Jennifer Smith
reviewed by Dr Michael Yapko
Wednesday, November 25, 2020
Jennifer Smith
Wednesday, November 25, 2020

IBS Pain Guide: Types, Locations, and Treatments

Contents

We all know IBS can be a pain in the gut—but did you know it can be a pain in the back, head, and jaw too? After bloating, pain is the most common IBS symptom, with more than 75% of all people with IBS experiencing frequent or constant abdominal pain. IBS pain is often reported in the lower abdomen, though people may experience pain directly or indirectly related to IBS in multiple places around the body.

Read on to learn about some common IBS pain locations, find out why living with IBS can be so painful, and discover soothing pain remedies you can try at home.

What is IBS pain?

IBS is a painful condition for many people. In fact, pain is the number one reason people see a doctor for IBS.

While IBS pain can be felt in multiple places around the body, it is most commonly experienced in the lower abdomen (an area of the body that stretches from the chest down to the pelvis).

IBS pain can occur after eating and may be relieved or worsen after a bowel movement. It can range from mild discomfort to a stabbing pain that can be so intense it is sometimes mistaken for appendicitis or heart attack pain.

Pain is a key symptom in assessing whether someone has IBS. The current medical guidelines, also known as the Rome IV criteria, required that for an IBS diagnosis, a person needs to experience:

Recurrent abdominal pain, on average, at least one day/week the last three months, associated with two  or more of the following criteria:

  • Related to defecation
  • Associated with a change in frequency of stool.
  • Associated with a change in form (appearance) of stool.

IBS pain that lasts for more than six months is known as chronic (long-term) pain. Chronic pain with IBS may mean that you feel pain or discomfort consistently or that you are experiencing frequently recurring pain often over an extended period of time.

Although abdominal pain is the most common type of IBS pain, research now indicates that people with IBS are more likely to experience other kinds of pain, including headache, back pain, and muscle ache.

What causes IBS pain?

You can think about IBS pain in two ways. First, pain may be caused or worsened by the physical and social factors associated with IBS (such as stress or how gas moves through the bowels). Second, pain may be caused by how IBS affects the pain signaling function of the nervous system between the brain and the gut.

Abdominal IBS pain is typically referred to as a type of visceral pain. Unlike somatic pain, which is felt by the skin, muscles, bone, and soft tissues, visceral pain is felt around the internal organs, including the stomach and intestines.

It is important for people with IBS to understand that while pain is felt in different areas of the body, it is actually processed in the brain.

What causes IBS pain?
IBS pain can be a perfect storm of physical, lifestyle, and sensory factors.


Research into IBS shows that pain may be caused by oversensitive nerves in the gut. These nerves send signals to the brain, telling it to overreact to physical stimuli or tell the brain that normal digestion sensations are 'painful.'

Millions of nerves and neurons run between the gut and the brain, along a neural highway called the gut-brain axis. This means that the brain can feel what's happening in the gut and that the gut can feel what's happening in the brain (which is why we sometimes feel 'butterflies' in our stomach when we're nervous!).

The brain doesn't just receive information about pain; it can also influence the information coming from the gut. When oversensitized nerves in the gut start miscommunicating with the brain, it may then cause the brain to overestimate or modify the information coming from the gut—causing more pain to be registered. This explanation for increased pain is called the gate control theory of pain.

IBS pain locations

While gut pain is common in IBS, pain unrelated to the digestive tract is also common in people with IBS.  

IBS pain locations

IBS abdominal pain

Abdominal pain is a frequently reported symptom of IBS and can be accompanied by nausea, abdominal tenderness, and bloating. The pain felt in the abdomen often stems from gas pain or from the contraction of the muscles in the intestines, which in turn can result in disordered defecation (constipation and/or diarrhea).

Abdominal pain from disordered defecation can also be caused by psychological factors, like stress or anxiety. During moments of stress, the sympathetic nervous system diverts blood flow, from the gut which slows its function.

This "fight or flight'' nervous system response can also be activated when the body feels pain signals (like gas pain or contraction of gut muscles), which can slow digestion, causing constipation and more pain.

IBS abdominal pain usually isn't restricted to one specific area of the gut; it may move from place to place and can vary in intensity. Abdominal pain may occur after eating, during times of stress, or during a woman's monthly period.

