Typical & Atypical IBS Pain Locations: A Complete In-depth Guide
By Dr. Farahat.
If you are an IBS sufferer like me. And you feel pain in unusual locations for IBS, then this article is for you.
I will guide you to different Typical and non-typical locations of IBS pain. And how to differentiate between IBS pain and other conditions according to each pain area.
Back in 2004, Dr. Tally from Mayo Clinic published an interesting study with striking results. Dr. Tally examined the health records of more than 89,000 patients. The IBS patients (compared to patients without IBS) were found to be:
- 3 times more likely to have a cholecystectomy.
- Twice more likely to have an appendectomy.
- 50% more likely to have back surgery.
This data may indicate that IBS can by Misdiagnosed as another more serious condition like appendicitis or cholecystitis.
Abdominal pain is one of the most confusing medical conditions in diagnosis and treatment.
Until today, there is no single laboratory or radiology investigation that is specific for IBS.
We -doctors- mainly rely on abdominal pain, and its association with mealtimes and stool frequency to diagnose IBS.
But this abdominal pain is not specific for IBS. And almost all diseases occurring inside your abdomen will also have abdominal pain.
So defining IBS pain locations, triggers, and characters are vital for accurate IBS diagnosis.
The usual IBS pain locations and characters:
IBS pain is usually located at the umbilicus and lower abdomen. The most common locations are:
- At the belly button (umbilicus),
- At the upper central part of the abdomen (epigastric or stomach area)
- At lower abdomen (especially the lower left abdomen).
But IBS pain can occur anywhere all over the abdomen. And it can even occur in locations outside your abdomen!
The diagram below is acquired with modification from the “Journal of Gastroenterology and Hepatology” explaining the common typical IBS pain locations.
The numbers below will give you an idea about common IBS pain areas.
(#1 is commonest and #7 is the least common).
1- Around the umbilicus (belly button): the most common in 39% of patients.
2- In the upper central part of the abdomen: 2nd most common, 33%
3- In the lower central abdomen: 13%
4- in the lower left abdomen: about 7%
5, 6, and 7 are less common locations.
These numbers are approximate. And other studies showed slightly different distributions of IBS pain.
Other Features Suggesting That The Pain Is Due To Your IBS:
According to Rome IV criteria, the IBS Pain is:
- Associated with meals: usually, the IBS pain increases after meals. Especially known food triggers like FODMAPs and gas-producing foods.
- Associated with defecation: some IBS patients report relieve of IBS pain with defecation. Others report worsening of IBS pain during or after defecation.
- IBS pain frequency: the IBS pain is chronic, your first time experiencing IBS pain should be 6 months ago or more. The IBS pain occurs at least once per week.
- IBS pain character: IBS is described as cramps or colics. Usually associated with bloating and gas distension.
- Associated with changes in stool character: Yellow stool (with IBS-Diarrhea), Mucus in stool, and Hard stools (with IBS-constipation).
Features suggesting that the pain is NOT IBS pain:
(1) Severe stabbing abdominal pain:
pain from “inflamed organs” inside your abdomen like appendicitis or cholecystitis is very severe. It is associated with severe pain on pressure in the affected area of your abdomen.
Example: Severe stabbing pain under the ribs in the right upper part of the abdomen with severe nausea may indicate “cholecystitis”. An inflammation of your gallbladder; usually caused by gallstones.
(2) Continuous pain:
continuous pain is different from Colicky pain. The continuous pain starts to increase gradually without time breaks.
The continuous pain occurs with pain originating from:
- Inflamed organs inside your gut, chest or pelvis (e.g appendicitis, pelvic abscess, hepatitis).
- Bone, ribs, and vertebrae, and joint pain (like hip joint pain).
- Abdominal wall (muscles or skin).
On the other hand, the IBS pain is “colicky” in nature. This means that IBS pain occurs in waves on cramps (seconds to minutes) then a period of partial relief from pain.
Example: The pain in the upper central part of your abdomen (epigastric area) that gradually increases after meals to a steady intensity for hours may suggest “gastritis”.
