It's 1:45 PM the meeting starts at two. You are presenting to the team. You feel that familiar gripping in your stomach. It’s bloated. You start to sweat. You need the loo. Urgently! Oh no, there's someone in there!
“What if you end up being late? What about the smell? What about the sounds? Oh my gosh, they won't respect me if I'm late. They’ll think I’m not very professional. They won't take me seriously if they know I had to run to the loo before the presentation.”
You start to panic. What do you do? Do you go to the toilet, or do you put it off? Try to wait. Now you’re thinking about going to the loo instead of concentrating on what you need to present.
This is a familiar story. I hear similar from my clients all the time. And it resonates so deeply as I used to have Irritable Bowel Syndrome (IBS) too. In this article, I'm going to explore this awful stress illness. What IBS is, how to control IBS and the chronic pain it causes, and whether recovery from IBS is possible.
What is IBS?
The NHS website states, irritable bowel syndrome is a common condition that affects the digestive system. Symptoms include stomach cramps, bloating, diarrhoea, and constipation. These come and go over time and can last for weeks or months at a time. IBS is said to be lifelong and can be very frustrating (and embarrassing) to live with. It has a huge impact on your everyday life. The NHS claim there's no cure, but diet changes and medicine can help control the symptoms. Conventional medicine also says that there is no exact cause of IBS but suggests possible links with things passing through the stomach or gut, too quickly, or too slowly, oversensitive nerves in the gut, stress, and a family history of IBS. So, I'm going to explore each of these in this article. And see if there are alternative explanations and cures for IBS.
IBS Symptoms
There are several common symptoms of IBS. These include:
Stomach cramps – these can occur anytime but seem to get worse after eating. This has led to the assumption that there could be a sensitivity in the gut wall. And that specific foods could contribute to the cause of symptoms.
Bloating – this is often due to excess gas and extends the tummy to feel uncomfortable and look swollen. Again, this could suggest certain foods (especially those known to create flatulence) could cause the symptoms.
Diarrhoea and or constipation – Symptoms can and often do alternate between constipation and diarrhoea. It is therefore natural to consider diet in the causation. Diarrhoea can also feel uncontrollable and in some cases become bowl incontinence (an inability to delay passing a motion).
Fatigue – IBS can also cause a reduction in energy and physical tiredness. It has been proposed that this is caused by a restriction in diet or poor absorption of nutrients from the food that is eaten.
IBS Flare-up
IBS is an intermittent condition, with symptoms stopping and starting over time. Flare-up is the term given to times when symptoms are present. In conditions such as IBS, these flare-ups can seem to happen for no reason. Yet it is often thought to correspond with the intake of various foods or substances. The most common being spicy or fatty foods, caffeine, and alcohol. Other than diet, stress and anxiety are implicated in the onset of a flare. But there is no evidence that diet causes IBS.
Diagnosis of IBS
If you present at a primary care doctor’s surgery with the above symptoms expect a few tests to be run. These can include blood and poo samples being checked for various diseases such as Coeliac Disease, Inflammatory Bowel Diseases (IBD, including Crohn’s Disease and Ulcerative Colitis), and cancer. Sometimes it may be necessary for a colonoscopy to check the inside of your bowel for anything abnormal. (Although this is unpleasant, it is usually painless).
Once diseases have been ruled out, the GP or gastroenterologist will likely diagnose Irritable Bowel Syndrome.
NOTE: IBS does not increase your chances of developing cancer or IBD.
Conventional Treatment for IBS
Medication and IBS
You may be offered medication to relieve the painful bloating and cramps and offered advice on diet. Again, these do not claim to cure IBS, merely control the symptoms.
Diet and IBS
You may be advised to reduce gas producing foods such as onions, greens, and beans, to try a low fibre diet, or to follow a low-FODMAP diet. FODMAP stands for “Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.” FODMAP foods are those hard to digest, such as:
Fructose: Fruits (including apples, mangos, pears, watermelon), honey, high-fructose corn syrup, agave
Lactose: Dairy (milk from cows, goats, or sheep), custard, yogurt, ice cream
Fructans: Rye and Wheat, asparagus, broccoli, cabbage, onions, garlic
Galactans: Legumes, such as beans (including baked beans), lentils, chickpeas, and soybeans
Polyols: Sugar alcohols and fruits that have pits or seeds, such as apples, apricots, avocados, cherries, figs, peaches, pears, or plums
These all would seem like common sense if the cause was diet. But as we have explored, diet is not the cause of IBS.
Having to watch what you eat, remember to take medication, and think carefully about where you go or what you do, to control stress levels and reduce IBS symptoms, causes more worry, anxiety, and stress.
