What is IBS?
Irritable bowel syndrome (IBS) is a chronic bowel condition that is comprised of a range of symptoms.
The symptoms of IBS include:
- Bloating
- Abdominal pain
- Changes in bowel patterns (e.g. constipation or diarrhoea)
IBS is termed a functional bowel disorder. This refers to the fact that routine tests have not found any structural or biological changes to the gut, however, symptoms persist. Therefore the structure has not changed but the function is impacted. [Source: Pubmed]
The rates of IBS vary depending on the region of the world. For most European countries and the USA, the rates of IBS are between 5-10% of the general population.
While the cause of IBS symptoms varies from person to person, several factors are understood to contribute to IBS and how long it might last.
These underlying factors of IBS can include:
- Food intolerances
- Imbalances in the gut microbiome
- Low-grade inflammation
- Increased nerve sensitivity in the gut
- Disruption of the gut-brain connection [Source: Pubmed]
While not included in the official symptoms of IBS, it is also common for there to be symptoms outside of the digestive tract. These extraintestinal symptoms include:
- Body pain
- Fatigue
- Disturbed sleep
- Stress
- Anxiety
- Depression
- Migraines
- Overactive bladder [Source: Pubmed, Pubmed]
Even though these symptoms are not-occurring within the digestive tract, gut imbalances can contribute to their presence.
How long does an IBS flare-up last?
It’s common for those with IBS to have periods where symptoms are reduced or non-existent. These periods with low levels of IBS can also be followed by IBS flare-ups.
Flare-ups can be described as when symptoms increase or reappear for a period of time. The amount of time these IBS flare-ups last for can depend on the individual and the overall health of their gut. Additional factors can lead to an increase in IBS symptoms.
The factors that can contribute to a flare-up in IBS symptoms.
These can include:
- Food poisoning
- Stress
- Antibiotics
- Fatty foods
- Alcohol
- Spicy foods [Source: Pubmed, Pubmed, Pubmed, Pubmed]
Once these factors have taken place (such as food poisoning) it can take some time for symptoms to calm down. However, there are ways to support the gut and help to manage symptoms and support any underlying imbalances in the gut.
Symptoms of an IBS attack
Symptoms of an IBS attack can be similar to normal IBS symptoms. However, during an attack, the symptoms can increase in severity. This means that overall symptoms can be worse whilst during the flare-up.
This increase in IBS symptoms can include:
- More frequent diarrhoea
- Mucus appearing the in the stool
- Increase tenderness in the abdomen
- Increased cramping in the gut
- Reacting to lots of foods
- Nausea [Source: Pubmed]
Poor sleep is also more common in those with IBS. This can worsen in relation to the level of IBS pain and discomfort being experienced. Therefore, during a flare-up sleep can also be impacted.
Due to poor sleep further impacting the gut and IBS symptoms, perhaps most notably due to the fact that poor sleep can increase pain, a vicious cycle can be created. This is where an increase in IBS symptoms impacts sleep which may then increase the symptoms of IBS. [Source: Pubmed]
Blood may also be present in an IBS flare-up which can be due to irritation along the gut lining, however, this is less common.
Can an IBS flare-up-up last for weeks?
The length of an IBS flare-up can vary from person to person. Often the symptoms of IBS can calm down by themselves over a period of hours or days. However, in other situations, the flare-up may last a longer period of time.
For example, our experience is that if the increase in IBS symptoms is triggered by food then the flare-up may only last for as long as it takes for this food to pass through the digestive tract. This may be more common if this is a reaction to a high FODMAP food. [Source: Pubmed]
However, if the flare-up in symptoms is due to food poisoning or the use of antibiotics this may take a longer amount of time to calm down. In some of these situations, symptoms may persist and additional support may be required in the form to address an underlying imbalance. This may be particularly true to SIBO is present. [Source: Pubmed]
IBS after Food Poisoning
IBS can be triggered by food poisoning as well as other types of gut infections. These can be bacterial or viral forms of gastroenteritis. These are grouped into the category of post-infectious IBS.
In post-infectious IBS, an offending organism (such as a virus) enters the gut, and then triggers symptoms. The body’s natural response is for the immune system to become activated which then leads to an inflammatory response to attack the invader (eg the virus).
In some situations, this inflammatory response does not fully calm down which can lead to longer-term changes in the gut. These changes then contribute to the ongoing nature of symptoms.
