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How Long Can IBS Flare Ups Go On For?


davcio
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Hi there,

Firstly thank you for providing this forum.

For almost 2 years now I have had tenderness and bloating in the abodminal area with often a feeling of need the toilet to make a bowel movement but not much coming out. Sometimes when it did it could dramatically alternated between a hard grenade-like stool and a long soft smooth one. So I was sent for various blood tests and stool tests. No blood was found in the stool but part of the result came back indicating that I had a low to moderate level of calprotectin so I was refered for a colonoscopy in December 2019. Unfortunately it was not very successful as the doctor could only get round one bend before he abruptly ended the procedure saying I was too anxious. He did take 8 biopsies of the lower part, which came back normal, then refered me for a colography which I had in January 2020. After the colography the results came back that there were no abnormalities in the large bowel. I was then refered back to the consultant who said that I had IBS and would have to learn to live with it. 

With this pain and discomfort going on for nearly 2 years off and on I am wondering if this is really IBS and what I can do to get rid of it. I don't smoke (stopped 11 years ago) but I do have a terrible diet and a stressful job. I have been given a couple of medications from the doctor (Mebeverine 135mg, and another one I can't remember the name of) however I've found that neither really work. Are their other better medications? Or could it be irritated by specific foods type or drinks? Should I go back to the doctor for a second opinion? How do you all cope with this? Sometimes I have to sleep with a hot water bottle on my stomach. Does sport or fitness help? Is it normal for flare-ups to go on for months before temporarily dying down then returning?

I feel a bit at the end of my tehter so any help and advice would be greatly appreciated.

Thanks in advance.

D


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Jeffrey Roberts

Dear Davcio,

It seems like you had a good work-up. Do you actually know what your calprotectin level was? Was it greater than 250?

It's too bad that you couldn't get a complete picture with the colonoscopy, just to be reassured that it definitely is IBS that you are dealing with.

So, IBS does wax and wane, but is never really constant. A flare can last 1 hour or 1 day or perhaps 2, but never is constant for a long period of time unless you have significant constipation.

There is a limit to medications in the UK. There really aren't many. Mebeverine is an antispasmodic. Another one available OTC is Buscopan.

You say that you have a terrible diet and I wonder if that's contributing to your long bout. Have you ever looked into the low FODMAP diet? I would consider that before going back to the doctor for a second opinion. You could say that you've done that.

Exercise and water may help constipation, but abdominal pain and bloating aren't necessarily helped with that.

I'm at a loss what to recommend because your symptoms are lasting so long. I safer diet might be helpful.

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Evening Jeffrey,

Thank you for your reply.

So to clarify is IBS similar to a headache, i.e. it will come and go within a few hours? Not something that could last a month then calm down before returning?

To be honest I cannot remember what the actual calprotectin count was but the consultant said it was borderline that it warranted further investigation. I will try to find the actual figure. Could other issues cause the calprotectin level to be elevated? Is it common for IBS sufferers to have calprotectin in their stool?

Yes I rememeber now that the other medication I tried was Buscopan. However for IBS treatments are you best to take them only when your symptoms flare up, or to take them consistently? When I told the doctor that I did not believe that either drugs were working she said that I did not give them time. So are IBS sufferers taking medication consistently, like say anti-depressants?

I feel I should probably clairfy by what I meant with "terrible diet". What I really mean is that I am eating and drinking as normal, not monitoring or recording anything. So in essence I'm eating junk food along side healthier options like salad and fruits etc. I'm just not 100% focused on eating healthy options if you know what I mean. Liquids I do drink coffee and alchohol and well as green and lemon teas and water. 

I'm going to try to record my diet going forward. 

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Jeffrey Roberts

A headache is a good analogy for some people's IBS flares; however, some experience a "headache" everyday and some experience it only once per month or once every few months. It varies widely. Investigating the symptoms is probably a better way to look at this.

Calprotectin simply indicates if inflammation is present in the digestive system. This could be the result of IBD or perhaps a bacteria infection, or even an NSAID medication like aspirin or ibuprofen. IBS patients do not have calprotectin in their stool. That's why they use it to differentiate IBS from IBD.

Buscopan is taken 30 minutes before a meal. I only take it when I am having a bad flare day. So yah, generally taken around flares.

Low dose antidepressants are used for the anti-cholinergic effect which causes the nerves not to 'fire' as often. It is something that you take every day. Different classes of antidepressants have either diarrhea or constipation as a side effect. That's why it's helpful for some people with IBS. Buscopan is actually a short acting anti-cholinergic medication.

I understand what you mean by your diet. I don't eat 100% focused on eating healthy either. Hard to live your life like that.

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4 hours ago, Jeffrey Roberts said:

A headache is a good analogy for some people's IBS flares; however, some experience a "headache" everyday and some experience it only once per month or once every few months. It varies widely. Investigating the symptoms is probably a better way to look at this.

