Understanding IBS Pain

Triggers, Locations, and When to Call Your Healthcare Provider

Abdominal pain is one of the best known symptoms of irritable bowel syndrome (IBS). But IBS pain can be hard to predict. What it feels like and where it's located can vary from person to person.

This article explores the causes and characteristics of IBS pain and cramps. It also explains when you should see a healthcare provider for care.

common IBS symptoms
Verywell / Brianna Gilmartin

Causes of IBS Pain

It's important to know what's behind IBS pain, including how it becomes chronic, or long-lasting.

The pain of IBS is visceral. It comes from your internal organs—your intestines in this case. It is also functional, meaning there is nothing wrong with the structure of the gut to explain the pain. In other words, the pain is real even though your imaging tests may show a normal-looking gut.

In people with IBS, normal amounts of gas or intestinal movement trigger pain-sensing nerve receptors in the intestines more than usual. These extra-sensitive receptors send messages to your brain, telling it there is pain.

Over time, something called central sensitization develops. The brain begins to overreact to pain messages. It perceives mild, non-harmful sensations like digestion as painful. That's where the chronic or long-lasting pain of IBS comes from.

IBS is called a central sensitivity syndrome. Some antidepressants, such as Elavil (amitriptyline) or Pamelor (nortriptyline), may be included in the treatment plan. These antidepressants can help keep the nerve receptors in the gut from becoming too active.

These medications also reduce anxiety, which is common in IBS. It's important to treat anxiety because it can start a cycle that ends up making gut sensitivity worse.

Understanding what to expect can help you put your pain in perspective. Even so, it's important to talk to your doctor about any abdominal pain that doesn't go away.

If your doctor doesn't know what's going on with your pain, your diagnosis might not be accurate. Your treatment plan might not be as effective.

What Does IBS Pain Feel Like?

Most of the time, people with IBS say the pain feels like cramps. People also report that the pain feels like:

  • Sharp and stabbing
  • Constant aching
  • Painful spasms
  • Tenderness when the abdomen is touched
  • Discomfort from bloating

Severity

IBS pain ranges from mild and nagging to severe and crippling. For some people, pain intensity can change throughout the day, making it hard to plan daily activities.

Frequency

People with IBS have pain at least one day per week, on average. Exactly how often can vary. For some, the pain never stops. For others, it comes and goes.

Some people experience pain in spurts. They may have pain-free days, mild-pain days, or days when the pain seems almost constant.

Location

IBS pain can occur anywhere from your chest down to your pelvis, where your main digestive organs are located.

Here is a breakdown of IBS pain based on where it's located:

  • Upper abdomen pain: This often occurs with bloating and may be worse after meals.
  • Middle abdomen pain: Cramps 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.

Identifying where your abdominal pain is located can help tell the difference between IBS and other common digestive disorders.

For instance, if you have pain behind your chest after you eat, and it gets worse when you bend or lie down, it may be heartburn (acid reflux) rather than IBS.

If you have pain after meals below your chest but at the top of your abdomen, is likely to be indigestion.

Bear in mind that people with IBS may have acid reflux and indigestion along with their usual IBS symptoms.

What Triggers IBS Pain?

Stress, irregular eating habits (for example, skipping meals), eating certain foods (for example, spicy or fatty foods), or exercising intensely can trigger IBS pain.

Having a bowel movement can worsen IBS pain in some people.

You may be surprised to learn that IBS pain can get worse with bowel movements. After all, the Rome III criteria, which was used to classify functional gastrointestinal disorders, said IBS pain was "improved with defecation."

However, the updated Rome IV diagnostic criteria note that abdominal pain is simply "related to defecation." That means pain could either get better or get worse with a bowel movement.

Other IBS Symptoms

IBS pain and cramps can be accompanied by other symptoms, including:

  • Constipation
  • Diarrhea
  • Mixed bowel habits (going from constipation to diarrhea)
  • Passing mucus during a bowel movement
  • A feeling that you haven't passed all your stool
  • Bloating of the abdomen
  • Looser or more frequent stools

When to Call Your Healthcare Provider

If you have abdominal pain with a loss of appetite, malnutrition, or weight loss, it is vital that you contact your healthcare provider right away.

Pain that gets worse over time or wakes you up from sleep may not be IBS. If you have pain that is progressing, you need a prompt medical evaluation.

Moreover, if your pain is unusually 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 have rectal bleeding or bloody diarrhea
  • You are having trouble breathing or chest pain
  • You are coughing up or vomiting blood
  • You are having severe pain in your neck or between your shoulder blades
  • You can't stop vomiting

IBS Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Woman

Summary

IBS pain varies from one person to the next. Long-term pain is caused by over-active nerve receptors sending pain messages from your intestines to your brain—even when your body is just carrying out its normal digestive activities. Over time, the brain becomes very sensitive to these pain signals.

Where the pain is, how severe it feels, how often it happens, and what triggers it can be different in different people. Your own symptoms can also change from day to day.

It's important to notice changes because abdominal pain can be caused by other conditions, too. If pain becomes severe, doesn't feel like your usual symptoms, or comes with bleeding, vomiting, or breathing problems, you need to seek immediate medical care.

A Word From Verywell

Learning about your pain can help you manage it better. If pain is negatively affecting your quality of life or interfering with your daily activities, please speak with your healthcare provider.

The good news is that there are a variety of treatments for IBS, including changes to your diet and medications that can ease symptoms. Cognitive-behavioral therapy is another good option. It can help you cope with the pain and other IBS symptoms.

Frequently Asked Questions

  • What does IBS pain feel like?

    IBS pain can feel like cramping in the abdomen. It can also feel like a stabbing or burning sensation. Other times, you may feel bloating or a tightness in your abdomen.

  • Can IBS be very painful?

    IBS can be very painful. And over time, the brain may even start to overreact to pain messages from the body. This makes it seem like mild sensations (like gas) are more painful than they used to be.

  • How can I relieve IBS pain?

    IBS pain and cramping may be relieved by applying heat to the affected area, drinking peppermint tea, practicing relaxation techniques, avoiding trigger foods, and other strategies.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Barbara Bolen, PhD
Barbara Bolen, PhD, is a licensed clinical psychologist and health coach. She has written multiple books focused on living with irritable bowel syndrome.