Managing Post-Infectious IBS: Treatment Options and Long-Term Relief

Understanding Post-Infectious IBS

Irritable bowel syndrome (IBS) is a common condition that causes continuous transformations to your bowel habits. Generally, it is considered that IBS is typically caused by stress, sensitive nerves in the gut, or a family history. But there is also another type of IBS that can occur after you suffer from an infection.

Post-infectious IBS is a type of IBS that starts after an infection, usually within 2 to 3 years. This condition is usually caused by bacterial, viral, or parasitic infections in the gut, like acute gastroenteritis. According to a study, the severity of your gastroenteritis infection is directly related to the potential of developing PI-IBS. 

Common Triggers

Typically, post-infectious IBS develops due to gastrointestinal infection. However, there are specific triggering factors that can aggravate the condition. Here is the list of triggering factors:

• Smoking
• Stress
• Sleep issues
• GI tract irregularities
• Immune system issues
• Use of certain antibiotics

Symptoms of PI-IBS

There is not much difference between the symptoms of IBS and PI-IBS. However, we can notice one significant difference in their onset: PI-IBS manifests after an infection.

Other symptoms:

• Vomiting
• Bloating
• Loose stools or other changes to stool
• Frequent defecation
• Constipation
• Diarrhea
• Fever
• Abdominal pain

Treatment Options for PI-IBS

IBS can bother you for a long time, whether caused by an infection or some other cause. Although IBS can be managed with medication, good dietary habits, and lifestyle changes, there is no specific cure for any type of IBS. 

Treatment for PI-IBS includes similar strategies for treating IBS. This includes similar dietary changes and using similar medications to control symptoms. You have various options to treat IBS or manage the symptoms and make your life easier. You can choose the one that suits you and can improve your condition.

Dietary Adjustments

Diet plays an important role in the management of PI-IBS. You should be clear about what to eat and what to avoid. Here are some important recommendations regarding diet in IBS.

Low-FODMAP Diet: FODMAP stands for "Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols." 
These fermentable short-chain carbohydrates are predominant in the diet. If you have IBS, FODMAPs may exacerbate your symptoms, such as gas, bloating, abdominal pain, and diarrhoea. The reason behind the low-FODMAP diet in PI-IBS is to limit the only problematic foods.

Limit the intake of these foods: cow's milk, pudding, yoghurt, custard, ice cream, Fruits such as apples, mangoes, pears, peaches, cherries, watermelon, blackberries, apricots, cherries, pears, peaches, plums, honey and agave nectar, vegetables such as asparagus, broccoli, beetroot, garlic and onions, chickpeas, lentils, kidney beans, and soy products.

Increase the intake of these foods: Lactose-free milk, almond milk, coconut milk, hard cheeses such as feta and brie, blueberries, bananas, grapes, kiwi, lemon, lime, oranges and strawberries, bamboo shoots, bean sprouts, carrots, cucumbers, eggplant, ginger, lettuce, olives, potatoes, spring onions and turnips, chicken, fish, eggs, beef, pork, peanuts, pine nuts, walnuts, oat, oat bran, rice bran, rice, corn, quinoa, and white rice.

Anti-Inflammatory Foods: An anti-inflammatory diet emphasizes eating whole, unprocessed foods and reducing the intake of foods that promote inflammation in the body. When you manage IBS through diet, the goal is to reduce inflammation in the body by limiting refined and processed foods. Some anti-inflammatory foods include oily fish such as salmon, mackerel, tuna, and sardines; leafy green vegetables such as spinach, kale, and spinach; fruits, specifically berries, stone fruit, citrus, grapes, apples, and pomegranate; nuts, seeds, turmeric and ginger, tomatoes, olive oil, nuts like almonds and walnuts, and fruits such as strawberries, blueberries, cherries, and oranges. 

Soluble Fiber: Doctors recommend increasing your dietary fibre intake to manage symptoms of PI-IBS. Soluble fibres are water-soluble plant-based foods. Digestive bacteria break them down into short-chain fatty acids. Sources of soluble fibres are fruits, including apples, oranges, avocados, bananas, strawberries, and pears, and vegetables, including broccoli, carrots, barley, oats, legumes, peas, beans, and root vegetables. 

