The Sensitive Gut

Understanding IBS

No, it’s not all in your head, but at least you can do something about that.

not all in your head

If IBS is all is your head, can somebody tell me how dietary fibre cures depression?                                                                                                                                                            Dr Gerald Crean. (1927-2005)

Your comments on Facebook tell us just how awful IBS is; how impossible it is to live with, how it affects every aspect of life, and how nobody is able to do anything to help.

It is bloody awful to be always walking around with a distended tummy.  The pain just rules my life.  And my doctor just isn’t interested.  

IBS rules my life.  I never know what my stomach is going to do. If I eat something it doesn’t like I’m awake all night with tummy ache and feel so tired. 

All of this is true. Nobody is putting it on.  They just seem desperate for some relief.

Desperation is the kind of emotional tension that demands immediate relief.  It may be triggered by pain and always magnifies the pain sensation.  In the same way, frustration might be the emotional concomitant of constipation, or anxiety a key feature of diarrhoea.  The point I am making is that physical symptoms are never just ‘physical’, they are also emotional.

‘It can easily trigger depression & anxiety. It’s so horrible to live with IBS’

‘Stress makes mine worse.  I’m a massive worrier.  There’s just no hope’  

So is it all in your head?  No it’s not, but, as I explained in my recent post, ‘Why do we feel ill’, the ‘feeling’ of illness is generated in the brain.  Without a brain we would not feel anything.  It may, however, start in the body.  After all, an injury or infection causes pain and dysfunction in the affected part, though the sensations and reactions are modified and filtered by the brain, according to our previous experience and the emotion we feel.  Or it may start in the brain, triggered by some upsetting circumstance and referred to that part of the body that most clearly represents the meaning with reference to our previous experience.  So if you have symptoms that have no obvious structural basis, it is important to ask yourself, what is so awful about them?  Does they make you feel desperately lonely? Can you not move on with your life?  Can you not live with what happened?  Does nobody care?  Pain is not just a sensation; it comes with it’s own luggage of context and feelings.    

And symptoms are never constant.  They ebb and they flow.   Something triggers them, then something else happens and they subside, only to start again when it comes back to mind.  So ask yourself, what situations bring them on,  what makes them worse, what takes the feelings away what do these feelings mean for you.  Do you feel that you have some incurable illness you could die from?  Is your doctor doing a good job?  Is the way you feel upsetting your relationship, your job, your ability to look after your children?  Why is that? Do your symptoms have a history?  What was going on when they first came on?  

No matter how they are caused, it is the emotional aspects of your symptoms that make them so unbearable; the hopelessness, desperation, powerlessness, inadequacy, the crippling sadness.  Such feelings may be so impossible to bear, some people may choose to take drugs or alcohol or even contemplate suicide to block them out.

Under certain traumatic circumstances, the mind can generate physical symptoms.  These might protect a person from emotional devastation by offering a bodily focus for hope and recovery.     When I listen to such a patient, I am often amazed by how the symptom represents what is going on:  how, for example, diarrhoea may symbolically evacuate all the bad stuff: how pain makes it imperative you stop: how constipation keeps it all secret and in control.  When symptoms cannot be explained in any medical sense, it is important to pay attention to what they seem to be saying.

Years ago, before the 20th century revolution in medical therapeutics, medicine was largely a matter of placebo and palliation.  Active ‘remedies’ such as bleeding, cupping, purgation, emesis, not to mention the primitive surgery of the time were downright dangerous.  It was not just a case of would the patient survive the disease?  It was more would they survive the treatment?  On the other hand, rest, reassurance, a healthy diet and removal from their ‘toxic environment’ could assist the body’s normal healing processes.  IBS is still in that era.  There is no cure, but appropriate palliation and safe, ‘healing’ remedies can work.

If the symptoms of IBS were based exclusively in the body, then physiological treatments that reduce bowel spasm or modify gut transit should work brilliantly. They don’t.  Big Pharma spends billions on developing drugs for IBS that offer no lasting resolution or cure.  The treatments that work best for IBS are hypnotherapy, psychotherapy, other complementary therapies and charismatic diets.  None of them can be proven by double blind randomised control trials.   They work because people have confidence and faith in them.  They comfort, reassure, relax and offer sufficient relief for them to imagine how things could be.  All they require is engagement and collaboration.

The only person who can manage your IBS is you.  Only you ‘knows’ the context of your illness and can modify how you ‘feel’ the symptoms by adjusting your behaviour, but you need your ‘friends’  to help you believe you will get better and suggest what might be necessary.

Chronic illness corrodes self esteem and undermines self efficacy.  From ‘Nothing seems to work’ and  ‘Nobody can help’, it is just a short step to ‘I am just no good’.  Giving way to feelings of frustration and desperation, no matter how justified these may be, just keeps you in your IBS.  And we can all get hooked on sympathy.  Sooner or later we’ve got to change the script.  So don’t be a victim.  Be a survivor! 

Recovery or at least coping replaces grievance and desperation by hope and determination.  There are some situations in life you can only get over by going through them.  In The IBS Network’s 25th Anniversary Event this year: ‘IBS, The Patients’ Perspective, five ex-patients explained how they managed to lead healthy and productive lives despite having a sensitive gut.  You can do it too.

In his recent article, entitled  Five Myths about Low Back pain,  Chris McCarthy from Manchester Metropolitan University wrote that if you have low back pain and there is no damage on Xray, just keep moving. If you stop, you could become permanently disabled. The  same principle applies to IBS.  So could dieting make you worse by encouraging a fear of food?   Might avoiding other things you enjoy, such as exercise, sex or going abroad, just cause you and your gut to be more unhappy? Can some drugs make you too frightened to stop them?  Life with IBS can be very limiting, but does it need to be?

Ten top tips to help you take control of your illness. 

  1. Do not expect your doctor to solve your IBS. Do your own research.  Decide the questions you need answered and come away equipped to manage it better.
  1. Keep a diary of any flare ups and note whether they coincide with any changes in your life situation.
  2. When your gut is sensitive, observe what foods make it worse. Manage your diet.  Reduce your intake when you are not feeling good, then try more when you are feeling better.
  3. If you are trapped in a situation that makes you and your gut feel unhappy, change it.  Find some way to make it better.
  4. If your illness was instigated by personal crisis, get some help, work through it. Be a survivor.
  5. Try and lead a healthy, balanced and fulfilling life despite your IBS.
  1. Create space during the day to unwind. Relax with something you enjoy doing.
  1. Pace yourself. Don’t take on more than you and your gut can realistically handle.
  1. Your illness is part of you. Understand what troubles it and what calms it down. Learn to manage it.
  1. Don’t let your IBS decide what you can or can’t do. If you want to do something, find a way through.

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