Irritable Bowel Syndrome
Irritable Bowel Syndrome
22 Coping Suggestions
Just as some people are the grumpy and irritable type, so, too, are some bowels. What exactly does it mean to have an irritable bowel? It means that certain foods and drinks and stressful events in your life—things that don't normally wreak havoc on other people—give you alternating bouts of diarrhea, constipation, and abdominal pain. Sometimes, you get all three at the same time.
Some doctors think that irritable bowel syndrome (also known as spastic colon) may be second only to the common cold as America's most widespread medical complaint. And your doctor now says that irritable bowel syndrome (IBS) is the source of your complaint. Well, rest assured that there are lots of things you can do to take the irritability out of your bowel.
Take the news in stride. "There's a very good connection between stress and an irritable bowel," says Douglas A. Drossman, M.D., a gastroenterologist and psychiatrist at the University of North Carolina at Chapel Hill School of Medicine. What you don't want to do is get stressed because you have an irritable bowel, and thereby create a "vicious cycle," he says. Especially during flare-ups of abdominal pain, it is important to "take a deep breath. Think about what's happening. Recognize that it's happened before and it will pass. Know that you're not going to die—because people don't die from an irritable bowel," he says.
Become a more relaxed person. Anything you can do to help yourself unwind should help to alleviate your symptoms, says Dr. Drossman. You may benefit from relaxation techniques, such as meditation, self-hypnosis, or biofeedback. If the stress in your life is particularly problematic, you may want to consider psychological counseling. The key is to find what works for you.
The Alternative Route See Yourself Pain-Free Remember the last time your irritable bowel gave you an attack of abdominal pain? You panicked. You got all stressed up inside. Didn't you? And—ironically—by getting stressed, you tensed your bowel, and probably helped to bring on more pain. How can you break this nasty cycle? With visualization, says Donna Copeland, Ph.D., a clinical psychologist and president of the American Psychological Association's Division of Psychological Hypnosis. It's "a very effective tool for dealing with pain and anxiety." Learning visualization techniques with a professional is probably the best route. But there's nothing wrong with trying a few on your own. Dr. Copeland suggests the following: If you feel pain, stop what you're doing, find a comfortable place to sit or lie down, close your eyes, and—instead of focusing on your pain—see yourself instead: - Diving expertly into the warm ocean surf off a beautiful, white-sanded tropical island beach.
- Standing atop a tall, snow-crested mountain, breathing the cool air, and listening to the crunch of snow under your feet.
- Sitting in a large wooden hot tub, chatting idly with several of your closest friends.
- Walking through a lush garden in a far-off, exotic land.
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Keep a stress diary. Persons with an irritable bowel have an intestinal system that overreacts to food, stress, and hormonal changes. "Think of your irritable bowel as a built-in barometer, and use it to help you determine what things in your life are most stressful," says Dr. Drossman. If, for instance, you have stomach pain every time you talk to your boss, see it as a sign that you need to work on that relationship (perhaps by talking it over with your boss, a friend or family member, or a therapist).
Log in your food and beverage intake, too. Certain foods and beverages, just like stress, can activate an irritable bowel, so it's also helpful to record in your diary the foods and beverages that give you the most trouble, says Dr. Drossman. Although there are some things that are likely to disturb most people, everyone is different.
Add fiber to your diet. Many people with IBS do much better simply by adding fiber to their diets, says James B. Rhodes, M.D., a professor of medicine with the Division of Gastroenterology at the University of Kansas Medical Center in Kansas City. Fiber tends to be most effective with people who tend toward constipation and small, hard stools, but it may also help you if you're suffering from diarrhea. The best fiber to add to your diet is the nonsoluble type—found in bran, whole grains, fruit, and vegetables.
Call psyllium seed to the rescue. An easy way to increase your fiber intake is with crushed psyllium seed, says Dr. Drossman. It's a natural laxative sold in pharmacies, supermarkets, and health food stores. Unlike chemical laxatives often found on the same shelves, psyllium-based laxatives such as Metamucil are nonaddictive and generally safe, even when taken over long periods.
Drink lots of fluid. To keep your bowels moving smoothly, you need not only fiber, but fluids as well. You'll need more on August days spent playing tennis than on December days spent at the movies, but in general, "you should drink between six and eight glasses of fluid a day," says Dr. Rhodes.
Reconsider dairy products. One fluid you may do better without is milk. "A large number of people who say they have IBS are really lactose intolerant," says William J. Snape, M.D., a professor of medicine, chief of the Gastroenterology Unit, and director of the Inflammatory Bowel Disease Center at the Harbor-UCLA Medical Center in Torrance, California. It means your body has difficulty absorbing lactose, an enzyme found in milk. Your doctor can test you for lactose intolerance, or you can give up dairy products for a couple of days and see how you do. In either case, you may find this one dietary change can clear up all your problems. (For more on lactose intolerance, see page 407.)