IBS gas pain

A buildup of gas in the gut can be extremely painful. Gas pain is most often felt in your abdomen and can feel as mild as light cramping or as intense as a sharp stabbing pain.

IBS abdominal pain may be caused by an increased sensitivity to gas rather than an increased production of gas. Contrary to what your bloating seems to be telling you, people with IBS usually do not produce more intestinal gas than people without IBS.

Gas may enter the gastrointestinal tract when:

  • You swallow air (aerophagia) into your stomach when you eat, drink, chew gum, or smoke.
  • Bacteria in your colon breaks down undigested foods and releases gas as a byproduct.

Normally, gas is evacuated by burping or passed through the rectum (as flatulence aka farting).

For people with IBS, gas can become trapped, leading to bloating and pain. A 2011 study summarized three reasons people with IBS might experience more bloating and gas pain than people without gut troubles, such as having:

  • Difficulties in moving gas through the gut: Some people with IBS have abnormalities in how gas passes through their intestines, which may contribute to symptoms of gas, bloating, and pain.
  • Difficulties in evacuating gas from the gut: People with IBS, functional bloating, and constipation are less able to effectively evacuate gas and are much more likely to develop symptoms of bloating.
  • Higher gut pain sensitivity than people without IBS: People with IBS have been shown to be more sensitive to stretch and distention of the gastrointestinal tract compared to people without IBS. So, more gas is trapped, and more pain is felt.

Hypnotherapy for IBS has been shown to help people decrease the sensitivity of nerves in their gut and reduce gas pain and discomfort without medication or diets. Additionally, hypnotherapy products, like Nerva, allow people to access IBS hypnotherapy programs at home for a more accessible cost than in-person hypnosis sessions.

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IBS back pain

Back pain is not a symptom that many people would associate with IBS, but it commonly is experienced as a result of gas buildup and colonic spasms.

Between 68% and 81% of people with IBS will experience back pain. While the exact cause of this pain is unknown, some experts believe that back pain from IBS may be 'referred pain.'

Referred back pain in IBS means that the pain originates from another part of the body (such as the gut)  and is felt in the back. Other examples of referred pain are when a heart attack causes pain in the jaw or when or menstrual cramps cause back pain.

People with IBS may also experience back pain as they are more likely to have other conditions associated with backaches, such as rheumatoid arthritis, interstitial cystitis (a painful bladder condition), and fibromyalgia (a condition marked by muscle pain and stiffness).

According to the UNC Center for Functional GI & Motility Disorders, up to 60% of people with IBS will also experience fibromyalgia, and up to 70% of people with fibromyalgia will experience symptoms of IBS.

IBS chest pain

IBS pain warning


Sometimes chest pain can be a symptom of a more serious condition, like coronary artery disease, though, for people with IBS, chest pain may be a symptom of trapped gas.

While gas pains are more typically associated with discomfort in the lower abdomen, you may feel gas pains in your chest when gas becomes trapped in your stomach or in the left portion of your colon.

Another reason why people with IBS may be experiencing chest pains is that they are also four times more likely to experience gastroesophageal reflux disease (GERD, also known as chronic acid reflux or heartburn).

Dr. Rao Satish, Director Neurogastroenterology & GI Motility at the University of Iowa, explains why chest pain from pressure on the esophagus can feel frighteningly like heart pain:  

"The nerves that supply the heart also supply the esophagus. Therefore, patients may think they are experiencing pain of a cardiac origin when the pain is, in fact, coming from the esophagus".


Some researchers believe the link between GERD and IBS may be due to poor muscle function of the intestinal tract. In a study published by the World Journal of Gastroenterology, Dr. Nicola de Bortoli suggests that motor abnormalities (impaired muscle movements) along the GI tract, including the esophagus, stomach, and intestines, might explain the overlap between IBS and GERD.

IBS headache and migraine pain

How can an irritable gut make your head irritable too? Head pain and gut pain may seem like an unlikely pair, but science shows that people with IBS also commonly experience migraines and headaches.

