This is an exception and not the rule. And this can be explained by a variety of causes:

1- Overlap of IBS pain with other chronic pain syndromes like fibromyalgia: This is Not an uncommon association. People with fibromyalgia have widespread muscle and joint pain. (Reference)

If you have fibromyalgia-associated IBS your gut pain may respond to ibuprofen. Always discuss the issue with your doctor especially if you have generalized muscle aches or headaches.

You can read more about fibromyalgia and IBS here.

2- Overlap of IBS pain with menstrual pain in females: period pain can be confused as IBS. if you are a female and experience abdominal pain before or during menstruation, this can be confused with IBS pain.

3- Overlap between IBS pain and any other inflammations inside your abdomen: other conditions like cholecystitis, renal pain, appendicitis can be confused as IBS pain. These inflammatory conditions may respond to ibuprofen. 

So, IF you experience improvement of your IBS symptoms with Ibuprofen, this may mean that you have other conditions associated with your IBS.  please consult your doctor.

2- Can Ibuprofen make your IBS worse?

Maybe.

Ibuprofen can make your IBS worse. It is better to use paracetamol (acetaminophen) instead. Paracetamol is relatively safer than ibuprofen. Ibuprofen commonly causes side effects especially after approval as an OTC medication (over usage without medical supervision). 

The side effects of Ibuprofen can make your IBS worse, they include:

• Abdominal pain (over your stomach or all over your abdomen).
• May be diarrhea.
• Ibuprofen may increase gas and bloat.
• Nausea and vomiting may occur.

Also, Non-steroidal anti-inflammatory drugs (NSAIDs) can affect your intestine and colon even if you don’t have IBS. This study illustrates the possible complications of NSAIDs (including Ibuprofen) affecting your lower gastrointestinal tract (small intestine and colon):

• Malabsorption of fluids and nutrients.
• Induction of gut inflammation.
• Increased gut permeability to toxins and bacteria passing into your bloodstream.
• May lead to ulcers in the mucosa of your intestine.
• These ulcers or erosions may lead to blood loss and anemia.

Source: This study

In addition to side effects on IBS, it may have other serious complications like:

• Increase the risk of gastritis (inflammation of your stomach lining).
• May lead to stomach or duodenal ulcers.
• May cause heart problems.
• May affect kidneys.

So, don?t use Ibuprofen if you have IBS unless prescribed by your doctor.

Ibuprofen can trigger IBS attacks when taken. If you experience IBS symptoms after taking Ibuprofen, stop Ibuprofen and consult your doctor.

4- Ibuprofen gel and IBS.

Ibuprofen gel is used to treat a variety of painful conditions (not including abdominal pain). Common uses of Ibuprofen gel: 

• Joint pain as knee ostro arthritis.
• Backache.
• Muscle pain. 
• Pain from strains and sprains.

No evidence that applying Ibuprofen gel to your abdomen can soothe your IBS symptoms. Ibuprofen gel is used only for muscular pain, arthritis, backache, and pain from strain and sprains. [reference]

On the other hand, only minimal amounts of ibuprofen gel pass into your bloodstream [reference]. So, using ibuprofen gel (for your joint or muscle pain) is unlikely to hurt your IBS.  

Ibuprofen gel is only to be applied to intact skin. Never try to apply ibuprofen gel into the analiarea, or lips (for external use only). [reference]

5- Can I take ibuprofen while I have IBS.

The use of Ibuprofen to treat your painful conditions and headache is not absolutely contraindicated if you have IBS.

Always consult your doctor about taking ibuprofen while you have IBS. Ibuprofen has the potential to worsen your IBS symptoms.

As we mentioned before, it may increase your abdominal pain, gas and bloating, and may cause constipation. If you plan to use Ibuprofen for any reason (fever, headache, muscle or joint pain), use with caution or take safer alternatives.

6- Tips to safely use Ibuprofen while you have IBS.

Using ibuprofen while you have IBS should be with caution. As it may cause worsening of symptoms in some (Not all) IBS patients. 

Here are my tips to use Ibuprofen safely while you have IBS:

1- Although Ibuprofen is an OTC drug in most countries, don’t use it by yourself if you have IBS. consult your doctor.

2- Try to use relatively safer alternatives (as paracetamol) if available.

3- Try to take minimal effective doses (start with ibuprofen 200mg tablet).

4- Try to use the gel form instead of oral tablets if suitable: less absorption into your bloodstream and less effect on your IBS.

5- Shorten the period of using Ibuprofen.

6- If you experience worsening of your IBS symptoms after taking Ibuprofen, cut the drug off and consult your doctor.

7- Don?t Use Ibuprofen if you have epigastric pain or heartburn (unless prescribed by your doctor).

8- Don?t use Ibuprofen if you have severe nausea or vomiting (unless prescribed by your doctor).

9- Don’t use Ibuprofen If you have chronic diseases affecting your kidneys, heart, or have a history of stomach or duodenal ulcers.

7- What about Paracetamol and other NSAIDs?

Other NSAIDs are present. Most of them are prescription drugs. An exception is Acetaminophen(paracetamol), an OTC anti-inflammatory drug. it is generally considered safer than Ibuprofen.

Generally speaking, acetaminophen and Ibuprofen have less frequency of side effects on your IBS and stomach than others like Ketoprofen, Meloxicam, and aspirin.

Paracetamol (acetaminophen) is less harmful to your IBS and your stomach. Also, it is generally safe for your kidneys and heart.

No evidence that any NSAIDs have a beneficial effect on your IBS. but another type of painkiller called opioid analgesics may have beneficial short-term effects (discussed below).

8- Could I take opioid analgesics for IBS?

Opioid analgesics are one of the most potent painkillers. They include morphine and its derivatives.

They may provide short-term IBS pain relief. But evidence exists that the use of opioids can make your IBS worse. As opioids slow down the movement of your colon. Causing more constipation, bloating, and nausea. 

Also, Dependence and tolerance may occur leading to worsening of symptoms when you withdraw the drugs. And with time, you will need more doses to reduce the abdominal pain. This condition is called ? Narcotic Bowel Syndrome?.

If you have IBS, Never use Opioids and narcotics unless prescribed by your doctor.

Take-Home messages:

• No evidence supporting that NSAIDs could help your IBS pain.
• Ibuprofen and paracetamol are generally a relatively safer option for pain management than other NSAIDs like ketoprofen, aspirin? etc.
• There is a risk of worsening your IBS symptoms with the use of ibuprofen and other NSAIDs.
• Always work with your doctor to determine the safe options for your IBS.
• Never Use opioid analgesics for IBS pain.