Post-Infectious IBS Recovery Time: 7 Tips for Faster Healing

From weeks to years: the winding road to recovery in post-infectious IBS​
Post-infectious IBS recovery time
Table of Contents

Understanding irritable bowel syndrome and Post-Infectious IBS (PI-IBS)

Different types of Irritable Bowel Syndrome (IBS)

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder affecting the large intestine, causing symptoms like abdominal pain, bloating, gas, diarrhea, and constipation. It’s estimated that 10-15% of the global population suffers from IBS. Though uncomfortable, it usually doesn’t cause any long-term damage to the digestive system.

Based on the predominant bowel habit IBS has three main subtypes : IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), and mixed IBS (IBS-M) which involves both constipation and diarrhea. 

Subtypes based on the trigger

Proton pump inhibitor abuse and IBS

Case Study

In addition to the three primary subtypes of Irritable Bowel Syndrome (IBS) based on bowel habits further categorization can be made based on specific triggers. For instance, post-radiation IBS is a type of IBS that can develop following radiotherapy treatment. The exact mechanisms behind post-radiation IBS are not fully understood; however, it is thought that radiation-induced damage to the bowel mucosa, blood vessels, and enteric nervous system might play a role. This damage can lead to altered bowel function, resulting in the characteristic symptoms of IBS Another IBS subcategory is the one that occurs after chronic use of PPIs. Long-term use of PPIs has been associated with an increased risk of developing IBS. It has been suggested that PPIs might alter the gut microbiome, leading to an imbalance in intestinal flora, which can trigger IBS symptoms. Moreover, PPIs can also decrease gastric acid secretion, impairing nutrient absorption and potentially causing inflammation in the bowel, contributing to the development of IBS. But, the one subtype that is more heterogenous and difficult to treat is Post-Infectious IBS.

What is Post-Infectious IBS?

Post-Infectious IBS (PI-IBS) (or Post-Infective Irritable Bowel Syndrome) is a subtype of IBS that develops after an acute episode of gastroenteritis, caused by viruses (Norovirus, Adenovirus, etc) or bacteria, like Salmonella or Campylobacter. The latter typically result from consuming contaminated food or water. In some cases, a bout of gastroenteritis can alter the GI system in many ways, leading to IBS-like symptoms that persist long after the initial infection has resolved.

Unlike typical IBS, PI-IBS often has a clearer cause and a more defined onset. The symptoms usually improve and resolve over time, with some patients recovering within months, while others may take a few years. However, the recovery process can be influenced by factors like the infectious agent, the severity of the initial illness, and the individual’s pre-infection gut health.

Which is the recovery time from Post-Infectious IBS?

The recovery time of Post-Infectious IBS is under normal circumstances 1-3 months after the resolution of the infection. This time window may become much longer, though, depending on several risk factors, like gender, the use of antibiotics, the pre-infectious microbiome health even the time of the year. This is why this type of IBS is much more complicated in comparison with other subtypes and needs a much more personalized approach.

READ A REAL CASE OF POST-INFECTIOUS IBS. Follow KATIE's story from the first visit to the final treatment and follow-up

Risk factors affecting Post-Infectious IBS recovery time

Original infectious agent

Post-Infectious IBS

Bacterial vs Viral

The type of microorganism plays a significant role in developing and recovering post infectious IBS. Bacterial infections, such as those caused by Salmonella or Campylobacter, tend to have more severe consequences than viral infections. The specific initial microorganism can impact both the severity and duration of PI-IBS symptoms.

Severity of the infection

The prognosis and recovery time for post-infectious IBS (PI-IBS) cases can be significantly influenced by the severity of the initial infection. In individuals who experience more severe illness, the intestinal lining and enteric nervous system may suffer greater damage, which can prolong the manifestation of IBS symptoms. As the severity of the infection increases, the damage to the intestinal lining becomes more extensive. This damage can lead to increased permeability of the gut barrier, allowing for the passage of harmful substances and potentially exacerbating inflammation. Furthermore, the enteric nervous system may become more affected, resulting in heightened sensitivity of pain receptors to various stimuli. This increased sensitivity can contribute to the characteristic symptoms of PI-IBS, such as abdominal pain and discomfort. In addition to the structural and functional impacts on the intestine, more severe infections can also lead to more pronounced alterations in the gut microbiome. The balance of beneficial and harmful bacteria in the gut is crucial for maintaining gut health, and significant disruptions in this balance can prolong the recovery process. The more severe the symptoms, the more time may be needed for the gut microbiome to restore itself and regain equilibrium.

