Living with irritable bowel syndrome (IBS) often means living with unpredictability, especially when you’re not sure of your IBS triggers. One week, your digestive system is gurgling along fine, the next you’re bloated, your whole abdomen is sore, and you’re constipated, dealing with diarrhea, or both. Or maybe your IBS manifests in different ways.
One of the primary characteristics of IBS is that symptoms and triggers vary between people, and even the same person, depending on lots of different factors. Some people tend to have diarrhea-predominant IBS while others experience the condition mainly as constipation, and it’s also possible to have a mix of both at different times, according to the Mayo Clinic. Maybe you experience additional symptoms like excess gas and mucus in your stool. It’s also not uncommon for people with IBS to go for a while without any symptoms, the Mayo Clinic explains.
While IBS is a mystery in many ways (experts aren’t totally sure what causes it, for starters), there do appear to be common triggers that kick off or exacerbate IBS symptoms for a lot of people. If you’re hoping to take some unpredictability out of life with IBS, here are various ways you could be making your IBS worse without realizing it.
1. Not managing stress
What’s going on in your brain affects your gut via the gut-brain axis. This pathway connects the central nervous system, which controls conscious and unconscious functioning (including breathing and thinking), with the enteric system, a network of nerves that regulates gut activity.
Thanks to the connection between your brain and your gut, stress—the excited kind and the nervous kind—can play a role in exacerbating IBS. For example, it’s believed that some of the abdominal pain that affects some people with IBS may be caused by visceral hypersensitivity. Basically, people with IBS appear to feel movements in their guts more sensitively than other people, and often experience these movements as pain. Since stress activates certain hormones that can affect gut motility, it may lead to increased sensitivity and more pain.
Clearly, telling people “don’t be stressed” is not helpful. Everyone experiences acute periods of stress sometimes. Many people also experience chronic stress, as well. Since you can’t wave a magic wand and get rid of all stress in your life, the best way to mitigate the effects is to learn how to handle the stress itself as best as you can under the circumstances. This can take the form of self-care. “For example, through mindfulness, yoga, meditation, exercise, reading a book—even bingeing on Netflix,” David M. Poppers, M.D., Ph.D., clinical associate professor of medicine in the division of gastroenterology at NYU Grossman School of Medicine in NYU Langone, tells SELF.
As the Mayo Clinic explains, it’s common for people with IBS to also have mental health issues like anxiety and depression. If this applies to you, it could take a more clinical approach to get to the issue at the root of your stress, and therefore possibly help relieve your IBS. If you can, reach out to a mental health professional for more guidance.
2. Medications that cause constipation or diarrhea
If you feel like your IBS symptoms are suddenly flaring, think about any medications you’ve taken recently. Some medicines appear to make IBS symptoms worse in some people.
If you have IBS, it’s a good idea to check any medication before you take it to see whether diarrhea or constipation (or other common IBS symptoms) are one of the possible side effects. “Anything that causes a transient worsening of diarrhea or constipation is certainly something that can make IBS symptoms worse,” James L. Buxbaum, M.D., assistant professor of clinical medicine specializing in gastroenterology at Keck School of Medicine in the University of Southern California, tells SELF. That’s not to say you shouldn’t take a drug if you need it. For example, constipation and diarrhea are common side effects of chemotherapy drugs. But talk to your doctor to weigh the cost versus the benefit before taking a medication if you’re concerned about your IBS.
One of the most notable culprits here is non-steroidal anti-inflammatory drugs (NSAIDs), which can cause both diarrhea and constipation, according to the Cleveland Clinic. Another group of medicines to think about is antidepressants. On the one hand, certain antidepressants have been found to cause constipation or diarrhea, at least when you first start taking them. However, given the connection between mental health issues and IBS, some people who also have depression or anxiety may benefit overall from antidepressants, depending on their symptoms. Weigh the pros and cons of any medication you’re taking that might affect your IBS with your doctor.