(3) A Pain that is related to movement:
The movement-related pain is the pain that:
- Greatly increases with a tiny movement like sitting or leaning forward, and
- Nearly relieved when you obtain a fixed position and stop moving.
The IBS pain is usually the same whether you are moving or in a fixed position. Movement-related pain occurs with other conditions like inflamed organs, bone, and joint pain.
Example: A pain in the lower right part of your abdomen that greatly increases while you move your right lower limb may suggest appendicitis.
(4) A pain that is not related to meals:
IBS pain usually becomes worse after meals. If the pain is of the same intensity regardless of your meals it may suggest conditions other than IBS.
Example: Severe abdominal colic and diarrhea that occurring several times even hours after your last meal may suggest “Gastroenteritis”; an infection of your intestine by a bacteria or other intestinal pathogens.
(5) A pain that awakens you from sleep:
The usual IBS pain doesn’t awaken you after sleep. “Nocturnal Pain” and “Nocturnal Diarrhea” is not a feature of your IBS.
Example: A female with lower left abdominal pain that interferes with sleeping and not related to meals may indicate left ovary or left Fallopian tube problems.
(6) A Pain that is associated with:
- Fever: fever usually suggests an infection or inflammation inside your gut.
- Vomiting: vomiting is not a feature of IBS. But IBS is commonly associated with GERD “Gastro-Esophageal Reflux Diseases” which may be the cause. Other common causes of vomiting are Gastritis, gastric ulcers, early pregnancy, cholecystitis, chemotherapy, and others.
- Blood in stool: If you have blood in stool with IBS you have to immediately consult your doctor. The bloody stool may indicate a variety of conditions ranging from simple piles to dangerous conditions like colon cancer. The topic is thoroughly discussed here.
- Other “RED-FLAG SIGNS” that require consultation of your doctor: in addition to the above;
- The onset of IBS pain after the age of 50.
- Progressive weight loss.
- Presence of iron deficiency anemia.
- If you have a family history of colon cancer or IBS (Ulcerative Colitis or Crohn’s Disease).
Typical IBS Pain Areas.
IBS pain location is typically anywhere in your abdomen. But is can occur in areas outside your gut like the back and the pelvis.
Here I will guide you to both the common and uncommon IBS pain areas.
For each IBS pain location, I will mention other conditions that can be confused with IBS pain.
(1) IBS Pain Around The Umbilicus (Belly Button):
IBS pain is commonest in the lower abdomen, especially around the umbilicus. IBS Pain located around the umbilicus retains the typical IBS characters:
- Colicky in nature: with waves of colon contractions (usually seconds to minutes) followed by waves of partial relief.
- Associated with gas distension and bloating.
- Usually increases after meals.
- Related to defecation: may become relieved or increased during or after you poop.
- Recurrent, but not progressive: this means that you experience IBS at least once per week for at least the previous 3 months. Usually, there are periods of remissions and flare-ups (IBS attacks).
But if the pain becomes progressive (increases day after day, and a week after week) you should consult your doctor.
Other conditions causing pain around the umbilicus (belly button):
- Early appendicitis.
- Umbilical hernia: usually present with a lump in the umbilicus.
- Gastric ulcer: sever epigastric pain mainly associated with vomiting. the pain is continuous.
- IBD (Crohn’s or Ulcerative colitis).
(2) IBS Pain under the ribs (at the middle, epigastric area).
Another common IBS pain location. IBS is commonly associated with GERD and Functional Dyspepsia.
The IBS pain has its specific criteria that we have just mentioned above. But the Pain from GERD and Dyspepsia is usually constant, progressively increases after meals, not related to defecation, and may become associated with vomiting & heartburn.
Other Conditions associated with mid-abdomen under the ribs (other than IBS pain):
- Hiatus hernia: a defect in your diaphragm through which your stomach rolls up into the chest cavity. This causes pain, heartburn, recurrent vomiting, or regurgitation of food.
- Gastric or duodenal ulcer.
- Cholecystitis: It may present with pain in the epigastric area. But more commonly to the right below the ribs. the biliary colic lasts longer. it is more sever, associated with sever nausea and may vomiting. the pain may be referred to the back or the right shoulder.
