Alcohol & IBS: Triggers, Signs & Treatment

IBS Statistics & Prevalence

The disorder appears to wax and wane in some individuals, and when it is at its peak, it is often associated with significant functional impairment. The estimates of the prevalence of IBS range from 7 percent to 21 percent worldwide.

According to a 2014 study in the journal Clinical Epidemiology, IBS occurs more often in women than in men (at estimated rates of 1.5-3 females per male) and across all age groups.¹ It occurs more often in industrialized countries and twice as often in people with a family history of the disorder.

Symptoms of Irritable Bowel Syndrome

Interestingly, even though IBS is often diagnosed according to specific criteria, there appears to be no formal agreement on the definition of what IBS actually is and what the core symptoms of the disorder are. The symptom profile includes a number of very vague and subjective symptoms that cannot be objectively identified, such as:

• Pain in the abdomen.
• Abdominal bloating.
• Cramps, particularly with bowel movements.
• Urgency.
• Excessive strain when passing a stool.
• Repeated belching.
• Diarrhea or constipation.
• Fatigue.
• Lethargy and tiredness.
• Psychological symptoms that can include depression, a lack of motivation, apathy, etc.

The imaging results of most IBS patients often do not reveal any significant pathology. The symptoms that are experienced by patients with IBS also tend to fluctuate over time, making the situation even more complex.

Alcohol Use Disorders

The term alcoholism no longer has any diagnostic or functional utility. Even though it is often still used, the term refers to a number of varying levels of alcohol abuse. The current diagnostic term for individuals who have a substance use disorder as a result of alcohol use is an alcohol use disorder. This term is applied to the dysfunctional use of alcohol that was formally defined as either alcohol abuse, alcohol dependence, or addiction to alcohol.

An alcohol use disorder is a mental health disorder that occurs when an individual’s use of alcohol results in significant impairment or distress in life, and they meet the diagnostic criteria for a number of specific behavioral symptoms. The older notions of alcohol abuse, alcohol dependence or addiction, and alcoholism actually occur in a continuum as opposed to being separate mutually exclusive categories. The diagnostic category of an alcohol use disorder takes into account this understanding of the presentation of varying levels of alcohol use/abuse.

The lifetime prevalence of alcohol use disorders worldwide is approximately 30 percent. Alcohol abuse costs billions of dollars yearly and takes a toll on society and individuals who suffer from it.

IBS and Alcohol Use Disorders

A handful of studies have investigated the relationship between IBS and alcohol abuse or alcohol use disorders. A 1998 research study published in the American Journal of Drug and Alcohol Abuse compared 31 patients seeking treatment for alcohol abuse with 40 patients seeking treatment for other medical conditions.³ A total of 13 individuals seeking treatment for alcohol abuse met the criteria for IBS, whereas only one of the other 40 patients seeking treatment for other medical conditions met the criteria for IBS. The researchers concluded that individuals who abuse alcohol may have high rates of IBS. However, the study could not make any type of causal determination, such that having IBS leads people to drink more or that individuals who drink alcohol at significantly higher rates were more likely to suffer from the symptoms of IBS.³

Subsequent community and population-based research studies found little or no relationship between alcohol use and the diagnosis of IBS.¹ However, other research studies noted a relationship between alcohol consumption and the symptoms of IBS.⁴ A 2013 study in the American Journal of Gastroenterology looked at drinking patterns and their effects in women diagnosed with IBS and a control group.⁵ The researchers found that the strongest associations between IBS symptoms in IBS patients and alcohol occurred after binge drinking events and on day following these events. The strongest associations occurred with diarrhea, stomach pain, indigestion, and nausea following binge drinking events. Moderate to light drinking produced no exacerbation of IBS symptoms in the IBS group or in the control group. The researchers concluded that the pattern of drinking individuals displayed could play a role in the inconsistent findings in the research on alcohol use and the symptoms of IBS.

Most recently, a large study reported in the journal Medicine that took place in China and looked at over 57,000 participants determined that having an alcohol use disorder increased the risk of also having IBS.⁶ The research does not support the notion that individuals who have IBS are more likely to develop alcohol abuse issues or have an alcohol use disorder, but that having an alcohol use disorder may be a risk factor for developing IBS.⁷ These findings make sense because it is known that moderate to heavy alcohol use can result in numerous gastrointestinal disorders or conditions. Frequent and heavy alcohol use is also associated with discomforting gastrointestinal side effects, such as nausea, vomiting, and diarrhea. Individuals who already have these issues would be more likely to shy away from drinking alcohol to deal with issues related to stress and depression due to the gastrointestinal complications.

Thus, the general conclusion made by the researchers in these studies is that individuals with alcohol use disorders or who drink alcohol heavily are more likely to experience symptoms related to IBS. Individuals who already have IBS typically do not begin drinking alcohol at moderate to heavy levels.

