IBS Pain Triggers, Locations, and When to Call Your Doctor
Abdominal pain is one of the hallmark symptoms of irritable bowel syndrome (IBS). But one of the challenges in understanding the pain of IBS is its unpredictability and uniqueness in how it manifests. This is because the abdominal pain of IBS can vary from person to person in how it feels, how severe it is, and where within the abdomen it’s located, amongst other things.
Illustration by Brianna Gilmartin, Verywell
Biology of IBS Pain
Before delving deeper into the specific features of IBS pain, it’s a good idea to explore a bit of the biology behind your pain, including how it becomes chronic or long-lasting.The pain of IBS is both a visceral pain, meaning it comes from your internal organs (your intestines in this case), and a functional pain, meaning there is no structural abnormality within the gut to explain the pain. Despite the lack of “visual” abnormality in your digestive system (for example, imaging tests are normal), the pain is most definitely very real.
In people with IBS, experts believe that normal amounts of gas or intestinal movement misguidedly activate pain-sensing nerve receptors located on the intestines. These “extra-sensitive” nerve receptors then send messages to your brain, telling it there is pain.
Over time, as these pain signals keep getting relayed to the brain, a phenomenon called central sensitization develops. With this, the brain molds itself into a state of heightened reactivity, perceiving and processing mild, non-harmful sensations (like digestion) as painful. This is where the chronic or long-lasting pain of IBS manifests.Due to the fact that IBS is classified as a central sensitivity syndrome, certain antidepressants, such as Elavil (amitriptyline) or Pamelor (nortriptyline), are sometimes included in the treatment plan. These antidepressants not only work to reduce a person’s psychological distress (anxiety is common in IBS and may perpetuate the vicious cycle of heightened gut sensitivity), but the activation of pain-sensing nerve receptors in the intestines.
While everyone experiences IBS pain differently, getting a general sense of what you might expect can help you put what you’re experiencing in perspective. Be aware, though, that any chronic, severe, or recurring abdominal pain should be brought to the attention of your doctor to ensure a proper diagnosis and treatment plan.
The abdominal pain of IBS is most commonly reported as cramping, although, there are other descriptors people use:
- Sharp and stabbing
- Constant aching
- Painful spasms
- Tenderness when the abdomen is touched
- Discomfort from bloating
The severity of IBS pain is variable, ranging from mild and nagging to severe and crippling. Unfortunately, for certain people, even within the course of a single day, their pain intensity can change, making it difficult to plan daily activities.
Emotional stress, irregular eating habits (for example, skipping meals), eating certain foods (for example, spicy or fatty foods), or engaging in overly strenuous exercise may worsen or trigger the pain of IBS.
Having a bowel movement can also exacerbate IBS pain in some people.
This may surprise you considering that according to the prior Rome III criteria—a system used to classify functional gastrointestinal disorders— the IBS-related pain was said to be “improved with defecation.” However, the updated criteria for IBS (Rome IV diagnostic criteria) note that abdominal pain is simply “related to defecation,” meaning a person may experience either an improvement or a worsening of their pain with a bowel movement.
While people with IBS experience pain at least one day per week, on average, the overall frequency of that pain can vary from person to person. For some, the abdominal pain of IBS is chronic and unrelenting, whereas, for others, it is intermittent. For those with intermittent pain, the pain can come in spurts, meaning a person may experience pain-free days, mild-pain days, or days in which they are highly symptomatic.
IBS pain can occur throughout the abdomen, which is the area of your torso from your chest down to your pelvis, where your main digestive organs are located.Here is a breakdown of IBS pain based on its located in the abdomen:
- Upper abdomen pain: This is often associated with bloating and may worsen after meals.
- Mid-abdominal pain: Cramping can occur around the area of the belly button.
- Lower abdomen pain: This type of pain is more likely to be eased by a bowel movement.
Though it varies from person to person, the overall location of a person’s abdominal pain can help differentiate IBS from other common digestive disorders.
For instance, pain that is experienced behind your chest, that occurs after meals, and is worsened by bending and lying down is more likely to be heartburn (acid reflux) than IBS. Likewise, pain that is experienced after meals below the area of your chest, but at the top of the abdomen, is likely to be indigestion.Bear in mind (and not to complicate the picture), it’s not uncommon for people with IBS to experience these above mentioned digestive problems (heartburn and indigestion) along with their usual IBS symptoms.
Some symptoms commonly experienced along with abdominal pain in IBS include:
- Mixed bowel habits (alternating constipation and diarrhea)
- Passing mucus during a bowel movement
- A feeling of incomplete evacuation of stool
- Visible (to the patient) bloating of the abdomen
- Looser and/or more frequent stools
When to Call Your Doctor
While it is common to experience one or more of the above-associated symptoms in IBS, there are some symptoms that should not occur and, therefore, warrant a visit to your doctor. These include abdominal pain associated with a loss of appetite, malnutrition, or weight loss.
Pain that is progressively getting worse and/or awakens you from sleep is also not suggestive of IBS and warrants a prompt medical evaluation. Moreover, if your pain is especially severe and does not feel like your typical IBS pain, you may need to seek immediate medical attention.Some signs that you need to get to a hospital immediately include:
- Your abdomen is extremely hard or tender to the touch.
- You are experiencing rectal bleeding or bloody diarrhea.
- You are having difficulty breathing or chest pain.
- You are coughing up or vomiting blood.
- You are experiencing severe pain in your neck or between your shoulder blades.
- You are unable to stop vomiting.
A Word From Verywell
While gaining knowledge about your pain can help you manage it better (for example, by avoiding certain triggers), if you are finding that your pain is negatively affecting your quality of life and/or interfering with performing daily activities, please speak with your doctor.
The good news is that there are a variety of treatments for IBS, including dietary changes, as well as medications that can ease bothersome symptoms. Lastly, for many people with IBS, a psychological intervention like cognitive-behavioral therapy can be extremely helpful in coping with the pain and other physically and emotionally distressing symptoms of IBS.