What causes an IBS attack? Triggers and tips to help

When you’re having an irritable bowel syndrome (IBS) flare-up, your symptoms might include stomach pain, bloating, diarrhoea or constipation.

These ‘attacks’ may last a few hours, days or weeks, depending on what’s triggered them and how you manage the symptoms. 

IBS is a common condition – you’re definitely not alone. An estimated 5–20% of the United Kingdom has IBS.

And many people with symptoms don’t seek help, so this is likely an underestimate.

During an IBS flare-up, taking peppermint oil capsules or certain medications, staying hydrated and incorporating movement into your day may ease the symptoms.

In the long term, lifestyle changes, such as tweaking your diet, trying probiotics and managing stress can help.

Below, we’ll explore the symptoms of IBS flare-ups, what causes them and how you can manage them.

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Symptoms of an IBS flare-up or attack

IBS is characterised by a group of symptoms that appear together. It’s typically a lifelong condition.

It may be reassuring to know that IBS doesn’t damage your digestive tract or raise your risk of colon cancer, though it can still be frustrating to live with.

The most common symptoms include:

• stomach pain or cramps
• bloating
• changes in bowel habits: diarrhoea, constipation or both
• excess wind
• passing mucus from your bum
• feeling tired
• nausea
• back pain
• faecal incontinence

The terms ‘IBS flare-up’ and ‘IBS attack’ both describe the sudden onset of symptoms in people with IBS. 

What does it feel like and how long does it last?

If you’re experiencing bloating, it may feel like your tummy is uncomfortably full or swollen.

You might also feel pain or cramps, particularly if you have excess wind. The pain should lessen after you have a poo.

If you have constipation, it can mean that you strain when you’re trying to poo. You might not feel like you’ve fully emptied your bowels. 

Research suggests a link between IBS and overactive bladder syndrome. So, if you have IBS, you might also pee more often or feel the urge suddenly.

Back pain that stems from IBS can be ‘referred.’ This means that pain in one area causes pain elsewhere. Pain in your abdomen that arises from cramping or bloating could lead to referred pain in your back. 

Overall, the symptoms of IBS affect people differently. A flare-up might involve one symptom that lasts for a few days or several symptoms lasting for weeks. 

The duration will depend on what has triggered the flare-up and how you manage it. 

Your symptoms should pass, but if they last for an extended period, make sure to see your doctor.

You can learn more about IBS back pain here.

What causes an IBS flare-up?

The triggers of IBS aren’t the same for everybody – what causes pain or bloating for one person may not for another. 

Still, here are some common triggers to be aware of:

Luckily, both short- and long-term strategies can help ease and prevent IBS flare-ups.

But everyone is different, so it’s important to pay careful attention to what works for your body.  

1. Reduce stress

Because IBS is worsened by stress, keeping your stress levels low can help soothe or even prevent an IBS flare-up.

While having an IBS flare-up can be stressful in itself, there are things you can do to help. 

If you’re able to deprioritise some projects at work during a flare-up, it may keep your stress levels down. Meditation, breathing exercises and journaling may help, too.

Some other options include acupuncture or apps that offer gut-directed hypnotherapy. 

You could also try setting aside time to listen to music, read a book or magazine, or go for a walk. 

Read more about how to manage stress here.

2. Add more movement

Don’t underestimate the power of moving your body. Not only can it help quell stress – movement may actually improve some of your IBS symptoms. 

For example, walking and doing gentle stretches can sometimes relieve bloating because it gets your system moving and releases trapped wind.

Likewise, some studies suggest that yoga can help with bloating, constipation and diarrhoea. 

3. Tweak your diet

As we note above, certain foods, drinks and ingredients are more likely to trigger IBS symptoms. You can find the top 10 triggers here.

Try limiting these foods and seeing how you feel. Keeping a food and symptom diary can help you spot trends.

Caffeine is on the list of top triggers, so if you drink a lot of caffeine, try swapping out one of your teas or coffees with the decaf version or try fruit teas instead.

Experts suggest limiting your caffeine intake to 400 milligrams per day, which is roughly 4 cups of coffee or 5–6 cups of tea. 

Staying hydrated by drinking water and most other liquids can also help keep things moving through your system and prevent bloating.

Meanwhile, peppermint oil capsules can ease abdominal pain and bloating by relaxing the muscles in the wall of your gut.

There’s also peppermint tea, but research shows that the capsules work best at relieving bloating.

For constipation, you could include any of these in your daily diet:

• 1–2 kiwis
• 1–3 tablespoons of ground linseeds, building up the amount gradually
• 10–12 prunes

For diarrhoea, try consuming fewer polyols. Some common examples are sorbitol, mannitol and xylitol – artificial sweeteners in many sugar-free sweets, chewing gum and drinks.

