Symptoms of an IBS Attack: Here’s What to Look For

Symptoms of an IBS attack are common to many conditions, so it can be difficult to know for sure that you have IBS. Here’s how to recognize an IBS attack, how to get IBS diagnosed, and some complementary and alternative medicine (CAM) options to help control symptoms.

What is irritable bowel syndrome? 

Irritable bowel syndrome, or IBS, is a gastrointestinal condition called a functional bowel disorder, or one where pain and changes in bowel movements and their frequency happen in the absence of any other explanation. IBS is a chronic condition that’s called a syndrome because it involves a group of symptoms that consistently occur together.

IBS isn’t dangerous. In fact, it’s one of the most common gut motility problems, affecting an estimated one in 10 people globally. However, it is a medical condition that can cause severe pain, interfere with daily activities, and negatively affect quality of life.

What is a functional disorder? 

A functional disorder is one where you show symptoms, but there’s no known biochemical or structural cause. For example, lactose intolerance has a biochemical cause; if your body doesn’t produce the enzyme lactase, then the undigested sugar lactose will be consumed by bacteria in your digestive tract instead, causing gastrointestinal problems.

Functional disorders, however, don’t have identifiable causes like this. Theories about the causes of IBS include autoimmune disorder, psychiatric issues, allergic reaction, microbiotic imbalance, and neurological disorder. The cause could be any of these, all of these, or even none of these, depending on the person, their body, and their specific circumstances.

This makes diagnosis and treatment difficult, as there are no tests for IBS, and each treatment works differently for each person. Complicating matters, there are no unique IBS symptoms, even with the worst attacks.

What are the possible symptoms of an IBS attack?

Common symptoms of an IBS attack include:

• Abdominal pain
• Cramping 
• Diarrhea
• Incontinence
• Nausea
• Constipation
• Bloating
• Gas
• Mucus in the stool
• An uncomfortable feeling that the bowel isn’t empty
• A sudden and urgent need to use the bathroom
• Pain that fluctuates with the menstrual cycle

Other non-gastrointestinal symptoms include:

• Lower back pain
• Headaches
• Halitosis
• Joint pain
• Fatigue

As you can see, none of these symptoms on their own, or even in combination, is a “slam dunk.” Everyone experiences some of these, alone and in combination, for various reasons. The problem could be IBS, it could be a number of more specific gastrointestinal disorders, or it could be related to something entirely different.

Can I self-diagnose IBS? 

Self-diagnosis isn’t recommended for IBS. Because the list of symptoms is so varied, it can be difficult to sort everyday discomfort from an IBS attack, and severe IBS symptoms can overlap with more serious gastric concerns that need immediate treatment. 

If your symptoms are mild, an approach that is recommended if you’re concerned about IBS, is to start with a few simple steps:

• Reduce your caffeine intake. Caffeine increases gut motility, among other effects, causing the infamous side effect of frequent urination. Reducing your consumption may help.

• Limit alcohol. A glass of wine with dinner or a beer at the grill is fine, but heavy alcohol use is associated with more intense IBS symptoms the next day.   

• Add more soluble fiber to your diet. Soluble fiber is a type of fiber that dissolves in water. It’s found in oats, apples, carrots, black beans, broccoli, and other foods. It adds bulk and limits gas, which can help with discomfort.

• Work on stress management. The full link between IBS and mental health remains under study, but it’s clear that reducing stress can help with stomach problems.

If these approaches mute your belly symptoms, you may still have a mild case of IBS, but it’s more likely that you simply need to make a few lifestyle changes. If they don’t work, however, or if they only work to a limited degree, you’ll want to talk to your doctor.

How is IBS diagnosed?

Generally, irritable bowel syndrome is diagnosed using the Rome IV criteria. If you think you have IBS, or are reporting gastrointestinal problems to your doctor for the first time, they will first rule out any more serious issues, such as colon cancer.

