When you have irritable bowel syndrome (IBS), the whole thing can feel a bit mysterious. IBS is often the result of other health problems. And since these problems can arise and disappear seemingly at random, it may feel like your IBS is simply “all in your head.”
Luckily, there are some proven approaches to decrease the severity of your symptoms. There’s a chance these triggers are making your IBS worse, and by understanding them, you may be able to find some welcome relief.
We spoke to Lloyd Perino, MD, a gastroenterologist at Banner Health in Arizona, about these triggers and how to approach them.
Trigger #1: Eating the wrong foods
“The most common trigger is just eating,” Dr. Perino explained. Now, food is obviously unavoidable. We all have to eat eventually. But which specific foods should you avoid outright? “FODMAP” foods (aka fermentable oligo-, di-, mono-saccharides and polyols) are a possible culprit for people with IBS. These are short-chain carbohydrates that aren’t easily absorbed and digested, which cause gas, bloating and general pain. Some examples:
- Sugary foods: dried fruit, apples, mangoes, watermelon and high-fructose corn syrup
- Foods with polyols: apples, apricots, avocados, cherries, nectarines, peaches and cauliflower
- Foods with lactose: milk, cheese, ice cream and yogurts
- Foods with oligosaccharides: vegetables like artichokes, asparagus, beetroot, broccoli and onions, and legumes including chickpeas, lentils and kidney beans
- Sweeteners with polyols: isomalt, maltitol, mannitol, sorbitol and xylitol, which are sometimes in gum and certain medications.
It’ll probably take time to learn which foods make your IBS worse. Consider consulting with your doctor and a dietitian, who can help you eliminate and track these FODMAP elements one at a time. And through it all, be patient with yourself.
“Lots of patients have foods they blame, but it’s highly variable,” Dr. Perino added. “A food can be a trigger to one person but have little effect on the next.” Tracking your own results is among the most important things you can do.
Trigger #2: Untreated anxiety, depression or stress
Brains and stomachs share a special connection. Your central nervous system, which controls your conscious and unconscious function (like breathing and thinking), is directly connected to your enteric system, which regulates gut activity.
Because of this connection, IBS often goes hand-in-hand with anxiety and depression. When your brain and nerves struggle, there’s a good chance your stomach will, too. And since IBS can itself be stressful, that alone can raise your anxiety, which then makes your IBS worse. It’s a vicious cycle but getting professional treatment for your anxiety and/or depression is quite helpful here.
Dr. Perino said stress is one of the most common reasons a patient’s IBS will get worse. Learning to better manage your stress will likely decrease your IBS’s severity.
Trigger #3: Treating the wrong condition
When it comes to IBS, the medical community is still learning. In fact, the National Institutes of Health (NIH) points out that doctors aren’t completely sure what causes IBS in every case.
“Most doctors, many patients and even some gastroenterologists don’t think there is any treatment and just try to ignore it,” Dr. Perino added.
We don’t recommend ignoring it. Your doctor may order tests to rule out other health problems — this can be a good starting point. IBS often overlaps with other gastrointestinal conditions like inflammatory bowel disease (IBD), which is more clearly identifiable than IBS. Celiac disease, lactose intolerance, small intestinal bacterial overgrowth (SIBO) — the list of related stomach issues goes on and on. Getting accurately diagnosed will help you make sure you’re treating the right issue.