A study published in the Polish Journal of Neurology and Neurosurgery showed that between 23 to 53 percent of people with IBS experienced frequent headaches. Additional research, published in the Journal of BMC Gastroenterology, reported that people with IBS were around 60% percent more likely to experience migraines than people without IBS.

The connection between the gut and the head works both ways. Just as people with IBS often have headaches, people with migraines often experience gastrointestinal symptoms associated with IBS (such as nausea, vomiting, abdominal pain, or diarrhea) during a migraine attack.

So, how are IBS and headaches connected?

While the exact reason is unknown, one theory is that it's the result of the relationship between the gastrointestinal system and the central nervous system— also known as the gut-brain axis.

The vagus nerve, the longest cranial nerve in the body, connects the brain to the gut along the gut-brain axis. This nerve sends communications bi-directionally, meaning it can relay pain signals and information from the brain to the gut and vice versa. Because the vagus nerve is involved in both migraine pain and IBS symptoms, it's often thought to be implicated in the overlapping symptoms.

Additionally, recent research into the migraine/IBS link has also identified two neuropeptides (chemical messengers that communicate along the gut-brain axis) that may contribute to both migraine symptoms and gastrointestinal functions.

An upside to the gut-brain connection is that it works both ways. So, while it's unfortunate that what happens in your gut can affect your head, there is evidence that what happens in your mind can also affect what in your gut. This is why treatments like hypnotherapy for IBS may effectively relieve IBS and headache symptoms without the need for drugs or diets.

IBS jaw and face pain

IBS can be such a pain in the...face? The research suggests that people with IBS are at a greater risk of experiencing joint and face pain due to a higher likelihood of experiencing other centralized chronic pain conditions.

One recent study showed that people with any subtype of IBS were three times more likely to experience pain and compromised movement of the jaw joint and the surrounding muscles due to Temporomandibular disorders (TMDs).

According to John Hopkins Medicine, TMDs are disorders of the jaw muscles, temporomandibular joints (the sliding hinges connecting your jaw to your skull), and the nerves associated with chronic facial pain.  

Similar to IBS, current research suggests that hypnosis may also be an effective tool for treating TMD pain.

IBS anal and rectal pain

IBS, particularly IBS-C, can lead to hemorrhoids and anal fissures, which can cause pain and bleeding of the anus and rectum. Because constipation can cause hard, dry, and difficult to pass stools, anal pain caused by hemorrhoids or anal fissures is often worse during defecation.

External hemorrhoids—what your grandmother might have called 'piles'—are swollen veins in your anus and rectum that are similar to varicose veins.

External hemorrhoids can be rather painful, as the overlying skin may become irritated or worn away. Hemorrhoids can be caused by prolonged straining or sitting on the toilet, which is why they're associated with IBS symptoms like constipation and diarrhea.

Patients with hemorrhoids also report symptoms like bloating, abdominal pain, and disturbed social life, which suggests that external hemorrhoids may be associated with irritable bowel syndrome.

An anal fissure is a small tear or an open sore in the lining of the anus. Anal fissures are caused by trauma to the lining of the anus from a dry, hard movement caused by constipation or by loose, frequent bowel movements due to diarrhea.

A 2017 study screening 255 people with irritable bowel syndrome noted that 27.8% of people diagnosed with IBS also had a history of anal complications, such as anal fissures.

While pain and bleeding down below might just be a painful side effect of IBS, you should always let your doctor know about changes in your symptoms. While small amounts of blood and pain may just be a case of small tears around the anus, large amounts of red blood or black, tarry colored stool are possible signs of bowel cancer.

Best pain medications for IBS

If you’re used to popping a pill to relieve IBS pain, then it may be time to rethink your treatment options.

Non-steroidal anti-inflammatory drugs (NSAIDs) (Advil, Motrin, and Aleve), acetaminophen (Tylenol, Paracetamol, Panadol), and aspirin are often used to treat IBS pain because of their pain-relieving and anti-inflammatory qualities.

However, research published in the Journal of Anesthesiology and Pain Medicine suggests that the efficacy of these drugs in treating IBS pain is not well supported and long-term is associated with chronic constipation—not great if you’re already struggling with bowel troubles.

Additionally, NSAIDs appear to have negative effects on IBS patients, with research showing a link between frequent use of NSAID and the development of IBS symptoms.

