IBS flare management in adults

Overview

Irritable bowel syndrome (IBS) is a common condition that affects the digestive system. It causes symptoms like stomach pain, bloating, and changes in bowel habits such as diarrhea or constipation. These symptoms can come and go, and sometimes they get worse for a while – that is called a flare.

Yes, IBS is very common. In the UK and internationally, about 1 in 5 adults experience symptoms at some point in their lives.

IBS can affect people of any age, but it often starts in the teenage years or early adulthood. Women are about twice as likely as men to have IBS.

Symptoms

Common symptoms

• Abdominal pain or cramping, often relieved after passing stool
• Bloating and a feeling of fullness or distension
• Diarrhea, constipation, or alternating between the two
• Urgency – a sudden need to go to the toilet
• Passing mucus (a jelly-like substance) with stool

Symptoms in children

• Children with IBS may complain of stomach aches but find it hard to describe the pain
• They may also have diarrhea or constipation, and feel bloated or nauseous
• Behavior changes like avoiding meals or school can be signs of discomfort

Symptoms in older adults

• Older adults with IBS often experience constipation more than diarrhea
• They may have less obvious pain and more general digestive upset
• Medications for other health conditions can worsen IBS symptoms

Causes

Main causes

• The exact cause of IBS is not known, but it involves how the brain and gut communicate
• Nerves in the bowel may be overly sensitive, causing pain from normal digestion
• Muscle contractions in the bowel may be too strong or too weak, leading to diarrhea or constipation
• Changes in the natural balance of gut bacteria can contribute
• Certain foods, stress, or hormonal changes can trigger symptoms

Risk factors

• Having a family history of IBS or other digestive problems
• Experiencing high levels of stress, anxiety, or depression
• Having a food intolerance (for example, to lactose or gluten)
• Being female – hormonal changes can play a role
• Having had a severe gut infection (such as food poisoning)

When to see a doctor

See a doctor urgently if:

• If you have any of the emergency symptoms listed above (severe pain, blood in stool, weight loss)
• If your symptoms are suddenly much worse and are not improving after a few days

Book a routine appointment if:

• If you have ongoing tummy troubles that affect your daily life for more than a few weeks
• If your bowel habits change (diarrhea, constipation) without a clear reason
• To get a proper diagnosis and rule out other conditions

Diagnosis

There is no single test for IBS. Your doctor will listen to your symptoms and ask about your health history. They will also check for 'red flag' signs that might point to a different condition. IBS is often diagnosed after ruling out other possible causes.

Tests that may be done

• Blood tests to check for anaemia, inflammation, or coeliac disease
• Stool tests to look for infections or signs of inflammation
• A test for coeliac disease (a gluten sensitivity)
• Sometimes a colonoscopy or sigmoidoscopy (a camera test of the bowel) if you have worrying symptoms

What to expect at your appointment

Your doctor will ask about when your symptoms started, what makes them better or worse, and your family history. They may also want to know about your diet and stress levels. It can help to keep a symptom diary for a few weeks before your visit.

Treatment

There is no cure for IBS, but treatment focuses on managing your symptoms. Many people find that a combination of self-care, diet changes, and stress reduction works well. Your doctor can also recommend medications to help with specific symptoms like pain, diarrhea, or constipation.

Self-care at home

• Keep a food and symptom diary to identify your triggers, such as certain foods or stress
• Try a low-FODMAP diet – this is a temporary eating plan that avoids foods that are hard to digest (always do this with a dietitian's guidance)
• Eat smaller, more frequent meals and chew your food slowly
• Stay well-hydrated by drinking plenty of water
• Get regular physical activity like walking, yoga, or swimming
• Practice relaxation techniques such as deep breathing or mindfulness to manage stress

Medical treatments

Depending on your main symptoms, a doctor may recommend a medicine like an antispasmodic to ease stomach cramps, a laxative for constipation (if fiber is not enough), or an anti-diarrheal medicine for diarrhea. Some people benefit from certain probiotics or from prescription medications that affect how the bowel moves. Always ask your doctor what is right for you – do not take over-the-counter treatments without advice.

When is surgery considered?

Surgery is not used for IBS itself. However, if tests find another condition that needs surgery (like a blockage or gallstones), that would be treated separately.

Living with this condition

Living with IBS means being aware of your triggers and planning ahead. You may feel fine for weeks and then have a flare. Learning what causes your flares can help you avoid them and feel more in control.

Lifestyle tips

• Eat at regular times and do not skip meals
• Get enough sleep – aim for 7 to 9 hours a night
• Reduce stress with activities you enjoy – hobbies, reading, or talking to a friend
• Keep a simple symptom diary to spot patterns

Diet and exercise

A balanced diet with plenty of fiber (if you have constipation) or low-fiber (if you have diarrhea) can help. Regular, gentle exercise like walking or yoga can reduce stress and improve digestion. Avoid vigorous exercise right after eating, as it may make symptoms worse.

Mental health and emotional wellbeing

IBS can cause anxiety and worry about when the next flare will happen. Stress and anxiety can also make IBS worse, creating a cycle. Talking to a therapist, especially one trained in cognitive behavioural therapy (CBT), can help break this cycle. If you feel very anxious or depressed, tell your doctor – they can suggest support.

Prevention

IBS itself cannot be prevented because the exact cause is unknown. However, you can reduce the frequency and severity of flares by identifying and avoiding your personal triggers. This includes certain foods, stress, and other lifestyle factors.

Screening programmes

There is no routine screening for IBS. However, if you have a family history of bowel cancer or other conditions, your doctor may recommend regular checks like a colonoscopy.

Complications

If left untreated

• Persistent symptoms can affect your quality of life, making it hard to work, socialise, or travel
• Severe diarrhea or constipation can lead to dehydration or haemorrhoids
• Chronic pain or urgency may lead to anxiety and depression

Long-term outlook

IBS is a lifelong condition, but with the right management, most people are able to lead full, active lives. Symptoms often improve over time as you learn what works for you. There is no evidence that IBS leads to serious diseases like cancer.

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