Exaggerated bowel movement is a frequently reported complaint. the majority of cases are due to a condition called exaggerated gastro-colic reflex. However, some other diseases can cause such conditions.
IBS pain relief: 8 Most Effective Tips From A Doctor With IBS.
MD, Assistant lecturer of internal medicine, Gastro-enterology, & Hepatology.
IBS sufferer, Gut health enthusiast, and writer.
Your health matters, my content is not a substitute for the medical advice by your doctor. #Stay_Safe
By Dr. Farahat.
Today I will share with you a mix of what I learned about IBS pain relief techniques.
These techniques helped me to control my IBS attacks 90% of the time.
This is an IN-DEPTH guide combined with disease-experience and research-based data. From a gut doctor who has IBS.
Also, this guide is evidence-based, helping you to put realistic expectations; Away from lots of crap found on the internet.
To be more specific, I only focused on IBS pain relief. Soon, I will publish in-depth guides for treating IBS diarrhea, constipation, bloating, and gas.
I divided this guide into 2 main parts:
- Part 1: Quick IBS pain relief tips that you can start with NOW.
- Part 2: Strategic tips for long term pain relief that you can start today and win the benefits later.
Short term IBS Pain relief Tips.
1- Listen To Your Colon.
This is the most basic, simple, and yet the most effective IBS pain relief mechanism for me.
The basic definition of IBS is “abdominal pain related to defecation”. “Related” means that your abdominal colics Improve with defecation in the majority of cases (in a small fraction of people, they may become worse with defecation).
Abdominal pain is a message from your body to you. The message tells you that you have to “evacuate” your colon.
I always get rid of mild IBS Flare-ups only by evacuating my colon frequently. And it succeeds in >90% of the time without even the need for antispasmodics.
Whenever I experience an IBS attack, I continue to listen to my colon. Even I if had to go to the toilet every 10 minutes. And what I found is that usually after 4 to 5 successive toilet visits, my IBS attack starts to calm down.
And the first step for IBS pain relief is to listen to this message. Never prevent your self from going to the toilet. As this may make your IBS symptoms worse.
People who tend to ignore their urge to go to the toilet are the worst IBS sufferers. You are more commonly to do so in the following conditions.
1- fear of going to the toilet in your work or college.
2- fear of going to the toilet in outdoor social events like visits or parties.
3- fear of going to the toilet during long trips (on trains or airplanes).
Train yourself to overcome any overthinking or embarrassment about going to the toilet in public places.
When you prevent yourself from going to the toilet, nothing occurs except for the discomfort, and colics continue to increase.
2- IBS Pain Relief With Heat.
Heat is one of the easiest and effective ways to ease the pain. And IBS abdominal pain is not an exception.
Why heat may be effective:
What causes IBS pain is the contractions of the muscles in your colon wall. The irregular or more intense contraction will make you feel pain, bloating, and may cause diarrhea.
Heat relaxes muscles and decreases colics when applied to your belly. It is effective in most people. Also, it is an inexpensive and safe remedy for IBS pain relief.
Here are some tips on how to do it the right way:
1- Only use it as a complementary remedy together with other tips enlisted here, and never expect too much.
2- Only use quality and safe pads with electronic shut-down to avoid any burns from heat applications
3- Apply heat to the area of maximum pain, the best way is by using a heating pad like this (amazon.com)
4- NEVER apply heat pads directly to your Skin. Always wear a layer or two of cloth.
5- Use it for at least 15 minutes and don’t exceed 2 hours.
6- Better to rest in a comfortable position and listen to relaxing music.
7- Never get asleep with the pad on your stomach.
3- Use antispasmodics.
The simple and most direct way to relieve IBS pain is to use antispasmodics. There are 2 categories of antispasmodics you can use:
- Prescription antispasmodics: like mebeverine hydrochloride (ColofacⓇ), Also Tricyclic antidepressants like amitriptyline that have antispasmodic effects.