Treatment for IBS and Alcoholism

There is no formal cure for IBS. The treatment often consists of symptom management techniques that may include:⁷

• Limiting alcohol intake or avoiding alcohol.
• Limiting caffeine intake.
• Avoiding junk food, including carbonated beverages.
• Antidepressant medications, such as selective serotonin reuptake inhibitors, to reduce abdominal pain and diarrhea.
• Increasing fiber intake.
• Eating moderate meals at regular intervals.
• Taking laxatives for constipation.
• Eating specific foods and taking probiotics and certain medicines to deal with symptoms.
• Using behavioral methods to identify which foods exacerbate IBS symptoms.
• Engaging in stress management techniques, including psychotherapy.

Treatment for alcohol use disorder would begin with a physician-assisted withdrawal management program to help an individual negotiate any withdrawal symptoms they may experience when they stop drinking alcohol.

Most often, physicians prescribe benzodiazepines on a tapering schedule and then prescribe other medications as needed.

Following the withdrawal management program, individuals are strongly encouraged to become involved in a formal alcohol use disorder treatment program that includes therapy (typically, Cognitive Behavioral Therapy), support group attendance (e.g., particularly groups like Alcoholics Anonymous), other forms of therapy as needed (e.g., family therapy), and other forms of treatment for any co-occurring conditions, such as IBS, depression, anxiety disorders, etc. Individuals find that their success in substance use disorder treatment is related to the length of time they remain involved in treatment. The longer individuals remain active in formal treatment, the better chances they have at being successful in recovery.

Individuals who begin to express the symptoms of IBS and already have issues with alcohol abuse should address both of these issues together.

A reduction of alcohol intake would help to address the symptoms of IBS, and addressing stress-related symptoms that are associated with IBS would help to curb the desire to use alcohol.

Attempting to address IBS without addressing a co-occurring alcohol abuse issue or a formal alcohol use disorder would not be a successful approach and most likely would not significantly address one’s gastrointestinal issues.

Can Alcohol Cause or Worsen IBS?

Research suggests that alcohol can worsen an already-existing diagnosis of IBS or bring about symptoms of IBS after a period of drinking.^3,4,5,6 Whether alcohol can cause IBS to develop in a person who formally did not have an IBS diagnosis is still up for debate, and various studies need to be conducted to determine whether alcohol use can, indeed, cause IBS.^3,4

Tips for Drinking With IBS

Here are some tips to keep in mind if you believe that you may wish to drink and have an IBS diagnosis:

• Take it slow and make sure to watch whether drinking increases the severity or frequency of your IBS symptoms.
• Make sure to hydrate properly when you’re drinking alcohol and follow the CDC’s guidelines for alcohol use in the United States.
• If your doctor tells you to not drink alcohol in relation to your IBS diagnosis (or any other reason), then be sure to follow your physician’s recommendations for your health and wellbeing.
• Consider limiting or completely eliminating your alcohol consumption.

Sources

1. Canavan, C., West, J., & Card, T. (2014). The epidemiology of irritable bowel syndrome. Clinical epidemiology, 6, 71–80.
2. Spiegel, B. M., Farid, M., Esrailian, E., Talley, J., & Chang, L. (2010). Is irritable bowel syndrome a diagnosis of exclusion?: a survey of primary care providers, gastroenterologists, and IBS experts. The American journal of gastroenterology, 105(4), 848–858. https://doi.org/10.1038/ajg.2010.47
3. Chey, W. D., Nojkov, B., Rubenstein, J. H., Dobhan, R. R., Greenson, J. K., & Cash, B. D. (2010). The yield of colonoscopy in patients with non-constipated irritable bowel syndrome: results from a prospective, controlled US trial. The American journal of gastroenterology, 105(4), 859–865. https://doi.org/10.1038/ajg.2010.55
4. Saito, Y. A., Locke, G. R., 3rd, Weaver, A. L., Zinsmeister, A. R., & Talley, N. J. (2005). Diet and functional gastrointestinal disorders: a population-based case-control study. The American journal of gastroenterology, 100(12), 2743–2748. https://doi.org/10.1111/j.1572-0241.2005.00288.x
5. Reding, K. W., Cain, K. C., Jarrett, M. E., Eugenio, M. D., & Heitkemper, M. M. (2013). Relationship between patterns of alcohol consumption and gastrointestinal symptoms among patients with irritable bowel syndrome. The American journal of gastroenterology, 108(2), 270–276.
6. Hsu, T. Y., He, G. Y., Wang, Y. C., Chen, C. Y., Wang, S. H., Chen, W. K., & Kao, C. H. (2015). Alcohol Use Disorder Increases the Risk of Irritable Bowel Disease: A Nationwide Retrospective Cohort Study. Medicine, 94(51), e2334.
7. Lucak, S., Chang, L., Halpert, A., & Harris, L. A. (2017). Current and emergent pharmacologic treatments for irritable bowel syndrome with diarrhea: evidence-based treatment in practice. Therapeutic advances in gastroenterology, 10(2), 253–275. https://doi.org/10.1177/1756283X16663396