What Is An IBS Attack? 

An IBS attack is a flare-up of IBS symptoms.

Irritable bowel syndrome is essentially a collection of symptoms, rather than a disease in itself. At IBS Clinics, we see IBS symptoms as evidence that you need to explore your gut health and find the root causes of your constipation, diarrhoea or bloating. We recommend working with a health professional and using evidence-based gut health tests to start your journey back to health.

To learn more about IBS attacks, and what to do about them, read on.

What is an IBS attack? 

Because everyone’s IBS symptoms are different, there’s no single definition of an IBS attack. If you suffer from diarrhoea and bloating, for instance, an IBS attack for you would be a sudden worsening of these symptoms. Irritable bowel syndrome attacks are also called ‘flares’.

You might experience irritable bowel syndrome symptoms every day, while other people can go long periods of time without symptoms. You could also have good periods and bad periods: An IBS flare up or attack is essentially a short period of time where your symptoms are bothering you more than usual.

An IBS attack could include:

• Pain in your abdomen
• Swelling or bloating in your abdomen 
• Being especially windy or passing a lot of gas 
• A feeling of not being ‘empty’ after having a bowel movement
• Diarrhoea or constipation
• Nausea and/or vomiting

You might get symptoms outside of your gut too, like:

• A headache 
• Pain in your joints or muscles
• Fatigue 
• Frequent urination 
• Panic, anxiety or depression
• Insomnia

An IBS attack can happen suddenly without warning or gradually over the course of a few days. Some people wake up in the middle of the night with abdominal pain, nausea, vomiting or diarrhoea. 

If you get IBS attacks, it’s important to let your doctor know so they can rule other medical issues out. They may also be able to advise you on what to do when it happens or prescribe medication to help ease your symptoms.

What does an IBS attack feel like? 

An IBS attack feels different for everybody, because IBS symptoms are different for everybody. It also depends on your level of pain tolerance, your state of mind at the time and many other factors we don’t know enough about yet.

Because IBS is a condition defined by symptoms, rather than a definitive disease, it’s difficult to reach any conclusions on why you have it, what to do about it or whether it might get better or worse. Although everyone experiences IBS attacks differently, there are a few common features.

If you have irritable bowel syndrome, you’re probably familiar with the symptoms of IBS attacks: stomach pain, bloating, extreme diarrhoea or constipation. Fatigue, depression, anxiety, headaches and insomnia can all play a part too.

If you haven’t had a diagnosis of IBS, and you’re suffering with these symptoms, talk to your doctor. It might be IBS, but it could be something else. IBS symptoms can come and go, or be almost unrelenting. For some people, they’re predictable: you might know exactly what causes your IBS attacks and be able to avoid or minimise the foods or activities that provoke them.

For many people with irritable bowel syndrome, symptoms arrive in well-defined episodes, lasting two to five days on average. They can get in the way of work, family life, friends, and hobbies, or just hover inconveniently in the background without interfering with your life.

Symptoms of IBS 

IBS is a long-term condition where pain in your abdomen is accompanied by a change in bowel movements: diarrhoea, constipation or both.

If you’re looking for specific signals that you have IBS—in the way that a blood test can reveal hypothyroidism, for example—remember that IBS isn’t a disease that we can measure or define in the same way.

There are no ‘identifiers’ or diagnostic markers for irritable bowel syndrome, because medicine doesn’t consider it to be a serious disease. A lot of experts call it a diagnosis of exclusion, because doctors will usually run tests for more serious conditions like coeliac disease or Crohn’s disease, for example, before giving you a diagnosis of IBS.

If you’re suffering with diarrhoea or constipation, and you tell your GP about your symptoms, they’ll probably use something called the ‘Rome IV criteria’ to decide whether or not you have irritable bowel syndrome.

The Rome IV criteria are:

Recurrent abdominal pain, on average, at least one day a week in the last three months, associated with two or more of the following criteria:

• related to defecation
• associated with a change in frequency of stool
• associated with a change in form (appearance) of stool.

The criteria must be fulfilled for the last three months, with symptom onset at least six months before diagnosis.

Specific symptoms of IBS in females 

If you notice that your irritable bowel syndrome symptoms get worse before or during your period, you’re not alone. Fatigue, food sensitivities, backache, abdominal pain and insomnia are often worse for women with IBS around their period.

Hormones are to blame. Hormones fluctuate throughout your menstrual cycle, and your gut, your hormones and your reproductive cycle are inextricably connected. Your gastrointestinal tract contains receptors for oestrogen and progesterone, so as they go up and down throughout your cycle, your symptoms can too.

IBS attack sweating 

If you’re straining during a bowel movement, it’s possible that your vagus nerve is triggering your body’s vasovagal reflex, or vasovagal response.

If you’ve ever felt faint through stress or standing for a long time, you’ve had something called a vasovagal syncope. The same process could be at work if you sweat while you struggle to pass a bowel movement.

