Effective, Natural IBS Pain Management and Treatment Options

Written by Dr. Michael Ruscio, DC on November 6, 2020

Written by Dr. Michael Ruscio, DC on November 6, 2020 — Reviewed by Heidi Turner

Research-Backed Ideas for Reducing IBS Pain

IBS|
IBS Pain|
Cause of IBS Pain|
Manage IBS Pain|
Diet|
Probiotics|
Digestive Support|
Fiber|
Enzymes|

Abdominal pain is one of the defining (and least comfortable) symptoms of IBS. Most IBS patients report some form of abdominal pain, including bloating, distention, cramping, or stomach pain. Let’s explore what causes IBS pain and how you can manage and prevent it.

Irritable Bowel Syndrome (IBS)

On average, 10-15% of American adults have irritable bowel syndrome [1], making it one of the most common digestive system problems.

IBS is not a specific disease with a clear mechanism — it’s a group of digestive symptoms [2]. Recurrent abdominal pain and changes in bowel habits are the hallmark symptoms of IBS [3]. IBS-C patients tend to have constipation, while IBS patients with IBS-D more often have diarrhea.

IBS may co-occur with other digestive medical conditions, such as inflammatory bowel diseases [4] (including Crohn’s disease and ulcerative colitis), celiac disease [5], and SIBO [6, 7, 8]. A family history of IBD or colorectal cancer may also increase your risk of developing IBS [9]. IBS patients tend to go through periods of symptom flare-ups, followed by periods of relative calm.

Common Symptoms of IBS That Can Cause Pain

Abdominal pain, stomach pain, and bloating are obvious sources of IBS pain. Digestive IBS symptoms that may cause IBS pain include:

Frequent bowel movements or diarrhea
Constipation
Cramping or a spastic colon
Flatulence or gas

IBS can also cause non-digestive pain symptoms by affecting the central nervous system [10], or the immune system [11, 12]. Symptoms such as joint pain [13] and headaches [14, 15] are surprisingly common for IBS patients. Additionally, one interesting study suggested up to 49% of fibromyalgia patients also have IBS as well [16].

What Is the Cause of IBS Pain?

Because IBS is a syndrome made up of a collection of digestive system symptoms, there are many potential underlying causes of IBS pain for individual patients.

Bacterial Overgrowth

Several studies suggest a significant portion of IBS patients have small intestine bacterial overgrowth (SIBO) or other types of bacterial imbalance [17, 18, 19]. Bacterial overgrowth can irritate the lining of the small intestine or large intestine, causing IBS pain or a change in bowel habits. Excess bacteria can also overproduce gas that leads to bloating and distention.

Other Digestive Diseases

Many IBD [20] and celiac disease [21] patients also have IBS symptoms, including pain. This may be due to intestinal inflammation or irritation. Your doctor may try to rule out these other potential causes of pain before diagnosing you with IBS.

Acute Gastroenteritis

Acute gastroenteritis, also known as food poisoning, can also certainly cause stomach and intestinal pain. It’s estimated that between 5%-32% of IBS is caused by gastroenteritis [22]. A meta-analysis and systematic review found that gastroenteritis increased the risk of developing IBS four-fold compared to people who never had gastroenteritis [23].

Some preliminary animal model research indicates that gastroenteritis can cause increased anti-cytolethal distending toxin B (CdtB) and anti-vinculin antibodies in the small intestine [24]. This can lead to an autoimmune reaction in the small intestine, which can lead to chronic IBS symptoms [25].

A subsequent study compared levels of these antibodies in patients with IBS-D and controls. The study found that “Anti-CdtB titers were significantly higher in D-IBS subjects compared to IBD, healthy controls and celiac disease…Anti-vinculin titers were also significantly higher in IBS compared to the other groups.” In other words, food-poisoning-triggered antibodies may be a cause of some cases of IBS-D and chronic IBS pain.

Constipation and Gut Motility

Constipation is one of the hallmark symptoms of IBS. It may also be a cause of IBS [26]. Slow gut motility increases the likelihood of small intestinal bacterial overgrowth (SIBO) or other dysbiosis, which can lead to chronic IBS symptoms [27]. Gut motility can also be slowed down by medications like opioids [28], abdominal scar tissue or adhesions, or lack of physical activity [29].

Food Sensitivities or Intolerances

Food sensitivities may also aggravate or cause IBS symptoms, including pain [30]. Intolerance to particular groups of FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) can increase bloating and abdominal pain and distention when those foods are consumed [31]. Other potential food triggers of IBS pain include gluten [32], dairy products [33], high histamine foods [34], or artificial additives or ingredients [35].

Hypersensitivity to Gas Pressure

Many IBS patients report that no matter what they eat, they are extremely sensitive to bloating and gas pressure, even normal levels. Inflammation [36] or altered serotonin metabolism [37] may play a role in this hypersensitivity. Some preliminary research suggests that certain types of foods, such as fats [38], or high FODMAP foods [39] may influence digestive hormones and trigger hypersensitivity.

Regardless of the underlying causes of your IBS pain, general gut support resolves many cases of IBS pain. This can often easily be done by making proactive diet and lifestyle changes to identify and resolve the worst triggers of your IBS symptoms. Let’s discuss how to help you reduce your IBS pain.

How to Manage and Treat IBS Pain

A gastroenterologist might order blood tests or a colonoscopy to rule out other possible diagnoses. They may then prescribe laxatives, antispasmodic medications, or prescription medications like loperamide to manage and treat IBS pain.

