Understanding and Managing IBS Pain
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5 Ways to Manage IBS Pain

Tips and tricks to understand and manage irritable bowel syndrome.
5 Ways to Manage IBS Pain
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Updated on March 22, 2024
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Irritable bowel syndrome (IBS) is relatively common in the United States and many Western countries, affecting nearly 5 percent of people, according to the American College of Gastroenterology (ACG). It’s a chronic and often debilitating disorder characterized by bouts of diarrhea, constipation, or both.

The cardinal symptom for IBS is recurrent abdominal pain over three months, plus changes in the quality or frequency of your stool.

“If you don’t have abdominal pain, you can’t have IBS,” says Brian E. Lacy, MD, PhD, a gastroenterologist at the Mayo Clinic in Jacksonville, Florida, and the lead author of the ACG’s clinical guidelines for the management of IBS.

 “One of the biggest challenges around diagnosing IBS is simply having patients overcome the stigma of discussing embarrassing bowel habits.”

The pain can be sharp, throbbing, or cramping, and may come and go. However your particular pain manifests, it can severely affect your quality of life.

Fortunately, an IBS diagnosis can often be very reassuring because the condition does not lead to inflammation, anemia, or any worse ailments, like bowel cancers. Also, it can be managed effectively through diet, exercise, and medication.

Once you have an IBS diagnosis, taking proactive steps can significantly reduce symptoms and make the disorder manageable. The first thing to remember though is that every case is unique, and it will take a period of trial and error to find what works best for you, Megan Riehl, PsyD, a gastrointestinal psychologist at the University of Michigan in Ann Arbor.

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“IBS is multifactorial in nature,” says Dr. Riehl. “Things that can contribute to IBS include diet, stress, and changes to your gut microbiome. It’s not a one-stop shop to get improvements in your IBS.”

Here are five strategies that experts recommend for managing IBS symptoms:

1. Try a Low-FODMAP Diet

The ACG guidelines suggest trying a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyol carbohydrates. Since that doesn’t roll off the tongue easily, it’s called a low-FODMAP diet, and it requires eliminating a lot of foods you may be used to and then slowly reintroducing them to see which foods trigger IBS symptoms.

A study found that a low-FODMAP regimen reduced abdominal pain by 62 percent and bloating, gas, and a sense of urgency to go by half. Furthermore, the patients who followed a low-FODMAP diet continued to feel better nearly a year after starting the diet and drastically reduced the number of times they needed to see their doctor.

Knowing exactly how to follow a low-FODMAP diet can be tricky because it eliminates so many foods that may be staples for you.

“It’s so effective that it can lead to food anxiety where patients will only eat five things that they know are safe, so it’s best to work with a dietitian who specializes in IBS to broaden what you can eat,” says Riehl.

If you don’t have a dietitian on your healthcare team, check out My Nutrition Health, a site created by gastrointestinal specialists at the University of Michigan and Cedars-Sinai in Los Angeles that’s entirely dedicated to the ins and outs of the low-FODMAP diet.

2. Get Moving

Whatever exercise you like to do is what you should do, advises Riehl. When you run, bike, swim, or simply go for a walk, you lower your levels of cortisol — your stress hormone — and you boost mood-enhancing endorphins. That combination works wonders on the tummy and helps relieve IBS symptoms.

A study found that people with IBS who spent 30 minutes on a treadmill just three times per week improved the severity of their symptoms and their quality of life.

“Exercise and activity improve the messages that go from the brain to the gut and the gut to the brain,” says Dr. Lacy.

3. Get a Good Night’s Sleep

“Exercise also helps you sleep better, and sleep plays a huge role in gut behavior and digestive functioning,” Lacy says.

Sleep and IBS are intertwined. A study found that people with IBS were 2 to 4 times more likely than people without IBS to suffer from insomnia or excessive tiredness.

“Taking measures to improve sleep can have a profound impact on feeling happier and improving digestion,” says Lacy.

4. Over-the-Counter Treatments

While your doctor may want you to take prescription medicines to relieve the pain associated with diarrhea, bloating, or constipation, plenty of over-the-counter treatments are effective as well, says Lacy.

Lacy often tells his patients to drink peppermint tea or take peppermint oil capsules before eating. “It’s cheap, safe, easy, and not addictive,” he says. “Menthol or peppermint acts on smooth muscle, so there’s biologic plausibility that it works to aid digestion.”