It’s an automatic reflex response where you might also:

• Feel dizzy or lightheaded
• Have cold and clammy skin
• Get blurry vision or tunnel vision (blackness in the periphery of your vision)
• Feel nauseous
• Get ringing in your ears
• Turn pale

However, sweating accompanied by pain in your abdomen could also be a sign of inflammatory bowel disease (IBD), so tell your doctor if this happens to you.

IBS flare up and chills 

Chills are in the same category as sweating when it comes to irritable bowel syndrome. When you have a bowel movement, you’re stimulating the vagus nerve. You have two nervous system settings: fight or flight, and rest and digest. Your vagus nerve is part of your rest and digest system, running all the way from your brain stem to your anus.

If you have a large bowel movement, that stimulation of your vagus nerve can cause sweats, chills, and a sudden drop in blood pressure and heart rate. Remember that chills can also be a symptom of many other conditions. Inflammation in Crohn’s disease, for instance, can cause your body temperature to rise and fall, causing chills and night sweats.

IBS attack at night 

If you have irritable bowel syndrome, you might experience abdominal pain, diarrhoea and gas at night. Having a large evening meal might make it worse. 

Most people with irritable bowel syndrome don’t experience diarrhoea during the night. Symptoms are usually more common during the daytime, often after eating.

Most doctors consider diarrhoea at night time a ‘red flag’ in people with IBS. This means that they will investigate it further, in case you have a more serious condition, especially if you have

• blood in your stool
• pain that’s getting worse
• unexplained weight loss

IBS attacks and vomiting 

Nausea and vomiting aren’t officially linked to irritable bowel syndrome, but people with typical IBS symptoms like diarrhoea and constipation can suffer from bouts of nausea and/or vomiting.

Research shows that people with irritable bowel syndrome are more likely to have a huge range of conditions as well as the IBS symptoms. While we don’t usually know which condition causes which, irritable bowel syndrome often appears in a ‘constellation’ of other symptoms. 

For instance, gastrointestinal reflux disease (GERD) or gallbladder problems are a lot more common in people with IBS than they are in people without IBS. Both these conditions can cause nausea and vomiting.

If you have nausea and vomiting along with your IBS symptoms, talk to a doctor and try to find out the root cause.

Can you pass out during IBS attack? 

It’s possible to pass out during an IBS attack if you’re very stressed or in a lot of pain.

If the flow of your blood is redirected to your large intestine, reducing blood flow to other areas, it can affect your brain, and you might feel dizzy as your blood pressure falls.

When your pain and cramps become severe, you could start to feel dizzy and faint, particularly if you’re panicking about your irritable bowel syndrome symptoms too. Dizziness or passing out may also happen during a panic attack. 

Around 60% of people with IBS also have emotional symptoms. Anxiety and depression are the most common. This makes sense because neurotransmitters like serotonin have most of their receptor sites in your gut. That’s why doctors sometimes use antidepressants to treat symptoms of IBS.

What can trigger an IBS attack? 

Everyone with IBS has their own set of triggers, but the most common triggers fall under one of three categories: food, hormones, and stress.

You may have already tried cutting certain foods out of your diet, or only be able to eat a small range of foods because of your irritable bowel syndrome symptoms. We recommend working with a nutritionist or other health professional to work out what foods could be bothering you, as there are certain foods and food groups that are more likely to be culprits than others.

Stress and hormones are more difficult to control than food triggers, but that doesn’t mean you can’t work around them. There are a huge amount of stress reduction techniques to try, and while you can’t control your hormones, you can take extra care of your body and mind when you know you’re likely to be more sensitive to them. 

Women are twice as likely to have IBS symptoms than men, and fluctuating hormones—like during the few days leading up to your period—could be a big reason why. 

The link between IBS and stress 

An estimated 40 to 60 percent of people with irritable bowel syndrome in the UK struggle with their mental health and have a psychiatric condition like anxiety or depression. 

One study looked at more than 1.2 million IBS patient hospitalisations from 4,000 US hospitals over a three-year period. Researchers found that people with IBS had double the rate of anxiety and depression than those without IBS. 

One possible explanation is the ‘brain-gut axis’. One way we know that your brain and your gut are inextricably linked is the huge amount of mood hormones found in your gut. For instance, 95 percent of your ‘happy hormone’ serotonin is produced in your small intestine.

Research has now proven that stress and traumatic events like death, divorce or losing a job or home can worsen irritable bowel syndrome symptoms like diarrhoea, constipation and/or bloating.

Stress can affect IBS symptoms through the following mechanisms:

• reducing blood flow to your gut
• increasing intestinal permeability (leaky gut)
• activating your immune system

Dysfunction of the brain-gut axis goes both ways, meaning that IBS symptoms influence anxiety and depression, and psychological factors like stress and depression can cause IBS symptoms. Exploring and treating both ends of the axis is key to solving the puzzle of IBS symptoms

Dietary triggers IBS 

Almost any food can trigger irritable bowel syndrome. It’s all down to your individual body and— as research has now proven— your microbiome.

