I am 27. What triggers can make my IBS symptoms worse?

Question

Hello doctor,

I am a 27-year-old and have been dealing with unpredictable bowel movements for over two years that are ruining my life. Some days, I have severe constipation where I do not go for four to five days, then suddenly I will have urgent diarrhea that sends me running to the bathroom with no warning. The abdominal bloating is so bad that I look pregnant by evening, and the cramping pain doubles me over.

I have missed important work meetings because I was stuck in the bathroom or too bloated to focus. My social life has disappeared because I am afraid to eat out or travel anywhere without knowing where every bathroom is located. I have tried elimination diets, probiotics, fiber supplements, and peppermint oil, but nothing gives consistent relief. The gastroenterologist said all my tests are normal and diagnosed irritable bowel syndrome (IBS), but that does not help me feel better. I am anxious all the time, wondering when the next flare-up will hit. My boyfriend is understanding, but I can see that this is affecting our relationship.

What triggers make IBS worse?
Are there any new treatments that actually work?

Kindly help.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

Because your usual pattern of constipation followed by urgent diarrhoea is common in irritable bowel syndrome mixed type (IBS-M). IBS is a condition where the gut is highly sensitive, and its communication with the brain (the gut-brain axis) is dysfunctional. This means things like stress, lack of sleep, and certain foods can make symptoms worse, like pain, bloating, and urgency.

Common triggers include:

Irregular meal hours.
Heavy/fatty foods.
Booze and Caff.
Carbonated drinks.
Onion and garlic.
Plants of the legume family.
Some wheat products.
Lactose (if you’re intolerant)
Sorbitol and other artificial sweeteners.
Changes in hormones during your period.
Antibiotics.
Fear.

You can take a targeted approach rather than going on an endless elimination diet. :

Follow a low- fermentable, short-chain carbohydrate (oligosaccharides, disaccharides, monosaccharides, and polyols) (FODMAP) diet correctly for two to six weeks and then reintroduce foods with the guidance of a dietitian.
You can add a small amount of psyllium, a soluble fibre, each day and avoid bran.
Take enteric-coated peppermint oil or an antispasmodic as needed for pain and bloating.
On days with diarrhoea, a low dose of Loperamide (a medicine against diarrhoea) can be useful.

If you have watery urgency, bile acid binders can be tried as well. Regular use of polyethylene glycol 3350 (PEG, a laxative) may help with constipation days.

If anxiety is a major concern, low-dose tricyclic antidepressants (TCAs) or a selective serotonin reuptake inhibitor (SSRI) may be useful in cases of severe pain and anxiety.

If you have major bloating issues, you might want to try a trial of Rifaximin (a broad-spectrum antibiotic) or probiotics for 4four to six weeks (if symptoms worsen, stop).

The link between mind and gut therapy is significant for you. Gut-directed hypnotherapy or cognitive behavioural therapy (CBT) can help significantly reduce flare-ups and anxiety about using the toilet. It is important to know that IBS does not lead to cancer or to inflammatory bowel disease (IBD) and that with the right combination of treatments, most people can lead a normal life.

Thank you.