How to avoid the discomfort of airline flights if you have IBS.
Last week, Adrian wrote: I love going to Africa for wildlife safari and photography, but each time my guts feel very uncomfortable on the journey and on arrival I continue to suffer from stomach pain with diarrhoea, which takes about a week to clear. On the return flight, the same thing happens. My diet in Africa is mainly barbecue style with meat and few vegetables, though I try to take my five fruits a day. I find it difficult to judge when to start eating fruit in order to avoid getting constipation as this might starting the cycle of diarrhoea and pain all over again.
He adds some relevant information: In 1991 when I was on a safari holiday in Kenya, I suffered a twisted bowel (volvulus), which became gangrenous and had to be removed by an emergency operation, followed by a colostomy, which was reversed the following year. The Kenyan surgeons saved my life.
Adrian also explained that he was taking Indapamide and Losartan for blood pressure, citalopram for depression and lanzoprazole for acid reflux.
There are aspects of Adrian’s experience that may have rendered him particularly susceptible to pain and bowel upset during and after the flight. Volvulus usually occurs in a bowel that is prolonged, floppy and retentive of faeces, though the removal of a section of colon would have reduced the ability of the colon to salvage nutrients and salt and water and made it more likely for him to have diarrhoea. The trauma of an emergency operation would leave a memory trace in the nerves that control the bowel, making the latter more sensitive to the context of the holiday. Finally, bowel upset and abdominal pain are side effects of the drugs he takes for blood pressure and citalopram can also cause bowel looseness.
All of these factors may contribute to bowel upset Adrian experiences, but are the conditions of long haul flights particularly difficult for people with IBS? Once, many years ago, I was working on a presentation on flatulence during a flight to Edmonton in Canada, when the flight attendant looked over my shoulder and told me that she and her colleagues all suffered symptoms of flatulence while flying. She explained that airline cabins are pressurised at levels that are below the atmospheric pressure at sea level, causing the gases in the gut to expand by about 30%. Not only would this account for somewhat feral aroma of passenger cabins; something that many airlines attempt to disguise by adding perfume to the circulating air, but it could also trigger symptoms of bloating and pain in people with IBS and might even cause diarrhoea by stimulating secretion and peristalsis.
So if you have IBS, how can you try to avoid the discomfort of flying? One practical solution is to avoid gassy foods and drinks during the flight and for a day or so before you go. Restrict FODMAPs even more than you usually do. Avoid onions, beans, sprouts, apples, stone fruits and if lactose or wheat are problematic, go without dairy and wheat too until you arrive at your destination. If you are on a short flight, politely refuse the airline meal and just nibble some nuts and drink plenty of still water. If you on a long haul flight, choose meals where you can see the constituents and avoid sauces containing onions and any gassy fruits and vegetables. Then when you arrive, you can relax these restrictions and return to your usual regimen, depending, of course, on where you are and your knowledge of the local cuisine. For more information, I recommend the recent blog published last week by the team from Monash University, Travelling on a Low FODMAP Diet: .
It is also worth taking a mild tranquilliser a few hours before you fly and adopting occupations that distract and relax you during the flight, like choosing a film you have always wanted to see, listening to music, reading a book or just closing your eyes and meditating. Travel is always stressful. We are out of our comfort zone and need to adopt methods of accommodating the changes. But, above all, try to focus on the anticipation and enjoyment of the holiday ahead and not the difficulties of getting there.
And if you are taking medications, it might be important to discuss with your doctor the benefits and risks of taking them while you are flying.
Addendum: Marking time
Remember that it takes a few days for your bowels to adjust to a new time zone. If you have landed in New York, your bowels still empty at Greenwich Mean Time and it can take several days for them to reset to Eastern Standard Time. Ignoring your usual time for evacuation because of an inconvenient schedule or because you are not in the security of your own toilet, can suppress this response and may make it harder to go the next day and set a pattern of constipation and pain until your body clock adjusts. In New York for example, you bowels may wake you up at 4am local time if you have just arrived from London. Relax, go and allow a few days for your bowel to adapt to the new time.