A hallmark symptom of irritable bowel syndrome (IBS) is the experience of abdominal pain. If you are looking for relief from this pain, it might be helpful to try to pinpoint just what might be causing the pain. It has been my experience that some people who have IBS assume that all abdominal pain comes from trapped gas. In many cases, they are right. Some foods contains elements that are set upon by gut bacteria with the result of intestinal gas. Due to a problem in IBS called visceral hypersensitivity (enhanced pain sensation), this gas can become quite painful. However, trapped gas is not the only thing that can cause the abdominal pain associated with IBS. Knowing what is really going on can help you to better pinpoint appropriate pain relief strategies.
Other Causes of IBS Pain
There are two other possibilities to consider as you try to figure out what might be behind your IBS pain symptoms. The close neural connections between your brain and your gut can result in visceral hypersensitivity even in the absence of intestinal gas. This is particularly likely if you have been experiencing a lot of stress (including the stress of dealing with IBS!) Another key factor in IBS is the motility dysfunction that results in the symptoms of diarrhea and constipation. This same motor problem can also result in painful cramping and/or spasms of the muscles within the large intestine.
As you can see, the causes of abdominal pain in IBS are quite complicated and poorly understood. To make things even more confusing, pain within our bodies is known to radiate away from the original site. Given all of this, however, I do believe that there are some guidelines that can be followed to help you to address, and hopefully find some relief from, your pain.
Your symptoms are more likely to be gas-related if any of the following factors are present:
- You have recently eaten gassy foods.
- Your pain location keeps changing. Pain may be experienced in the upper abdomen and chest/rib cage areas.
- You are constipated or overdue for a bowel movement.
- You are passing wind.
Your pain is less likely to be gas-related and more likely to be the result of IBS problems of visceral hypersensitivity and/or motility if you are experiencing any of the following:
- Pain is more widespread, feels like large parts of your colon are hurting. Pain may radiate upward.
- Pain is crampy and/or your colon feels like it is in spasms.
- You feel anxious or are under stress.
How to Address the Pain Problem
Once you have identified what might be causing your pain symptoms, you can tailor your management strategies accordingly. One of the mistakes I have seen in some IBS patients is a tendency to believe that they need to sit on the toilet for an extended period of time to ensure they have completely emptied to avoid "trapping in" any gas. This kind of thinking can enhance anxiety and sensations of incomplete evacuation, not to mention increasing a risk of hemorrhoids from excessive straining. The Catch-22 problem here is that the anxiety related to worrying about trapping gas can end up increasing abdominal pain due to that brain-gut connection mentioned earlier.
If you determine that your problems are probably gas-related, look into strategies that target that symptom. Gas-related problems are more likely to be food-related, and if your symptoms are severe, you might benefit from a low FODMAPs diet. If your symptoms are less severe, you may benefit from the use of over-the-counter gas relievers. Here are some articles with more in-depth discussion on treating gas problems:
If you think that your abdominal pain is more likely the result of the visceral hypersensitivity and motility problems inherent in IBS, you will want to be thinking about strategies that calm the central nervous system. This is where the various mind/body approaches, such as relaxation exercises, yoga and meditation, might be of most help.
If your pain appears to be more muscle-related, e.g. cramps and spasms, you may best benefit from antispasmodic medications or peppermint tea and/or capsules.
The following article offers a more in-depth discussion of strategies for addressing IBS pain:
Essential Reading from Dr. Bolen, Your IBS Guide:
Delvaux, M. Role of visceral sensitivity in the pathophysiology of irritable bowel syndrome Gut 2002 51:i61-i67.
Farhadi, A. “I Have IBS…Now What?!!!” SanitizAir, Inc. 2007.
DISCLAIMER: The information contained on this site is for educational purposes only and should not be used as a substitute for diagnosis or treatment rendered by a licensed physician. It is essential that you discuss with your doctor any symptoms or medical problems that you may be experiencing.