However, many of these approaches have unwanted side effects and don’t get at the root cause of your IBS pain or symptoms. There are many proactive steps you can take in your day-to-day life to manage and treat your IBS and IBS pain.

Using Diet To Prevent IBS Pain

Eating an anti-inflammatory diet is the first step to addressing your IBS pain.

Particular food sensitivities or intolerances may very closely relate to your IBS symptoms like pain, or your foods may be encouraging bacterial overgrowth.

A simple 3-4 day gut reset with an elemental diet is an effective and easy way to start. An elemental diet reduces IBS pain and other symptoms by starving bacterial overgrowths, which reduces exposure to food irritants and allows your digestive system to rest temporarily. In one study, 86% of SIBO patients on a two-week elemental diet saw their breath tests normalize, and 65% of IBS patients saw an improvement in their IBS symptoms [40].

Once you’ve completed a gut reset, consider adopting a low FODMAP diet.

FODMAPs are Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols, which are all simply natural, fermentable sugars and starches that occur in plant foods.

The low FODMAP diet is the most researched diet for IBS. It has been shown in two meta-analyses (the highest quality evidence) and several smaller studies to improve IBS symptoms like bloating and abdominal pain and to improve quality of life for IBS patients [41, 42, 43]. The low FODMAP diet has also been shown in research to improve the function of gut endocrine cells, which can normalize bowel habits [44, 45, 46].

The low FODMAP diet temporarily eliminates high FODMAP foods, such as foods high in lactose, like dairy products, and foods high in fructose, like mangoes, to reduce food with bad bacteria that may be overgrown in the intestines.

Once your inflammation has calmed down, you reintroduce foods to see which ones you truly need to keep avoiding. For help eating a low FODMAP diet, see our guide to the low FODMAP diet.

Probiotics To Reduce IBS Pain

Many cases of IBS are caused by dysbiosis, or an imbalance of your good and bad bacteria, and the inflammation this can trigger in your digestive system [47]. Probiotics have been shown in several meta-analyses and smaller studies to improve IBS symptoms, including bloating, abdominal pain, and gas [48, 49, 50, 51, 52, 53].

Probiotics have also been shown to improve outcomes of antibiotic or antimicrobial herb treatment for infections like H. pylori and SIBO [54, 55, 56].

Probiotics don’t work like medications to reduce IBS pain and symptoms. Instead, they work to generally reduce inflammation and help balance your gut microbiome and environment [57].

There are three main categories of probiotics. Using probiotics for IBS pain is as simple as using one probiotic from each of the three main categories together:

A Lactobacillus-Bifidobacteria blend, containing mainly Lactobacillus and Bifidobacteria species.
Saccharomyces boulardii, a beneficial yeast
A soil-Based probiotic, usually containing Bacillus species

The three categories work together to restore balance in your gut environment.

Meta-analyses and systematic reviews suggest that a diversity of probiotic species improves IBS symptoms more than single strains or species [58, 59]. Many people try a single probiotic product and give up when they don’t see results. By using a diverse complement of probiotics, IBS patients often see a positive shift in their IBS symptoms. My clinical experience mirrors this research.

Other Digestive Support for IBS Pain

Consider trying these additional digestive supports if they are appropriate for you to help reduce your IBS pain.

Fiber Supplements

Research suggests fiber supplements are helpful for people with IBS-C [60]. A meta-analysis concluded that soluble fiber improved IBS symptoms, including IBS pain [61]. Several individual studies support this conclusion [62, 63]. However, fiber supplements may trigger an increase in bloating, gas, and abdominal pain for a significant portion of IBS patients [64], so they should be used with caution.

If you’re interested in trying fiber supplements, start low and slowly increase your intake. If you notice negative side effects, discontinue use immediately and try again when your gut has done some healing.

Digestive Enzymes

Some IBS patients get IBS pain flares because they have trouble digesting certain foods, such as FODMAPs or dietary fats. A meta-analysis showed that pancreatic enzyme replacement therapy improved IBS symptoms compared to a placebo [65]. One additional small study found that digestive enzymes improved symptoms for IBS and IBD patients [66]. Digestive enzymes are worth a trial for managing your IBS pain.

Lifestyle Changes for IBS Pain

Stress is a common trigger for IBS pain and other IBS symptoms [67]. Getting your stress under control can make a huge difference in your experience of IBS pain.

Research shows that treatment options like cognitive behavioral therapy [68, 69] and relaxation techniques such as hypnotherapy [70, 71] and meditation [72] can improve IBS pain from 20% to 65% percent. Regular exercise was also shown in one small study to improve bloating and IBS patient quality of life [73].

Say Goodbye to IBS Pain

Though pain is one of the more common IBS symptoms, you need not be a prisoner to your IBS pain. Diet and lifestyle changes such as eating a low FODMAP diet, including probiotics, fiber, and enzymes may improve symptoms, while relaxation techniques can help improve your gut-brain-stress related symptoms.

For more detail about how to properly use these options, see my book Healthy Gut, Healthy You.

Dr. Michael Ruscio is a DC, natural health provider, researcher, and clinician. He serves as an Adjunct Professor at the University of Bridgeport and has published numerous papers in scientific journals as well as the book Healthy Gut, Healthy You. He also founded the Ruscio Institute of Functional Health, where he helps patients with a wide range of GI conditions and serves as the Head of Research.

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