Managing your IBS-D
Understanding and Managing IBS Pain
What causes abdominal pain in IBS patients, and what can people living with IBS do to ease their discomfort?
By Diana Rodriguez
Medically Reviewed by Pat F. Bass III, MD, MPH
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Irritable bowel syndrome (IBS) can cause significant pain and discomfort in the abdomen. Common IBS symptoms such as diarrhea, constipation, and gas can all cause pain in the belly. Management of these other IBS symptoms will help relieve your IBS pain.
IBS Pain: What Are the Causes?
When your belly gets crampy and painful, it's most likely because of constipation or diarrhea. If your pain gets better after you go to the bathroom, then it's related to those other symptoms.
People who have IBS have also been found to be more sensitive to pain. "IBS is also characterized by what's called hypersensitivity, says Norman Gilinsky, MD, a gastroenterologist and an associate professor in the department of internal medicine at the University of Cincinnati. People with IBS "tend to be more aware of rumblings in their belly. IBS patients seem to be hypersensitive to discomfort. The greater the discomfort in patients with IBS, the greater the potential psychological overlay, be it depression or anxiety," notes Dr. Gilinsky.
The pain is caused by a contraction of the intestines, according to Gilinsky. "An old term for IBS was spastic colon, a contraction of muscle of the intestines. However, there is no structural abnormality when one does a colonoscopy, CT scans, etc.," says Gilinsky. In short, there is no abnormality that causes the pain of IBS. Rather, the pain results from the way the digestive tract functions and responds to triggers, including stress and certain foods.
IBS Pain: Tips to Ease Discomfort
- Antidepressants.The pain isn't in your head, but in some cases, doctors believe that may be the origin of the pain. "Those patients who are debilitated by abdominal pain in the setting of IBS may have significant underlying depression,” says Gilinsky. “Those patients should benefit from formal psychological evaluation and possibly even antidepressant medication to help moderate the discomfort."
- Diarrhea or constipation treatment.When IBS pain is a side effect of bowel dysfunction — like diarrhea or constipation — those symptoms need to be dealt with to manage pain. "Constipation will increase pressure in their bellies, so it's important to treat constipation,” says Gilinsky. “When bowels move, discomfort, bloating, and distension in bellies improve also."
You can manage constipation and diarrhea with:
- More fiberin the diet.
- Laxatives(constipation only). Check with your doctor before using over-the-counter laxatives, as they could irritate your intestines. It is also possible to become dependent on them.
- Anti-diarrheal medications(diarrhea only)
- Medications prescribed by your doctor, like antidepressants and anti-spasmodic medications
- Eliminating common irritantsfrom the diet like dairy products and fattening foods
- Stress reduction
- Hydration.You should drink six to eight glasses of water each day.
- Acetaminophen.While over-the-counter acetaminophen (Tylenol) is okay for managing IBS pain — as long as it is taken in the recommended doses — in general, pain-relieving medications aren't really the right tool to manage IBS pain, says Gilinsky. That’s because common pain medications can often irritate the belly and cause even more pain. "We try and avoid narcotics in this situation because that can aggravate the vicious cycle these patients may be getting into,” says Gilinsky. “Narcotic dependency unfortunately is common in these patients. It is vitally important to avoid narcotics in patients with IBS."
It's also very important to make sure that IBS pain is correctly identified, and not actually caused by something else. "The physician needs to rule out other causes for the pain," says Gilinsky. If pain is truly from IBS, Gilinsky notes that good general management of the condition can help to reduce pain. Gilinsky adds that "stress management, possibly antidepressant medication, and anti-anxiety medication if appropriate should help — and even hypnosis if indicated."
IBS pain shouldn't be ignored, but you do need to figure out what's causing it to figure out the best way to manage it. Once you get constipation and diarrhea under control, your belly should feel much better. And making healthy lifestyle changes — like eating a healthy diet and getting regular exercise — will help both your mind and body be less stressed as well as pain-free.
Video: Irritable bowel syndrome (IBS)
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