- Over-the-counter antispasmodics: the two most famous are peppermint oil (IBrard and hyoscine butylbromide (BuscopanⓇ IBS Relief).
Antispasmodics whether prescription or over the counter are proven to be effective in symptomatic relief of IBS pain.
Here are my top tips if you decide to take antispasmodics:
1- start with over-the-counter antispasmodics, they are safer, with fewer side effects. For example, IBgard or Buscopan IBS relief.
2- stick to standard dose for the antispasmodics, don’t let the pain make you abuse the drugs in large doses.
3- for best effect, take the antispasmodic 15 minutes before the meal.
4- For the best results with antispasmodics, try to avoid foods that trigger IBS and heavy meals.
5- better to consult your doctor about the duration, side effects, and contraindications specific to your health condition.
If you are planning to take antispasmodics, check this guide that tells you exactly how to take antispasmodics for IBS pain relief.
4- Soothing Tea Also Can Relieve IBS Pain.
A warm herbal tea may also aid in IBS pain relief. You can use teas specific for IBS, like peppermint oil tea.
Peppermint tea can have a pain-relieving effect on IBS similar to peppermint oil capsules.
Example: Organic Peppermint Tea Bags (amazon.com).
Note: don’t over-consume herbal teas. As this may worsen your IBS or cause heartburn. Also, these herbal teas are not thoroughly studied. The results vary, but it is worth a trial.
5- Cut The Foods That Hurt Your IBS.
The following food is known to trigger IBS pain. Cutting these foods during an IBS pain attack is one of the most rewarding strategies to relieve pain.
A-Gas producing foods:
- beans, onions, celery, carrots, raisins.
- bananas, apricots, prunes, Brussels sprouts, wheat germ, pretzels, and bagels.
- Alcohol: especially, high FODMAP alcohols.
B-Foods high in FODMAPs:
They are a group of foods that are found to trigger IBS pain. They are types of sugars that are easily fermentable and produce lots of gas. They include:
- Fermentable: as the gut bacteria break them down producing lots of gas.
- Oligosaccharides: these are compounds called fructans and galacto-saccharides present in wheat, barley, rye, onion, garlic, and legumes.
- Disaccharides: fructose sugar present in milk ice cream custard and yogurt.
- Monosaccharides: Refers to free fructose present in Apples, pears, mangoes, cherries, watermelon, asparagus, sugar snap peas, honey, high-fructose corn syrup.
- Polyols: sorbitol, mannitol, xylitol, and maltitol present in certain types of fruits like apples and watermelon and artificial sweeteners like artificially sweetened gum and alcohols.
If the above measures fail, you may try to avoid lactose (milk, Ice cream, and other milk products) and Gluten (found in wheat and barley).
Some studies found that many people benefit from cutting these two types of foods with IBS. this beneficial effect with IBS doesn’t mean you have frank lactose intolerance or celiac disease (gluten intolerance).
But mild degrees of sensitivity exists with your IBS. And again, the response to cutting these foods differs from one person to another.
If you want to know how to exclude these foods from your diet the right way, head to the diet elimination plan below.
D-Decrease insoluble fibers and grassy foods:
2 types of fibers, the soluble and insoluble fibers. Both can benefit or harm your IBS.
- Insoluble fibers: found in grassy foods, cabbage, broccoli, fruits. They didn’t dissolve in water. If you eat too much insoluble fiber, they can cause IBS pain, bloating, and gas.
- Soluble fiber: dissolve in water, when taken in the right amount, they can help your IBS. they are especially effective in IBS-diarrhea as they trap water and form a gel. They found in whole grains like brown rice, some fruits.
To learn more about fibers and IBS, read this in-depth article.
Long term IBS pain relief strategies:
6- Start With Your Mind & Thoughts
Your Mind greatly affects your IBS. Stress and anxiety for any reason can cause your IBS flare Up.
Research says that people with IBS have more:
Anxiety is your body’s response to stress and thoughts. It means a feeling of fear about what is to come. Anxiety is one of the commonest findings I experience with my patients.
