Flip-Flop Flail: Navigating IBS Flares

By Amy Dodd Pilkington

2 min read

I was diagnosed with IBS well over 2 decades ago. In all this time, I have learned a lot. The most important lesson I have learned is I have no idea what to expect. Anything I think I have learned about living with IBS is subject to change at any time.

My reaction to certain foods may change. My reaction to stress may change. With IBS-M, the type of flare I have may be very different from the type of flare I expect. Everything I think I know is actually a guess. I am a phony fortune-teller, guessing and hoping I am right.

Reactions to foods vary over time

In recent years, I have noticed my reaction to certain foods is not always the same. I have an ongoing love affair with Mexican food, and I have always assumed it triggered IBS-D flares. I am rethinking that assumption. An IBS-D flare might be much worse after eating Mexican food, but did eating Mexican food actually trigger the flare or just worsen it?

I thought certain foods were actual triggers, but maybe they are not. Maybe foods are not the actual trigger. Perhaps certain foods agitate rather than initiate a flare. Perhaps flares come and go with no provocation. It seems that might be the case.

Fasting does not prevent flares

I know that raised some eyebrows, but it is the truth. Fasting does not prevent a flare, and here is why I say that: I can still have symptoms of a flare even if I am fasting. I have still had cramps and bloating while fasting. Do you know why I believed fasting prevented flares? I believed this because I was not running back and forth to the bathroom.

Just because my digestive system is empty and has nothing inside to send me running to the bathroom does not mean I am not having a flare. It means I deprived my body of food to keep from running to the bathroom or having an accident. I may lessen the symptoms or I might get lucky and the fasting break lets my digestive system calm down, but I no longer think fasting prevents flares.

What actually causes a flare?

The answer to that question is IBS. IBS causes a flare. What I call a trigger food might actually trigger a flare or it might just be agitating a flare. I really do not know which it is. Eating foods I thought caused an IBS-D flare seems to have as much chance of being followed by an IBS-C flare.

I do know fasting does not prevent a flare because I have had symptoms the entire time I have fasted many times. Fasting definitely does not end a flare for me. It might prevent me from running back and forth to the bathroom and it may reduce the severity of other symptoms. Still, the minute I resume eating the one symptom it totally relieved will reappear. I will be running for the bathroom once more.

Flip-flop flail is my method of coping with IBS

My flip-flopping understanding of IBS makes about as much sense as IBS. It will never really make sense. As much as I try to understand it and attempt to ease my suffering, it never seems to be truly effective. I am simply flailing around and hoping for the best.

How do you handle the ever-changing symptoms of IBS?

