What Causes IBS Flare-Ups? And How to Prevent Them

Irritable bowel syndrome (IBS) is a common condition that affects more than 10% of people worldwide. If you experience IBS, then you’ve probably felt the anxiety and frustration that comes with an unexpected flare-up. The symptoms of an IBS flare can make it difficult to work, socialize, and relax.

There are different types of IBS, and it’s important to know which type you have. That’s because the type of IBS determines what kind of flare-ups you experience. The types of IBS include:

• IBS-C: IBS with flares of constipation 

• IBS-D: IBS with flares of diarrhea

• IBS-M: IBS with mixed flares of diarrhea and constipation 

What causes IBS flare-ups?

Researchers aren’t sure what causes IBS. But there are some factors that seem to be linked to IBS flare-ups. These include environmental, dietary, hormonal, and emotional triggers. IBS triggers vary from person to person and by IBS type. 

Let’s take a closer look at common triggers that can cause IBS flare-ups.

Foods

Most people with IBS can identify certain foods or drinks that make their symptoms worse. Keeping a food diary may make it easier to identify those patterns. Some common food triggers for IBS flares include: 

• Caffeine

• Carbonated drinks

• Artificial sugar

• Spicy foods

• Fried foods

• Processed meats like hot dogs, deli meat, sausages

• Dairy products

• Alcohol

Mental health conditions 

Many people who have mental health conditions also experience IBS. In fact, people with IBS are three times more likely to also have depression or anxiety. Treating both IBS and any mental health conditions at the same time offers the best outcome in managing IBS flares. 

Hormonal changes

Researchers have found that IBS is also influenced by changes in hormones, especially estrogen levels. This may also explain why IBS symptoms are more common in women than men. IBS can be triggered during certain phases of the menstrual cycle, pregnancy, and menopause. Scientists believe that certain hormones affect how the gut and brain communicate. And they may play a role in your perception of pain. 

Stress

Stress can also be a trigger for an IBS flare-up. That’s because of the gut-brain connection, a link between the gut and your mood. This means that your mood may influence the activity of your gut, and your gut may influence your mood. Stress makes your body release chemicals that can make your gut more sensitive and cause an IBS flare.  

Stress might also worsen IBS flares through other means. Stress can sometimes trigger people to find relief in comfort food. Many of these foods tend to be fatty or processed foods, and they may trigger IBS symptoms.

Bacteria

Abnormal bacteria (an infection) or bacteria growing in an abnormal part of the bowel (small intestinal bacterial overgrowth, SIBO) can trigger IBS flare-ups. People with SIBO-triggered IBS flares are more likely to:

• Be female 

• Be of older age 

• Have IBS with diarrhea

• Experience bloating and gas (flatulence) 

• Take proton pump inhibitors, such as omeprazole (Prilosec)

• Use narcotics 

• Have low hemoglobin

Quiz: Do I Have IBS?

What are the symptoms of an IBS flare-up?

The symptoms of an IBS flare mostly depend on the IBS type. But in general, common symptoms of IBS flares include:

• Bloating

• Diarrhea

• Constipation

• Mucus in stool

• Abdominal pain

• Nausea 

Some people may also notice that symptoms are worse during the menstrual cycle. These symptoms tend to come and go and can vary from person to person.

How long does an IBS flare-up last?

The duration of IBS symptoms can vary slightly based on the IBS type. The most common IBS type is IBS-M. About 85% of people with IBS-M have symptoms that last less than 1 week. And most of those people have symptoms that clear within 3 days. 

Most people with IBS report at least two flare-ups per year. But taking measures to prevent flares may help to decrease your number of flares.  

How do I prevent an IBS flare-up?

Dietary and lifestyle changes may help to prevent your IBS flare-ups. This includes trying to avoid those triggers that cause symptoms. Here are some ways to decrease how often you have IBS flares.