3. Eating foods that disagree with you
Given that IBS affects the gut, it makes sense that eating certain foods can exacerbate symptoms. However, as with most things related to IBS, exactly which ones aggravate you can be different from which ones set off another person’s IBS symptoms. “I would say that there are a number of classic triggers, but not everyone falls into them,” Dr. Poppers clarifies.
Many of those classic triggers, he says, fall under the umbrella of fermentable oligo-, di-, mono-saccharides and polyols (FODMAPs). These are short-chain carbohydrates that are hard to digest and are poorly absorbed, leading to excessive gas and fluid which can cause bloating and pain. Examples include:
- High fructose foods, e.g. dried fruit, apples, mangoes, watermelon and high fructose corn syrup
- Foods that contain lactose, i.e. dairy products like milk, cheese, ice cream, and yogurts
- Foods that contain oligosaccharides, e.g., vegetables like artichokes, asparagus, beetroot, broccoli, and onions, and legumes including chickpeas, lentils, and kidney beans
- Foods that contain polyols, e.g. apples, apricots, avocado, cherry, nectarines, peach, and cauliflowers
- Sweeteners that contain polyols, including isomalt, maltitol, mannitol, sorbitol, and xylitol, which can be found in gum and various medications
It’s not just what you eat but how you eat that can make your IBS symptoms worse. If you’re prone to eating quickly, you could be adding to that bloated, gassy feeling and the pain that goes with it. “Eating too quickly exaggerates the amount of air that you swallow, which can cause gas and bloating,” Dr. Poppers says. The fancy word for swallowing too much air is aerophagia: it can also be caused by smoking and chewing gum.
4. Not getting enough quality sleep
Too little sleep and low quality sleep may be major contributors to IBS, which is why one lifestyle change doctors often recommend for treating this condition is getting enough rest, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). A 2017 study in Alimentary Pharmacology & Therapeutics with 50 participants (24 with IBS and 26 without) found that those with IBS woke up more frequently throughout the night, and that this correlated with worse abdominal pain, gastrointestinal distress, and more days with IBS symptoms. As with many factors that affect IBS, the impact of sleep on symptoms varies from person to person.
“We don’t fully understand the mechanism behind how sleep affects IBS,” Dr. Poppers admits. According to research, some theories revolve around how sleep deprivation can affect the stress response and physiological workings of the gut. “But there is a clear correlation between those who get adequate sleep versus those who don’t or get more fragmented sleep,” Dr. Poppers says. As someone whose own schedule changes depending when he’s on call, he also acknowledges that getting regular sleep can be hard for people who work night shifts or switch hours regularly. “That really can affect the quality of sleep and also gastrointestinal symptoms,” he says. “Control sleep to the extent that you can.”
5. Consuming too much caffeine and alcohol
Researchers have also pointed to caffeine and alcohol as potentially worsening IBS symptoms, although as with everything else, it varies from person to person.
As the Mayo Clinic points out, people who experience bloating and gas with IBS may want to cut back on alcohol and caffeine, which can worsen these issues. Interestingly enough, though, some people find that a certain amount of caffeine actually helps their IBS, especially people with the constipation-predominant kind. “It can trigger spasms in the intestinal tract, which for some people is helpful because it helps them do a bowel movement,” Dr. Poppers explains.
It will likely take some trial and error to find out how caffeine and alcohol affect your IBS personally. For reference, guidelines issued by the U.S. Department of Health and Human Services and U.S. Department of Agriculture define moderate drinking as one alcoholic drink a day for women and two for men. And the Food and Drug Administration (FDA) recommends consuming no more than 400 milligrams of caffeine a day. That’s about four cups of coffee, but remember, it’s not just coffee you need to watch out for. As the FDA notes, caffeine is also in dark chocolate, soda, energy drinks, and certain teas. It’s also in some over-the-counter painkillers. Note, too, that these are guidelines based on the general population. You may have to cut down to a smaller amount to manage your IBS effectively.