(3) IBS pain in the lower abdomen (in the middle):
Also, it is a common IBS pain location, but it may be confused with a variety of other conditions:
- Cystitis: an infection of the urinary bladder usually associated with the change color of urine. Painful urination (dysuria), and you will need to pee very frequently but only small amounts of urine. Cystitis is more common in females.
- Prostatitis: This occurs only in males, especially those who are older than the age of 50. May be associated with fever, abnormal urinary secretions and difficult passage of urine.
- Pelvic/Menstrual pain (in females): a common form of pain that is misdiagnosed as IBS. pain from the uterus, fallopian tubes, or ovaries may resemble IBS. the pain is exclusively at the lower abdomen and lower back. It has little relation to meals and defecation.
- Inguinal Hernia.
(4) IBS pain at the lower left abdomen (left iliac pain):
Some studies refer to the left iliac region as the most common IBS pain location. And if your IBS pain occurs at this location it usually relieved by defecation.
Left lower abdomen IBS pain is more common with IBS-Constipation (IBS-C).
But IBS pain at the left lower abdomen can be confused with a variety of other conditions like:
- Chronic constipation: some people have chronic constipation. And it is different from IBS-C; Chronic constipation describes patients with long term constipation without abdominal pain or pain that is not fulfilling the criteria of IBS pain.
- Right ovarian or Right fallopian tube problems (in females).
- Inguinal Hernia.
(5) IBS pain under the ribs at the right side (Right hypochondrial pain):
IBS pain can occur under the ribs to the right, but the right side is the site of the liver and gallbladder. The IBS pain is related to meals, associated with bloating or gas distension, related to defecation and is crampy in nature.
Other common causes of pain under the right ribs (other than IBS pain):
- Biliary colics and cholelithiasis: Gallstones causes sever hypochondrial pain. Also, your gallbladder can get inflamed without the presence of stones (Non-calcular cholecystitis).
Unlike IBS pain, the Biliary pain is:
- More intense, continuous for hours or days,
- Associated with severe nausea or even vomiting.
- Associated with severe tenderness just below the ribs at the right side
- May become referred to the right chest side or the right shoulder.
- In severe cases, you may experience a fever together with severe vomiting.
- Acute Hepatitis: acute inflammation of your liver can cause pain under the ribs at the right side. The most common cause of hepatitis is Hepatitis A virus but it can occur due to a variety of other causes. Unlike IBS pain, the pain from hepatitis is:
- Constant pain (not crampy or colicy).
- Usually associated with Jaundice, Dark urine.
- Fever, vomiting and abdominal pain are also common with Hepatitis A virus.
- Abdominal and chest wall pain in the right side: pain from lower right ribs, right diaphragm or abdominal muscle wall in the right side can cause pain under the ribs at the right side.
The pain is usually constant, increases with movement or respiration.
- Duodenal and Stomach Ulcers.
(6) IBS pain under the ribs, in the left side (left hypochondrial pain):
IBS pain occurring on the left side is more commonly present in the left lower part of your abdomen. Less commonly, IBS pain occurs under the ribs of your left side. This area overlies the stomach, spleen and the pancreas.
IBS pain in this area can be confused with:
- Functional dyspepsia: a sense of fullness and bloating for hours starting after meals. Unlike IBS, It is more like discomfort, not colics. Functional dyspepsia is associated with nausea and maybe vomiting.
- Pain from Gastritis or stomach ulcers:
- Pancreatitis: severe agonizing pain associated with vomiting. The most common causes of pancreatitis are obstruction of its duct by stone or tumor and alcoholism. The pain from pancreatitis usually becomes relieved when you lean forward.
(7) IBS pain in the kidney areas (right and left):
IBS colics can occur all over your abdomen; the kidney areas are not exceptions.
IBS pain in the kidney area can be confused with:
- Kidney stones: renal colic is different from IBS pain.
The renal colic resulting from a Kidney stone is:
- Colicy in nature but usually confined to the kidney area.
- Not related to meals.
- Not related to movement.
- The pain is usually very intense and may be associated with vomiting.
- May become associated with turbid or bloody urine.
