Post-Infection Irritable Bowel Syndrome

Post-infection irritable bowel syndrome is a condition that can affect your digestive tract after an infection in your gut (intestines). It’s widespread, affecting about 1 in 10 people who have gut infections. And the effects of post-infection irritable bowel syndrome (PI-IBS) can last for years.

PI-IBS has many possible symptoms. And it can look different for you than it does for others. Some might have minor symptoms that they can manage easily. Others might have severe symptoms that disrupt their daily life.

Symptoms of post-infection IBS

Post-infection IBS has the same possible symptoms as other types of IBS. They include:

• Bloating and bloating-related sensitivity
• Gas or farting
• Pain
• Poop-related symptoms, like diarrhea or constipation

Post-infection IBS causes

Post-infection IBS happens after an infection that causes enteritis (inflammation in your intestines). Enteritis can happen on its own. It can also include your stomach (gastroenteritis) or your large intestine (enterocolitis).

The germs that can cause these infections can be:

• Bacterial: Examples of bacteria that can cause this include strains of E. coli, Campylobacter, Salmonella and Shigella. Bacterial infections are the most likely trigger for PI-IBS.
• Parasitic: Waterborne parasites like the kind that cause giardia can lead to PI-IBS.
• Viral: Norovirus and rotavirus can cause infections that lead to PI-IBS. Viral infections are less likely to trigger PI-IBS.

Experts suspect PI-IBS happens because these infections disrupt how your gut microbiome and immune system work together. That causes inflammation in your gut, which leads to PI-IBS symptoms.

Risk factors

Research shows there are several risk factors for having PI-IBS. Those include if you:

• Are female
• Are age 60 or under
• Didn’t vomit with the infection
• Have longer-lasting diarrhea with the infection
• Have mental health conditionslike depression or anxiety

Your mental health and gut health have strong ties. Things that affect one can often affect the other. That’s why mental health concerns are a major risk factor for all types of IBS, including post-infectious IBS.

How doctors diagnose this condition

Healthcare providers can diagnose post-infection IBS with the following:

• Asking you questions about the symptoms, your health history, and any recent travel or illnesses
• Lab tests like a bacteria culture on your poop
• A glucose hydrogen breath test
• A tissue biopsy taken with an upper endoscopy

You might need other tests, depending on your situation. Your healthcare provider can tell you more about your options.

Diagnosing any kind of IBS requires you have abdominal pain that happens at least one day per week for the last three months. At least two of the following also have to be true of your pain:

• It’s related to pooping
• It happens along with a change in how often you poop
• It happens along with a change in what your poop looks like

This needs to last at least three months. And the diagnosis can only happen after it’s been six months since the symptoms started.

How is post-infection IBS treated?

There’s no standard treatment for post-infectious IBS. Most treatments try to ease your symptoms and limit how they affect your life. Some possible treatments include:

• Changing what you eat: The low-FODMAP diet is a common part of treating IBS of all types, including PI-IBS. Not eating wheat, dairy or gluten may also help.
• Probiotics: These are things that help good bacteria in your gut. Encouraging good bacteria to grow can help you in the long run.
• Fecal transplant: This treatment adds healthy bacteria to your gut. Doing that may help your own gut bacteria recover.
• Complementary therapies: These are supportive treatments that can help make others more effective. Examples include relaxation therapy or hypnotherapy.
• Mental health care: Treatments like psychotherapy can help. Mental health concerns like anxiety, depression and stress can make PI-IBS symptoms worse. So, treating those mental health needs can help with PI-IBS symptoms.

Medicines may also help with the symptoms of PI-IBS. These include medicines like:

• Diarrhea medicines like loperamide, cholestyramine, eluxadoline, alosetron or ondansetron
• Spasm-stopping drugs like dicyclomine, hyoscine or peppermint oil
• Constipation medicines like docusate, prucalopride, linaclotide, lubiprostone, plecanatide, tegaserod or tenapanor
• Antidepressant medicines that also help with pain, like amitriptyline or imipramine

When should I see my healthcare provider?

See a healthcare provider if you notice a difference in your pooping habits after you get over a stomach bug. That difference means having abdominal pain and other IBS symptoms at least one day a week for three months or more.

Your provider can’t make an official PI-IBS diagnosis until six months after the symptoms start. But seeing them before then lets them start the process sooner.

What can I expect if I have post-infection IBS?

What you can expect from post-infection IBS varies. If you have a milder case, you may not have symptoms that are as severe or as frequent. If your case is more severe, you might face more intense symptoms that greatly disrupt your life.

It’s common for PI-IBS to last for years. About half of PI-IBS cases go away on their own within six to eight years after the infection that started it.

Can this be prevented?

The only thing you can do to lower the odds of developing PI-IBS is to avoid infections that could cause it. Some things you can do include:

• Wash your hands often. Hand sanitizer is a good option if your hands aren’t visibly dirty.
• Clean and sanitize your spaces. Disinfect surfaces, door knobs and things you touch often.
• Handle and prep food safely. Avoid contaminating nearby areas when you’re cooking. And be sure to cook foods to the recommended temperatures.
• Only drink bottled water when traveling abroad. You should use bottled water for brushing your teeth, too. Avoid eating produce that was only rinsed with tap water, too.