Cut out the fat. There are lots of good reasons to eat a low-fat diet—and now you have one more. "Fat is a major stimulus to colonic contractions," says Dr. Snape. In other words, it can worsen your IBS. A good place to begin to cut the fat out of your diet is by eliminating heavy sauces, fried foods, and salad oils, says Dr. Snape.
Pass on the gas. Some people with IBS are particularly sensitive to gas-inducing foods, says Dr. Rhodes. If you fall into this group, you may find relief by avoiding such flatulence champs as beans, cabbage, brussels sprouts, broccoli, cauliflower, and onions.
Go easy on the bran. If you are adding fiber such as bran to your diet, add it slowly to give your body time to adjust. Too much fiber, too fast, can produce gas, says Dr. Rhodes.
Beware of spicy foods. Some people with IBS are sensitive to foods laden with peppers and other spices, says Dr. Rhodes. Try eating a lot of spicy foods for one week and a lot of bland foods the next week, and note if your condition changes, he suggests.
Be careful of acids. Acidic foods tend to bother some people with IBS, says Dr. Rhodes. Here again, you may wish to experiment by laying off such things as oranges, grapefruits, tomatoes, and vinegary salad dressings for a while, to see if things get better.
Don't brew trouble with coffee. coffee is a major cause of woes among people with IBS, says Dr. Snape. To some extent, the culprit may be caffeine, but it may also be the resins in the coffee bean itself. You may get some relief if you switch to decaffeinated—if not, try cutting down on all coffee.
Know that some alcoholic beverages are worse than others. Alcoholic beverages can exacerbate your problems, but it's probably not the alcohol itself, says Dr. Snape. Rather, it's the complex carbohydrates in beer and the tannin in red wine that probably cause the most grief. Drinkers with IBS should order anything but these two drinks, he says.
Put out that cigarette. "A large number of people experience IBS problems with smoking," says Dr. Snape. The most probable culprit is the nicotine, so if you're trying to quit with the help of nicotine gum, you may not see any difference in your tummy problems.
Spit out the gum. Nicotine gum is not the only kind of gum that can give you troubles. Gums and candies artificially sweetened with sorbitol are not easily digested and can worsen your IBS, says Dr. Drossman. While the amount of sorbitol found in one stick of gum or one hard candy isn't likely to affect you greatly, if you gobble up ten or more such sweeties a day, it's time to cut back.
Eat regular meals. It's not only what you eat, but how you eat that can vex an irritable bowel, says Dr. Snape. Digesting a lot of food eaten all at once overstimulates the digestive system. That is why it's much better to eat frequent smaller meals than infrequent larger ones.
Go for a jog. "Good body tone, good bowel tone," says Dr. Rhodes. Exercise strengthens the body (of which the bowel is a part). It helps relieve stress. And it releases endorphins that help you control pain. All in all, regular exercise will more than likely calm your irritable bowel. Be careful, however, not to overdo it. Too much exercise can lead to diarrhea.
Try a painkiller. Hormonal changes can sometimes pique an irritable bowel. For this reason, women often get attacks during their periods, says Dr. Drossman. Ibuprofen medications such as Advil or Panadol may help to inhibit some of the hormonal releases that are the root of the problem. For the rest of us, these pills can help with the pain.
Call a hot-water bottle to the rescue. If you're experiencing an attack of abdominal pain, the best thing to do is to sit or lie down, take a deep breath, and try to relax. Some people also find it helpful to put a hot-water bottle or a heating pad on the tummy, says Dr. Snape.
PANEL OF ADVISERS
Donna Copeland, Ph.D., is a clinical psychologist and president of the American Psychological Association's Division of Psychological Hypnosis. She is also an associate professor in pediatrics and director of the Mental Health Section at the University of Texas M. D. Anderson Cancer Center in Houston.
Douglas A. Drossman, M.D., is a gastroenterologist and a psychiatrist. He is an associate professor of medicine and psychiatry with the Division of Digestive Diseases and Nutrition at the University of North Carolina at Chapel Hill School of Medicine.
James B. Rhodes, M.D., is a professor of medicine with the Division of Gastroenterology at the University of Kansas Medical Center in Kansas City.
William J. Snape, Jr., M.D., is a professor of medicine, chief of the Gastroenterology Unit, and director of the Inflammatory Bowel Disease Center at the Harbor-UCLA Medical Center in Torrance, California.
