How to Relieve IBS Pain

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1Managing the Pain

2Improving Your Nutrition

3Following the Low FODMAP Diet

4Understanding IBS Symptoms and Risk Factors

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While everyone occasionally experiences diarrhea or constipation, Irritable Bowel Syndrome (IBS) can make them daily problems. IBS is a chronic condition of the large intestine. Though it might feel like IBS is a disease, the large intestine is not actually changed by any diseased organism. Instead, IBS describes groups of symptoms. IBS is recognized in three forms: IBS with predominant diarrhea (IBS-D), IBS with predominant constipation (IBS-C), and mixed IBS with both constipation and diarrhea (IBS-M). Since it's not a disease, your doctor will work with you to change your diet so you can get relief.

Steps

Part 1

Part 1 of 4:

Managing the Pain

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   Apply heat. Reduce the pain associated with IBS cramping by applying heat. You can place an electric heating pad or hot water bottle over your abdomen. This can stop painful spasms. Leave the pad or bottle on for around 20 minutes and make sure not to apply it to your bare skin.

   • You can also relieve pain by soaking in a hot bath. Consider adding epsom salts if your IBS is making you constipated.
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   Take medication. Ask your doctor to prescribe medication to relieve your symptoms. If you're experiencing constipation, your doctor may prescribe lubiprostone. If you're mainly having diarrhea, your doctor might prescribe alosetron. If you have severe IBS, your doctor might put you on a low-dose antidepressant. This can soften the pain signals going from your brain to your gut, rather than treat your symptoms.

   • Alosetron is the only drug currently approved to treat IBS-D. It is thought to reduce colonic motility. There are some serious side effects associated with alosetron, such as ischemic colitis (decreased blood flow to the bowels) and severe constipation which may require hospital treatment. It can also interact with other medications, such as antihistamines and certain antidepressants.
   • You can also take over-the-counter medications to deal with the symptoms. For example, take an anti-diarrheal medication.
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   Exercise. Regular exercise can help your gut contract and expand normally. Try to do 30 minutes or moderate exercise five days a week, which can also reduce your anxiety, improve your mood, and help you manage your weight. If you find that exercising makes your symptoms worse, talk with your doctor and try a different form of exercise.

   • Moderate activity includes biking, brisk walking, water aerobics, and gardening.
   • Make a habit of exercising so you're more likely to do it. For example, you might try going for a jog before breakfast every day or swimming laps on the weekends.
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   Learn to tolerate the pain. If traditional pain treatment isn't working for you, you may consider working through the pain. Practice relaxation or hypnotherapy to deal with the pain. Cognitive behavioral therapy is also thought to be an effective IBS treatment. It's also useful in relieving anxiety associated with IBS symptoms.

   • Unlike medications or changing your diet, these learning pain management is free from side effects.
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   Take peppermint oil. Take an enteric-coated peppermint oil supplement to relieve abdominal pain caused by IBS, as well as diarrhea and bloating. Follow the manufacturer's instructions regarding dosage. Peppermint oil has long been used to calm the stomach and digestive system. This can help intestinal gas pass easier.

   • In addition to peppermint, you can drink herbal teas to relieve digestive pain. Try herbal teas that contain ginger, fennel, cinnamon, or cardamom.
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Part 2

Part 2 of 4:

Improving Your Nutrition

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   Eat more soluble fiber. If you have diarrhea or constipation from IBS, eat soluble fiber. This dissolves in water and forms a thick gel in your large intestine which can slow down diarrhea. Soluble fiber also relieves constipation by making it easier to pass stools, reducing pain. The amount of fiber you need depends on your age and sex. The Institute of Medicine has specific guidelines for daily fiber intake. It's roughly about 25 g for adult women and 38 g for adult men. To get soluble fiber in your diet, eat:

   • Oatmeal
   • Barley
   • Okra
   • Legumes: garbanzo beans, lentils, soybeans
   • Grits
   • Nuts and seeds
   • Fruits: apples, pears, berries
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   Include insoluble fiber. If you mainly have constipation from IBS, gradually increase insoluble fiber (which doesn't dissolve in water). Slowly increase the amount of fiber in your diet by 2 to 3 grams a week, until you eat 25 to 60 grams a day. If you increase fiber too quickly, you may have gas. Fiber will support the bacteria in your gut which improves bowel function. To get insoluble fiber from your diet, eat:

   • Whole grains (unprocessed): these contain both soluble and insoluble fiber
   • Carrots
   • Zucchini
   • Celery
   • Flaxseed
   • Lentils
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   Eat probiotics and prebiotics. Probiotics and prebiotics feed and support healthy gut bacteria. They can also protect your gut from harmful bacteria that irritates your bowels. Since it's hard to gauge how many Colony Forming Units of probiotics (CFUs) are in foods, eat a variety of foods known to contain probiotics and prebiotics. To get probiotics in your diet, eat leafy green vegetables (kale, spinach, Swiss chard, spinach, beet greens, collard greens, mustard greens), broccoli, cauliflower, and cabbage. To get prebiotics, eat:

   • Chicory root
   • Jerusalem artichoke
   • Dandelion greens
   • Leeks
   • Asparagus
   • Wheat bran
   • Baked wheat flour
   • Bananas
4. 
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   Choose a probiotic supplement. Look for a supplement that has many different strains of bacteria (but at least has L. acidophilus, L. Fermentum, L. rhamnosus, B. longum, and B. bifidum). Some supplements include a yeast, Saccharomyces, which protects gut bacteria. It doesn't matter whether you take a liquid, capsule, tablet, or supplement powder. Just take a supplement that has a controlled release so that it doesn't dissolve in your stomach acid.

   • The brands Florastor and Align are often recommended by health care professionals.
   • Check the expiration date and make sure the supplement has at least 25 billion Colony Forming Units (CFUs). Adults should get 10 to 20 billion CFUs a day from a supplement.
   • Look for a USP Verified seal which means that a non-profit lab has checked the supplement for the bacteria it lists on the label.
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   Add unpasteurized fermented foods to your diet. Fermented foods can support and replenish the microbes in your gut. Choose unpasteurized products because pasteurization destroys the "good" bacteria (probiotics). While there are no scientific or government recommended guidelines for how much unpasteurized fermented food you should eat, researchers are urging global food guides to start including them. In the meantime, eat:

   • Tempeh: fermented soybeans
   • Kimchi: fermented Korean cabbage
   • Miso: fermented barley paste
   • Sauerkraut: fermented cabbage
   • Yogurt: fermented milk with active probiotic bacteria
   • Kefir: fermented milk
   • Kombucha: black or green fermented tea with added fruit and spices
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Part 3

Part 3 of 4:

Following the Low FODMAP Diet

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   Adjust your diet. Follow the "Fermentable Oligo-, Di-, Monosaccharides And Polyols (FODMAP)" diet. FODMAPs are foods or ingredients that are associated with making IBS symptoms worse. Avoid these foods or limit them to one to three servings a day. In general, you should follow a low-fat, complex carbohydrate diet. For example, eat whole grains, lactose-free dairy products, gluten-free foods, fish, chicken, meat, and certain fruits and vegetables (such as bok choy, carrots, bananas, cucumber, grapes, tomatoes).

   • Try the low FODMAP diet for at least four to six weeks. You may immediately get abdominal pain relief, or it may take longer for the pain to go away.
   • Talk to your doctor about what you should and should not eat on this diet.
   • It is believed that short-chain carbohydrates are poorly absorbed by the intestine and rapidly fermented by bacteria in the gut. The production of gas during this process is a cause of symptoms.
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   Limit your sugar (fructose) intake. Fructose isn't absorbed well by your gut, which can cause cramping and diarrhea. Avoid fruits that have simple sugar, like apples (and applesauce), apricots, blackberries, boysenberries, cherries, canned fruit, dates, figs, pears, peaches and watermelon. You should also avoid any food with high-fructose corn syrup (HFCS), which may include baked items and beverages.

   • Don't forget to cut out artificial sweeteners like xylitol, sorbitol, maltitol and mannitol (which all contain polyols that irritate the digestive system).
   • You should also avoid the these vegetables which can aggravate your digestion: artichokes, asparagus, broccoli, beetroot, Brussels sprouts, cabbage, cauliflower, garlic, fennel, leeks, mushrooms, okra, onions, and peas.
3. 
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   Eat less dairy. Dairy contains lactose which is a carbohydrate that breaks down into sugar. Lactose can irritate your sensitive digestive system. If you think you may be sensitive to lactose, you might actually be lactose-intolerant, which can also cause digestive problems like those of IBS. Try to limit the amount of milk, ice cream, most yogurts, sour cream, and cheese you eat.

   • You can still eat soy-based yogurts since they don't have lactose. But, you should still avoid soybeans.
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   Watch your grain and legume consumption. Several grains contain fructans which can irritate your digestive system. Try to limit your intake of grains that contain gluten, like wheat, spelt, rye, and barley. You should also reduce the amount of legumes in your diet because these contain galactans which may also irritate your digestive system. Galactans and fructans can cause the gas and bloating symptoms of IBS. Avoid these legumes:

   • Beans
   • Chickpeas
   • Lentils
   • Red kidney beans
   • Baked beans
   • Soybeans
5. 
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   Eat fruits and vegetables. Lots of fruits and vegetables are allowed in the FODMAP diet. These fruits and vegetables don't contain large amounts of the carbohydrates that your body has trouble breaking down. For fruits, you can eat bananas, berries, melons (except watermelon), citrus, grapes, kiwi, and passion fruit. There are also a variety of vegetables you can eat that won't irritate your digestive system. Try making half of your plate vegetables every meal. Try:

   • Bell peppers
   • Cucumbers
   • Eggplant
   • Green beans
   • Chives and green onion
   • Olives
   • Squash
   • Tomatoes
   • Roots: carrots, parsnips, potatoes, radishes, sweet potatoes, turnips, yams, ginger
   • Greens: kale, lettuce, spinach, bok choy
   • Water chestnuts
   • Zucchini
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   Include meats and grains. Get protein from a variety of sources like meat, fish, eggs, nuts and seeds (except for pistachios). You shouldn't feel like you can't eat food. Just watch to make sure these meats and grains don't have added sugars or wheat, which can irritate your digestive system. Try to choose meat that hasn't been fed grain or high-fructose corn syrup (which are high in FODMAPs). Grains that you can eat include:

   • Corn
   • Oats
   • Rice
   • Quinoa
   • Sorghum
   • Tapioca
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Part 4

Part 4 of 4:

Understanding IBS Symptoms and Risk Factors

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   1
   Watch for symptoms of IBS. Symptoms of IBS can be different for each person and vary in severity from one time to another. The most common symptoms of IBS are:

   • Abdominal pain and cramping that may improve after a bowel movement
   • Bloating and gas
   • Constipation (which may alternate with diarrhea)
   • Diarrhea (which may alternate with constipation)
   • A strong urge to have a bowel movement
   • Feeling as if you still need to have a bowel movement after you've already had one
   • Mucus in the stool
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   Consider your risk factors. IBS is a "functional" digestive disorder. This means that the digestive system changes for unknown reasons. But, these changes don't actually damage the digestive system. Conditions that usually happen with IBS include:

   • Mixed nerve transmissions between the brain and large intestine
   • Problems with the way food is pushed through the digestive system (peristalsis)
   • Depression, anxiety, and panic disorders
   • Infections in the digestive system
   • Bacterial overgrowths (like Small Intestine Bacterial Overgrowth [SIBO])
   • Changes in hormone levels
   • Food sensitivities
3. 
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   Talk with your doctor. Since there's no diagnostic test, your doctor will do a physical exam. The doctor may order blood tests, stool tests, and imaging tests, depending on your specific situation. These tests can also rule out other health conditions.

   • If your doctor believes you have IBS, you'll probably be advised about changes you need to make to your diet. Your doctor might prescribe medications (like muscle relaxants, anti-depressants, bulk-forming laxatives and anti-diarrheal medicines) to relieve symptoms.
4. 
   4
   Keep a food journal. Track the foods you eat and make note of which foods seem to make your symptoms worse. Try to avoid eating these foods in the future. Most people with IBS find that one or more of these cause digestive problems:

   • Foods that are high in fat
   • Foods that are artificially sweetened
   • Foods that cause gas or bloating (cabbage, some beans)
   • Some milk products
   • Alcohol
   • Caffeine
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Expert Q&A

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• Question

  Which foods are common triggers for IBS?

  

  Dale Prokupek, MD
  Board Certified Internist & Gastroenterologist

  Dale Prokupek, MD is a board-certified Internist and Gastroenterologist who runs a private practice based in Los Angeles, California. Dr. Prokupek is also a staff physician at Cedars-Sinai Medical Center and an associate clinical professor of medicine at the Geffen School of Medicine at the University of California, Los Angeles (UCLA). Dr. Prokupek has over 30 years of medical experience and specializes in the diagnosis and treatment of diseases of the liver, stomach, and colon, including chronic hepatitis C, colon cancer, hemorrhoids, anal condyloma, and digestive diseases related to chronic immune deficiency. He holds a BS in Zoology from the University of Wisconsin – Madison and an MD from the Medical College of Wisconsin. He completed an internal medicine residency at Cedars-Sinai Medical Center and a gastroenterology fellowship at the UCLA Geffen School of Medicine.

  

  Dale Prokupek, MD

  Board Certified Internist & Gastroenterologist

  Expert Answer

  It can vary a little bit from person to person, but carbonated beverages, broccoli, cabbage, beans, citrus, and cauliflower are common culprits.

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Tips

• The low FODMAP diet was developed for IBS at Monash University in Australia.
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• If you are looking for a prebiotic supplement that contains inulin and fructooligosaccharides (FOS), the supplement should also contain galactooligosaccharides or GOS.
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• Talk with your doctor about taking a supplement and always follow the manufacturer's instructions regarding dosing.
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Warnings

• Add fiber to your diet slowly. This gives your body enough time to get used to the increased fiber. If you add fiber too quickly, you may worsen IBS symptoms.
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