One of the commonest causes of your IBS flare-ups is your IBS itself. Most IBS patients get worried about their conditions.
Thinking that IBS is a dangerous disease or thinking it is something else like colon cancer or IBS may put you in a state of stress.
Anxiety increases IBS symptoms and IBS pain increases anxiety. And a vicious circle is formed:
More fear & thinking > more stress signal from your brain to your colon > IBS pain > your brain feels pain from your colon > More fear and thinking.
Also anxiety for any other reason like fear of what is coming in your personal life like financial stress or Uncertainty about your work or relationships.
This impacts your health by:
- Triggering your IBS pain, diarrhea (more common), or constipation.
- Causing sleep problems.
- Causing rapid heartbeats.
- Chronic stress and headache.
So your first step to Relieve your IBS pain is starting to deal with your thoughts.
Here are my top tips to control your anxiety:
1- Catch & eliminate Your “Destructive Thoughts”
You can’t solve a problem you don’t know if it even exists. So starting to analyze what you are thinking about. How you expect things happening or going to happen.
For example, one of my patients (aged 42) was suffering from repeated IBS attacks because of his fear of colon cancer (as his closest friend, aged 47 suffered from colon cancer).
This man always thinks like “this aches in my gut may be going to be a colon cancer”. A wrong conclusion by his subconscious mind. This wrong conclusion is enough to put him in a case of chronic stress and repeated IBS flare-ups.
Once I discussed the issue with him, and I explained to him his “ illogical thoughts” he started to see improvement.
What I talk about now is known as CBT or “cognitive-behavioral therapy” for IBS.
Source: this study
The biggest challenge for you is to become aware of your thoughts. Most of us experience fear and anxiety without even knowing the cause. But if you start to educate yourself to look deep inside your thoughts, you will find the “reason why” you are in fear.
2- Stop expecting the “worst scenario”:
After realizing what thought is running in your head, it is time to analyze and RE-LABLE it.
The problem with your anxiety is you always expecting the worst scenario. And you have to start to educate yourself that IBS is a benign condition and it can’t lead to dangerous complications.
The most effective way to identify your thoughts and to re-label them is to write them down.
3- speak about your stress!
Try to speak out about your problem with anxiety. Start taking with your partner or close family member. Just taking may be an eye-opening experience. When you start taking your thoughts, fears and unlogical expectations becomes more clear to you.
More effectively, you can consult your gastroenterologist to refer you to CBT or use an online CBT established program like online-therapy.com. An online service specialized with Cognitive Behavioural Therapy with lots of tools and sheets.
Online Cognitive Behavioural Therapy is an established method of treatment, shown to have the same effect as face-to-face CBT. Even the American Psychological Association published guidelines for Online CBT (telepsychology).
7- Try an elimination diet plan like a pro.
Starting an elimination diet plan has many benefits:
- It helps you identify and exclude food triggers.
- May be very effective in relieving IBS pain and bloating.
- Safe, inexpensive strategies to control your IBS.
- If you are motivated to learn enough, it can be done by yourself.
Step-by-step elimination diet plan:
1- talk to your doctor:
To plan a successful elimination diet plan, you have to talk to your doctor about:
- Confirming that you don’t have any other gut diseases other than IBS.
- If necessary, you can test for celiac disease or other food allergies before you start an elimination diet.
- Assess the safety of the elimination diet; especially if you have any other chronic disease like diabetes or hypertension.
2- Decide what diet to eliminate:
For IBS patients hoping to follow an elimination diet, I always advise eliminating a single food group at a time. If eliminations of a group of foods don’t improve your IBS, move to eliminate the next food group.
The most important food groups to start with (in order of importance)::
- FODMAPs: I suggest to all IBS patients to start with eliminating all FODMAPs.
- Gas producing foods: like beans, onions & others (enlisted above). This is the second step if eliminating FODMAPs didn’t work.
- Lactose: the third food group to try. It includes Milk, icecream, yogurt, and soft cheese.
- Gluten: in wheat and barley.