- Kidney Inflammation or infection: you can catch an infection inside your urinary tract or inflammation of the kidney tissue (glomerulonephritis). This kidney inflammation can result in pain in your kidney areas. Usually, it is less severe than kidney stone pain. May be associated with fever or turbid urine.
- Inflammatory bowel disease: Crohn’s disease or Ulcerative colitis.
- Chronic constipation.
- Muscular pain ( in the abdominal wall): Usually, it is related to movement.
The Non-Typical IBS pain Locations.
The Rome criteria describe IBS Pain as Abdominal pain. Other studies suggest that IBS may cause Pain in atypical sites.
These “Non-typical” IBS pain may locate in the back, chest or pelvis. The evidence that IBS can cause extra-abdominal pain is still weak.
If you experience pain in your back, chest, or pelvis you have to discuss this with your doctor.
The potential non-typical IBS pain locations are:
(1) IBS pain in the back (Backache).
A study in the UK found that up to two-thirds of IBS patients complain from back pain.
It is common that IBS sufferers complain from back pain. The back pain with IBS can be confused with the typical pain from spines.
The IBS pain in the back is described mainly as lower back pain (at tail bone). It is thought to be a referred pain from the pelvic organ.
The IBS back pain can lead to unnecessary orthopedic clinic visits. Furthermore, it can lead to unnecessary back surgery.
If you have back pain with your IBS you have to consult your doctor about this relation. Especially if the back pain increases during your IBS flare-ups.
(2) IBS headaches and Migraines.
You may complain of headache with your IBS. as headaches are more common in IBS patients than the general population.
Some reports suggest headache is more common with patients with IBS-constipations.
Also, Migraine is related to irritable bowel syndrome. Actually, one of the manifestations of the “aura” of migraine is abdominal pain.
This means that migraine may be the cause of IBS abdominal pain.
(3) IBS Pelvic pain.
IBS is related to a large variety of painful symptoms originating from the pelvis
- IBS is related to painful or difficult urination (Dysuria).
- IBS is related to painful intercourse in females (Dyspareunia).
- IBS may flare-up more frequently during menses in females.
- Some of my patients describe pain in the bum (buttocks), hips groins, pain in testicles and scrotum during the IBS attacks.
If you feel pain at any of the locations above you have to discuss it with your doctor. It is not necessary that IBS is the cause. As it may reflect an actual pelvic problem, not IBS-related pain.
(4) IBS pain in the chest.
IBS is commonly associated with oesophageal diseases like Gastro-Esophageal Reflux Disease (GERD). This may cause Non-cardiac chest pain.
Unlike cardiac chest pain, chest pain due to IBS is not related to exercise.
But you should immediately consult your doctor if you have chest pain and you are:
- Older than 40 years old,
- Have a family history of cardiac disease.
- Your pain is related to exercise.
(5) Fibromyalgia syndrome (IBS pain in joints).
Fibromyalgia is a common disease (1% of the general population). Its actual cause is unknown. Fibromyalgia is a chronic disease.
If you have fibromyalgia you will experience pain in muscles, tendons, and joints. Some people with IBS describe pain in hip bones, pain down the legs, and pain in the tail bone. This may reflect Fibromyalgia syndrome.
Several studies have related IBS to fibromyalgia. Actually, some studies evidenced that IBS is very common among Fibromyalgia patients (50 to 80% of patients with fibromyalgia have IBS).
So If you have IBS and feeling pain in joints or muscle you have to consider fibromyalgia. Discuss this with your doctor.
IBS is a “syndrome” with a wide variety of symptoms and pain areas.
You may experience some symptoms that may seem unrelated to IBS like:
- Joint and muscle pain.
- Dysuria, and painful sexual intercourse.
- Chest and back pain.
- Chronic fatigue.
These symptoms may result from your IBS (but not always).
The typical IBS pain is abdominal, related to meals and associated with a change in bowel habits.
If you experience any of the abnormal pain characters below you have to see your doctor:
- Severe stabbing pain and tenderness in any area of your abdomen.
- A pain that is associated with vomiting or fever.
- Continuous pain that is not related to meals
- A pain that awakens you from sleep.
- Progressively increasing pain with weight loss or anemia.