6. Not tracking your symptom patterns
Since each person’s experience with IBS is so different, it’s useful to keep track of your symptoms and possible triggers. If you’ve made it to this point in the article, you already know these can include certain foods, how fast you eat, your caffeine and alcohol intake, your stress levels, how much sleep you’re getting and the quality of that sleep, and medications. In addition, IBS symptoms can fluctuate depending on menstruation.
If you’ve been living with IBS for a while, you might already have a pretty good idea about what can kick your symptoms into high gear. But Dr. Poppers recommends keeping a detailed diary that covers all of these possible factors and your symptoms. For example, not just what you’re eating but how much, when, and how fast. And not just how many hours you’re sleeping but if it’s interrupted, and even what position you were in. Write about your emotional state and your stress levels, including things that are making you anxious or excited. If you’re someone who has periods, keep track of your menstrual cycle. Travel is also an important detail, since that means a change in routine.
The point is to look for patterns that can identify triggers. For example, if you notice that your symptoms are often exaggerated on days after you’ve had less than six hours of sleep, you’ll have a hint that sufficient sleep is likely one important factor in your management of your IBS. Even if you think you know all your triggers, this thorough and methodical approach might just help you figure out something new. “Sometimes patterns confirm what people know, and sometimes there are surprising things that they didn’t know trigger their symptoms,” Dr. Poppers explains.
Another reason to track your symptoms closely is so you can notice any changes in your symptoms. Dr. Poppers explains: “Changes are what gastroenterologists and physicians should always be most cognizant of, because changes make us question, is it only IBS? Am I missing something else?” If you notice that your symptoms have changed, it’s time to see an expert.
According to the Mayo Clinic, you should also get in touch with your doctor if you notice these symptoms:
- Unexplained weight loss
- Unexplained vomiting
- Chronic pain that isn’t relieved by passing gas or stool
- Rectal bleeding
- Trouble swallowing
- Diarrhea at night
- Iron deficiency anemia (symptoms of this include weakness, fatigue, lightheadedness, and shortness of breath)
7. Cutting out potential triggers without an expert’s help
Figuring out your triggers will probably mean systematically cutting things out, especially foods, with the help of your doctor. As frustrating as this is, try to stick with it.
“One thing I tell people is, don’t expect overnight results,” Dr. Poppers cautions. “For example, if you stop eating, say, cruciferous vegetables, don’t expect that this time tomorrow you’re going to feel 100 percent better. If you do, that’s fantastic. But it can take several days, it could take longer.” One reason for this is that you probably have multiple triggers. Even if you’ve found one, there could be other factors affecting your symptoms.
It’s also important not to go overboard when you’re cutting out potential triggers, particularly when that comes to food. As Dr. Buxbaum points out, if you try to eliminate every possible dietary trigger, “That’s going to be hard to follow: if you do it all the same time, it’s a bit restrictive.”
Both Dr. Buxbaum and Dr. Poppers instead recommend working with your doctor and an expert like a registered dietitian to eliminate the different FODMAP elements one at a time. “I don’t like to overly restrict foods initially, because I want people to be able to enjoy what they enjoy,” Dr. Poppers explains. “The other reason I advise against restricting multiple things at once is that if someone is improving, it’s very difficult for me to determine what has actually made the difference if they’ve changed too many things at once.”
Even if you find a food that makes your symptoms worse, you don’t necessarily have to say goodbye forever. “I try to refrain from absolutes,” Dr. Poppers says. “I don’t say, ‘You may absolutely never have asparagus, or cauliflower, or dairy,’ for example. It’s a question of what patients can tolerate and what they are willing to put up with in terms of symptoms.”
This could be seen as a long list of “don’ts,” but it’s also good to know that there are ways to manage IBS. “I think a lot of people think IBS means, ‘I’m going to be suffering every day for the rest of my life,’” Dr. Poppers says. “But for the vast majority of patients, what they do themselves in terms of identifying and modulating or avoiding triggers will make a difference. There are a lot of lifestyle changes that can be helpful that are minimally invasive.” No one is perfect, and we don’t always do the best things for our health. But if you keep rules these in mind and do your best to follow them, they may give you a better handle on your condition.