Shirley had written to me for advice about the dreadful abdominal cramps that were associated with her constipation. The following day she wrote again. ‘Thank you for your response regarding my pain and constipation. It has now turned to diarrhoea. Nothing that I know of has triggered this apart from sitting on a bus for a few hours which is something I am not used to.’
One of the most perplexing things about IBS is how the symptoms can change from constipation and pain to diarrhoea. It’s like whatever lies at the root of it all has to come out in some way. There is always a reason for the change, but it may not be that obvious.
In my book (‘Sick and Tired; healing the illnesses doctors cannot cure’, still available on Amazon), I described the case of a youngish woman with IBS, whose predominant bowel habit changed with her fluctuating mood and lifestyle. When she was excited and out and about in town having a good time, she developed frequent diarrhoea with headaches, flushing and ‘red hands’. I remember her exclaiming in frustration ‘Now how on earth can IBS cause red hands?’ Anyway, it all got too much and so she stopped, stayed home, ate and drank sensibly, watched the television, read her book and went to bed early. After a day or two, her headaches and diarrhoea cleared and she became constipated and lethargic. But she couldn’t live life like a recluse so after a week she was out and about again and the diarrhoea recommenced.
We talked about the effect of drinking too much, eating erratically, not getting enough sleep when she was in her diarrhoea phase, but there was more to it. The story seemed to click into place when she explained how she loved both her mum and dad dearly but they were such different personalities and were now living separate lives. Her dad was very sociable and loved to have a good time with a wide circle of friends. Her mum was the complete opposite. She was very rather strict, and enjoyed a much quieter life, where she could keep things in control. It was like my patient was trying to be her own person and ‘hunted’ between her strong identifications with both her mum and dad, between what she wanted to do and what she ought to do; between desire (chaos) and responsibility (control), and her body and in particular her gut expressed that dichotomy.
Now, of course, everybody is different. We all have our own stories to tell (or not) and so many different factors can influence bowel habit, but for the rapid changes that Shirley described and my patient experienced, the most likely can be broadly covered by food and mood, which, like my patient, often work together. And of course, these will affect all the factors described in my last post, the bugs that make you fat and irritate your bowel: the gut bacteria, the immune system, gut permeability, inflammation (even red hands!) and can be equally as rapidly reversed by changing attitude and life style.
Most of you, who write in to The IBS Network, tend to assume that it is something you have eaten that is responsible for the change. You may be right, but often it is not so simple. My experience suggests it could also be the way you are feeling about the things that are happening or have happened to you. Memories, events, situations, change (of any sort), apprehension, guilt, sorrow – the whole panoply of human life can not only alter the way we feel emotionally, but may also act through the sympathetic and parasympathetic branches of the autonomic nervous system and associated mechanisms to affect the way our bodies and in particular our guts react.
So, I would encourage anybody who suffers from the fluctuating symptoms of IBS to ‘be your own investigator’. Keep a note of what is associated with the fluctuations in your symptoms. You may well see a pattern and if you do, that will empower you to avoid certain situations or find your own ways to deal with particular trigger factors. And write in and tell us.
The change of going somewhere, getting away from the familiar, getting unstuck, may have changed things for Shirley, but what works for you?