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Wordsmithlynn Member
I can relate to this lately. I think age and hormones (or lack of them) also play a part in changing symptoms because now that I’m well past menopause my D seems to be more of a C. Still trying to get used to that!
1. Wordsmithlynn Member
 <inline-mention username="Elizabeth Alvarez" user-id="2297012"/> that’s some of the testing coming up
2. Elizabeth Alvarez Moderator & Contributor
 <inline-mention username="Wordsmithlynn" user-id="4191057"/> I hear you. I hope the new tests can offer some new insight. Keep us posted. Sending big hugs your way, Elizabeth (team member)
barbaraegd Member
Totally agree with the unpredictability! Flares are completely random to me--but bloating and discomfort are more predicatable. I avoid a excess amounts of cheese, and beans. A lot of sugar doesn't help either. As far as Mexican, a normal meal (no beans) and a margarita will definitely leave me uncomfortable for awhile(which doesn't mean I won't do it!). For some reason, I can tolerate fried things and bread. Quantity also matters. 
1. Elizabeth Alvarez Moderator & Contributor
 I hear you. I am the exact same with Mexican food. I will be uncomfortable but I do it anyways because it's my favorite. I can tolerate fried chicken really well. It's all so strange. -Elizabeth (team member)
Kim Dolce Moderator & Contributor
Amy, totally with you, word for word. I too used to benefit from fasting, but your observations about reducing the severity rather than eliminating symptoms rings true. Emptying my bowel completely and fasting reduces the full, bloated feeling, and I welcome the relief. But as soon as I take a sip of coffee the next morning, the cramping, distention and urgency send me running to the john within 20 minutes. Quantity does make a difference, but the difference is only in the degree of discomfort and quantity of "output," you might say. There is no real relief. I eliminated the differential diagnoses long ago. FODMAP revealed nothing useful. I was recently advised to try Xifaxan for IBS-D, an antibiotic known to treat IBS. But it is a tier 5 drug with an insanely high copay. I am at a loss, truly, and feel resigned to merely treat the symptoms. 
1. Elizabeth Alvarez Moderator & Contributor
 <inline-mention username="Kim Dolce" user-id="2331646"/> My heart goes out to you. Just thinking of suggestions to help: are you taking a probiotic? Also, what does your diet look like? Hugs, Elizabeth (team member)
barbaraegd Member
I have been taking Viberzi for a couple of years with significant positive results. I only take one instead of 2 per day (100 mg each) because it exacerbates constipation. I don't mind some constipation because it's interferes so much less than diarrhea. I rarely have those kinds of flares, although the bloating and discomfort does happen regularly. The big drawback with Viberzi is the cost. With commercial insurance you can get copay assistance and only pay $30/month. But with Medicare drug insurance it's unaffordable. Last year I was getting it free from the Abbvie/allergan patient assistance program and am working on doing that again. 
1. Elizabeth Alvarez Moderator & Contributor
 <inline-mention username="barbaraegd" user-id="2328262"/> It's always so disheartening when insurance is the cause for discomfort in patients. I hope you are able to get the Viberzi for free from Abbvie. Sending positivity your way! -Elizabeth (team member)
hateibs Member
Yes, I have come to a similar conclusion. That IBS seems to have a mind of its own. My food choices seem to be a way of managing and balancing it as well as I can, and only that. I could never understand why I can happily eat certain (pretty innocuous) foods perfectly happily when going through one of my apparent "non-IBS" phases. The best time I have clocked up for one of those is 6 weeks. My worst time is 2 days. Those come and go on a whim and a fancy of their own, it seems. I haven't yet got to the point of eating really spicy food. But I found that a bit too hot for me even when I was 100% normal. So the way I get through I think, is by listening to my body's reactions and by a kind of instinct about what foods might not be advisable on a certain day. My IBS can swing a bit too from a basic IBS-D situation, to a bordering on constipation phase. Actually I feel better in myself the closer to slight C I get. It also makes me kind of happier because it means I can eat a few more veggies, or brown rice! I also strangely feel healthier and more energy in myself at those times. Then I monitor what's happening and if I need to balance that out with slightly more "binding" foods in a few days, I do. That can help. But I'm fully aware it's a game I am never really going to win with a jackpot! I just do my best daily, to keep as best a balance as I can. In my case, I suspect serotonin fluctuations between brain and gut as my main triggers, and not really foods at all.
1. Elizabeth Alvarez Moderator & Contributor
 <inline-mention username="hateibs" user-id="4146293"/> Interesting, your last statement. Maybe ask your doctor about taking a serotonin supplement to see if that helps? Best, Elizabeth (team member)
Shane Member
This sounds so familiar! I have had IBS since about 1996, back then it was mainly constipation and bloating with a lot of gas. Now I have both constipation and then diarrhea, the diarrhea often happens straight after a firm or constipated motion. This particular “flare up” started back last March 2021 and went through till November 2021, stopped for a month or so with mild symptoms then came back on the 9th of February 2022! I had a colonoscopy on the 28th of January this year 2022, after that it was bliss with no IBS symptoms. Thankfully it came back all clear except for one polyp and when tested that was non cancerous, so good news! My the way I am male aged 62. All these years I have tried to find the triggers to the flare ups with no real success. During this last year I have thought it was many things from red wine, dairy, spicy food and the list goes on!! I tried to limit or exclude all these things at one time or another and came up with no conclusion. I am limiting dairy at the moment but do not hold any high hopes of a answer. It’s a frustrating path we are all on with no real end in sight, and as we all know, most with IBS suffer with anxiety and depression, either mild or severe which of cause does not help IBS at all! As I lay here writing this at <a href='http://2.46am' target='_blank' rel='noopener noreferrer ugc'>2.46am</a> I have mild bloating which is a whole lot better than it was two nights ago when the gnawing pain kept me awake most of the night, small mercies hey. 😊 I guess I will continue to be mindful of what caused a flare up but like you, I’m beginning to think bottom line, IBS caused it and a certain food may just exasperated it. 🤔