If all test results come back negative, you’ll be asked four questions:

• How often you have abdominal pain
• If your symptoms of pain and cramping are associated with bowel movements
• If the pain is associated with a change in bowel habits
• If your stool has changed in appearance

If you have pain an average of at least one day a week over the last three months tied to two or more of the above issues, then you’ll likely be diagnosed with IBS.

Mainstream medical treatment options for IBS attacks

If you’re diagnosed with IBS, your doctor will likely recommend a combination of treatments to ease symptoms. Depending on the severity and the impact on your quality of life, they’ll start with the simplest approaches and move to more complex interventions as needed. Treatments your doctor might recommend include:

Changes in diet

While research is ongoing to discover the best diet for all forms of IBS, your doctor will likely recommend shifting to a diet higher in soluble fiber and lower in fat, removing processed foods from your plate, and avoiding foods that can irritate the gut.

Psychological interventions

IBS can affect your emotional health, and your emotional health can affect your gut. Working with a mental health professional, especially one who is trained in cognitive behavioral therapy (CBT) is generally seen as one of the more effective interventions for IBS. Visit our provider directory for help finding one in your area.

Medication 

If medication is warranted, there are a few drugs that doctors may prescribe. However, the side effects or cost of some of these make them unattractive options for many people.   

• Antispasmodics. Drugs in this class relax smooth muscles, including those in the gut, and may help with constipation. They’ve been available for a long time and are well understood, but they can have unwelcome side effects that make them intolerable for some people.
• Antidepressants. Some antidepressants, especially tricyclic antidepressants, have been shown to help with some forms of IBS. 
• 5-HT3 antagonists. These belong to a class of drug called serotonin receptor antagonists and include alosetron. These drugs work by blocking certain receptors in the gut that may cause IBS attacks. Alosetron, however, has been highly controversial, and its use is heavily restricted.
• 5-HT4 agonists. These serotonin receptor agonists are a similar class of drug that includes prucalopride, a more targeted blocker that helps with gut motility. 

Another option your doctor may recommend is complementary and alternative medicine (CAM) therapy. Many people find that a combination of Western and CAM therapies gives them the best symptom relief. 

CAM therapies for IBS attacks 

Complementary and alternative medicine (CAM) therapies are increasingly popular for treating IBS because they often dovetail with Western medicine, are non-invasive, and can be effective at controlling IBS symptoms. 

That said, research on CAM and integrative therapies is ongoing. Due to the nature of IBS, not every therapy will have health benefits for every person, but CAM approaches with scientific backing for IBS include:

Behavioral therapy

Behavioral therapies are often effective at treating IBS. Cognitive behavioral therapy, in particular, can be very helpful. Originally developed to treat depression, CBT is aligned around action, teaching people strategies to manage their mental health when confronted with problems in daily life. CBT has been shown to be effective for IBS, even in severe cases.

Gut-directed hypnotherapy

Hypnotherapy for IBS is a mind-body therapy that is often used for IBS symptoms. A meta-analysis of studies involving 400 participants and a separate randomized controlled clinical trial, both published in 2016, have shown that hypnotherapy can be effective for IBS.

Herbal remedies

Herbalism has many traditions that treat gut disorders, and may work well with a spiritual or mindfulness practice. Multiple studies have concluded that herbal therapy can be an effective treatment for irritable bowel syndrome.  

Acupuncture

The use of small, thin needles in the skin, acupuncture for IBS has been shown to improve quality of life. Acupuncture is becoming more mainstream in Western medicine. Acupuncture services are often included in hospital integrated medicine departments, and medical doctors are increasingly suggesting acupuncture for their patients.

Nutrition therapy

Nutritional therapy for IBS, including the low-FODMAP diet, can be one of the most effective treatment methods. However, the process of trial and error needed to learn which foods to eat and which to avoid can be complex. A nutritionist or dietician can help manage diet recommendations and make sure that you continue to eat a healthy diet throughout the process.

For more information 

Want to learn more about CAM therapies and IBS? Follow our blog for the latest in evidence-based research on complementary and alternative therapies for IBS. 

Ready to take the plunge and try a complementary treatment for your IBS symptoms? Visit our provider directory to find a practitioner near you.