Microbiome status before the infection

The recovery from PI-IBS can be significantly influenced by a healthy gut microbiome. Certain strains of probiotics, like Bifidobacterium and Lactobacillus, have been shown to provide protection against and shorten the duration of infection, subsequently reducing the risk of developing PI-IBS. A diverse and balanced microbiome prior to a bout of infection may play a role in determining how quickly an individual recovers from PI-IBS and the likelihood of experiencing persistent symptoms.

One specific strain of Lactobacillus, Lactobacillus Casei-DG, has been studied for its potential role in attenuating the inflammatory mucosal response in a model of PI-IBS. According to a study, Lactobacillus Casei-DG and its postbiotics (metabolic byproducts of bacteria) can help modulate the immune response and decrease inflammation in the gut lining. The presence of Lactobacillus Casei-DG in the gut microbiome before or during a bout of infection may lower the chances of developing PI-IBS. The mechanisms by which Lactobacillus Casei-DG and its postbiotics work involve the modulation of the gut’s immune response, which can help prevent the cascade of events that cause PI-IBS.

Antibiotics

Antibiotics can affect PI-IBS recovery time in various ways. While they may help treat the initial bacterial infection, they can also disrupt the gut microbiome, potentially exacerbating PI-IBS symptoms. The type and duration of antimicrobial treatment can influence recovery time, as some antibiotics are more disruptive to the gut microbiome than others.

Previous dietary habits

Dietary habits can impact recovery time from PI-IBS. Diets high in junk food and low in fiber may weaken gut mucosal immunity, making it harder for the body to recover from an infection and increasing the risk of developing PI-IBS, especially after food poisoning. Maintaining a healthy, balanced diet can support gut health and promote a quicker recovery.

Time of the year

Seasonal factors play a crucial role in the recovery time of post-infectious irritable bowel syndrome (PI-IBS). The winter months are particularly notorious for harboring a variety of viruses that may cause bowel ilnesses and subsequently exacerbate PI-IBS symptoms. People with IBS are more susceptible to these viral agents, and their presence may prolong the recovery process.

Two specific winter viruses that may cause gastroenteritis in individuals with IBS include norovirus and rotavirus. The norovirus, a member of the Caliciviridae family, invades the small intestine’s epithelial cells, causing inflammation and damage to the gut lining. On the other hand, the rotavirus, a double-stranded RNA virus from the Reoviridae family, is another common cause of gastroenteritis, particularly in children. This virus primarily targets the mature enterocytes of the small intestine, leading to malabsorption, inflammation, and disruption of the gut’s epithelial barrier. Consecutive bouts of gastroenteritis from these two viral entities may lead to symptoms associated with IBS.

Gender differences

Women tend to develop PI-IBS more frequently than men, and hormonal factors are thought to contribute to this disparity. Female sex hormones like estrogen and progesterone are known to modulate susceptibility to stress, gut motility, and visceral pain perception. Meanwhile, male hormones, such as testosterone, have shown an analgesic effect in experimental pain models, potentially lowering the incidence of PI-IBS in men.

Additionally, gut microbiota, pain perception, and mucosal immune function all exhibit gender-related differences that can affect recovery time. For instance, women with IBS have been found to have increased activation in areas related to processing emotional responses, which can affect symptom severity.

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Personalized treatment for PI-IBS

Why generic treatments fail

Generic treatments for PI-IBS often fall short due to the limitations of one-size-fits-all approaches. Spasmolytics, for example, only provide temporary relief from symptoms. Antibiotics target only one kind of bacteria, which might not be the root cause of PI-IBS for every individual. Moreover, generic probiotic formulations cannot cater to the unique microbial imbalances specific to each case of PI-IBS. All treatments must be accompanied by dietary and lifestyle interventions, and since the enteric nervous system is affected by the infection, caution should be exercised in adopting new treatments. Addressing individual factors in recovery is crucial to ensure a more effective and lasting treatment for PI-IBS. 

