Understanding Post-Infection IBS

A stomach bug or food poisoning usually clears up within days. But for some people, digestive symptoms such as abdominal pain, bloating, and changes in bowel habits may linger for weeks, months or even years. This condition is known as post-infection irritable bowel syndrome (PI-IBS).

Each year, an estimated 48 million people in the U.S. suffer from foodborne illnesses, according to the Centers for Disease Control and Prevention (CDC). Research suggests that roughly 10 percent of those who experience a gastrointestinal infection may later develop persistent IBS symptoms. With the rise in food recalls and foodborne illness outbreaks linked to cyclospora, salmonella, listeria, E. coli and other pathogens in recent months, healthcare providers are paying close attention to PI-IBS.

Sowmya Sharma, MD, a gastroenterologist with Yale New Haven Health and assistant professor of Digestive Diseases at Yale School of Medicine, addresses common questions about post-infection IBS.

What is post-infection IBS?

Post-infection IBS is a type of irritable bowel syndrome that develops after a gastrointestinal infection, such as food poisoning, viral gastroenteritis or a bacterial intestinal infection. It’s a change in your normal bowel habits.

What are the symptoms of PI-IBS?

PI-IBS causes many of the same symptoms as other forms of IBS. Common symptoms can include:

• Abdominal pain or cramping
• Bloating and excess gas
• Diarrhea
• Constipation
• Alternating between diarrhea and constipation
• Urgent need to have a bowel movement
• Feeling of incomplete bowel emptying

What are the risk factors?

Not everyone who gets a stomach infection develops PI-IBS. Factors that can increase your risk include:

• Severe or prolonged gastrointestinal infection
• Longer-lasting diarrhea during the initial illness
• Being female
• Younger age
• Experiencing anxiety, depression or high levels of stress

How is it diagnosed? When should I seek medical attention?

A diagnosis of post-infection IBS is based on your symptoms, when they began, and your overall medical history. If your symptoms started after you’ve had a gastrointestinal infection, it’s likely PI-IBS. It could be within days, weeks or even months after the infection. If you still have digestive symptoms several weeks after a stomach infection or if they interfere with your daily life, see your healthcare provider.

It’s important to rule out a more serious condition, so a colonoscopy or additional tests may be recommended if there are any warning signs. Tell your doctor if you have:

• Unintentional weight loss
• Blood in the stool
• Fever
• Persistent vomiting
• Severe abdominal pain
• Symptoms that wake you from sleep
• New digestive symptoms that begin later in life (over the age of 45)

How is it treated or managed?

No specific therapies exist for post-infection IBS. Managing post-infection IBS focuses on controlling the symptoms. Treatment is individualized because symptoms and triggers vary from person to person. Changes to diet and activity may help. Depending on your specific symptoms, you may benefit from:

• Trying a low FODMAP diet. This involves temporarily limiting certain carbohydrates that can be difficult to digest, then gradually reintroducing them to identify which foods trigger or worsen symptoms.
• Eating more fiber if you are constipated
• Anti-diarrheal medications when needed
• Certain prescription medications used for IBS
• Regular exercise and healthy sleep habits
• Stress management, counseling or other behavioral therapies

How long does it last? Is it chronic?

PI-IBS can be long-lasting, but it does not affect everyone the same way. Most people improve over time, but the improvement can be very gradual and may require ongoing management to keep symptoms under control.

The bottom line

PI-IBS is a common complication of gastrointestinal infections that can cause ongoing abdominal pain, bloating and changes in bowel habits. Although symptoms may persist, a healthcare provider can help rule out other conditions and develop a treatment plan to help you manage symptoms and improve your quality of life.

Practicing safe food handling, being mindful of any current food recalls, cooking foods thoroughly and maintaining good hand hygiene can help reduce the risk of foodborne illness and potentially lower the risk of developing post-infection IBS.

Learn more about how we treat functional gastrointestinal disorders at Yale New Haven Health.