Calprotectin simply indicates if inflammation is present in the digestive system. This could be the result of IBD or perhaps a bacteria infection, or even an NSAID medication like aspirin or ibuprofen. IBS patients do not have calprotectin in their stool. That's why they use it to differentiate IBS from IBD.

Buscopan is taken 30 minutes before a meal. I only take it when I am having a bad flare day. So yah, generally taken around flares.

Low dose antidepressants are used for the anti-cholinergic effect which causes the nerves not to 'fire' as often. It is something that you take every day. Different classes of antidepressants have either diarrhea or constipation as a side effect. That's why it's helpful for some people with IBS. Buscopan is actually a short acting anti-cholinergic medication.

I understand what you mean by your diet. I don't eat 100% focused on eating healthy either. Hard to live your life like that.

Thanks for getting back to me again. You are being more helpful than the doctor if I'm being honest. Once the colography came back as nothing unusual I was given a leaflet about diet and made to believe I'll have to live with this. I don't know anyone else who suffers from IBS so have no one to ask and compare. Though I'm still not 100% convinced that it is IBS that I have.

Do you know what the differences between IBS and IBD are? I am wondering if it's IBD I have then instead of IBS. And do these have different medications? When I spoke to the doctor I was made to believe that I should be taking Mebeverine all the time because I told her that I did not believe that it helped me. Do you get a noticable relief from IBS taking the medications? Like a headache would disappear after painkillers? Does it sound right to you that someone with IBS should take Mebeverine or Buscopan all the time?

Also, if you do not mind me asking, when you have a flare up how do you feel physically and how does it typically start? Is it different for everyone? Today I feel better compared to yesterday but have been for a BM 3 times already with varying degrees of amount and consistency. Since I went that last time it feels to me that it may flare up again. 

Thanks again, I appreciate your time. 

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Jeffrey Roberts

Please keep in mind that my knowledge is limited and I always recommend that you discuss anything that you've learned here with your doctor.

I have both IBS and IBD. I created a page which has a guide which explains the difference between IBS and IBD. Basically, IBD is all about inflammation and physical changes to your digestive system anywhere between your mouth and your anus. Ulcerative Colitis is limited to your colon, whereas Crohn's disease can be anywhere in your digestive system. IBS is generally limited to your colon and no physical changes are seen. It is referred to as a functional disorder.

Some medications for IBS work on patients some of the time. It's a lot of trial and error to find the right combination of medications. Medications like mebeverine and buscopan don't work like painkillers work for headaches. Whereas a painkiller might take your headache away, the IBS medications cause symptoms to be more manageable. Some medications for diarrhea or constipation do relieve those symptoms, but not in everybody and not all of the time. Unfortunately, there is no medication that works perfectly for IBS. I can't see why you would take mebeverine and buscopan all of the time. I might try one or the other and see which one works best, if at all.

When I have a flare, it is usually abdominal pain with diarrhea and it is usually relieved by a bowel movement. It's a feeling that comes every 30 mins - 1 hour and eventually causes me to have 5-8 bowel movements. I feel completely fatigued from it. Everyone is different.

It's hard not to focus on your bowel movements and consistency when you have a digestive condition. Live I've said, IBS does come and go for some people. Others deal with it daily.

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  • 1 year later...

Hello Jeff,

I have been having diarrhea, excessive gas, bloating , abdominal cramps and belching for the last 7 weeks. I wake up at 3 a.m. for work and usually have 1 to 4 bowel movements before I leave for work at 4:20 a.m. I am able to work all day with no symptoms or bowel movements until about 2 p.m. when I get home. Then I start again until 7 p.m. when I go to bed.

I just saw a gastroenterologist and a colonoscopy is scheduled in 10 days.

When I am in these flares that go from 1 to 6 bowel movements my hemorrhoids flare and I see blood in the last movements. I feel hollow and empty. The hemorrhoids are so painful.  I am mildly low in iron and have started taking iron pill. I have also started fiber but it has helped but not as much as I though. The stool has gotten better to Bristol #5 but goes back to #7 by evening.

My question is how long can a flare last?

I have anxiety with all areas of my life. I constantly worry about my health and am now fearing the worst.

Thanks,

Christa

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Jeffrey Roberts

Bunny (Christa),

It's good that you are being seen a GI doctor and having a scope to rule out any potential causes other than IBS.

If IBS is the cause, I wouldn't consider this a flare per se, but rather your normal. If it is IBS, I would want to get out of this cycle. One way is to be prescribed a neuromodulator which can slow down your BM's and help with pain.

The key is to be properly evaluated by a doctor to rule out any other causes. Generally, an IBS "flare" doesn't last 7 weeks. It's usually 1-2 days for most people. That's the waxing and waning symptoms that many doctors describe with IBS.

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