REMEMBER: eliminate one group at a time, if elimination fail, move to eliminate the second group.
3- The elimination phase:
You have to keep a food diary whether a digital food diary app or an old school pen and paper notebook.
You will record at for times a day; 3 times after every meal, another 4th time before you go to bed.
Record the following:
- The type of food ingested after each meal and before you go to bed you can record any other foods, snacks, or drinks other than the main 3 meals.
- The symptoms experienced during each recording session like colics, diarrhea, bloating… etc. and each symptom is given a score from 1(mild) to 5 (most severe).
- Any other factor that may contribute to your gut pain like menstruation in females.
Continue for at least 2 weeks (ideally for 8 weeks).
Look for symptom improvement or any pattern of worsening symptoms after certain foods.
If no improvement at all, reintroduce the food group. If significant improvement occurs, move to the Re-introduction phase.
4- the re-introduction phase:
If no symptom improvement at all after the period of elimination (2-8 weeks) cancel this step and reintroduce all the food groups at once. Then start the elimination plan for the next food group.
If your IBS pain improved by elimination you will start to introduce a single type of food. Eat a small amount of specific food and wait two days without eating it again. Then record if your symptoms worsen again.
If no worsening of symptoms starts to eat a larger amount on the third day of introduction and wait again for 2 days. If no worsening of symptoms, start re-introducing another type of food… etc.
8- Try Probiotics.
Your gut teams with the normal bacteria that live inside it. You provide them with a place to live and food to eat. And they help your gut to digest food and fight other unwanted organisms.
One of the most accepted theories of IBS is the imbalance between the good bacteria (normal intestinal flora) and the bad bacteria.
This imbalance can lead to the appearance of IBS symptoms such as abdominal pain, bloating, diarrhea, or constipation.
Probiotics supplements are “good bacteria”. It can help your gut to regain its balance and function.
We are now in the probiotic era of IBS treatment, the research around different probiotics strains are still inadequate. But there is a piece of growing evidence that certain probiotic strains and combinations are effective in some IBS patients.
To be clear, the results of Probiotic supplements are not typical for all patients. but still promising and you should give it a try.
Probiotics are extremely safe, that’s why we -doctors- are comfortable prescribing it.
The best probiotics to try:
probiotics are available in many forms (capsule supplements, probiotic yogurt, probiotic milk). Unfortunately, there are no standard dosing, duration, and strains that fit all IBS. patients.
All we know that probiotics containing “Bifidobacteria” and combinations of multiple strains have better results. but remains lots to be studied about the perfect types, dosing, and duration.
the standard rules to take probiotics:
1- only choose probiotics containing strains that research has proved its efficacy.
2- take probiotics that contain combinations of different strains in full doses
3- Adhere to one type of probiotics for 3 to 4 weeks, if no improvement, you can shift to another type (trial and error).
4- only choose established brands from a quality manufacturer.
Soon, I will publish a complete guide for probiotics with IBS. and I will link to it here in this article.
My recommended probiotic (contain strains that are specifically improves IBS, more than one strain and good reputation of the manufacture with tons of positive reviews on amazon and other platforms:
Best soluble fiber fruits for IBS include passion fruit, guava, kiwi fruit, oranges, mandarin, strawberries, unripe bananas, and pear.
Choosing the best probiotic that works for both IBS and GERD is challenging. the two golden rules for choosing the best probiotic for IBS & acid reflux is to go Multi-strain and to avoid probiotic with high FODMAP constituents.
IBS doesn’t cause anemia, and anemia is not a symptom of IBS. presence of anemia with IBS requires consultation of your doctor about the causes of anemia with IBS. Both anemia and IBS are common conditions, their co-existence doesn’t necessarily mean they are related.
Apples are high in both sorbitol and fructose (two FODMAPs). Those two sugars rapidly ferment and produce gas, resulting in worsening of your IBS symptoms such as abdominal pain, distension, and bloating. So, they can do more harm than improvement in your IBS-constipation
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