It’s also a good idea to reduce your alcohol intake. 

Psyllium husk can help with both constipation and diarrhoea: it softens hard poo and firms up watery poo. Gradually build up from 1–3 tablespoons a day.

4. Consider probiotics

Probiotics are live microbes that can benefit your health. 

A large systematic review published in 2018 concluded that specific probiotics helped reduce bloating for some people with IBS.

Research also shows that probiotics can help with constipation-predominant IBS (IBS-C). Certain probiotics can improve the consistency of poo and increase the number of beneficial gut bacteria. 

For people with diarrhoea-predominant IBS (IBS-D), probiotics may help with abdominal pain and the symptoms overall.  

Probiotic supplements come in many forms, including powders, capsules and liquids. It’s important to remember that not all probiotics work for everyone with IBS. 

If you're interested in probiotics, guidelines in the United Kingdom recommend giving a new probiotic a trial period of 4–12 weeks to see if your symptoms improve. 

Some foods, such as yoghurt, kefir, kombucha and sauerkraut, can also contain live microbes which may support a healthy gut microbiome. 

You can learn more about probiotics for bloating here.

5. Ask about medication

Your doctor can recommend medications that may help with IBS flare-ups, including:

• Antispasmodic drugs for stomach cramps: Some options include Buscopan and medicines containing alverine citrate or mebeverine hydrochloride.
  
  
• Laxatives for constipation: The doctor can advise about which of the four types of laxatives will work best for you.
  
  
• Antidiarrheals: Loperamide is one option for diarrhoea.
  
  
• Antidepressants for IBS pain: In a 2023 study, researchers found that participants who took a low dose of a common antidepressant had improved IBS symptoms, including abdominal pain.

When to see your doctor

Though the symptoms of an IBS flare-up can be uncomfortable, they should pass within a couple of weeks.

But ask for an urgent appointment with your doctor if you’re concerned about any of your symptoms or if you’re experiencing any of these:

• blood in your poo or bleeding from your bottom (the blood may be bright or dark)
• a persistent, unexplained change in your poo habits, such as looser poo, pooing less or more often, or flat or ribbon-like poo
• unexplained weight loss
• extreme tiredness for no apparent reason 
• pain or a lump in the abdomen

They could be signs of another condition that your doctor will want to investigate.

Summary

IBS is a common issue, and it often causes stomach pain, bloating, diarrhoea or constipation.

Flare-ups, or attacks, of IBS symptoms may last a few hours, days or weeks, depending on their triggers and how you manage them. Common triggers include stress, certain foods, infections and hormonal changes.

IBS doesn’t damage the digestive system, but it can be challenging to manage at times.

To ease the symptoms, peppermint oil capsules and other antispasmodic medications may help.

Long-term strategies to ease flare-ups include reducing stress, incorporating more movement into your days and tweaking your diet. Probiotics could help, though this depends on your symptoms and other factors. 

Keeping a food diary or trying a gentle low-FODMAP diet can help you identify your dietary triggers. 

If your IBS symptoms worsen – and especially if you have unexpected weight loss or blood in your poo – be sure to see your doctor straight away.

To learn more about IBS and other gut health topics, visit Symprove’s Gut Hub.

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Amitriptyline at low-dose and titrated for irritable bowel syndrome as second-line treatment in primary care (ATLANTIS): A randomised, double-blind, placebo-controlled, phase 3 trial. The Lancet. (2023). Link.

Bifidobacterium animalis subsp. lactis BB-12 protects against antibiotic-induced functional and compositional changes in human fecal microbiome. Nutrients. (2021). Link.

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Caffeine: How much is too much? (2022). Link. 

Co-occurrence of fecal incontinence with constipation or irritable bowel syndrome indicates the need for personalized treatment. Neurogastroenterology & Motility. (2023). Link. 

Definitions & facts for irritable bowel syndrome. (2017). Link.

Effectiveness and safety of probiotics for patients with constipation-predominant irritable bowel syndrome: A systematic review and meta-analysis of 10 randomized controlled trials. Nutrients. (2022). Link.

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Overactive bladder syndrome symptoms in youth with abdominal pain-associated disorders of gut–brain interaction. Scientific Reports. (2023). Link.

Post-infection irritable bowel syndrome. Gastroenterology Clinics of North America. (2021). Link.

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Systematic review: Instruments to assess abdominal pain in irritable bowel syndrome. Alimentary Pharmacology and Therapeutics. (2015). Link.

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