If you still want to try an over-the-counter pain medication for IBS, then acetaminophen could be a better option, as it’s gentler on the stomach. Pain-relieving NSAIDs, like ibuprofen and naproxen, are known to cause gastrointestinal problems, ranging from mild to severe indigestion to the development of ulcers after long term use.

Common IBS pain treatments

There are a range of things you can try at home to ease pain that don't include NSAID pain medications.

Abdominal pain

Because IBS abdominal pain is caused by physical factors and miscommunicating pain signals in the gut and the brain, there are several helpful things you can do to ease symptoms. 
For abdominal pain, try taking peppermint oil, taking antispasmodics (like Buscopan), applying a heat pack, or trying gut-directed hypnotherapy.

Gas pain

To reduce gas pain, you can try an over-the-counter treatment like Simethicone, which is available as Gas-X, Mylanta Gas, or Phazyme, though there is little objective evidence of its benefit over placebo. Similarly, a small study of five volunteers taking activated charcoal for gas made no difference in levels of gas production nor abdominal symptoms.

If you can manage the pain, exercises like very gentle crunches and some yoga positions are known to help dislodge acute gas trapped in the colon.

The best treatment for gas is often prevention. Expert advice for reducing gas and bloating includes restricting wheat-fiber, limiting fat intake, and avoiding carbonated drinks, and artificial sweeteners.

Back pain

As back pain from IBS is often caused by gas, it’s a good idea to try and avoid foods and drinks that increase gas production. A 2006 study in The American Journal of Gastroenterology found exercise can help trapped gas move through your system and relieve gas and bloating.

While laying down might seem like a good remedy for back pain, research has shown that gas retention can actually worsen when you’re laying down. To reduce backache, try to do some light exercise and minimize periods of reclining rest during the day.

Chest pain

If you’re experiencing chest pain due to a combination of IBS and acid reflux, taking antacids, such as Mylanta, Rolaids, and Tums, may help soothe burning pain. Make sure you talk to your doctor about chest pain, as it may be a sign of another condition.

Headaches/jaw pain/face pain

Unlike abdominal IBS pain, which is usually unlocalized and visceral pain, headache and jaw and face pain are somatic, which means it’s localized to the pain receptors in one specific area.

Two common treatments for somatic pain are non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (Tylenol, Paracetamol) — but remember that if you take an NSAID (like Advil, Motrin, or Aleve), you might end up fixing your headache but make your gut symptoms worse.

Anal/rectal pain

Sitz baths (shallow baths with warm water), several times a day for 10-20 minutes at a time, may help relieve pain and swelling associated with hemorrhoids or anal fissures.

Stool softeners may help relieve the pain of defecating; however, laxatives can lead to additional irritation. For pain, itching, or swelling, over-the-counter topical creams, ointments, or cortisone suppositories may help. Avoid hemorrhoid treatments promising to numb pain (medications ending in “-caine”) as they can cause irritation with long-term use.

When to see a doctor about IBS pain

If you’re experiencing any kind of pain associated with IBS, it may be a good idea to make an appointment with a healthcare professional to discuss treatment options. Your doctor can ensure you’ve received a correct IBS diagnosis, check that you’re using the right treatments, and help you identify any red flags that might indicate a condition other than IBS.

Red flags of potentially serious conditions include:

  • Rectal bleeding
  • Weight loss
  • A family history of colon cancer
  • Fever
  • Late-onset of IBS symptoms (after 50 years of age)

The Wrap Up

IBS can be a painful condition. Although IBS pain is commonly felt in the abdomen, pain directly or indirectly associated with IBS may also be felt in multiple areas of the body, including the back, chest, head, jaw, face, anus, and rectum.

While many people turn to over-the-counter treatments for IBS pain relief, it’s best to avoid NSAIDs, such as Advil, Motrin, and Aleve, which are not proven to help with IBS pain and may cause additional stomach upset or ulcers with long term use.

At-home IBS remedies, such as peppermint oil, antispasmodics (like Buscopan), heat packs, or gut-directed hypnotherapy, may help soothe pain associated with IBS. Remember, if you’re experiencing pain, it’s a good idea to speak to your doctor to discuss treatment options and rule out conditions besides IBS.

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