However, some foods are much more common triggers than others. Here are some examples we see a lot at IBS Clinics:

• Gluten
• Dairy
• Fried foods
• Beans and legumes
• Caffeine
• Processed foods
• Artificial sweeteners
• Alcohol
• Very high-FODMAP foods, like garlic, onions, cauliflower, brussels sprouts and dried fruit

Other triggers IBS 

Stress and anxiety 

Stress can make irritable bowel syndrome symptoms worse. Even people without IBS are familiar with the feeling of a ‘nervous tummy’ before a big event like an exam or getting married.

If you have IBS, it might take less stress than it does for the average person to flare your symptoms. Everyday events like the following could be enough:

• Issues at work
• Your commute: traffic or bus/train delays
• Problems with family and/or friends
• Financial problems
• Health worries
• Interrupted sleep
• Too much or not enough exercise

Medicines

Some of the most common medicines can be IBS triggers. You could be taking something every day that makes your irritable bowel syndrome symptoms worse, for example:

• Antibiotics
• Antidepressants
• Ibuprofen
• Acid suppressants (PPIs)
• Liquid medicines with artificial sweeteners

Other triggers

The list of other possible triggers is almost endless. Some examples are:

• Eating too quickly
• Smoking
• Using recreational drugs
• Eating too much
• Travel
• Trauma (psychological or physical)

How do you calm an IBS attack? 

The NHS gives the following advice on how to deal with an IBS flare:

• Cook homemade meals using fresh ingredients when you can
• Keep a diary of what you eat and any symptoms you get: Try to avoid things that trigger your IBS
• Try to find ways to relax
• Get plenty of exercise
• Try probiotics for a month to see if they help

At IBS Clinics, we think these are great tips. However, be careful with exercise as too much is a common IBS trigger. Intense, cardiovascular exercise diverts blood flow from your gut to your limbs and can cause bloating, diarrhoea and constipation.

IBS attack relief 

If you have a severe IBS attack, sometimes taking a warm bath can help. Deep breathing in through your nose for five seconds and out through your mouth for another five can calm your nervous system and relieve cramps and bloating. 

You could also try ‘child’s pose’: Bend over while kneeling on the floor and place your forehead on the floor too, in front of your knees. Spread your arms up away from your body, with your palms down in front of you and breathe deeply.

IBS attacks often feel worse if you panic. That’s because intense stress immediately activates your sympathetic nervous system, also known as your fight or flight response. Anything that makes you feel calm will help you to activate your parasympathetic nervous system: your ‘rest and digest’ mode, which can change your perception of pain and discomfort.

Recovering from an IBS attack 

To recover from an IBS attack, it’s important that you rest, get enough sleep and avoid your triggers.

IBS attacks can sometimes happen in a vicious circle of stress and IBS symptoms. You feel anxious, so you get diarrhoea, constipation and/or bloating, which makes you feel more anxious, worsening your symptoms. You might then worry about getting your symptoms back, even when you feel well, potentially triggering another attack.

Minimising stress is key.

Fatigue after IBS attack 

IBS attacks can leave you feeling drained, exhausted and weak. A number of factors are at play, but stress hormones are a primary reason. Just like a big event like an exam or performance,  IBS attacks can make your body release cortisol, a stress hormone.

When the cortisol dies down, your body ‘makes’ you feel tired so you can do the resting and digesting you didn’t do during the stressful event. It’s important to listen to your body and take it easy.

Foods to eat after IBS attack 

After an IBS attack, stick with the foods you know are ‘safe’ for your body. These are different for everybody. The NHS recommends oatmeal, but even that can be a trigger for some people.

Lower ‘FODMAP’ foods are generally safe for most people, but again, they could be triggers for you. Some examples are:

• Bell peppers
• Bok choy
• Carrot
• Cherry tomatoes
• Cucumber
• Green beans
• Kale
• Lettuce
• Parsnip
• Spinach
• Aubergine
• Meat
• Poultry
• Fish and seafood
• Eggs

Conclusion

While there’s no definition of an IBS attack, at IBS Clinics we say that any flare or intensification of your ‘normal’ IBS symptoms like diarrhoea, constipation and/or bloating is an IBS attack. Usually that lasts around two to five days, but you could get an IBS attack for anything from a few minutes to a number of weeks.

Food triggers, stress and hormones are the most common causes, so avoiding trigger foods and reducing stress as much as possible is the best way to avoid an attack. To calm an attack when it happens, again, reducing stress is fundamental. Breathing deeply, having a bath or whatever helps you feel calm is your most powerful tool.

Author

Alexandra Falconer MA (Dist) DipCNM mBANT is a Nutritionist and Registered Nutritional Therapist. After graduating from Brighton’s College of Naturopathic Medicine in 2018, she set up her nutrition practice specialising in gut health, IBS, IBD and related conditions.

Before becoming a nutritionist, Alex was a journalist and copywriter. Now, she combines her two great loves—words and natural medicine—to help bring vibrant health to everyone who needs it.

Reviewed by: Tracey Randell