Stay Hydrated: Water intake might improve IBS by affecting GI function. In IBS-C, water intake might improve constipation, whereas it can prevent diarrhoea-induced dehydration in IBS-D patients. However, there is no evidence that water intake can relieve abdominal pain in IBS patients. Drinking sufficient quantities of water in a day can help control IBS symptoms such as bloating, abdominal pain, constipation, and diarrhoea. Water is also essential for digestion and eliminating waste from the body.

Probiotics and Prebiotics

Probiotics and prebiotics are elements that improve gut health. Probiotics are live microorganisms, and prebiotics are non-digestible fibres. 

Probiotics: Probiotics are microorganisms that enhance your gut's natural bacteria, helping balance intestinal flora. Probiotic supplements, especially those with a predominance of Bifidobacterium infantis, help alleviate IBS symptoms like bloating, abdominal pain, and irregular bowel movements.

Prebiotics: Prebiotics are non-digestible food substances that promote the growth of microorganisms in the gut. Foods rich in prebiotics are Oats, Apples, Garlic, Onions, Asparagus, Bananas, Barley, Flaxseeds, Wheat bran, and Avocado.

Medications

There is no widely accepted treatment for PI-IBS, so it is treated based on the severity of the disease and the predominant symptoms. Your doctor may recommend a variety of medications to treat your PI-IBS.

Antispasmodics: These medications help relax the muscles in the digestive tract and relieve spasms that occur with irritable bowel syndrome. Examples of antispasmodic medicines are dicyclomine and Hyoscyamine. 

Anti-Diarrheal Medications: In diarrhoea-predominant (PI-IBS-D) conditions, medicines such as bismuth subsalicylate, loperamide, etc., are used.

Laxatives: Laxatives help you pass the bowel easily and may help in occasional constipation. Examples of laxatives are Bisacodyl and Sennosides.

Antibiotics (For SIBO-Related PI-IBS): Antibiotics make harmful gut bacteria less dangerous and protect the intestinal lining from bacterial infection. Rifaximin is the most common antibiotic used in IBS treatment.

Low-Dose Antidepressants: Antidepressants are helpful in IBS treatment. They can affect GI motility, influencing the time it takes for food to pass through your GI tract. They can also help reduce visceral pain (pain related to internal organs), anxiety, and depression during IBS. Antidepressants useful in IBS treatment are amitriptyline, desipramine, imipramine, nortriptyline, etc.

Stress Management

Anxiety, stress, and depression can activate chemicals in your brain called neurotransmitters, which in turn can activate pain signals in your gut. This is why stress can sometimes cause an upset stomach. You can benefit from these techniques in the management of stress in PI-IBS.

Cognitive Behavioral Therapy (CBT): CBT is an effective remedy for managing IBS symptoms, and its benefits are maintained for at least one year after the therapy. CBT is a short-term, skills-based therapy that helps modify behaviours and alter dysfunctional thinking patterns. This approach can influence your mood and anxiety level.

Relaxation Techniques: Incorporating simple relaxation techniques into your daily life may relieve symptoms and improve your health. Stress is inevitable, but if not managed well, it can harm your physical and emotional health. Thus, the regular practice of relaxation techniques is associated with several health benefits.

Exercise can decrease the severity of IBS symptoms. In contrast, less physical activity will cause severe IBS symptoms. Physical exercise can improve your PI-IBS symptoms by contributing to stress relief, inducing better sleep, clearing gas accumulation or bloating, and promoting bowel movements.

Natural Remedies

Natural remedies for IBS include dietary changes, exercise, good sleep habits, consuming probiotics to balance gut bacteria, yoga, meditation, and more. Lifestyle changes are a significant factor that helps you manage your IBS. The effectiveness of treatment options depends mostly on customization. Because what works for you may not work for others. Here are some of the natural ways to manage PI-IBS:

Physical Activity: Physical activity is the best medicine for managing IBS. Physical exercise helps reduce constipation and diarrhea. Exercise also improves intestinal motility, reduces bloating, and relieves stress.

Healthy and Balanced Diet: Diet plays a major role in gut wellness. Certain foods may complicate IBS symptoms. Consuming a high-fibre diet, probiotic-rich foods, and unrefined and unprocessed foods will help improve gut health and reduce IBS symptoms. Also, avoid trigger foods, such as dairy products, fried foods, alcohol, and caffeine.

