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A woman looks skeptically at a bottle of pills she hold in her right hand as it stares back just a as skeptically at her.

Antibiotics and IBS

The doctor squinted at the computer and then returned her glance to me.

“It looks like you have an infection,” she said. “We should try you on a round of antibiotics.”

She must have seen the skeptical look on my face, because she continued, trying to convince me: “This infection will make your cramps worse and your bleeding heavier with your periods. If you want some relief, combating the infection should help, at least in the short term.”

Antibiotics and IBS

The infection, in this case, was endometritis, which is an infection of the lining of the uterus. I had had a biopsy of my uterine lining the month before, which had revealed the presence of a low-grade but chronic infection. Hence, this was (one reason why) my periods been heavier and more painful in recent months.

She urged me again to take the prescription she was offering, saying that it was important to try the antibiotics.

I finally responded: “I have IBS, and a really sensitive gut.”

“Ah,” she said, finally understanding my reluctance. “It’s true these might bother your tummy a bit.”

But then she added: “But you still should take them.”

At the time, I was only less than a week from traveling to a conference for people with chronic illness and disability. Traveling is another thing that can cause an IBS flare. So, I made the decision I would wait till a couple of days after I returned from my trip to start taking the recommended course of antibiotics. I also made plans to stick close to home (and to a bathroom) and not make any major trips for the next 5-6 days while on the course. I also decided to triple up on my probiotics at the same time–taking them three or sometimes even four times a day as opposed to my standard once-a-day regimen.

Why do antibiotics make IBS worse?

Why? Antibiotics can really wreak havoc with someone’s stomach. Even those who don’t have IBS can get diarrhea and other issues when taking them.

Antibiotics work by killing off the bacteria that can cause infections, like endometritis, ear infections, urinary tract infections, etc. But the bad news is, the antibiotics can’t distinguish between good and bad bacteria. Good bacteria are present in the gut–that is, in the intestinal tract. Good bacteria can really help make a difference in bowel function. I know this well because taking probiotics daily have been one of the single most effective things in helping me get my IBS under control and minimizing flares. This is why taking probiotics can help preempt and counter the negative impacts of antibiotics by adding back in that good bacteria to the GI tract the antibiotics are killing off.

My experience with antibiotics

When I returned from my trip, I began taking my antibiotics. I also stuck to an extremely safe IBS diet the entire time–no fatty foods, spicy foods, alcohol or anything else that might trigger a flare. Lots of low FODMAP and soluble fiber-rich foods.

Even when I finished the round of antibiotics, I continued to triple up on probiotics and eat a safe/relatively bland diet for the next few days after, since antibiotics can still linger in your system for a while. Luckily, I didn’t have any IBS issues the entire time I was on the antibiotics or right afterward either. This probably was at least in part due to all of the precautions I took. It might also be that the kind of antibiotics I took (some bother me more than others). Or perhaps the antibiotics benefited my gut as well, either indirectly (by soothing the infection in and with it, the inflammation, of my uterus, my intestines might have had less pressure on it since my uterus is retroverted and so leans right on my colon) or more directly. Maybe the antibiotics might have also been effective in killing off some bad bacteria lingering in my gut as some people with IBS do sometimes benefit from a course of antibiotics. One study from a few years back even found that one kind of antibiotic (rifaximin) can, in fact, be helpful in alleviating symptoms associated with IBS-D. In particular, the study concludes that: “….the safety and mechanism of action of rifaximin has enabled success in the empiric treatment of D-IBS.” 1

Do antibiotics make your IBS worse? If so, what things do you do that help minimize the negative side effects (if anything)? Or has antibiotics actually helped your IBS? Please answer in the comments below!

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The IrritableBowelSyndrome.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Basseri, R. J., Weitsman, S., Barlow, G. M., & Pimentel, M. (2011). Antibiotics for the treatment of irritable bowel syndrome. Gastroenterology & hepatology, 7(7), 455–493.

