What is a flare?
IBS tends to give us good days and bad days. When we talk about an IBS flare, we're usually referring to a period when your symptoms are noticeably worse than usual and start interfering with your day. You might experience:
- bloating or distension
- abdominal pain or cramping
- excessive wind
- diarrhoea or urgency
- constipation or incomplete emptying
- nausea or a generally unsettled gut.
A flare might last a few hours, a day or sometimes several days before your gut feels completely back to normal. It’s good to know that managing IBS is not a game of perfect and the occasional flare doesn’t mean you have ruined anything.
However, if you've been following a low FODMAP diet for some time and you're still having frequent or unexplained flares, your symptoms are getting worse, or you're finding yourself removing more and more foods to try to control them, it may be time to look beyond food and work out what else is contributing to your symptoms. If this sounds like you, message me to find out more about how I help people with IBS.
Step 1: Treat your symptoms
When your gut is flaring, start by assessing you current symptoms. You don’t need to work out exactly why it happened before you can do something to feel more comfortable. Choose the strategies that match your symptoms:
Bloating, cramping, trapped gas, abdominal discomfort:
- heat packs are seriously under rated
- gentle walking, stretching and yoga can help to move trapped gas
- Peppermint oil capsules and simethicone can relax smooth muscle and break up gas making it easier to pass
- Antispasmodic medications such as Buscopan can also help with abdominal cramping
Diarrhoea or urgency:
- Stay hydrated, dehydration can make you more fatigued and nauseous, so drink plenty and use hydration drinks if necessary
- Soluble fibre acts like a sponge in the gut and soaks up excess water, so adding in PHGG or psyllium can be helpful to improve stool form and slow things down
- Medications such as loperamide (Gastro-stop or Imodium) are not a permanent long-term solution but can be useful to tide you over when appropriate.
Constipation or incomplete emptying:
Fibre is great for prevention of constipation, but if you are already backed up it can make you more bloated and uncomfortable. Instead treat the constipation first:
- Fluids & movement
- Kiwifruit has an enzyme the speeds up gut transit and no, you don’t need to eat the skin
- Osmotic laxatives such as Movicol or Osmolax are gentle and may be appropriate for some people.
If histamines are playing a role in your IBS:
- H1 Antagonist e.g. loratadine (claratyne), fexofenadine (telfast) or cetirizine (zyrtec)
- H2 Antagonist e.g. Ranitidine, Famitodine or Nizatadine
- DAO enzymes
You don’t need to throw everything at every flare. Use what you know helps, give your gut time and focus on getting more comfortable.
Note: Medications and supplements aren't suitable for everyone. Speak with your doctor, pharmacist or IBS dietitian about which options are appropriate for you.
Not sure what should be in your IBS toolkit? This is something I can help you with. Together, we can work out which strategies are appropriate for your symptoms, so you have a plan ready for the next time your gut has a bad day. Find out more about working with me for IBS.
Step 2: Keep food simple & comfortable
When your gut feels awful, it's natural to want to stop eating or retreat to a short list of “safe” foods. But you don't need to fast, detox, restart the low FODMAP diet or survive on chicken and rice until your gut behaves itself again. In fact, fasting or undereating can make your gut more reactive. Instead, keep eating regularly and choose familiar foods that you know generally feel comfortable.
If you're particularly bloated, nauseous or full, smaller meals may feel easier for a day or so. Keep up your fluids and temporarily go easy on foods or drinks that you already know tend to aggravate your symptoms.
That might include things like:
- your known personal food sensitivities
- very large, rich, spicy or fatty meals
- lots of caffeine
- fizzy drinks
- alcohol.
This isn't about making your diet perfect. It's simply about making things a little easier on your gut while it settles. As you start feeling better, start to return to your usual foods and variety.
Step 3: Be kind to yourself
When your gut flares, it’s really easy to go into problem-solving mode. "What did I eat?" "Is this getting worse?" "Should I cancel tonight?" "What if I need the toilet while I’m out?" "Do I need to cut that food out again?" Before you know it, you’ve spent the whole day thinking about your gut.
IBS is a disorder of gut-brain interaction, which means your gut and brain are constantly communicating. When you’re worried, stressed or hyper-focused on symptoms, that communication can turn the volume up on sensations that are already uncomfortable. You can read more about IBS and the gut-brain axis here.
This doesn’t mean your symptoms are “all in your head”. The bloating, pain, diarrhoea or constipation are very real. And also, calming your nervous system and changing how you respond to those sensations can help turn down the intensity while your gut settles.
Start with how you talk to yourself.
- Instead of “Here we go again, my gut is completely screwed,”
- Try: “My gut is having a bad day. It’s uncomfortable, but I know what to do and it will pass.”
Then give your gut something else to focus on. Depending on how you’re feeling, that might be:
- going for a gentle walk
- diaphragmatic breathing
- meditation or gut-directed hypnotherapy
- yoga or stretching
- getting outside
- reading a book, listening to music or watching a movie
- painting or drawing
- Anything else you enjoy and makes you feel happy
-
Instead of spending the day monitoring your symptoms or trying to work out exactly what went wrong. Remind yourself:
My gut is having a bad day. I've had these before. It's uncomfortable, but it will pass.
If you find yourself constantly monitoring your gut, worrying about what symptoms mean or changing your plans because of “what ifs”, I have a whole article on how to feel more in control of your IBS here.
Is there anything to learn?
Once your gut starts to settle, it can be worth getting a little curious about what happened. Not because every flare needs an explanation, but because sometimes there’s something useful you can learn for next time.
What else had been happening in the lead-up:
- Had your sleep been off?
- Had your gut been a bit sluggish for a few days?
- Was work particularly stressful?
- Were hormones at play
- Had you been eating out, drinking more or generally out of your usual routine?
- And most importantly, what helped you feel better?
You don't want to turn into a forensic investigation of everything you ate and did over the previous few days. If there’s something obvious or useful to learn, make a note of it and move on. And if there isn’t? Move on anyway. Guts can be fickle, sometimes you’ll never know exactly what caused a flare. And that’s ok.
What matters more is the pattern over time. If your flares are becoming more frequent or severe, or you’re finding yourself removing more and more foods in an attempt to prevent them, this is where personalised support can help you work out what’s contributing to your symptoms, what strategies are actually worth focusing on, and how to manage your IBS with more confidence.
Final thoughts
Of course we want your IBS symptoms to improve. But even a well-managed gut can have an off day. In fact, being completely symptom-free might not be the best measure of successful IBS management anyway.
Sometimes a better measure of progress is knowing that when your gut does have a bad day, you can manage it without restricting more food, cancelling your plans or letting IBS take over. Treat your symptoms, keep eating, support your gut-brain axis and then get back to living your life.
Still having IBS flares despite doing “all the right things”?
You probably don’t need another generic food list. Because if that was the answer, you’d feel better by now.
Instead, you need a plan that helps you understand what may be contributing to your symptoms, which strategies actually matter for your gut, and what to do when symptoms show up.
That’s where I can help. Together, we can build a practical, personalised approach that gives you more confidence with food, more confidence managing your symptoms and more freedom to get on with your life.
Find out how I can help with IBS here