Quality Sleep: Improper sleeping habits affect all body functions and can aggravate IBS symptoms. So, make sure that you get quality sleep by sleeping for at least 7 to 8 hours a day and maintaining the same bedtime and wake-up time.

Water Intake: Water deficiency can lead to dehydration and digestive tract issues that trigger IBS symptoms. A healthy target is to drink six to eight 8-ounce glasses of water per day. However, your water requirement may change depending on factors such as your physical activity level, weather, and general health.

Use of Herbs: Ginger and Peppermint are essential herbs in managing PI-IBS. Ginger has an anti-inflammatory action and relieves boating. It also reduces gut hypersensitivity. Drinking fresh ginger tea or using ginger in your diet will help.

Peppermint helps reduce cramps and regulates bowel movements. It is beneficial in PI-IBS as a tea or capsule.

Mindful Eating and Stress Management: Mindful eating habits and stress management techniques can help improve your IBS symptoms. Eating slowly, swallowing food after proper chewing, and avoiding large meals can help your digestion go smoothly. Also, managing stress through deep breathing, meditation, and yoga can help keep your symptoms under control.

Yoga and Meditation: Stress and gut health are always connected. An increased stress level worsens PI-IBS symptoms. So, practising yoga and meditation helps manage stress, which optimizes gut health.

Long-Term Relief Strategies

PI-IBS usually requires a long-term management approach. However, you may not prefer the long-term use of medicines. You can follow certain strategies to help you keep PI-IBS symptoms at bay.

Maintain Gut Health: You can maintain your gut health through lifestyle and diet changes. Lowering your stress level, getting quality sleep, following eating etiquette, maintaining hydration, consuming prebiotic or probiotic foods, and avoiding triggering foods will help improve your gut health naturally.

Monitor Trigger Foods: Avoiding specific triggers like processed food, dairy, fried food, and gluten may help you with IBS symptoms. You can eliminate common triggering foods to improve your gut health in IBS. Suppose you can identify and avoid foods that aggravate your symptoms. In that case, you will observe a significant improvement in your digestive health.

Regular Medical Check-Ups: Regular medical check-ups are vital in managing any disease. Visiting your doctor at the right time, before symptoms negatively impact your daily life, can prevent the disease from worsening. Similarly, visiting your doctor periodically will allow you to record and monitor your symptoms regularly. This can ensure a good quality of life even when you are suffering from IBS.

Focus on Mental Well-Being: The gut is often called the second brain. Gut health and mental well-being can affect each other. Managing your PI-IBS symptoms always includes maintaining your mental well-being. Nourishing your mind and gut can help you manage your symptoms and maintain long-term well-being.

Gradual Reintroduction of Foods: If you eliminate a food item and your symptoms do not improve, you can reintroduce that food item.

At the same time, if your symptoms improve significantly by eliminating that food item, you can gradually reintroduce the foods you eliminated one by one. However, it is important to monitor for any recurrence of symptoms or worsening of the condition as you reintroduce the food item.

When to See a Doctor

If you have recently suffered from gastroenteritis and are experiencing symptoms related to IBS, it is important to consult your doctor for proper advice and diagnosis.

Your doctor will ask you a variety of questions to gain a better understanding of your symptoms. This will help determine whether your diagnostic criteria suggest PI-IBS.

You should also see a doctor if your symptoms negatively affect your daily and professional life.

Wrapping Up

Understanding the connection between infections and long-term digestive issues enables you to seek timely medical advice and improve your gut health and quality of life. If you are experiencing persistent GI symptoms after an acute infection like acute gastroenteritis, consult a doctor immediately because you might be suffering from PI-IBS. 

As important as getting a diagnosis is getting your symptoms under control, that is, treating the disease. Treating IBS does not rely solely on medication. Instead, it requires a holistic approach. Wouldn't it be great if you could get advice on medication, diet, lifestyle, yoga, breathing exercises, meditation, etc., all under one roof? Remember! Specialized comprehensive care for your gut health is available at Nirva, and you can approach our health experts as a first step toward better digestive health.