For constipation, Lacy recommends soluble fiber like psyllium (Metamucil). Bran, on the other hand, does not help. He also recommends laxatives with few side effects, such as Miralax.

For diarrhea, Lacy often steers his patients to loperamide (Imodium).

5. Talk It Out in Psychotherapy

Since IBS is a disorder in how the brain and the gut communicate with each other, it’s important to learn tips and tricks that foster relaxation and improved digestion.

“There are a lot of interventions, like cognitive behavioral therapy and gut-directed hypnosis, that are extremely beneficial,” says Riehl. She adds that psychotherapy can help patients learn strategies to calm their body down before the bowels rev up anxiety. “The tools you learn can prevent symptoms from happening.”

Treatment focuses on providing patients with tools to improve coping, resilience, and stress management. Additionally, brain-gut therapies are evidence-based treatments that target abdominal pain and are recommended in the ACG guidelines.

While hypnosis may conjure images of tracking a swinging pocket watch with your eyes and then losing control of your will, gut-directed hypnosis is far from that. Gut-directed hypnosis steers patients toward relaxing mental images and control of their breath to find relief for IBS symptoms.

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Waseem Ahmed, MD

Medical Reviewer

Waseem Ahmed, MD, is an assistant professor of medicine in the Karsh Division of Gastroenterology and Hepatology at Cedars-Sinai Medical Center in Los Angeles and serves as Director, Advanced Inflammatory Bowel Disease Fellowship and Education within the F. Widjaja Inflammatory Bowel Disease Institute.

He received his undergraduate degree from the University of Michigan and attended medical school at Indiana University. He then completed an internal medicine residency at New York University, followed by a fellowship in gastroenterology and hepatology at Indiana University, and an advanced fellowship in inflammatory bowel disease at the Jill Roberts Center for Inflammatory Bowel Disease at New York-Presbyterian Hospital/Weill Cornell Medicine. Prior to his current role, Dr. Ahmed served as an assistant professor of medicine within the Crohn’s and Colitis Center at the University of Colorado from 2021-2024.

Dr. Ahmed is passionate about providing innovative, comprehensive, and compassionate care for all patients with inflammatory bowel disease (IBD). His research interests include IBD medical education for patients, providers, and trainees; clinical trials; acute severe ulcerative colitis; and the use of combined advanced targeted therapy in high-risk IBD.

He enjoys spending time with his wife and dog, is an avid follower of professional tennis, and enjoys fine dining.

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Jordan M. Davidson

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Jordan Davidson is a freelance health and science writer interested in everything from nutrition and fitness to hobby farming and medical breakthroughs. His work has appeared in many publications, including the Wall Street Journal, Psychology Today, Men’s Health, Prevention, Science Friday, The Scientist, and General Surgery News. He is senior copywriter at FCB Health in New York.

Davidson spent years as an ESL teacher in New York City public schools before transitioning to journalism. He holds a bachelor's degree from Brown University and master’s degrees in education and journalism from The City College of New York and the School of Journalism at CUNY. Davidson is now based in upstate New York after living in Bali, Indonesia, and volunteering on farms in Australia and New Zealand. He’s always on the hunt for good pub trivia.

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Resources
  1. Lacy BE et al. ACG Clinical Guideline: Management of Irritable Bowel Syndrome. The American Journal of Gastroenterology. January 2021.
  2. Seamark L et al. Long-Term Symptom Severity in People With Irritable Bowel Syndrome Following Dietetic Treatment in Primary Care: A Service Evaluation. Journal of Human Nutrition and Dietetics. October 2021.
  3. Fani M et al. The Effect of Aerobic Exercises Among Women With Mild and Moderate Irritable Bowel Syndrome: A Pilot Study. Journal of Bodywork and Movement Therapies. January 2019.
  4. Grover M et al. Psychological, Physical, and Sleep Comorbidities and Functional Impairment in Irritable Bowel Syndrome: Results From a National Survey of U.S. Adults. PLoS One. January 14, 2021.
  5. Bauzá M. How Gut-Directed Hypnosis Helps IBS, IBD and Other GI Disorders. Michigan Medicine. June 1, 2018.