Tips for shorter PI-IBS recovery time

  1. Hydrate to the max: Staying well-hydrated is essential for promoting healthy bowel movements and preventing mucosal dehydration. Drinking sufficient water can also help regulate electrolyte balance and support the natural peristalsis of the gut.
  2. Do not take random probiotics: Choose supplements based on a thorough understanding of your individual microbiome imbalances. Research suggests that specific strains of probiotics can be more effective for particular IBS subtypes, so identifying the right strains can significantly impact the recovery process.
  3. Avoid histamine-rich foods: As with symptoms of inflammatory bowel disease (Crohn’s and ulcerative colitis), histamine can also exacerbate IBS symptoms. Limiting the consumption of histamine-rich foods can help in reducing IBS-related discomfort. Examples are fermented products, aged cheeses, cured meats, and animal protein that has been cooked for more than 12 hours. A low FODMAP diet is also useful, but it should not be maintained for longer than 3 months.
  4. Eat before 19:00: Eating earlier in the evening allows for better digestion and reduces the risk of nighttime gastrointestinal symptoms. Research has shown that timing meals according to the body’s circadian rhythm can improve gut motility and overall digestive function.
  5. Take quercetin to relax the enteric nervous system: Quercetin is a bioflavonoid with potent anti-inflammatory and antioxidant properties. It has been shown to modulate the production of inflammatory cytokines and inhibit mast cell activation, which can help soothe the enteric nervous system and improve IBS symptoms.
  6. Stretch: Incorporating targeted stretches into your daily routine can help alleviate stress and muscle tension in the abdominal and pelvic regions. Specific stretches like the cat-cow pose, deep squat, and pelvic tilts can help release tension in the muscles surrounding the gastrointestinal tract, thereby relieving IBS-related discomfort.
  7. Drink peppermint herbal teas: Drink it even when you are symptom-free. Peppermint contains the active compound menthol, which has antispasmodic effects on the smooth muscles of the gastrointestinal tract. Drinking peppermint tea can help reduce muscle spasms and alleviate symptoms such as abdominal pain, bloating, and gas.

FAQ

How do you recover from Post-Infectious IBS?

Post-Infectious IBS
Diet guides

Recovering from PI-IBS takes patience and a tailored approach. Eat a diet that is low-residue, low-histamine, and low-FODMAP, hydrate well, and consider taking quercetin supplements. Allow your gut to rest and be very mindful of your symptoms after your IBS diagnosis.

Do probiotics help with Post-Infectious IBS?

Probiotics may help with PI-IBS, but their effectiveness depends on each individual’s unique microbiome composition during and after the illness. A thorough clinical investigation is needed to determine the right approach. This is crucial as introducing certain probiotics could lead to small intestinal bacterial overgrowth (SIBO) or exacerbate symptoms. While some people may find relief in using probiotics to treat IBS, others might experience worsening symptoms. Alternate therapies should be considered to cater to individual needs and microbiome profiles.

What are the symptoms of post-infectious IBS?

Post-infectious IBS symptoms may encompass a wide range of typical IBS manifestations, like bloating, gas, flatulence, and alternate stool consistency. However, due to the involvement of the enteric nervous system and the vagus nerve, heightened pain sensitivity becomes a distinguishing feature of this subtype. Besides mainstream treatments and lifestyle interventions, alternate therapies should be explored to accommodate the unique needs of each person.

Theodoros Prevedoros
BIOCHEMIST MSc
With extensive experience evaluating over 3000 cases in various specialties, including gastroenterology, pediatrics, and endocrinology, Theodoros has collaborated with more than 25 doctors from Greece and Cyprus and over 10 laboratories worldwide.

With a background in Chemistry and Biochemistry from the National and Kapodistrian University of Athens, Theodoros brings a wealth of knowledge in functional medicine and advanced treatments to his role. He possesses exceptional skills in analysis, pattern recognition, diagnostic translation, and storytelling. He is also FMU certified in Functional Medicine and has received training in advanced treatments from the Saisei Mirai Clinic in Japan.
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