Comments

  • ExplodingGuts
    3 months ago

    I managed to get pneumonia shortly after moving a couple yrs ago. I found that the strong antibiotics calmed my IBS so considerably that I returned to MD with this revelation. Like talking to a brick wall. Med school didn’t touch on it so no understanding or interest. Wasn’t until I consulted pulmonologist-respirologist, a very sr guy who teaches at the local med school, that I learned the connection btwn asthma and acid reflux. I now observe that when I manage asthma, stomach is generally better. A gastro-enterologist did all the correct tests for infection – nothing. So there was no known reason to apply more antibiotics. I am now left with tbsp of apple cider vinegar in cup of water and what I call the Water Cure, guzzling at intervals a gallon of water before 8 p.m. Both have helped VERY much. But I remain curious about why my stomach felt so much better when treated for pneumonia. I find the medical establishment is not at all on top of IBS. Neither Olystra nor Dexilante nor Ramiprazole nor Metamucil nor indeed FODMAP have made a blind bit of difference to me. Dull but necessary introspection helps me manage stress response pattern but I still rely on Immodium more than I would like.

  • GreeneyesNY
    3 months ago

    Thanks for the insightful article. I’m hit or miss with antibiotics. I get bad sinus infections especially when the pollen gets high. Sometimes they make my IBS flare and other times it helps it. What probiotic do you take? I have tried a bunch and they all seem to make me worse. I used to be able to take them a couple years back and they helped but not now. I’d luv to find one and start taking them again!

  • Kelly Dabel, RD moderator
    3 months ago

    Thanks for commenting! So glad this article was helpful to you. I’d encourage you to speak with your doctor and/or Dietitian about which probiotic strain may work best for you. It really can be an individual choice based on tolerance and your personal medical condition. In addition to speaking with your doctor, this article may be helpful: https://irritablebowelsyndrome.net/treatment/probiotics/. Best, Kelly, Irritablebowelsyndrome.net Team member

  • ExplodingGuts
    3 months ago

    Speaking to MDs about IBS is rarely helpful. That is my experience.

  • JanetLH
    3 months ago

    I have allergies and asthma, and probably IBS as well. I’ve never been officially diagnosed, but every dr. including a gastro has agreed it’s probable, also since several family members have similar symptoms. Anyway, people with asthma are more prone to get sinusitis and other upper respiratory infections. I’ve been on antibiotics 3 times this spring, due to the extremely high pollen and mold counts in Michigan. I try to baby my stomach as the author did above, but usually while on an antibiotic, I can count on at least one day of having diarrhea, not to mention the other days of my stomach just not feeling good and hurting. I don’t want to get pneumonia, and I don’t want my asthma to get worse; it’s bad enough as it is. I do eat yogurt and take probiotics. I’m doing about everything I can think of to help with this particular issue.

  • ExplodingGuts
    3 months ago

    Bowen therapist had serious IBS while job training. Her homeopath trainer recommended tbsp apple cider vinegar in c of water an hour before eating and it worked. She also did FODMAP and found it effective. Not me. But the apple cider vinegar in water has been just tremendous. Better than all the useless gunk gastro-guy had me on. Am now doing what I call the Water Cure – guzzling a gallon of water at measured intervals before 8 p.m. Lots of exercise as you can imagine but the dilution seems to be quite effective. There is a connection btwn asthma and acid reflux, as my pulmonologist/respirologist advised me. I now pay much closer attention to asthma, which has helped bring acid reflux and IBS under control. It sounds very simple and half-baked but for me, better than all the overpriced sand I was pushing down. You might consider a breathing meter to measure your exhales and apply puffers on that basis. Works for me.

  • tmholland moderator
    3 months ago

    @janetlh,

    Thank you so much for sharing your thoughts and story with us. It sounds like you are working as hard as you can to do whats best for you and your wellness. I hope you are well today. -Todd, IrritableBowelSyndrome.net Team

  • coxapple
    3 months ago

    The poll below is stupid as it depends on the kind of anti-biotic.

  • coxapple
    3 months ago

    The medical advice seems to be clear…don’t take broad spectrum anti-biotic unless your life depends on it, or words to that effect. Amongst many examples, broad spectrum can send you down with a severe C diff infection including effectiive destruction of sections of your bowel . Some peopl die.

  • tmholland moderator
    3 months ago

    @coxapple,

    Thank you for sharing your thoughts. The antibiotic discussion is an important and difficult topic. The opinions tend to vary from one person to another and one doctor to another. It sounds like you’ve spent some time on the topic and your input is appreciated. Hope you are well today. -Todd, IrritableBowelSyndrome.net Team

  • Poll