Travellers Toils
My IBS flares up as soon as I go abroad. I get such dreadful pain and constipation, and during long air trips, the bloating is so bad it feels I might explode. And then when I get there, everything I eat seems to upset me and give me diarrhoea. To tell you the truth, it’s just not worth it
So why does travel seem to upset the sensitive bowel? There are the obvious reasons. It is not always easy to be sure what you are eating. Eating out all the time may create a diet that is too rich and contain too much fat, spices, fermentable carbohydrates or alcohol. You may be unlucky enough to contract gastroenteritis from swimming pools or food that has been left out too long in the sun. The cabins of commercial aircraft are pressurised to half atmosphere which means that the volume of gas in the gut will double. Much of this gas is expelled, which explains why cabins of long haul aircraft develop a rather rich aroma, but in people with IBS, the gas may be trapped and cause distension and bloating
If you have IBS, your gut is also particularly sensitive to change. And travel is a major source of change: your home, your food, the people you engage with, the climate, even the time. It may take days before you may start to acclimatise and then it’s time to come home. Travel is a real shock to the system and much of the impact may be felt by the sensitive bowel.
Human beings are creatures of habit. Life for most of us has its own daily routine. We tend to get up at about the same time, eat at the same time, have our bowels open at the same time, go to work at the same time. Our rituals ground us and give us confidence. We know our world and can predict quite accurately what is likely to happen in it and can adapt to the changes that occur within that framework.
Travel takes us out of this zone of confidence. The rapidity of change is a fundamental shock to the system. Modern air travel speeds us to way of life alien to us within a few stressful hours. It also involves a loss of autonomy. We are transformed Into automata and are processed through immigration, security and boarding in a way reminiscent of the way the Nazis processed the Jews in preparation for the gas chambers.. We relinquish all sense of control end become objects in a mass transport system. We either have to adapt very quickly or we become ill. So in a world which strips away identity, no wonder so many people turn to Facebook to publicise their own individuality.
Faced with such a instant stress, with no individual resources to protect our autonomy/integrity, it is not surprising that people with a sensitive gut become so ill. Change resets the gut by an integrated sequence of physiological actions, orchestrated though alterations in activity in the autonomic nervous system and release of the stress hormone, cortisol. These adjust the way food is processed by the gut, determining how much is digested and delivered to the colon. They also modify the composition of the microbiome, which influences the permeability of the gut, allowing bacterial products to invade the gut wall and activate the immune system. This causes proliferation of inflammatory cells and increased gastrointestinal sensitivity and reactivity.
There are several ways you might protect your sensitive gut from such an assault? You could be very careful what you eat, avoiding anything you think might upset you and maintaining rigororous standards of food surveillance and hygiene. You could take prophylactic probiotics or prebiotics to try to maintain the integrity of the microbiome. You might make it easier on yourself and your gut by travelling more slowly, choosing destinations that are closer and less different. You could preplan as much as possible, anticipating what you might encounter on your journey or at your destination. Or you could just not go.
The Sensitive Gut 