Causes of IBS
As you can see, conventional medicine considers the physical causes of IBS. Medicine also says that there is no cure for IBS. They believe that IBS is often a lifelong illness, experienced in flare-ups and times of remission. However, the latest research from neurobiology and pain psychology indicates other ways to conceptualise certain stress illnesses. So, let’s look at other potential causes, starting with genetics.
IBS and Genes
As Yuri A. Saito, MD, MPH, explains, there is no evidence for a genetic cause of IBS despite relatives of an individual with IBS being two to three times as likely to have IBS, with both genders being affected. So, what is going on?
One explanation is that you have learned unconstructive behaviours and thoughts patterns from the influential adults in your life. You are more susceptible to these influences in the first few years of life. Therefore, it is conceivable that several health behaviours and beliefs were created at this time as a direct result of watching and mimicking your parents or carers. If these adults were fearful of being ill, felt shame around toileting, or had gastro issues themselves, it is possible that you learned unhelpful ways to deal with these things from them. This can potentially explain how many of your fear and thoughts can keep IBS going.
What keeps IBS going
An alternative or additional, reason is suggested by Saito, 2011. He claims the role of childhood events such as nasogastric tube placement, poor nutrition, abuse, and other stressors have been clearly associated with IBS. Sometimes experienced as trauma, these adverse experiences can all contribute to chronic stress.
When experiencing chronic stress, you experience physical, emotional, cognitive, and behavioural consequences.
Physically, the mind automatically informs the body to create more cortisol to enable it to survive. Cortisol increases inflammation in the body, which can lead to pain. It also halts all gastrointestinal functioning, which causes constipation.
If the mind perceives an immediate threat to life, adrenaline is released into the bloodstream. This threat can be real or imagined. These sudden spikes of adrenaline inform the stomach and bowel to immediately evacuate anything contained there. This feels like an urgency to go to the loo, and/or nausea.
Emotionally, we can keep this cycle going by fearing these symptoms and their potential consequences of them. So, thoughts such as “I might not make it in time”, or “I’m going to be sick”, can then contribute to the maintenance of IBS symptoms by inciting further release of adrenaline.
At these times, you are likely to consider avoiding situations that entail being somewhere that would be embarrassing if you were to experience these bodily functions in public. Evading events can reduce fear, stop adrenaline and cortisol release, and allow the symptoms to calm down.
This can cause you to then believe that it is ‘safer’ to not do these things, or go to these places, and you may start to worry more and continue to avoid them.
Being able to make these choices for yourself can feel good and can explain why we continue to look for other ways to take control.
IBS and Control
Most human beings hate uncertainty and will try to avoid unpredictability as much as possible. Control is much more desirable. If you can predict what will happen, you have a much better chance of survival. If you know that something will definitely cause harm, you can choose to actively avoid it. Not knowing causes confusion and the potential for you to get hurt.
IBS feels very uncontrollable, and thus dangerous. This increases fear, which increases symptoms.
Taking control feels more empowering. Therefore, you try to control everything you can. The environment or situations you are in, your thoughts, and your bodily functions.
As above, you avoid places believed to cause more issues, e.g., the presentation at work, or live on Facebook, because you fear needing the loo whilst speaking. You try to NOT think about the pain or the need for the loo in the hope they will go away. You put off going to the loo in case it means you need to go more, or someone may hear you. Controlling all this does not help, but instead causes more stress and symptoms.
Stress and IBS
Rachel Nall, MSN, CRNA explains in this article how stress may trigger IBS. She explains:
“the body’s goal is to maintain homeostasis or a steady state of being. After a stress response, fluctuating hormones are meant to return to normal levels. However, when people experience chronic stress and anxiety, their bodies can’t achieve homeostasis. This is often the case when a person has IBS.
Stress can wreak havoc on your gut. It causes the release of many hormones, including corticotropin-releasing factor (CRF). This hormone is linked to the gut’s healthy bacteria, which maintains bowel function. The extra CRF also activates your body’s immune response. While that may sound like a good thing, immune activity can have adverse effects, as is the case when a person has a strong allergic response to a healthy food.
Chronic stress can cause your intestinal bacteria to be imbalanced, a condition known as dysbiosis. According to an article in the World Journal of Gastroenterology Trusted Source, stress-induced dysbiosis may play a key role in a person developing IBS.”
Stress can also reduce intestinal blood flow, increase intestinal permeability, activate your immune system, and cause inflammation in the immune system.
So, reducing stress is key. Additionally, adapting your thoughts and behaviours, from those that have been learned previously and are unhelpful to those more aligned with modern neuroscience, are essential components to a successful recovery from IBS. It's the way I cured my IBS and how I support my clients to do the same.
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