Why Is IBS So Painful?
One of the hallmark symptoms of irritable bowel syndrome (IBS) is pain. This is what sets IBS apart from simply chronic constipation or chronic diarrhea. And this is often the most worrisome symptom for those living with IBS. Because the pain can be severe and intense, causing panic about what’s going on.
If you’ve experienced this, you likely agree. And you may have been told “oh, it’s just IBS.”
This is meant to be reassuring, meaning there’s no inflammation, damage, or cancer present causing the pain. But this can further the panic you feel because you know the pain is real, but not knowing exactly why it’s happening can make you feel out of control.
The goal of this article is to explain why pain happens in those with IBS, what can make the pain worse, and what you can do to reduce it.
The gut-brain connection
Before we get to pain, we first must understand the gut-brain connection. This refers to the bidirectional communication between the gut and the brain. Meaning both can influence the function of the other. This involves hormones, nerves, neurotransmitters, and two major nervous systems in the body: the central nervous system and the enteric nervous system. This connection plays a crucial role in regulating various physiological processes, including digestion, immune function, mood, and even cognition.
In those with IBS, this communication pathway is shown to be altered, leading to visceral hypersensitivity. This is where pain comes in.
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Visceral hypersensitivity
Visceral hypersensitivity is a key factor in the development of IBS symptoms, particularly pain. This refers to an increased sensitivity of the nerves in the gastrointestinal (GI) tract to normal sensations during digestion, including stretching, distention, or contraction.
These are very normal sensations that happen in all bodies during digestion, however with IBS they may lead to pain because the body communicates the sensations to the brain and the brain communicates a heightened sense of pain and discomfort.
This means that the pain is very very real. However, the cause of the pain includes normal sensations in the gut, which is why you’ll often be told by your doctor that “it’s just gas,” “you’re just constipated,” “it’s just cramps,” or “it’s just IBS.”
Several factors can contribute to visceral hypersensitivity in IBS, including:
Abnormal Serotonin Levels: Serotonin, a neurotransmitter found in the gut, plays a role in regulating bowel function and sensitivity to pain. Imbalances in serotonin levels have been observed in those with IBS, which can lead to increased sensitivity.
Altered Gut Microbiota: The gut microbiota, the community of microorganisms living in the digestive tract, can influence gut sensitivity and function. Imbalances in the gut microbiota, known as dysbiosis, have been associated with IBS and may contribute to visceral hypersensitivity.
Inflammation: Low-grade inflammation in the gut, although not always present, can contribute to visceral hypersensitivity in some individuals with IBS. Inflammatory mediators can sensitize the nerves in the gut, making them more responsive.
Central Nervous System Dysfunction: Changes in how the central nervous system processes signals from the gut can lead to increased sensitivity and perception of pain.
Psychological Factors: Emotional stress, anxiety, and depression can exacerbate symptoms of IBS and may contribute to visceral hypersensitivity. The gut-brain connection is bidirectional, meaning that psychological factors can impact gut function and sensitivity, and vice versa.
With all of this in mind, increased stress and rumination about symptoms when they are happening can worsen these symptoms. Because what you think about more, tends to grow in your body and in your body. This will increase the sensations of pain and may prolong the symptoms you experience.
Increased sensations, including excess gas production, excess stool buildup with constipation, or increased cramping with diarrhea, can also increase the pain you experience. Because more sensations = more your nerves will react to.
So how do you reduce pain then?
Here are ways you can address this holistically:
Improve gut-brain communication through nervous system regulation and relaxation therapies. Cognitive behavioral therapy (CBT) and gut-directed hypnotherapy may also be helpful here!
Reduce the severity of sensations you experience to reduce the reactions. This means you address both constipation and diarrhea to improve gut movement, reduce gas-causing foods including FODMAPs, spread meals out during the day, and reduce volume of meals if needed.
Support overall function of the gut so it’s working at maximum capacity to help reduce a buildup of gas and stretching of the intestinal wall. This can include eating enough, sleeping, movement, hydration, and increasing fiber intake.
If you’re dealing with pain with IBS, know that it’s not in your head and you’re not alone. While it may seem like it just is what it is and you’re stuck with it, that’s not true. There are many ways to reduce pain and support your gut, so you can feel your best.
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