Understanding Nausea and Vomiting in IBS: Beyond Diarrhea and Constipation

With IBS, diarrhea and constipation are not the only symptoms that occur, and for some people, they may not even be the most common symptom experienced.

What is Irritable Bowel Syndrome (IBS)?

Irritable Bowel Syndrome (IBS) is usually characterized by the predominant symptom, either diarrhea or constipation, occurring in the lower gastrointestinal (GI) tract. The term syndrome is a set of symptoms that typically occur together. Many symptoms of IBS affect the upper GI system as well. These may include acid reflux, functional dyspepsia, feeling full while eating earlier than usual (i.e., early satiety), bloating, pain in the upper abdomen, referred pain in the lower back, nausea, and vomiting.

IBS is considered a functional disorder, meaning that while the symptoms are present and impair normal or expected function of the affected body system, no tests or specific examinations can definitively confirm the diagnosis. Because there is no specific known underlying cause of IBS, the goal of treatment is to manage symptoms and decrease their impact on someone’s quality of life.

Nausea and Vomiting in IBS: An Overlooked Symptom

Interestingly, nausea and vomiting seem to be rarely mentioned as significant symptoms with IBS unless an individual is experiencing these symptoms and asks about the possibility. However, one study found that 38% of women and 27% of men previously diagnosed with IBS report nausea. This study did not consider any coexisting conditions (like migraine headaches) that may have contributed to individuals' reports of nausea and vomiting. Another study confirmed that women reported higher incidences of nausea and vomiting than men with IBS but that it does affect both sexes. Again, another study confirmed that women report higher incidences of nausea and vomiting than men and hypothesized that this may be due to hormonal changes due to their menstrual cycle or because some studies show delayed gastric emptying occurring more in females than males with IBS. 

Stress, Anxiety, and IBS

It is well known that increased stress/anxiety tends to exacerbate IBS symptoms. If someone notices that stress seems to increase their nausea, then finding anxiety-decreasing techniques that work for them is recommended. This may include guided meditation or other relaxation techniques. It is also important to perform a medication review to determine if any medicines individuals are taking may be contributing to their nausea. A food and symptom diary may also be beneficial if certain foods or beverages cause worsening nausea/vomiting.

Complementary Treatments for IBS Symptoms

Individuals who experience nausea and vomiting that affect their quality of life may try complementary treatments to reduce symptoms. Some find peppermint oil or tea, ginger, and/or probiotics beneficial. Some find biofeedback reduces symptoms. Biofeedback is a technique used to train one's own body to respond to conscious commands; it may be considered an advanced meditative technique. 

Medications for Severe Nausea and Vomiting

For individuals with severe nausea or vomiting, there are medications that their healthcare provider can prescribe to treat the nausea symptom specifically. These medications may include ondansetron (Zofran), promethazine (Phenergan), prochlorperazine (Compro), metoclopramide (Reglan), and others. Of course, with any supplements or treatment, you should always discuss this with your healthcare provider, as there may be interactions with other medicines or potential side effects. If someone experiences other conditions (such as migraine headaches) that may cause nausea, then they should also ensure that these conditions are under control. 

When to Consult Your Healthcare Provider

It is also important to remember that there may be a condition other than IBS causing nausea and vomiting symptoms. If you have previously been diagnosed with IBS but have not experienced nausea/vomiting and suddenly develop these symptoms, then discuss this with your healthcare provider (as you should with any newly occurring symptoms). It is not uncommon for individuals with IBS to have other disorders affecting the GI system, and these may need evaluation, diagnosis, and a different plan of care.  

1. _{Anbardan, S. J., Daryani, N. E., Fereshtehnejad, S. M., Taba Taba Vakili, S., Keramati, M. R., & Ajdarkosh, H. (2012). Gender Role in Irritable Bowel Syndrome: A Comparison of Irritable Bowel Syndrome Module (ROME III) Between Male and Female Patients. Journal of neurogastroenterology and motility, 18(1), 70–77.}
2. _{Chang F. Y. (2012). Why do irritable bowel syndrome women often have nausea symptom?. Journal of neurogastroenterology and motility, 18(1), 1–3.} 
3. _{Mayo Foundation for Medical Education and Research. (2023, March 18). Biofeedback. Mayo Clinic.}