Exercising and doing physical activity

Regular exercise can decrease flares of IBS. Data shows that moderate exercise for at least 12 weeks may improve the symptoms of IBS. Examples of moderate exercise include:

• Walking

• Cycling

• Aerobics

The exercise, posing, and relaxation of yoga may also help to decrease symptoms of IBS and prevent flare-ups. 

Keep in mind that some exercise may also increase symptoms of IBS. Studies show that high-intensity exercise, like running, causes stomach upset. So you don’t want to overdo it. Talk with your healthcare professional about an exercise plan that may help your symptoms of IBS.

Avoiding trigger foods

In addition to avoiding common trigger foods, it may be useful to avoid foods high in FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols). FODMAPs are sugar compounds that are in many foods. High-FODMAP foods can cause bloating and excess gas. A diet high in FODMAP foods can trigger or worsen a flare of IBS. 

Some high-FODMAP foods are:

• Grains like wheat, barley, and rye

• Fruits like apples, pears, and mango

• Vegetables like onions, cauliflower, and asparagus

• Dairy products like milk, cheese, and yogurts

• Legumes like beans, lentils, and chickpeas

Low-FODMAP foods break down easier in the gut and are less likely to cause bloating and IBS flare-ups. Examples of low-FODMAP foods include:

• Gluten-free bread and crackers

• Lactose-free milk and plant-based milks like soy and almond milk

• Eggs

• Nuts

• Some fruits like pineapple, banana, and strawberries

• Certain vegetables like spinach, cucumber, and eggplant

In nearly 30% of people with IBS, a low-FODMAP diet alone doesn’t improve symptoms. But for most, a low-FODMAP diet helps. It can be difficult to follow a restricted diet and get all of the nutrients you need. And nutrition labels don’t always include FODMAP ingredients in food. A nutritionist can work with you to make an eating plan that reduces your symptoms and that you can stick to. 

Relaxation techniques

Some people with IBS may also have mental health challenges as well. Up to 60% of people with IBS also have at least one mental health condition, like depression or anxiety. Because of the gut-brain connection, decreasing your stress level may help prevent IBS flares.

While you may not be able to avoid stress altogether, you can manage how you respond to it. A few options to manage stress include:

• Mindfulness practices

• Regular physical activity

• Antidepressants or anxiety medications

• Hypnotherapy

Probiotics and other supplements

Probiotics may help to keep your gut healthy. These supplements can increase the levels of bacteria in your gut that help to break down your food. Probiotics may be most useful in improving bloating and gas from IBS. Experts don’t recommend a specific type or dose of probiotics. Talk with your healthcare professional to see if probiotics might be a good option for you and how you should use them.

Peppermint oil may also help if you have IBS. The menthol in peppermint oil may be why it works. Menthol relaxes the muscles in the gut and can help relieve the symptoms of IBS. Peppermint oil can come in many forms, but studies show capsules have benefits for IBS.

How do I treat an IBS flare-up?

Medications that target specific IBS symptoms may help to treat IBS flares. The medications that work best for your symptoms will vary depending on your IBS type. 

For IBS with diarrhea, medications that prevent diarrhea may help. These include:

• Loperamide (Imodium A-D)

• Eluxadoline (Viberzi)

• Lotronex (Alosetron), for women

• Rifaximin (Xifaxan)

For IBS with constipation, medications that loosen and soften stool might be helpful. Common medications include:

• Linaclotide (Linzess)

• Plecanatide (Trulance)

• Lubiprostone (Amitiza), for IBS in women who are at least 18 years old

• Tegaserod (Zelnorm), for women younger than 65 years

Some people also use antigas medication. This can help with stomach pain and cramping that excess gas and bloating in the gut cause. But be sure to connect with your healthcare professional before starting any medications. 

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Written by:

Stephanie Reese, DO, MS

Dr. Reese is board-certified in family medicine and resides in Savannah, Georgia. She received her undergraduate degree from the Florida Institute of Technology and master’s in hematology/immunology from Long Island University.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Frank Schwalbe, MD

Frank Schwalbe, MD, is an assistant professor of anesthesiology at the Yale School of Medicine. He has practiced anesthesiology for 30 years.

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