1. Shane Member
 <inline-mention username="Elizabeth Alvarez" user-id="2297012"/> , thanks so much for your concern. Yes, being a wake at that time of the morning it’s often a lonely feeling and a good place for your mind to take you into the realm of unrealistic thoughts about what it could be! 
2. Elizabeth Alvarez Moderator & Contributor
 <inline-mention username="Shane" user-id="4266166"/> So true! The thoughts that come during the early mornings are definitely in the realm of unrealistic. I hope you are doing well today and getting better rest. Hugs, Elizabeth (team member)
hateibs Member
<inline-mention username="Shane" user-id="4266166"/> It's good to know your colonoscopy was clear, and very interesting that you didn't get IBS symptoms just after that. I wonder if the prep. helped in some strange way? I was like you last night. I didn't get to sleep until 3am because I suddenly got the worst trapped wind and my lower tummy felt like a balloon. Hard to understand because I had eaten my own "safe" foods for dinner which don't usually aggravate my IBS. I did a tummy massage and managed to get some of the wind out . It was enough to be able to fall asleep exhausted. I wasn't up for walking or doing yoga in the middle of the night! A hot water bottle would be a good idea for the future I imagine. I don't have one, or a microwave for a heat pad. Yes, flares come and go, and I have had weeks of complete normality in between flares, and times with only very mild symptoms too (such as mild lower abdo. bloating on and off, but nothing else.) The only Serotonin supplement I think it is likely the doctor would give me would be an SSRI antidepressant. To tell the truth, I am very wary of further or possibly worse upset if I had that level of interference with serotonin. That medication might be just right for some though. <inline-mention username="Elizabeth Alvarez" user-id="2297012"/> 
1. Elizabeth Alvarez Moderator & Contributor
 I hear you @hateibs You have to do what is best for you, always. -Elizabeth (team member)
2. Shane Member
 <inline-mention username="hateibs" user-id="4146293"/> thank you, yes I was certainly pleased that the colonoscopy came back all clear! While I understand the goings on of IBS and what is happening witness these flare ups, it can still be a worry and then the mind starts over thing and all of a sudden it tells you “ it has to be colon cancer”! Thankfully for me it was my over active mind. I guess being an artist my mind does go off on its own tangent time. Thank you for sharing some of your experiences with IBS. I do warm a heat pack up in the microwave which does ease the discomfort with the stomach at time. Wishing you the best…..Shane
hateibs Member
If the results of your colonoscopy saw no signs of cancer, then trust that. Big red flags for cancer are pooping blood, and anemia, plus other bloodwork abnormalities. If they aren't there, that shouldn't be a worry. You could always take a stool analysis test yearly to be on the safe side, but that sounds positive for you. Yes, creative minds do create some stuff sometimes! I basically am a creative person. My mother warned me when I was a teenager, that if I didn't have something creative to give out, it turned in on me. And over the years, I have noticed she was right, God bless her Soul. Age 68 going on 69, I do my own version of thought and how to handle it. I will give serious thought to anything which seems important, or possibly dangerous of course, and won't really stop until it's sorted. But I have also noticed what I call "grunge thoughts" which my mind finds itself indulging in. I stand back a bit and take a look. Are they important? Are they intuition? Or are they just habitual tracks the mind has found easy to go down? Then I think "is this thought useful? Is it perhaps telling me something? Or shall I ditch it? Swap it for another one?" (usually after hard evidence to the contrary, or sometimes when my mind slips into low-vibe gear generally, and some thoughts become like "ear worms".) Do I really want this thought, and is it doing me any good, warning, informing, or just grunge which is dragging me down? Just like dreams we have, we imagine we can't change our thoughts, but we can. If I find a low useless waste-of-time thought coming in, I just switch it for something better. Focus on lots of other things that interest me. That works.....sometimes, but it does mean being aware of thoughts, what train of thought triggered them off, and whether they are helpful or not. The more I keep aware, the better it is, and I find I can often change what groove my mind is in. But it takes some doing to change an habitual pathway. Thought creates emotion too. It happens so quickly. @Shane
1. Michaela Contributor
 This is a great mindset to have. Negative thoughts and feelings can be hard to keep in check and it's a constant work in progress. Self-awareness is a great thing to practice. I also find it helps, especially when I've had a hard few days. Thank you for sharing-you are not alone in this! ~Michaela (irritablebowelsyndrome.net Team Member)
maureen1958 Member
Absolutely brilliant, Amy Dodd Pilkington, best description I have seen of IBS in all my 35+ years of it!
1. Michaela Contributor
 I'm so glad you enjoyed this! Thank you for sharing your feedback. How have you been feeling? ~Michaela (irritablebowelsyndrome.net Team Member)

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