Stomach Pain, Cramps, and Irritable Bowel Syndrome

Stomach pain is the most common symptom of irritable bowel syndrome (IBS). Stomach pain is so common among people with IBS, it is part of the Rome 4 criteria used to diagnose someone with the disorder.^1,2

The Rome 4 criteria define IBS as: “recurrent abdominal pain on average at least 1 day/week in the last 3 months, associated with two or more of the following:".²

• Related to pooping (defecation)
• Change in the frequency of poop (stool)
• Change in the appearance of poop

How stomach pain affects the body

For those with IBS, the pain felt in the stomach – or abdomen – is commonly described as an unpleasant, uncomfortable, or painful cramping sensation. It is most often felt in the lower belly, but it can be felt anywhere in the abdomen. It varies from person to person.¹

People with IBS describe their stomach pain as:¹

• Cramping
• Stabbing
• Aching
• Sharp
• Throbbing

Stomach pain can happen repeatedly or in cycles, and it can be severe. It can also be chronic, lasting 6 months or longer. It may get worse soon after eating or after eating a particularly triggering food. Lower abdominal cramping may also be felt before an episode of diarrhea.¹

These sensations may or may not get better after having a bowel movement. A person's stomach pain also can change over time.¹

How many people with IBS are affected by stomach pain?

The majority of people with IBS deal with stomach pain. Three out of 4 people with IBS report having frequent or constant stomach pain.¹

Stomach pain affects people with all types of IBS, including:²

• IBS with constipation (IBS-C)
• IBS with diarrhea (IBS-D)
• Mixed IBS (IBS-M) – both constipation and diarrhea

Why stomach pain occurs with IBS

Nerve endings in the gut send pain signals to the brain. Brain scans show that people with IBS feel more pain than those without IBS. This is called hypersensitivity.¹

A person with IBS may feel more pain from sensations that a person without IBS does not regard as painful (allodynia). Or they may have more severe pain than others (hyperalgesia).¹

Stomach pain with IBS does not mean that damage is occurring to the gastrointestinal (GI) tract. With IBS, there is no visible damage to the GI tract or intestines, unlike with some other disorders of the gut like ulcers. But just because the pain does not do structural damage, it can still be intense and extremely bothersome.¹

Stomach pain and cramps interfere with daily life

Abdominal pain with IBS interferes with a person’s mental and physical quality of life, including work and daily activities. Having IBS may mean missing school and work, avoiding social situations because of symptoms, and more.³

People with IBS – particularly women – report lower quality of life than people without IBS. In fact, quality of life was found to be lower for those with IBS compared to people with other chronic conditions like diabetes and end-stage kidney disease.³

A 2022 study found that depression and anxiety often contributed to abdominal pain. However, depression and anxiety played a larger role in affecting quality of life than abdominal pain.³

How stomach pain is treated

Stomach pain can be treated in several different ways. A combined treatment approach is usually best. Experts recommend a treatment plan that combines changes to diet, medicines, psychological therapies, and self-management.^1,4

Changes to diet

Certain foods may contribute to your stomach pain. Your doctor may suggest cutting out these foods from your diet. They may include:⁴

• Gas-causing foods
• Gluten
• Foods that are high in FODMAPs (fermentable oligo-, di-, monosaccharides, and polyols)

Medicines and supplements

Certain medicines have been shown to help relieve IBS symptoms, including stomach pain. These include:^1,4

• Fiber supplements – Over-the-counter fiber supplements can help to bulk up stool.
• Laxatives – Over-the-counter laxatives may be helpful for someone with constipation.
• Anticholinergic agents – These gut-targeting drugs have been shown to help with pain, diarrhea, and constipation.
• Central-acting agents – These medicines help to improve gut motility and decrease hypersensitivity in the gut, which can help the brain control pain.
• Antidiarrheals – Several anti-diarrheal medicines are available over the counter and can be very helpful for those with IBS-D.
• Antispasmodics – These drugs help relieve muscle contractions associated with diarrhea.
• Antidepressants – These medicines are used to treat depression. But they can also ease neuron activity in the intestines, which may help ease stomach pain. There are several types, so talk to your doctor about what they recommend.
• Pain medicines – Check with your doctor about which pain medicine is right for your IBS symptoms. Strong painkillers are not recommended for people with IBS and can make the pain even worse.

Prescription drugs approved specifically for IBS are also available. Talk with your doctor about what might be right for you.^1,4

Psychological therapies

Because IBS is related to the connection between the brain and the gut, working with the mind can help ease pain and gain some control over IBS symptoms. This can be done in several ways:¹

• Cognitive behavioral therapy (CBT), or talk therapy
• Relaxation therapy
• Hypnotherapy
• Meditation

Self-management

Incorporating self-care into your everyday routine is an important part of managing the stress and anxiety that can impact IBS symptoms. Here are some habits you can think about doing on a regular basis:^1,4

• Avoid problem foods
• Eat a healthy, balanced diet
• Exercise daily
• Get enough sleep
• Reduce stress
• Reach out to family and friends for support

Talk with your doctor

Some treatments may work for some people but not others. Try to be patient. IBS treatment requires some trial and error.¹

Talk with your doctor if you live with IBS and have stomach pain. They can recommend treatment options and ways to manage symptoms. Remember, all medicines can have side effects, even those you can get over the counter. Talking to your doctor before starting these will help you choose the right treatment for your condition.