IBS Flare-Ups: Understanding Inflammation, Triggers, and Management Strategies

If you are living with irritable bowel syndrome (IBS), then you have probably had your fair share of flare-ups. The frequency and severity of these flare-ups can sometimes dictate or motivate the things you will do to get through it and back to being flare-free. Between dietary changes, medications, or even surgical intervention, someone living with IBS can be anywhere on the spectrum of change and symptom management and/or freedom. 

Living with IBS: Understanding the Discomfort and Underlying Inflammation

Irritable bowel syndrome (IBS) is a common and chronic disorder that impacts the gastrointestinal tract. Symptoms include cramping, bloating, gas, and abdominal pain. When diagnosed, IBS can be classified into three different types. First is diarrhea-predominant IBS (IBS-D), with the main indicator being increased diarrhea output. This can be caused by stronger and longer-lasting muscle contractions as food moves through the digestive tract, overactive signals from the nervous system, or changes to gut microbes. 

Second is constipation-predominant IBS (IBS -C). As you guessed, being constipated is the key indicator of this. This is where muscle contractions are weaker as food moves through digestion, slowing the process down (also known as gastroparesis). Other causes are underactive signals within your nervous system, poor hydration, and altered bacteria in the GI tract.

The third and final type is mixed IBS (IBS-M). This is when you mix hard, constipated stool output and loose, watery diarrhea. Again, like the first two, there is generally some dysmotility with muscle contractions and mixed nervous signaling. Other causes can be childhood stress or trauma, severe GI infections, or food sensitivities/allergies. 

Inflammation can overlap with irritable bowel syndrome, with studies proving that inflammation can lead to the damage of the intestinal mucosal barrier (the lining of your intestinal wall), changes to the enteric nervous system (what controls digestion and other gut functions), and impact the gut-brain axis (the connection between the gut and the brain through your nervous system, the body’s stress response, and gut bacteria). Long-term inflammation, or delayed recovery from it, can present as irritable bowel syndrome. Don't you love how the human body is just one big, connected family working together (or sometimes not)? 

Anti-Inflammatory Medications: A Potential Ally in IBS Management?

In having long-term inflammation, one would think, oh hey, what if I control my inflammation with anti-inflammatory medication and therefore control my IBS? Great idea in theory, but there is a lot of conflicting evidence that may not support this line of thought. Let’s take a small step back and describe exactly what classifies a medication as an anti-inflammatory drug.

Common over-the-counter meds are Nonsteroidal anti-inflammatory drugs, known as NSAIDs, with side effects ranging from shifts in gut microbiota all the way to enteropathy, a GI bleed, or severe ulceration. Other drugs commonly associated with IBS and IBD are corticosteroids, whose side effects can be hyperglycemia (elevated blood sugars), rapid weight gain, gastritis, ulcer formation, and GI bleeding. 

Some ongoing studies look into certain anti-inflammatory medications that can benefit IBS-C or IBS-D. Research continues to provide mixed findings, but exploring these medications is ongoing, and some are promising. Certain antidepressants and antipsychotic medications have been enlightening and have more consistent evidence of helping with the treatment or management of IBS.

Beyond Medication: Strategies for Managing IBS Flare-Ups

Looking beyond medication and at lifestyle changes and adjustments, you can take control of your IBS. One important and helpful thing you can do is make dietary changes by maintaining a food journal and tracking trends. After you have identified trigger foods, you should start to avoid them. A helpful way to do this is to follow a Low FODMAP diet. By going to the foodguides.com website, you can find many helpful articles, recipes, and more to get you started and keep you going in the right direction. 

Besides dietary changes, you can also start including stress management techniques like meditation, deep breathing, and yoga. Regularly exercise to keep your body moving, manage your weight (which can impact IBS), and reduce stress. Good sleep habits can make a huge impact on your GI tract and your overall health. If I am over-tired or not getting consistent sleep 100% of the time, it impacts my mood, motivation, and health. All these options are things you can control in your own life to manage your symptoms.

The Importance of Consulting Your Doctor

Another tool to keep in your kit is an established relationship with your primary care or GI-specific doctor. Work with your doctor to narrow down your symptoms and triggers (food, lifestyle, etc.) and get an individualized treatment plan tailored to your needs. As we age, things change; this is no different for your GI tract. Having a plan that adapts to you so you know the next steps and can research and plan for them can mitigate stress and prepare you for the future. 

Other things you can do with your doctor is make sure you have an accurate diagnosis and rule out any potential underlying conditions. There are many conditions that can mimic each other, especially ones that manifest in the GI tract. Make sure you have ruled these out so you aren’t treating the wrong thing and getting nowhere with symptom management. Your doctor can also guide you to support, whether it be a group of other people living with IBS, a registered dietitian, or other resources and allies that can assist you with symptom management. 

Managing your IBS, whichever version you have, is doable, but it does take some work. At this time, abstaining from using Anti-inflammatory medications to assist with symptom management would be the best idea. The side effects are too great and can lead to more problems. Working with your doctor to make the best choice for you and making some lifestyle changes is ideal. If you have any insight you want to share with the community, please comment below!

1. _{Chen, L., Ilham, S. J., & Feng, B. (2017). Pharmacological Approach for Managing Pain in Irritable Bowel Syndrome: A Review Article. Anesthesiology and pain medicine, 7(2), e42747. https://doi.org/10.5812/aapm.42747} 
2. _{Keszthelyi, D., Dackus, G. H., Masclee, G. M., Kruimel, J. W., & Masclee, A. A. (2012). Increased proton pump inhibitor and NSAID exposure in irritable bowel syndrome: results from a case-control study. BMC gastroenterology, 12, 121. https://doi.org/10.1186/1471-230X-12-121} 
3. _{Mayo Foundation for Medical Education and Research. (2023, May 12). Irritable bowel syndrome. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/symptoms-causes/syc-20360016} 
4. _{Wang, C., & Fang, X. (2021). Inflammation and Overlap of Irritable Bowel Syndrome and Functional Dyspepsia. Journal of neurogastroenterology and motility, 27(2), 153–164. https://doi.org/10.5056/jnm20175} 
5. _{What is irritable bowel syndrome (IBS)?. Cleveland Clinic. (2024, July 18). https://my.clevelandclinic.org/health/diseases/4342-irritable-bowel-syndrome-ibs}