This can impact the gut in the following ways:
- Microbiome imbalances
- Low-grade inflammation
- Immune activation
- Intestinal permeability [Source: Pubmed]
There are certain factors that increase the risk of food poisoning leading to IBS symptoms. These are being female, being younger as well as the severity of the infection. [Source: Pubmed]
SIBO (small intestinal bacterial overgrowth) can also be the result of a gastric infection. This is due to the changes listed above contributing to changes in the small intestine which then allow for a bacterial overgrowth to occur. [Source: Pubmed]
How long does IBS last after antibiotics?
Antibiotics have been shown to lead to changes within the gut. These changes can be in the balance of the gut microbiome as well as in the gut lining.
This may be part of the reason but the use of antibiotics is associated with an increased risk of developing IBS symptoms. One study showed that IBS symptoms are 3 times more likely to appear in the 4 months after taking antibiotics. [Source: Pubmed]
It is possible to calm symptoms down with factors such as:
- Dietary changes
- Probiotics
- Gut-directed hypnotherapy [Source: Pubmed]
Can an IBS flare-up go away on its own?
IBS symptoms can increase and decrease over time and it’s common for symptoms to appear and reappear on their own. This means that an IBS flare-up can go away on its own.
However, if symptoms come and go time and time again, this may indicate the gut isn’t as strong or as resilient as we’d like it to be. So, while symptoms may disappear by themselves, if the gut isn’t well balanced it may be more likely the symptoms will appear again.
There are many evidence-based strategies to address these underlying imbalances in the gut to improve or resolve symptoms of IBS.
Certain diets such as the low FODMAP diet have been shown to be effective at reducing symptoms of IBS. This can be a helpful short-term strategy to manage IBS symptoms.
Additionally, the long-term approach to work towards is often described as the Mediterranean Diet. This diet focuses on fruits, vegetables and high-quality protein. However, due to the potential imbalances in the gut, some of these foods may not be well tolerated during a flare-up. [Source: Pubmed]
IBS foods to eat
The low fodmap and the Mediterranean diet have been researched to support the gut.
While the benefits of a low FODMAP diet are based on the removal of foods that trigger IBS symptoms, the Mediterranean diet is used to support the underlying health of the gut. In particular, anti-inflammatory and prebiotic properties.
They include the consumption of anti-inflammatory omega-3 oils which are found in high amounts in foods such as salmon, mackerel and flaxseeds. Research has found that those with IBS may have low-grade inflammation in the gut. Therefore supporting anti-inflammatory processes with these oils may be an important way in which this diet supports gut health. [Source: Pubmed]
Extra virgin olive also has also been found to support many areas of health that relate to IBS and gut health. This includes the ability of olive oil compounds to block inflammatory processes and act as antioxidants. These have also been shown to support the balance of the gut microbiome, improving levels of beneficial bacteria such as Lactobacillus and Bifidobacterium. [Source: Pubmed]
Certain types of fibre found in food support the growth of key gut bacteria which help to regulate the gut microbiome. This is through the fermentation process that produced beneficial compounds called short-chain fatty acids. This can lead to improvements in the gut such as a stronger gut lining, reduced inflammation and normalising motility (bowel movements).
However, If FODMAP fibres are not tolerated, beta-glucan-rich fibres can be an important dietary source of fibre to include while the underlying issue is address. These are found in oats, which are often very well tolerated on a low FODMAP diet. [Source: Pubmed]
How to treat IBS
Strategies to address IBS symptoms is an approach that is divided into 2 categories. The first is symptom management which is where a low FODMAP diet can often be helpful. However, as a symptom management strategy, this is not addressing the underlying imbalance in the gut.
The second category is the active approach which contains the elements to address the underlying imbalance in the gut. This is working to balance the gut, so FODMAP-rich foods are tolerated again and symptoms are resolved.
While this approach varies from individual to individual, the common aspects to treat IBS symptoms include:
- Probiotics [Source: Pubmed]
- Post-biotics [Source: Pubmed]
- Prebiotics [Source: Pubmed]
- Herbals medicine [Source: Pubmed]
- Gut-direct hypnotherapy [Source: Pubmed]
Working with a registered Nutritional Therapist can help to guide you through this process and work on addressing the underlying imbalance, rather than just managing symptoms.
